This essay is based on the talk I was asked to give at BadEMFest18 in South Africa. When I submitted my pitch I suggested I could talk about ‘something to do with paediatrics… or anything really, I’m happy to help out‘. Then I opened the DM from the team and found that I was given the near impossible challenge of reminding the delegates ‘How to be Kind‘. In order to distill my thoughts down to a succinct 15 minutes I thought I’d let you in on what I’ve been thinking about. What I thought would be a thousand words or so blew out into 5000, hence I’ll break it up into a couple of posts. This is the WHY. I’ll follow up with the HOW tomorrow.
What is kindness?
Kindness can be really tough to define.
Perhaps it is easier to talk about the opposite of kindness? – the rudeness we display towards others, the curtness, the incivility. We’ve seen how disruptive doctors make it hard to work together as a cohesive team. We’ve seen angry relatives jab fingers at a nurse for not being at their beck and call. We’ve seen in-patient unit registrars roll their eyes when a ‘fresh out of medical school’ intern stammers through their first referral. Someone shouting at you for making a mistake is going to hamper your work, but researchers have also found that just being uncivil also has a negative impact on performance. In a simulation-based study, making derogatory comments about the subjects medical training led to a marked drop-off in successful outcome measures. Perhaps this another example of the stereotype threat at work? Doctors and nurses are told they are no good and so they try too hard and make mistakes. Whilst the researchers suggested coming up with ways which “… offer a means to mitigate the adverse consequences of behaviors that, unfortunately, cannot be prevented…” in the next post I am going to try to offer some practical guidance for those that want to at least try.
So is ‘being kind’ just not being rude? We might walk past as a junior member of the team gets berated for a mistake, not wanting to get involved. How about showing a little kindness? I think kindness is moving beyond the casual indifference of an empty glance, towards making a connection, a bond, however momentary, with another human. It is what Archbishop Tutu would call ubuntu.
A culture of kindness
Creating a positive workplace culture, leading to more acts of kindness, organizational citizenship behaviours (OCB) in the parlance of psychosocial research, is not just the responsibility of the individual. It is the responsibility of the organization itself. Researchers at Google found that when their teams actions were rooted in fairness, trust and cooperation more OCB’s occurred. But when rude or uncivil behaviours were witnessed in an authority figure there was a drop in prosocial acts within the team. It seems that kindness is contagious. One positive act begets another to form a potential virtuous circle of goodness. You may have seen the film Pay it Forward, with Haley Joel Osment, that takes this principle to Hollywood levels of excess.
In hospitals there tends to be a culture of apathy, of “it’s not my job“, as if we are inured to the human suffering around us. Meal trays are placed just inches out of reach, requests for another blanket are ignored. If we just stop for a moment and recognize that the human being making the request is somebody’s mother/father/daughter/son we might jolt ourselves out of this apathy. It can certainly be a challenge to be kind if you are the only one doing it but that does not mean you should not try. Like the anti-vaxxer that is determined to not immunize their child against measles, the apathetic bystander, by not being kind, allows bad behaviour to spread.
Don’t ‘nice guys finish last’?
It’s important not to conflate being nice with being kind. Nicety is a societal construct designed to give power to those who do not have any. We are nice because we want people to like us. We are nice because we crave external validation. We are kind because we want to be, not for anyone else, but because it is the right thing to do.
You might think that a kindness is an act of unselfishness but such prosocial behaviours can be beneficial to the giver as well as the receiver. We know that small, everyday acts can lead to a sense of greater connectedness with loved ones or colleagues, especially if they are freely given, without obligation. It makes sense that if you feel happy you are more likely to be kind but the opposite is also true. Just performing an act of kindness, whatever you feel inside, can also improve your mood.
There is much to be said, also, of the evolutionary benefits of kindness. With Richard Dawkins assertion that we are all here to help pass on genetic material from one generation to the next much we should consider the ‘unselfish gene‘.
