This Is My Hogwarts

Sylvan Dale Lodge

My friends, I belong.  This weekend marked the beginning of a ten month training program in communication, leadership, connection, and creativity.  9 of us made it to Colorado after the bomb cyclone (Patrick, we missed you—can’t wait to meet you in May!) to launch Cohort 11 of Leading Organizations to Health (LOH).  Our teachers, Tony Suchman and Diane Rawlins, led us through three days of introspection, skills acquisition and practice, and formation in community.  It all happened at the Sylvan Dale Guest Ranch in Loveland, surrounded by mountains, river, wildlife, and a rich history of family and hospitality.

We are training in relationship-centered care and administration, helping one another embody our best relationship tendencies, so we may help our organizations function at higher levels of connection and effectiveness.  It’s too exciting!

I walked into the lodge at Sylvan Dale, saw the vaulted ceiling with the icicle lights, and immediately thought of Hogwarts.  I came to this place, called by something to the Why of my soul, to be with others like me.  We are here to train, to hone our skills for good.  Within the first session I realized I can totally be myself in this crowd.  Here, I’m no longer a lone voice focused on relationships ahead of everything else, no longer the only one who cannot help seeing how the nature of our relationships permeates every interaction, every decision—and how we recreate them in every moment.  No more self-editing and explaining, tip-toeing around what matters most to me.  I can fully inhabit my relationship convictions here, in this space and among these new friends.  I feel an ease of purpose and values in this group that I come to, like a deep well, to fill my bucket and irrigate my garden of personal and professional growth.  Here, I am not a black sheep.

I now have 9 new people-nodes to connect and integrate into my existing relationship webs—a new and energizing system.  We share stories with common themes, new insights, and mutual support.  These ten months we will form and evolve as individuals as well as a community.  It’s a type of love, really…  At least that’s how it feels to me.  Hooray!

 

 

Thank you, Mr. Zander

Zander Cheng

Dear Mr. Zander, I met you almost 10 years ago and you transformed my life.

You and Ms. Zander gave the keynote address at the second ever Harvard conference on coaching in healthcare.  I was one of only a handful of physicians in attendance.  You discussed the central tenets of your book, The Art of Possibility.  I could not wait to get my copy signed, and you also graciously agreed to a photo.  I have since read and listened to your book at least a dozen times, and every time I gain something new and relevant.  The names of the practices ring in my consciousness on a regular basis:  Give the A, Rule #6, Be a Contribution, Lead From Any Chair, and Be the Board.  I describe the practices and their benefits, still, to anyone who will listen.

Zander book sig

Back in 2015 I boldly contacted the Boston Philharmonic to see if you could speak at the American College of Physicians Illinois Chapter Meeting.  You actually spoke to me on the phone and considered coming!  I was honored.  Though it did not work out (I knew it was the longest of long shots), it amazed me that someone as sought after as you would personally take a phone call from a random, unknown doctor in Chicago.  Later that year, when I attended the Harvard Writers conference (the birthplace of this blog), I had the honor of observing a master class where I witnessed you love some young musicians into their best selves.  They believed in themselves because you saw them, loved them, and believed in them.  That is the best thing any teacher can do for a student.

Throughout these last ten years, I have continued to seek, study, and attempt to apply learnings from authors, teachers, and mentors like you, people who see the world as broken as it is, and also the hope of humanity’s strengths and connections.  There is no shortage of people trying to help us all be better, for ourselves and one another, and no more urgent time or need for this teaching than now.  I count myself beyond fortunate to have benefited from your influence and inspiration so early in my life and career, to have you as my model.  No doubt I am only one of thousands, if not tens (hundreds?) of thousands, whose lives you have transformed for the better.  I wish you an ever broader and higher platform from which to reach countless more people and organizations.  I wish you peace, health, and joy in all your endeavors and relationships.

Please know how much you have meant to so many.

Sincerely,

Catherine Cheng, MD

 

“People Don’t Care…

Lily Pad Lake trail weather coming

…how much you know until they know how much you care.”   –Teddy Roosevelt (the most common attribution—but at this point, who knows?)

