The Optimized Doctor

An introduction to Naikan


The list of things to be ungrateful for last year is long. You’re not supposed to make this list, though. The best practice is to list what you’re grateful for, even when living in trying times. That’s a long list too, but I find making it similarly unfruitful.

Of course, I’m grateful I don’t have COVID-19, thankful my practice hasn’t been significantly impacted, grateful I got the vaccine. But simply repeating these gratitudes daily seems ineffective. I’ve learned a different “gratefulness practice” that perhaps works better.

Man walks onto dock over lake and watches sunrise over mountains and forest AscentXmedia/E+

It’s a Japanese method called Naikan (pronounced “nye-kan”). The word means introspection and the practice is one of self-reflection. But unlike Western “introspection” which puts you at the center, Naikan is focused outwardly. It makes salient the truth that each of us is being cared for by others. Yoshimoto Ishin developed Naikan in the 1940s. He was a Japanese businessman and devout Buddhist who wanted to make a difficult form of meditation more accessible. He removed the ascetic bits like sleep deprivation and refined the exercises such that they better see how others see us. The result is a way to reframe your life experiences and help you understand how much others do for us and how our actions and attitudes impact others. It can be done alone or with a partner. You can do it at the beginning or end of your day.

The method is simple. You ask three questions:

What have I received today from ___________?

What have I given today to ___________?

What difficulty or trouble have I caused to ___________?

The first question is similar to most gratitude practices. For example, you might ask, “What have I received from (my husband or nurse or friend, etc.)? Today, I received a beautifully tidied-up office from my wife who spent time last night sorting things. This made it easy for me to sit down and start writing this piece.

Dr. Jeffrey Benabio, director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego.

Dr. Jeffrey Benabio

The second question is better. What have I given today to (my wife, or patient, or mom, etc.)? It can be simple as: Today, I slowed down to let everyone who was in the closed highway lane back into traffic (even though some were clearly undeserving of my generosity). Or last night, I worked to coordinate with anesthesia and scheduling to help a little girl who would benefit from conscious sedation for her procedure.

Combined, these two questions pull you 180 degrees from our default mode, which is complaining. We are wired to find, and talk about, all the inconveniences in our lives: Roadway construction caused a traffic backup that led to running late for clinic. First patient was peeved and had a list of complaints, the last of which was hair loss. Isn’t it much better to rave about how our dermatology nurse volunteered to work the hospital COVID-19 unit to give her colleagues a break? Or how my 10:15 patient came early to be sure she was on time? (It happens.)

The last question is the best. We all spend time thinking about what others think of us. We should spend time thinking about what impact we’ve had on them. Like a cold shower, it’s both briskly awakening and easy to do. Go back through your day and reflect on what you did that made things difficult for others. It can be as simple as I started whining about how a patient waylaid me with her silly complaints. That led to my colleague’s joining in about difficult patients. Or I was late turning in my article, which made my editor have to work harder to get it completed in time.

There’s plenty of things we should be grateful for. In doing these exercises you’ll learn just how much others have cared for you and, I hope, how you might do things to make them grateful for you.

If you’re interested in learning more about Naikan, I discovered this from Brett McKay’s The Art of Manliness podcast and the teaching of Gregg Krech, summarized in his book, “Naikan: Gratitude, Grace, and the Japanese Art of Self-Reflection.”

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at .

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