Abstract

Chronic disease care is a challenging vocation. One of the reasons for this is the need to inform and share decision making with patients. Communication and conversational skills are the pillars of chronic care delivery. In this editorial, we take guidance from the Srimad Bhagavad Gita in order to improve the quality of clinical conversations, and make them meaningful. The Gita encourages us to be ‘saatvik’ or balanced in thought, words and deeds, to perform ‘penance’ of mind, speech and body, and to accept equanimity. This introspective opinion piece should help us polish our communication skills, and improve interaction with our patients.

Keywords: Chronic care, diabetes, obesity, patient-centered care, person-centered care, psychosocial aspects

Chronic disease care is a challenging aspect of clinical medicine. To ensure that biomedical and psychosocial issues are addressed in a person-centered way, communication is very important. Health care professionals are cognizant of the fact that language matters.¹ Persons living with chronic disease, such as diabetes, obesity and cardiovascular disease, need sustained support and mindful motivation in order to ensure optimal self-care and management.² Using appropriate forms of communication is imperative in achieving this. Communication and conversation skills, therefore, must be integrated into medical and health care curricula.

THE SRIMAD BHAGAVAD GITA

The Srimad Bhagavad Gita, the divine song of Lord Krishna, is a fountain of wisdom.³ All health care providers need to work (i.e., perform penance and share sacrifices) in order to attain, and maintain the required professional competence.⁴ In this communication, we discuss verses from the Gita which help us interna­lize pleasant, person-friendly language in chronic care practice.

The Gita is structured in eighteen chapters. Chapter 14 describes the three gunas or qualities of man: sattva, rajas and tamas. Chapter 16 differentiates between divine and demoniacal properties with Chapter 17 explaining this further in a three-pronged rubric. We use shlokas from these chapters to create reader-friendly suggestions for health care professionals.

SATTVA AS A TOOL AND AS A TARGET

“Sattva, Rajas and Tamas – these three gunas born of Nature tie down the imperishable soul to the body, Arjuna.” (14:5)

“Of these Sattva, being immaculate, is illuminating and flawless, Arjuna; it binds through attachment to happiness and knowledge.” (14:6)

“Arjuna, know the quality of Rajas, which is of the nature of passion, as born of desire and attachment. It binds the soul through attachment to actions and their fruits.” (14:7)

“And know Tamas, the deluder of all those who look upon the body as their own self, as born of ignorance. It binds the soul through error, sloth and sleep, Arjuna.” (14:8)

“When light and discernment dawn in this body, as well as in the mind and sense, then one should know that Sattva is predominant.” (14:11)

“The reward of a righteous act, they say, is Sattvika, i.e., faultless in the shape of joy, wisdom and dispassion. __.” (14:16)

“Wisdom follows from Sattva, __.” (14:17)

“Those who abide in the quality of Sattva wend their way upwards__.” (14:18)

These verses describe three innate qualities of mankind: sattva, rajas and tamas. The reader may feel that being saatvik, i.e., being “immaculate, illuminating and flawless”, is an ideal state, as it leads to “happiness and knowledge”, promotes “wisdom” and allows one to “wend their way upwards”. This means that the health care professional should aim for a saatvik disposition, of mind, body and senses. Having a saatvik temperament is a target in itself, and a tool towards mastering the art of meaningful conversation as well.

THE MIND, BODY AND SPEECH

This can be accomplished by practicing austerity of the mind, penance of the body and penance of speech.

“Worship of Gods, the Brahmanas, one’s elders and great souls, purity, straight-forwardness, continence and non-violence – this is called penance of the body.” (17:14)

“Words which cause no annoyance to others and are truthful, agreeable and beneficial, as well as the study of the Vedas and other Shastras and the practice chanting of Divine Name – this is known as penance of speech.” (17:15)

“Cheerfulness of mind, placidity, habit of contemplation on God, control of the mind and perfect purity of inner feelings – all this is called austerity of mind.” (17:16)

“This threefold penance performed with supreme faith by Yogis expecting no return is called Sattvik.” (17:17)

Table 1 lists these descriptions of penance in an allitera­tive, reader-friendly manner. Health care professionals should include these features in their daily routine, both personal and professional, with no expectations in mind. This will create a welcoming and friendly health care ecosystem which will foster saatvik communication as well as actions. This, in turn, will automatically lead to optimal health-related outcomes.

EQUANIMITY AND EQUIPOISE: A DIVINE GIFT

The above discussion is incomplete, however. Saatvikta cannot exist in isolation, and our environment, both physical and psychosocial, may not always be conducive to, or accepting of, saatvik behavior. As health care professionals, we may be exposed to unpleasant attitudes, behaviors and actions, and ourselves exhibit traits of raajsik or taamsik behavior. Are these acceptable?

The Bhagavad Gita has an answer to this as well.

“He who sees that all actions are performed in every way by nature (Prakriti) and the Self as the non-doer, he alone verity sees.” (13:29)

“___ he who hates not light (which is born of Sattva) and activity (which is born of Rajas) and even stupor (which is born of Tamas), when prevalent, nor longs for them when they have ceased.” (14:22)

“He who is equipoised in honor or ignominy, is alike towards a friend or an enemy, and has renounced the sense of doership in all undertaking, is said to have risen above the three gunas.” (14:25)

We should view all persons, all behaviors and all situations with equanimity. Chapter 16, verses 1 to 3, describe the characteristics of a person who is born with divine gifts. These include perfect purity of mind, control of the senses, non-violence in thought, word and deed, absence of anger even on provocation and compassion towards all creatures.

We should strive to “control the senses” (16:1) and “avoid anger even on provocation” (16:2). Table 2 paraphrases the 21 features of a “divine” person, as mentioned in these verses, into 5 overarching descriptions. Holistic hygiene, harming none and helping all, with humility and a high sense of purpose, are the attributes of an evolved person, and his/her conversation.

The health care profession is a divine calling, one that can make a difference between life and death. Keeping this in mind, we should aim to inculcate these “divine gifts” in our thoughts, words and actions. This can be done through penance of mind, speech and body, as described in Chapter 17 (Table 1). While we target Saatvikta in every sphere of life, we should be open to encountering, and accepting, raajsik and taamsik situations as well. These should be handled dispassionately.

SUMMARY

As we endeavor to help our patients with chronic disease live healthy and happy lives, we will certainly face challenges. Many of these can be tackled by effective counseling. The Srimad Bhagavad Gita guides us in polishing our conversational skills, which can help us communicate better with our patients, and their caregivers. This will assist in making clinical conversations meaningful and thereby, contribute to optimization of health for all.

REFERENCES

1. Kalra S, Kar P. Diabetes therapy podcast collection: language matters in diabetes. Diabetes Ther. 2021;12(7):1769-77.
2. Kalra S, Sridhar GR, Balhara YP, Sahay RK, Bantwal G, Baruah MP, et al. National recommendations: psycho­social management of diabetes in India. Indian J Endocrinol Metab. 2013;17(3):376-95.
3. Srimad Bhagavad Gita. Gorakhpur: Gita Press, 2009.
4. Kalra S, Joshi A, Kalra B, Shanbhag VG, Bhattacharya R, Verma K, et al. Bhagavad Gita for the physician. Indian J Endocrinol Metab. 2017;21(6):893-7.