Friends, I had a great conversation on Facebook this week that really made me think!  I have pasted it below so you can decide what you think of it—please share your impressions, as my own have evolved as I reread it.

I initially shared an article by Ozan Varol entitled, “Facts Don’t Change People’s Minds.  Here’s What Does”.  In it he outlines steps to help others and ourselves change our minds rather than dig in:

  1. Make it psychologically safe to admit they (or we) were wrong before—stop shaming one another for our diverse beliefs
  2. Disentangle ourselves from our beliefs—hold them loosely rather than in identity-defining death grips
  3. Practice empathy
  4. Exit our echo chambers

I thought this was all pretty good, and my friend agreed that the method is effective, and also ‘morally ambiguous.’  At the end of the conversation my understanding of his perspective (again, please see for yourself below) is that he opposes ‘tricking’ people by manipulating their emotions into agreeing with us, while ignoring facts and evidence.  I agree with this opposition, and I also see this article as not actually suggesting we do this.

Basically it got me thinking:  It’s not that we can either argue/convince with facts or we can’t.  It’s that we have to make a personal, emotional connection before someone in opposition can be open to our facts and evidence.  This is not an either/or proposition.  It is both/and, as most things are.

After the two-day thread concluded I felt an urge to listen again to Never Split the Difference, a book on negotiation by Chris Voss, a former FBI hostage negotiator.  Funny how that came up…  In it he references Daniel Kahneman’s book, Thinking, Fast and Slow.  Kahneman describes two aspects of mind, System I, our intuitive, limbic, subconscious mind, and System II, our rational, logical, cognitive mind.  Voss’s and the FBI’s most successful negotiation strategies are founded on the understanding that System I is the primary driver of human behavior and action, though we would like to think otherwise.  This reminded me of Jonathan Haidt’s analogy of the mind as an elephant (System I) and a rider (System II).  He also posits that though we assume the rider steers the elephant, really the elephant goes where it wants and the rider rationalizes the path.

None of this is meant as a negative judgment on humanity or to say that we are not the super-intelligent, creative, and highest order creatures we claim to be.  It is simply the reality of how our minds work, a consequence of evolution for individual survival and tribal living.  When confronted with someone I perceive as an enemy (someone who shames me, threatens my sense of self and belonging, even if unintentionally), why in the world would I open my mind and experience to her point of view, even it would benefit me in practical terms?  Under threat of attack (of my ideas, beliefs, and identity), the elephant will stampede and trample, not stop, put its snout to its forehead, and consider thoughtfully.  But if my own tribe member, whom I already trust implicitly and with whom I feel relaxed and open, encourages me to change our usual path to the water hole because she has found one that bypasses the lion pride, I am far more open to the idea.

Similarly, if we consider ‘changing our minds’ as analogous to behavior change, we see how knowing the facts and evidence is definitely not enough to change anything.  I know I should eat less if I want to lose weight.  I know added sugars and simple starches are not healthful staples for my diet.  I know that eating late wrecks my metabolism.  So why do I still eat big, yummy brownies at 10PM?  Some days I can muster the motivation to head off self-sabotage; other days not so much.  I stress eat, especially when I’m sleep deprived.  So now I’m also listening again to Chip and Dan Heath’s book Switch: How to Change Things When Change Is Hard.  They propose a three-pronged approach to behavior change at the individual, organizational, and societal levels:  1. Direct the Rider (know the facts and have them ready to present).  2. Motivate the Elephant (find meaning for motivation).  3. Shape the Path (make it easy, remove obstacles).  All of these articles and books reflect the same reality: we are emotional beings who think, in that order.

Of course changing people’s minds, especially about emotionally charged and controversial ideas, is hard!  And of course facts and evidence are crucial and we absolutely should not ignore or abondon them!  And, we would all benefit from practicing a little more generosity, patience, empathy, kindness, and charity in our approach to one another—whether we’re trying to change minds or not.

 

*    *   *   *

CC

Friends, please read.
Applies to vaccines, politics, family conflicts, and relationship communication in general.

