Dictionary definitions describe authenticity in terms of truth; to be authentic is to be closer to the truth. As a philosophical concept espoused by the existentialists, to be authentic is to live unencumbered by external pressures to conform to a society’s norms. In leadership studies, authenticity is a tool that authentic leaders leverage to increase their influence and power: self-reflection mingled with empathy, delivered via charismatic communication and designed to bridge the gap between the manager and the managed. And this LGBT+ history month, I’ve been thinking about personal authenticity, which perhaps most closely aligns with the philosophical ideal, what it means to us as medical students and healthcare professionals. The thought struck me this week as I attempted to auscultate the chest of a ‘simulated patient’ (a onesie stuffed with a pillow) in my first attempt at performing a full respiratory examination, as we will one day be expected to do in OSCEs.
The process of learning these professional skills does feel very much like acting (listen to this episode of the BMJ’s Sharp Scratch podcast, where the advice really is to ‘act the part’), and acting suggests a level of artifice – of adopting a persona, a metaphorical mask over our real faces. This is all par for the course of becoming a competent medical professional, but it feels at odds with the concept of authenticity as described, and leads to the question of whether authenticity is possible as a medical student or junior doctor. Does the ability to express oneself authentically at work increase with experience and the higher up the professional ladder one climbs? Or, is the permission to present oneself authenticity at work a privilege afforded to some and not others, following all the usual patterns of privilege that exclude minority groups? Is authenticity even a useful or necessary attribute for healthcare professionals at work; does it improve outcomes for patients?
Akin to empathy, authenticity, and by extension, authentic leadership, are terms and concepts that we use in healthcare as a shorthand for something else, something more diffuse like ‘being a good professional’. But, professionalism is, on its face at least, at odds with the concept of authenticity – to do a good job as a professional, you have to speak and act within the bounds of certain constraints that exist to ensure patients get the best care possible, while authenticity would dictate that a person completely free themselves from constraints. I think we would agree that the latter would make for a very dangerous healthcare environment (and probably some quite unpleasant colleagues). But at the same time, I think our working understanding of ‘authenticity’ does encompass a privilege that some do indeed experience at work – the space to express themselves more freely and share more of their identity without fear of sanction. And therefore, through allyship and self-reflection, we should be working for a healthcare environment that breaks down persisting prejudices that make certain expressions of identity difficult, or even dangerous, for some patients and staff. Whether or not this would lead to more ‘authenticity’, I can’t say, but I believe it would have the potential to improve outcomes for those who shoulder more of the burden of identity oppression than others.