THE BECOMING-DOCTOR JOURNEY:DESIGN FOR ATTUNEMENT AND CARE

R O L E

Ethnographic ResearchService Design

C O N T E X T

HealthcareEducationPhysical Movement

T I M E F R A M E

2018

A F F L I A T I O N

Memorial Sloan Kettering Cancer CenterRe-Imagine End of Life

In this research, we examine the concept of attunement in psychology and trauma studies and how it could become an ideal, a principle, and an outcome in physical practices of care. We started from the end-of-life and medical care experiences, locating the body as the site of inquiry and "intervention" where the personhood can be maintained, nurtured, and recovered in a healthcare system that inclines towards alienating bodies and breeding misattunement.

P R O J E C T B R I E F

O V E R A L L P R O C E S S

1 . 2 . 3 . 4 .Bird’s-eyeLandscape

PrototypeProblemSpace

From principles to possibi l i ties

PrototypeSolutions

5 .ParadigmShift?

Scan existing ethnographic works and secondary research to map out critical issues pertaining to the dying experience in the US healthcare system

• Secondary research• System Mapping• Expert Interviews

Zoom into opportunity space where there has been lack of attention (in this case, physical practices of care). Formulate hypothesis (lack of attunement across the system) and workshop to define and articulate problem

• Participatory workshop

• Problem definition

From the workshop, we idenfity the relationship between doctor-patient as the starting point of intervention. Several mapping exercises and interviews lead us to further zoom into the journey of becoming the doctor, in which attunement skills are often neglected and unrewarded

• Interviews• Mapping journeys

Based on this becoming doctor journey, we choose to prototype an intervention that takes in movement practices to manifest and test how the ideas of attunemnent can be manifest physically.

• Participatory workshop• Movement practice

The result of the workshop gives us confidence in the idea (and ideal) of attunement. We extrapolate further interventions based on this initial exploration across the whole becoming-doctor journey.

• Formulate further possible interventions The

Becoming Doctor

Journey

The Becoming

Doctor Journey

I N F A N C Y

A D O L E S C E N C E

TOUCH

BATHE FEED

COMFORT

EDUCATION MEDICAL

A D U L T H O O D

HOLD

SHELTER

SELF

O L D A G E

FEEDBATH

PALLIATIVE

S E L FS U F F I C I E N T

T H E C U L T U R A L I D E A L ( A N D P R E S S U R E ) T O B E S E L F - S U F F I C I E N T

When we’re infants and through our childhoods, we are dependent upon physical care. We are touched, bathed, comforted, taught, fed. But as we grow, we enter cultural systems and norms that demand we limit our needs and become self-sufficient, independent. We become less touched, less held, our bodies become more isolated experiences. Our skills in the reciprocity of care stall or dwindle, until parenthood, old age, or serious illness catch us off guard and force a sudden, destabilizing, and undeniable recognition of the fragility and need of our bodies. And in those moments of crisis, when we are suddenly confronted by our vulnerability, dependent and in need of help, we are unpracticed. Despite best intentions, it’s often too late and opportunities for nurture become accumulations of trauma.

HMW honor through action the basic need

for physical intimacy? HMW explore

dimension of consent in physical care across life

cycle?

HMW disrupt the consumer model of

the body and redefine the cost of

physical care?

HMW establish a relational basis for for

consent/care?

DISCONTINUTIES OF PHYSCIAL CARE INTERPERSONALLY AND INSTITUTIONALLY

ACROSS OUR LIFE STAGES

SECONDARY RESEARCH IS SYTHESIZED INTO HMW QUESTIONS TO GUIDE PRIMARY RESEARCH

1 .

Bird’s eyelandscape

The Becoming

Doctor Journey

Attunement, in psychology, is the practice of attuning to others’ needs, responding to the communicative need in ways that allow the care receivers to feel understood. Misattunement happens when needs are not met. These empathic failures are built up over time, leading to unhealthy attachment and lifelong accumulation of traumas. The medical system, with the focus on efficiency, creates conditions in which a variety of needs cannot be met, creating conditions for Misattunement to happen.

M I S A T T U N E M E N T A N D L A C K O F R E C I P R O C I T Y I N P R A C T I C E S O F C A R E

To further understand these hypothesis, we organized a workshop with doctors, nurses, medical administrators, and the public to understand the cultural and societal structures in which behaviors of care are desired and manifested.

Conversations and activities happened across age groups and professions, cutting across life stages and needs.

Conversations around care, through visuals, were located in the micro-interactions of everyday life, in familial and medical contexts so as to understand the concept of attunement.

Feelings and emotions are integral to understanding of care, which were made manifested through both verbal and making activity/appreciative inquiry.

2 .

PrototypeProblem

Space

The Becoming

Doctor Journey

H O W M I G H T W E M A N I F E S T A T T U N E M E N T I N T H E D O C T O R - P A T I E N T E N G A G E M E N T ?

Acknowledge, embrace and engage with change, discomfort, and suffering

Mutuality and reciprocity as truth,

path, and tools

Minimize trauma in moments of crisis

Build accessible paths to agency

Cultivate and implement a paradigm of care as an

act of mutual vulnerability

3 .

From Principles to Possibilities

The Becoming

Doctor Journey

Our movement-based attunement workshop served as a generative research tool and has become a design outcome in and of itself. While the workshop can be customized for many settings, we intend it to become a component of the medical school curriculum. The arc of the workshop was carefully designed, mixing personal reflection and written response, group and partnered movement exercises, bidirectional interviewing, and partnered attunement “challenges” to create opportunities to identify and practice the journey of building self-reflection, trust, communication, and attunement as mechanisms of care.

L E A R N I N G A T T U N E M E N T T H R O U G H M O V E M E N T P R A C T I C E S

Participants were asked to locate their experiences of receiving and giving care, identifying the behaviors as well as the caregivers. Impromptu dialogues were initiated to draw their attentions towards the micro-level interactions.

L O C A T ER E L O C A T E

To facilitate further conversations between participants, we asked them to form partnership and ”interview” each other throughout the whole workshop. This dialogic exchange helps solidify the partnership as they went through movement exercises together.

B I D I R E C T I O N A L I N T E R V I E W S

By borrowing techniques from movement and improvisation techniques, participants manifested ”attunement” (and misattunement) with their own bodies, allowing for a more embodied understanding to emerge.

M O V E M E N T +I M P R O V I S A T I O N

Thoughts and emotions were recorded in a booklet, designed for participant to capture and affirm their own experiences throughout the 2-hour workshop.

D I A R Y K E E P I N G

4 .

PrototypeSolutions

The Becoming

Doctor Journey

What if attunement become our key principles of actions throughout the whole medical system? In an extrapolative exercise, we want to design a broad systemic return to attunement based care that allows us to thrive not in spite, but because. After all: “We are not the survival of the fittest. We are the survival of the nurtured.”

P A R A D I G M S H I F T T O W A R D S A T T U N E M E N T A N D C A R E

Children still imagine themselves becoming doctors when they grow up. By changing the way

doctors are educated - to privilege a broader array of skills

and intelligence - the aspirational image of the doctor

changes, too.

What if medical school admissions looked for

candidates who are as good at attunement as they are at

biology?

If practice and expertise in attunement were an integral part of the med

school curriculum, we’d be bringing a new type of caretaker into

society.And Doctor’s would become cultural icons of both competence and

security.

HMW honor through action the basic need

for physical intimacy

5 .

ParadigmShift?