 

JM

I’m a total believer in the successfulness of this philosophy as a general rule, and I also find it Machiavellian and morally troubling. A great many people have a severely limited ability to understand the facts they believe. They can hold contradictory views easily and they prize simplistic notions of tribal loyalty, common sense vs actual knowledge and nostalgia for a past that never existed. Until we prize critical thinking as a a skill, we won’t display it as a people. And of course, this article correctly but tragically argues that since we don’t, and since we all just walk along blasting confirmation bias all over the place, it’s pointless to attempt persuasion with critical thinking skills and one should instead seek to trick people into doing what’s right through revisionist personal histories (you aren’t responsible for your past failures in critical thinking) and personalized sales pitches (who cares about the principled notions of the greater good or what’s just! Let’s talk about you and your family’s short term best interests!)

 

CC

Thanks, Jonathan. I wonder what you think of this post that I wrote, then?https://catherinechengmd.com/…/talking-to-the-opposed…/

 

JM

In this article you don’t have a clearly stated goal. So while I gather that you support vaccination, you don’t seem too bothered by patients who opt not to vaccinate. I see this as raising a question. If you learned that a parent was deliberately harming a child you wouldn’t casually suggest the idea that next year you revisit the benefits of not abusing kids. You’d act. You’d report. You’d get authorities involved. You’d protect the kids, even against the parents wishes. And you would do it now. So as I said, it raises the question: how bad is it to not vaccinate? Your article implies that it’s not that bad. In fact, you give two examples of outcomes: one of a child who gets autism and one of a child who gets whooping cough. Can you see how this implies balance in the perspectives? Are these views equally valid? Sympathy towards the emotional struggle of making the right decisions for kids should not be conflated with sympathy for endangering children -both one’s own and others in the community. Is there reasonable doubt about whether vaccines cause autism or not? That’s not only testable but actually repeatedly and widely tested already. Let me state it in reverse: I currently vaccinate but if verifiable scientific evidence started raining doubts about whether vaccines caused autism, I would want my doctor to tell me ASAP and explain it emphatically and with little regard to my previously erroneously held belief.

 

CC 

Thanks for your feedback, Jonathan. I actually do state a clear goal: “my primary objective is actually to cultivate our relationship.” Of course I think it’s harmful to both the child and the community to not vaccinate. I am absolutely bothered by non- and anti-vaxxers (as evidenced by multiple posts on this page). And I also have to take into account the likely outcomes of my actions. My goal is to get everybody vaccinated, no question. But demanding it now, as if it’s really the same as witnessing a parent beating a child physically, is not often productive. I have learned in multiple relationship settings that chasing agreement and acquiescence gets me the opposite result. In this case, taking the long view and strategy, with a soft front, works.  Just this flu season, I estimate my ‘conversion’ rate at about 60-70%, which I assess as successful. And I did so while maintaining and strengthening the physician-patient relationship, which is even better. And for those who continue to defer vaccination, at least they are still with me and I have more chances to continue the conversation and eventually make an impact. To me that’s worth a little waiting in the short term, which could be long term waiting and making people dig in harder against, if I came at them too aggressively.

 

JM

all that sounds great. My comments were only about that article, not your actions.

 

CC

Huh, okay… The article I wrote speaks directly to my actions, so I am not sure what the distinction is? Regardless, I respect your opinion so I hope I have your confidence in me as a physician and a steward of public health.

 

JM

you do!
—next day—

CC

 I’m beating the dead horse! Feel free to ignore. Here is an article along the same lines, which I saved at the time it was published. Interesting to read it again now.https://hbr.org/…/how-to-build-an-exit-ramp-for-trump…

 

JM

Yup. Same deal. Machiavellian. Ends justify means. Critical thinking is not taught or valued so let’s ditch it in favor of methods that are effective at achieving the desired result. That may actually achieve the most social good in the end. But it’s still morally ambiguous. When does an elephant in the room become so large that you simply can’t claim not to have seen it? Must we always pretend that it’s reasonable to have thought it was a grey desk to give people an out? These articles seem to say yes. They might be right. I’m just not happy about it.