The evolutionary benefits of kindness
Consider that the etymological derivation of the word ‘kindness’ is ‘kin-ness’. Performing an act of kindness was seen as performing an act that drew the tribe together, perpetuating the line. How could this be so?
Whilst Darwin may have written about the survival of the fittest he believed that humankind was a profoundly social and caring species. It seems that kindness to ones kin, even the weakest of the tribe, could allow the passage of shared genetic material. Experimentally this has been demonstrated by showing that men are more likely to donate to charities using images of children that have been digitally altered to resemble their own. They think they are helping one of their own tribe.
When we roamed the wilds as hairy hunter-gatherers mutual coordination would have been the only way to bring down big game. This is the “I’ll scratch your back…” approach to kindness done purely out of explicit self-interest.
Mutualism implies an action carried out for a common goal whereas sometimes people are kind in the hope that karmic balance will restored at some point in the future – I perform I kind act today in the hope that someone else will perform a kind act for me in the future.
And finally there is the proposition that being kind is, in part, a way of displaying ones status, in the sense of noblesse oblige or, using a more popular frame of reference, with great power comes great responsibility.
So then, it all boils down to this… We know kindness is good for others (and ourselves) so can we teach it? I believe we can. Children begin their lives as naturally kind beings but as they grow into doctors and nurses and paramedics something happens to them. The introduction of a kindness curriculum to younger children promotes prosocial behaviour. Perhaps this is why the Sesame Street Workshop introduced kindness as the theme for its 47th (2017) season. So what can we do? We can role-model kind behaviour but I want to be more explicit about how we can act kind. More on that next time.
If you woke up one day and found that you were the only person left in the entire world, you still need to be kind. We think of being kind as something we do to others – our patients, our colleagues, our loved ones – but it is also something we need to do for, and to, ourselves. If we cannot be kind to ourselves, then what?
Some Footnotes and Further Reading
About Time (2013) dir Richard Curtis – Please can everyone watch this, if not for Rachel McAdams, then for the lesson of the last fifteen minutes.
Le fabuleux destin d’Amelie Poulain (2001) dir Jean-Pierre Jeunet – One of my all time top ten films ever. You will forget it is in French as you are drawn into the world of Amelie Poulain, a young waitress who only wants to do good.
Cinderella (2015) dir Kenneth Branagh – Have courage and be kind – ’nuff said.
Pay it Forward (2000) dir. Mimi Leder – Haley Joel Osment, playing a less creepy but just as intense a child as he did in The Sixth Sense, tries to change the world.
Brown, Derren – Happy – What appears to be a bright and colourful book on the happiness is really a deep philosophical dive into Stoicism in the modern era.
Frankl, Viktor – Man’s Search for Meaning – This is one of those books that most of us have heard of but never read. Do yourself a favour and pick up a copy.
Jeffers, Oliver – Here we are – I’ve loved all of his work, especially The Day the Crayons Quit and this book is no exception. It’s a simple yet beautifully drawn instruction manual for a new life.
McCloud, Carol – Have you filled a bucket today? – Sometimes a childrens books can put in 32 pages what a professional philosopher cannot put in 400.
Palacio, R.P – Wonder – A couple of people had recommended this book to me and I read it in a weekend. I only cried twice.
Thackeray, W.M. – Vanity Fair – This 1848 collected serial of life in England during and after the Napoleonic wars is one of the few books I re-read every couple of years. Everyone knows of the anti-hero, Becky Sharpe, but to me Dobbin is the true hero.
Adolphs R, Tusche A. From Faces to Prosocial Behavior: Cues, Tools, and Mechanisms. Current Directions in Psychological Science. 2017 Jun;26(3):282-7.
