Practitioner Persona: Cyborg Edition

Published in on May 13, 2021

Since we’ve established -- quite thoroughly at this point -- that I’m a nerd, I hope it won’t surprise anybody if I use science fiction (that I’m a fan of!) to illustrate a point about the practitioner persona. I used to think of my practitioner persona as a suit of clothes, like a uniform, that I put on to go to work in the clinic. Now I think of it as a cyborg.

Can we talk about the Murderbot Diaries (a series of novellas plus a novel by Martha Wells) for a minute? I’m sorely tempted to assign them as reading for students (but don’t worry, students, I won’t) because I think they’re a fantastic way to talk about empathy and particularly, the person-hood of people who are generally treated as objects rather than subjects. Here’s a review from NPR:

"Murderbot is a SecUnit — a partly-organic, mostly-robotic security guard of unspecified gender, owned by The Company and leased out (to human explorers)...There are subtexts to be read into Murderbot — that its experience is a coming-out narrative, that it mirrors the lives of trans people, immigrants, those on the autism spectrum or anyone else who feels the need to hide some essential part of themselves from a population that either threatens or can't possibly understand them...It's the wonder of the character — that something so alien can be so human. That everyone who has ever had to hide in a crowded room, avert their eyes from power, cocoon themselves in media for comfort or lie to survive can relate. It's powerful to see that on the page. It's moving to ride around in the head of something that is so strong and so vulnerable, so murder-y and so frightened, all at the same time."

Anyway, you should read them! But now that we’ve established which fictional cyborg I’m thinking of, let’s talk about why you might want to be one at work.

I’ll say it again: I wish my own acupuncture school had been a lot more explicit about how to build professional boundaries, and I especially wish that the topic had been uncoupled from shame. I wish that I had known to approach building boundaries as a task, not unlike setting up a system for charting or bookkeeping or any other task under the heading of “practice management”. I’ve heard a lot of scolding of practitioners for being unprofessional, but it seems that not nearly as much energy goes into describing exactly what it means to be professional, particularly for those of us who didn’t grow up in a professional managerial/upper middle class context.

What can be confusing about being a community acupuncturist is how personal and how impersonal you have to be at the very same time. That’s why a cyborg is a helpful metaphor for how to be in the practitioner role: it has both organic and inorganic components and they have to work together seamlessly. Your organic components are about you, your selfhood, while your inorganic components are about your decision to serve your community in a (relatively) selfless way.

The personal, organic components are what make you, YOU. You can’t be a successful community acupuncturist if you’re not yourself. It’s not one of those jobs where a smooth corporate persona will get you far. If you’re doing community acupuncture right, your heart will break repeatedly -- in a good not a bad way, but nonetheless in a way that alters you permanently. The personal, organic components of your practitioner persona include your empathy, your kindness, your sense of humor, your likes and dislikes about acupuncture itself, your preferred treatment style (if somebody else pulled your needles, they should be able to recognize your treatment style the way they might recognize your handwriting), and most of all your desire to do this work. The organic components of your practitioner persona will inevitably include some quirks.

The impersonal, inorganic components are what allow you to do the work while protecting you and your patients (from any number of things, including certain aspects of your humanness that aren’t a good fit in the clinic). Your inorganic components represent self-discipline, boundaries, routines, orders of operations, technical knowledge, and everything else that allows you to show up in a predictable, neutral way for your patients. Your inorganic components are what let you go on autopilot on a packed shift where at least one person tells you about something terrible they’re going through and at least one other person does something irritating -- while you keep a steady pace, giving solid treatments to all your patients one after the other, without breaking your stride. Someone watching couldn’t tell the difference between patients you like and patients you don’t like. You’re tired at the end of it, but in a good, not a bad way. Your inorganic components steady you.

Part of what we’re trying to do at POCA Tech for students is to install the hardware, the inorganic components, and they’re the same for everybody. (We store them in big boxes in the back room at WCA Cully. Just kidding.) All students learn order of operations, how to do Miriam Lee’s Great 10 in speed drills, how to treat 6 people an hour, how to move around a clinic filled with sleeping people, how to do an intake. Once the inorganic components are installed, they kick in when you walk into a community clinic and no matter what else might be going on in your life, you grab your hand sanitizer, you snag a rolling stool, you open your packet of needles, and you do your thing. (And a lovely thing it is.)

What we can’t do at POCA Tech is to manage your personal, organic components, and how to meld them with the hardware -- that part is all yours, though we can talk about how we’ve done it for ourselves. That process is unique and everyone has to find their own way through it.

Building a practitioner persona that you can trust to protect yourself and your patients is a way of having proactive rather than reactive boundaries. Your practitioner persona is based on foundational decisions about who you want to be at work, that you’re not going to abandon under stress. This is a big reason we keep going on about foundational decisions -- you need them to be a safe practitioner.

Your personal, organic components have bias, but your impersonal, inorganic components don’t, and so your practitioner persona shouldn’t either; it should allow you to show up in a remarkably similar way for a dizzying range of people, including people you couldn’t stand if you had to, say, eat lunch with them, as well as people who might be distractingly beautiful or famous. Treating a literal rock star is a good test of your practitioner persona. So is treating somebody who you happen to know has political opinions that are diametrically opposed to yours (maybe they’re just wearing a button with an obnoxious slogan, but bonus points if they actually ran for office, got elected, and are now inflicting their obnoxiousness on the general public).

Coming soon: posts on dual relationships with patients and on not dating patients, and lots more details about how your practitioner persona engages with the world. The point I want to make here, though, is having good boundaries in clinic isn’t just about dealing with situations that potentially cross boundaries. I think maybe 80% of having good boundaries is about how you inhabit your practitioner persona on all the ordinary days. Boundaries that are constructed only for threats and special occasions, to my mind, aren’t safety-positive enough.

One of the best things about being a cyborg is NOT having to be a perfect human who inspires their patients to try to be perfect humans also. (Trust me, most community acupuncture patients do not want this as a goal, they have more than enough hard things to deal with already -- even the rock stars.) You do not have to commit to relentless, perpetual self-improvement in order to be good at your job. A cyborg can have wonky human parts that are offset by super-solid hardware.

The corollary though is that you have to give your organic parts what they need, including things they won’t get from the job -- or your practitioner persona won’t be strong when you need it to be. Self care is not optional when it comes to maintaining boundaries. In a sense, being a cyborg in clinic means you’re stronger than an ordinary human when you’re at work, but you’re also more limited. Your practitioner persona is only your work self, not your whole self, and you need to attend to your whole self. Your practitioner persona is who you are when you’re wholly focused on showing up for other people. Outside of that, you still have to show up for yourself as a human. You don’t have to improve yourself, but you do have to care for yourself. Because that’s the point of this whole enterprise: humans need care.