 

Oh, and I do apply this to “both sides”. There is a position I’ve heard espoused on the Left that argues that holding people accountable for stupidity is a form of prejudice. <insert shock face emoji here> It’s apparently “ableist”. And that it’s inappropriate to expect people to all be able to reason and know things. Any things. That one leaves me speechless. It seems more about a race to decry the most possible prejudices than an attempt to help improve our world. Virtue signaling. I’M SO WOKE! I’M EVEN MORE WOKE! I WOKE UP WOKE!

 

CC

Thank you for engaging, Jonathan! Your perspective is so interesting to me, I don’t see it these strategies as nearly as manipulative as you see them. To me, they are enlightening paths of empathy, leading to clearer and more compassionate, understanding communication. Underlying the methods I see an implication that we all may be more open-minded than we know, if given space and connection to explore alternative perspectives to our own. The methods themselves are simply a way to uncover and allow that openness, and thus possibility for change and growth, to emerge. If one practices these strategies with NO commitment to a particular outcome, but simply for the sake of continuing a conversation or relationship–an exchange of perspectives for mutual understanding and respect–if we all practiced this we all might end up changing, little by little, for the better, and better together.

 

JM

We’d be more open to dialogue in the non-judgmental world you describe. But, while it’s popular to embrace profound egalitarianism as positive, that is a disaster in practice. Not every viewpoint should enjoy the same privileges. For instance, slavery is a viewpoint. Might makes right is a viewpoint. The Nazis had a viewpoint. Should these all be engaged with with respect for a differing worldview? I don’t think so. Determining your actual reason for why not is key. It’s because we believe deep down in hierarchies. Even egalitarians tend to believe that egalitarianism is BETTER than non-egalitarianism. There is a Buddhist parable in which the student asks: “If we meet bandits on the road, and they try to kills us, how are we to act compassionately as our noble truths dictate?” The teacher answers “You must cut them down with your sword, compassionately.”

 

CC

I agree with everything you write here. But is this not a tangent? Do any of these articles or any of my comments claim that all viewpoints are equal? This conversation is not about ‘profound egalitarianism’ and its merits or lack thereof. Being slightly more open minded and empathetic toward our fellow humans (which is the point of these articles, in my view) does not equal throwing away all forms of morality and ethics, absolving ourselves of any and all judgment, or elevating slavery, xenophobia, and genocide to anything remotely acceptable. So I’m curious. When you encounter people whose opinion or whatever is opposed to your own, how do you engage? What are your objectives when you interact with them on these topics? For instance on this thread–why are you still here? You go first and then I’ll tell you mine. 

 

JM

Firstly, I’m arguing from the edges. Is an approach sound? You can test it by how it handles just such situations. The articles discuss a successful methodology for achieving a change in position. You can describe that most generously as sympathetic openness combined with non-confrontation. That is presented for its effectiveness. When I engage with people with differing opinions, it matters greatly what the opinions are. I evaluate them based on the soundness of the facts and theory underlying them. When more sound than my own, I change my views. When less sound, I can safely place them back in the bin of the disproven, false or less effective. I’m typically delighted to be convinced of a new position. I don’t view all positions as being basically equal. I view positions as very often being hierarchical. Some are intrinsically better than others. That means when I change position for just reasons, I am improving myself and the world at large. My engagement here is based on the warmth of our relationship and the desire to see higher truths recognized wherever possible -the ultimate purpose of information exchange. If the real purpose of the articles is to “be suuuuuuper nice before and while presenting your logic” then that’s just “getting more bees with honey than vinegar”. I don’t disagree. But some part reads to me like an acceptance of tribalism. In other words, this system doesn’t increase the likelihood of the “right” answer or the just answer. Just the answer of the person most effectively using the technique.

 

CC

THANK YOU, I understand you much better now!! I very much appreciate what you wrote here, and I wholeheartedly agree, especially with the self-improvement part. You have elevated my point of view and I will refer back to this conversation often now! So on my end, I engaged because I noticed myself feeling defensive and I wanted to understand what I was feeling a need to defend against. Now I don’t feel defensive at all, and I am so glad we continued the exchange! Big hugs, old friend! 😀

 

Theory and Practice

ben ski

Does anyone become a great skier or volleyball player by just reading books and watching videos of other people doing it?  Of course, not.  And even if you have the best coach, with the most knowledge and expertise, you still have to get out on the trail or the court and do it yourself, find your own groove, create your own style and habits that work for you and your team.