Aknin LB, Hamlin JK, Dunn EW (2012) Giving Leads to Happiness in Young Children. PLoS ONE 7(6): e39211. https://doi.org/10.1371/journal.pone.0039211
Alden, L. E., & Trew, J. L. (2013). If it makes you happy: Engaging in kind acts increases positive affect in socially anxious individuals. Emotion, 13, 64–75
Amutio-Kareaga A, García-Campayo J, Delgado LC, Hermosilla D, Martínez-Taboada C. Improving Communication between Physicians and Their Patients through Mindfulness and Compassion-Based Strategies: A Narrative Review. Journal of clinical medicine. 2017 Mar 17;6(3):33.
Barsade SG. The ripple effect: Emotional contagion and its influence on group behavior. Administrative Science Quarterly. 2002 Dec;47(4):644-75.
Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Annals of Internal medicine. 1984 Nov 1;101(5):692-6.
Böckler A, Herrmann L, Trautwein FM, Holmes T, Singer T. Know thy selves: Learning to understand oneself increases the ability to understand others. Journal of Cognitive Enhancement. 2017 May 16:1-3.
Brugel S, Postma-Nilsenová M, Tates K. The link between perception of clinical empathy and nonverbal behavior: The effect of a doctor’s gaze and body orientation. Patient education and counseling. 2015 Oct 31;98(10):1260-5.
Buetow SA. Physician kindness as sincere benevolence. Canadian Medical Association Journal. 2013 Jul 9;185(10):928-.
Chancellor J, Margolis S, Jacobs Bao K, Lyubomirsky S. Everyday Prosociality in the Workplace: The Reinforcing Benefits of Giving, Getting, and Glimpsing.
Chestnut DH. On the road to professionalism. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2017 May 1;126(5):780-6.
Curry OS, Rowland L, Zlotowitz S, McAlaney J, Whitehouse H. Happy to Help? A Systematic Review and Meta-analysis of the Effects of Performing Acts of Kindness on the Well-being of the Actor.
Davidson J, Graham P, Montross-Thomas L, Norcross W, Zerbi G. Code Lavender: Cultivating Intentional Acts of Kindness in Response to Stressful Work Situations. Explore: The Journal of Science and Healing. 2017 Apr 12.
Disalvo D. Forget Survival of the Fittest. Scientific American Mind. 2009 Sep 1;20(5):18-9.
Rudeness at work
Flook L, Goldberg SB, Pinger L, Davidson RJ. Promoting prosocial behavior and self-regulatory skills in preschool children through a mindfulness-based kindness curriculum. Developmental psychology. 2015 Jan;51(1):44.
Foulk T, Woolum A, Erez A. Catching rudeness is like catching a cold: The contagion effects of low-intensity negative behaviors. Journal of Applied Psychology. 2016 Jan;101(1):50.
Fowler JH, Christakis NA. Cooperative behavior cascades in human social networks. Proceedings of the National Academy of Sciences. 2010 Mar 23;107(12):5334-8.
Froman L. Positive psychology in the workplace. Journal of Adult Development. 2010 Jun 1;17(2):59-69.
Fuhrman RW, Bodenhausen GV, Lichtenstein M. On the trait implications of social behaviors: Kindness, intelligence, goodness, and normality ratings for 400 behavior statements. Behavior Research Methods. 1989 Nov 1;21(6):587-97.
Hawley PH. Evolution, prosocial behavior, and altruism: A roadmap for understanding where the proximate meets the ultimate.
Jeffrey D. A duty of kindness. Journal of the Royal Society of Medicine. 2016 Jul;109(7):261-3.
Kline JA, Neumann D, Haug MA, Kammer DJ, Krabill VA. Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency care setting. Emerg Med J. 2015 Jan 1;32(1):3-8.
Latané B, Darley JM. Bystander” Apathy”. American Scientist. 1969 Jul 1;57(2):244-68.
Launer J. On kindness. Postgraduate Medical Journal. 2008 Dec 1;84(998):671-2.
Layous K, Nelson SK, Kurtz JL, Lyubomirsky S. What triggers prosocial effort? A positive feedback loop between positive activities, kindness, and well-being. The Journal of Positive Psychology. 2017 Jul 4;12(4):385-98.