I realized this over the past week, as once again I found myself calling forth everything I have learned about leadership from books and observations of other leaders.  Leading people is hard, and I often feel at the same time that I do it well and that I totally suck at it.  I worry that because it feels mentally and emotionally exhausting, I must be doing it wrong—like if I really knew what I was doing it would just be easy.  But that is perfectionism and fixed mindset talking, I’m pretty sure.

Knowing theory is key, no question.  If you don’t understand in advance what it will be like to stand up on skis (they don’t stop themselves and if the tips are pointed downhill that is exactly where you will slide), you will fall and risk injury to self and others a lot more than if you are prepared with a few pointers in advance.  It’s the same with leadership.  Remembering how it feels to be led well, versus poorly, allows me to have empathy for those I lead.  Mastery of, or at least proficiency in, some key communication tools such as reflective listening, nonjudgmental questioning, and objective feedback, makes the skills easier to access under stress and pressure.  Holding core values and principles in front, and exemplifying them, rather than just professing them, earns trust and credibility.

I wrote to a mentor recently, “I find myself repeating language from the books, inventing analogies and using examples from the team’s lived experience to show how the theories apply.  Words like empathy, curiosity, generosity, non-judgment, deep breathing, and ‘How fascinating!’ exit my mouth a lot, as well as, ‘It’s all about relationships!’ People must see me as a broken record…”  He reminded me that we need these mantras to keep ourselves focused and also to repeat out loud and invite accountability in our actions.  I wholeheartedly agree.  Maybe I will take a misstep here or there (no maybe—it will happen!).  It won’t be because I’m not trying or I don’t care—it will be because I’m human and we all make mistakes.  It’s because I’m out there practicing.

When I think back to high school volleyball practice, residency, personal training, and the early days of parenting (hell, every day of parenting), it’s not the easy days that stand out in memory.  It’s the hard days, the days when I really struggled, but came out having grown, even in a little, in my learning.  It’s the days when I can say, hey, I know better now, and I will do better next time—bring it.

So yes, leading well is hard.  It’s exhausting.  It costs inordinate amounts of energy, self-awareness, -monitoring, and -control.  It makes me hypervigilant of my words, posture, and actions.  Theory and practice go hand in hand; they are the twin pillars of learning, application, and success in all realms.  I will keep reading for theory (I highly recommend Legacy by James Kerr and Big Potential by Shawn Achor).  I will keep showing up every day ready to do my best in practice.  I feel confident in the trust and credibility I have already earned, and that people can see that I’m honestly doing my best, for all of us.

 

Washi Tape Gratitude

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My friends, I have a new and serious obsession:  WASHI TAPE!

I have loved paper and stickers since I can remember, and I have hoarded pretty stationery, stickers, rubber stamps, ink pads and all kinds of other writing accessories for at least 30 years.  I left for college with 100 postage stamps and used all of them before returning home for summer.  I plan to single handedly keep the US Postal Service in business if I have to.  I LOVE SNAIL MAIL!!!

So imagine my joy and enthusiasm when the Gottman Institute published this article suggesting that instead of keeping a gratitude list or journal, we instead hand write thank you notes.  Specifically, write one every day for one year—365 hand written notes in 2019.  I read the piece and exclaimed with abandon, “Done!”

I started January 18 and it only gets better! I have connected with friends, just to say thanks for being my friend.  I have acknowledged people at work for going above and beyond.  I have sent cards to Chicago Streets and Sanitation for always being on top of our snow and working on nights and weekends, as well as JBJ Soul Kitchen for providing meals for federal workers during the partial government shutdown.

Best of all, I get to create stationery again.  My favorite hobby is making cards.  Tonight I wrote a card to my friend Audrey, who introduced me to rubber stamping during residency, almost 20 years ago.  Over the years I have used the kids’ art, my own photos, cut-outs from the Paper Source catalog, and of course, stickers.  I have a rolling drawer caddy full of stamps and tools—I could host my own workshop!  But washi tape can be expensive, and my deep-seated hoarder tendencies would never let me use it in large quantities, so I would never let myself buy any…  Until now!  I’m 45 years old, I make a good living, I love making cards, and they bring my friends and me much happiness, so I can afford to invest in my creativity, for all our sakes!

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These last few weeks I have pulled out cardstock and envelopes from the myriad stacks of cardboard boxes in the basement.  I have opened the giant plastic storage containers where I carefully organized and filed all different kinds of paper, labels, stickers, etc.  I have worked out my washi tape art style, and combined it with my favorite rubber stamps and inkpad—Peacock Gold by ColorBox (discontinued, but no worries, I hoarded at least two refill bottles!).  And, cosmically, last week a friend introduced me to another store here in Chicago that sells the most exquisite paper products: Bari Zaki Studio.  It was like heaven on earth.  When I checked out (after joyfully browsing at least 40 minutes in a space smaller than my bedroom) they packaged every piece in its own little envelope or bag, and closed them with—you guessed it—washi tape!  Even the receipt!

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In the month since I started this practice/commitment/challenge/discipline/excuse-to-play-with-paper-and-tape, I think it has actually elevated my mood and helped me feel more generous toward others.  I notice more small things that make me appreciative.  I have a lower threshold for expressing my gratitude, no matter how small, in writing.  I can share it in a tangible, concrete way, with small pieces of art, created with delight and love.  Even if they end up in the trash (cringe—I keep every piece of personal mail I receive), it will have been worth it if my card brightened someone’s day.  And bonus if it also helps them act generously and joyfully toward someone else!

Because that’s how gratitude works, I think—it starts with a positive observation, then an appreciative expression, generating new observations and expressions that connect us in shared humanity, ever pointing us toward what’s good.  I think we need as much of that as we can get these days, and it makes me happy to make even a small contribution.

 

Synthesis and Integration: Self and Other Focus

DSC_0439

Hey friends, how was your week?  Learn anything new and interesting?  Anneal any new ideas to existing frameworks in your already complex world view?  I did!  And it came in another big wave after my presentation on Friday.

I wrote last week about how I put together a new presentation.  For the first time, I added the idea of medicine as a complex adaptive system to a talk I gave to physicians at various levels of training and practice.  The objective of the presentation was for people to understand the scope of physician burnout, and leave with some ideas of how they could not only cope better themselves today, but also influence the system and move it toward a healthier, more compassionate state in the future.

As usual for my talks, I focused first on personal resilience.  Many physicians push back at this idea, and rightly so, as many medical organizations have instituted physician wellness programs aimed mainly at ‘fixing’ the doctors with yoga and meditation classes, while allowing the system that burns them out to continue its toxic trends toward over-regulation, loss of physician autonomy, and driving metrics that lie outside of, or even counter to, our core values.  I worried that my talk would be taken as just another attempt to tell physicians we aren’t good enough at self-care.

Thankfully, the feedback so far has been positive and I have not heard anyone say they felt berated or shamed.  I hope it’s because in addition to tips for self-care (eg 7 minute workout, picnic plate method of eating), I talked about how each of us can actually help change the system.  In a complex system, each individual (a ‘node’) is connected to each other individual, directly or indirectly.  So, difficult as it may be to see in medicine, everything I do affects all others, and everything each other does affects me.  This means I can be a victim and an agent at the same time, and the more I choose one or the other (when I am able to choose), I actively, if unintentionally, contribute to the self-organizing system moving in one direction or another [URL credit for image below pending].

Nodes in Complex System

My primary objective in every presentation is to inspire each member of my audience to claim their agency.  Before that can happen we must recognize that we have any agency to begin with, then shore up our resources to exercise it (self-care and relationships), and then decide where, when, and how that agency is best directed.