Leap E. Kindness as Medical Treatment. Emergency Medicine News. 2001 Feb 1;23(2):14-5.
Leimgruber KL, Ward AF, Widness J, Norton MI, Olson KR, Gray K, Santos LR. Give what you get: capuchin monkeys (Cebus apella) and 4-year-old children pay forward positive and negative outcomes to conspecifics. PloS one. 2014 Jan 29;9(1):e87035.
Lipp MJ, Riolo C, Riolo M, Farkas J, Liu T, Cisneros GJ. Showing you care: An empathetic approach to doctor–patient communication. InSeminars in Orthodontics 2016 Jun 30 (Vol. 22, No. 2, pp. 88-94). WB Saunders.
Mehrabian A, Wiener M. Decoding of inconsistent communications. Journal of personality and social psychology. 1967 May;6(1):109.
Nook EC, Ong DC, Morelli SA, Mitchell JP, Zaki J. Prosocial conformity: Prosocial norms generalize across behavior and empathy. Personality and Social Psychology Bulletin. 2016 Aug;42(8):1045-62.
Pearson CM, Porath CL. On the nature, consequences and remedies of workplace incivility: No time for “nice”? Think again. The Academy of Management Executive. 2005 Feb 1;19(1):7-18.
Pickering WG. Kindness, prescribed and natural, in medicine. Journal of medical ethics. 1997 Apr 1;23(2):116-8.
Pollak KI, Arnold RM, Jeffreys AS, Alexander SC, Olsen MK, Abernethy AP, Sugg Skinner C, Rodriguez KL, Tulsky JA. Oncologist communication about emotion during visits with patients with advanced cancer. Journal of Clinical Oncology. 2007 Dec 20;25(36):5748-52.
Porath CL, Erez A. Does rudeness really matter? The effects of rudeness on task performance and helpfulness. Academy of Management Journal. 2007 Oct 1;50(5):1181-97.
Porath CL, Erez A. Overlooked but not untouched: How rudeness reduces onlookers’ performance on routine and creative tasks. Organizational Behavior and Human Decision Processes. 2009 May 31;109(1):29-44.
Pressman SD, Kraft TL, Cross MP. It’s good to do good and receive good: The impact of a ‘pay it forward’style kindness intervention on giver and receiver well-being. The Journal of Positive Psychology. 2015 Jul 4;10(4):293-302.
Rakel DP, Hoeft TJ, Barrett BP, Chewning BA, Craig BM, Niu M. Practitioner empathy and the duration of the common cold. Family medicine. 2009;41(7):494.
Rhodes DR, McFarland KF, Finch WH, Johnson AO. Speaking and interruptions during primary care office visits. Family Medicine-Kansas City-. 2001 Jul 1;33(7):528-32.
Riskin A, Erez A, Foulk TA, Kugelman A, Gover A, Shoris I, Riskin KS, Bamberger PA. The impact of rudeness on medical team performance: A randomized trial. Pediatrics. 2015 Sep 1;136(3):487-95.
Rowe MB. Wait time: slowing down may be a way of speeding up!. Journal of teacher education. 1986 Jan;37(1):43-50.
Sadati AK, Iman MT, Lankarani KB, Ebrahimzadeh N. From good to great physician: a critical ethnography based on patients’ views. Journal of medical ethics and history of medicine. 2016;9.
Sirgy MJ, Jackson PA. How to enhance the well-being of healthcare service providers and their patients? A mindfulness proposal. Frontiers in psychology. 2015;6.
Spiro H. What is empathy and can it be taught. Ann Intern Med. 1992 May 15;116(10):843-6.
Tonks A. What’s a good doctor and how do you make one?. Bmj. 2002 Sep 28;325(7366):715.
Weatherall DJ. The inhumanity of medicine. BMJ: British Medical Journal. 1994 Dec 24;309(6970):1671.
Andrew- thank you for highlighting a really important issue in this post. The Cinderella quote ‘Have courage and be Kind’ is one my personal mottos!