 

In 5 years of PowerPoint iterations, including and excluding certain concepts, I have always incorporated David Logan’s framework of stages of tribal culture.  Basically there are 5 stages, 1-3 being low functioning, and 4-5 high functioning.  The tribal mantras for the first three stages are, respectively, “Live sucks,” “My life sucks,” and “I’m great”.  Stage four tribes say, “We’re great” and in stage 5 we say, “Life’s great.”  The gap between stages 3 and 4 is wide, as evidenced by the traffic jam of people and tribes at the third stage.  In my view, the difference is mindset.  In the first three stages, most individuals’ implicit focus is on self, and subconscious mindset centers around scarcity and competition.  Victims abound in these cultures, as we focus on recognition, advancement, and getting ours.  We cross the chasm when we are able to step back and recognize how our mutual connections and how we cultivate them make us better—together—we see the network surrounding and tied to our lone-node-selves.

This week I realized that crossing the stage 3-to-4 chasm relates to two frameworks I learned recently:

The way I see it, in Logan’s tribal culture structure, one initially works toward self-actualization, essentially achieving it when fully inhabiting stage 3, “I’m great.”  But crossing to stage 4 requires self-transcendence, as described by Abraham Maslow, by recognizing a greater purpose for one’s existence than simply advancing self-interest.  In the same way, through stage 3 we live in what the Arbinger Institute describes as an ‘inward mindset,’ and we cross to stage 4 when we acquire an ‘outward mindset’, which is pretty much what it sounds like.  Essentially in stage 3 we mostly say, “I’m great, and I’m surrounded by idiots,” and in stages 4 and 5 the prevailing sentiment resembles, “We’re great, life’s great, and I’m so happy to be here, grateful for the opportunity to contribute.”

An astute colleague pointed out during my talk on Friday that we do not live strictly in one stage or mindset in serial fashion.  Depending on circumstances, context, and yes, state of mind and body (hence the importance of self-care!), we move freely and maybe often between stages, sometimes in the very same conversation!  The goals are to 1) look for role models to lead us to higher functioning stages more of the time, and 2) model for others around us to climb the tribal culture mountain with us, spending more and more mindset and energy at higher and higher stages.

The problem is the system, and we are the system.  So, onward.  Progress moves slowly and inevitably.  It will take time, energy, and collective effort.

We’ got this.

Self-Care:  Act Local, Think Global

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Gotta be quick tonight, friends, as I have sat in front of this screen too long already today!

Creating and putting together slides for three upcoming distinct and related presentations, I am happy to report continued synthesis in my position on the relationships between personal resilience, culture of wellness, and efficiency of practice in medicine.

Drivers of burnout are systemic, no question, and not related to individual physicians’ lack of resilience and strength.  And yet, it will be up to us physicians, more than any other group, to lead change and make the system better for all of us, physicians and patients alike.  But we will not do it ourselves.  We must engage so many other stakeholders—hospital administrators, nurses and other care providers, insurance and pharmaceutical companies (by way of their leaders), and, of course, patients.

How can we engage any of these groups of people effectively?  Do we expect productive conversations and collaborative decision making when we stomp on the offensive with righteous indignation and passive-aggressive name calling?  Even if our language is polished, people can feel our underlying attitude and can tell when we’re not fully authentic.

I still think it starts with self-care.  Because if I’m not well, I cannot show up my best for anyone else.

Be The Change You Seek:

Curious–Kind–Forgiving–Accountable–Humble–Empathic.

How can I be all of these things, which I referenced last week, if I am sleep-deprived, wired on caffeine, skipping meals, and not connected to my emotional support network?  I finally made my own visual for the reciprocal nature of our habits:

Reciprocal Domains of Health Star

If I am attuned and attentive, then the bottom four serve to hold up my relationships, which is how I interface and interact with the universe.  I am one node in multiple subsystems, all connected, overlapping and integrated in larger and layered super-systems.  So the best thing I can do for the universe—to keep the systems intact and optimal—is make myself the strongest, most stable, most reliable node I can be.  I recently attended a strategy meeting where I learned the SWOT framework: for any given project and the people trying to implement it, what are the Strengths, Weaknesses, Opportunities, and Threats?  It occurred to me to apply this framework to my habits:

Health Habits SWOT grid

It really does show how each domain relates to and influences each other one, and makes it all pretty concrete, especially how stress threatens almost everything.

So in the interests of self-care, and in order to care my best for everyone and everything around me, I will now do today’s free 7 minute workout and get to bed.

Onward!