Relationship Revolution

Posted on May 12, 2018 by Catherine Cheng, MD

“In my lifetime I want to see the culture of medicine driven more by relationship than by revenue.”

–me

Nice to be back, friends!

This post is a bit different from my usual format and style. It’s maybe more raw and blunt.

Please bear with me and keep an open mind?

I know posting this may be risky. It started out as just jotting down ideas for a longer, more detailed future post. I had to get the ideas and thoughts out so I could focus on work. And then the ‘jotting’ somehow evolved into what I imagine a poetry slam might look like. So I decided to post as is.

My long term objective is to stimulate generous thought and respectful discussion between patients and physicians. I wish to prod us out of our default complaint modes and reorient all of us to the idea that we are all on the same team, but our connections are under siege by outside forces. The system harms and oppresses us, physicians and patients, the end users, and the ones with the real power. Together, we are the sleeping (sedated?) giant that must rise up and reclaim the system for ourselves. This post is an attempt to spark the flame that draws us together, by pointing directly to the spikes that drive us apart.

Disclaimer: What follows is my own expression and does not represent or reflect the opinion or position of any colleague, institution, or professional society with whom I associate or to which I belong.

I hear my colleagues say: Get rid of the patient portal!

It’s too much!

Limiting characters does not work, they just send multiple messages

Charging for messages just makes more work

“They abuse the system”

“We give an inch, they take a mile”

Keep them away!

Us vs. Them mentality.

Antithetical to mission of medicine: To meet patients where they need us, and help them.

WHY?

Because we are too busy.

DOING WHAT?

Every. F*ing. Thing.

Rx prior authorizations

Endless documentation, infinite clicks

Rx refills with no information on follow up or patient status

Filling slots to meet RVU goals

Prescribing more meds to meet “quality” goals

Keeping up with the latest evidence for every disease, test, treatment, guideline, diet fad

Rushing to the next patient so that the patient we’re with does not have time to even think of their questions, must less ask them

Patients walk away from visits with their true needs unmet.

So they use the resources available to them to ask for what they need.

And this ‘adds’ to our work

And we feel busier and more frustrated, exhausted, frayed, irritable

We feel Overwhelmed.

Patients also feel it

They feel unseen, unheard, dismissed, discarded

And they don’t understand or relate to where it comes from

They get angry

So they send more messages: to us, about us; criticizing us, lashing out

Making us feel bad about ourselves

Which manifests as defensiveness first, then even more frustration, exhaustion, irritability

But we don’t disengage.

We remember our calling.

We forge on in smoldering resentment, pride, bitterness, duty, guilt, shame, and occasional fulfillment

And then abstractions to reconcile the cognitive dissonance

Patients suck

All they do is take take take

They don’t understand that I’m Doing My Best to help them

Why don’t they appreciate me

They are so entitled these days

They want everything now now now

They think I’m at their beck and call

Like I’m not working every minute of every day

Like I don’t have a family and a life also

Like I live only to serve them

Patients are the enemy

Really?

Oh and it happens on both sides

Doctors suck

All they do is type away at that blasted computer

They don’t even look up, see me, or hear me

They don’t understand what I need

They just want to see more patients

Make more money

I’m just a number to them

A cog on a conveyor belt

They’re all in the pockets of Big Pharma and Insurance

They withhold the help I need

They hoard it

They don’t care about me

They Don’t Care About Patients

All they care about is making the next buck

Doctors are the enemy

Really?

There is no substitute for the Time and Energy

Required to cultivate Healthy, mutually Respectful, mutually Fulfilling, mutually Beneficial relationships

It is always a two-way street

Our relationships kill us or save us. Always.

Doctors and patients must find ways to reconnect

Find one another through the thick morass

And Hold Tight

In Solidarity

Learn, Train and Practice Together

Our Communication, Empathy, Compassion, and Collaboration skills

Defend against the forces that drive us apart

Advocate for one another and for our Sacred Contract

So we may once again

Heal Through Connection

Brain-Fried Noodle

Posted on February 28, 2018 by Catherine Cheng, MD

It’s post-op day 8, woo hoooo! To all my patients who have had surgery, now I know what it’s like—a little bit. What a fascinating experience, and I’m so grateful now that I can relate!

Some of you may know that I tore my ACL in November playing volleyball. It only took me a few weeks to decide I wanted to have it repaired (reconstructed, actually), because I don’t ever want to wonder whether my knee is stable enough to do the things I want to do. I have now officially embarked upon that journey of rehab, and so far so good. This post is my story so far. Just wanted to share.

Pre-Op Eval

The 10 days prior to surgery were some of the busiest in recent memory, starting with a whirlwind weekend with the kids in San Francisco ending with us on a redeye back to Chicago and cabbing it straight the office where I borrowed my colleague’s clothes for the day. Then back to back meetings, clinic days full of patients, a team-building seminar, a Grand Rounds presentation, Chinese New Year, a teaching session with my awesome medical students, a movie playdate, a confirmation retreat, and laundry. I barely got enough sleep, and the eating was not great. But at least I wasn’t sick/infected.

I got all kinds of useful advice from friends and colleagues:

–Use the meds! Opioids are great for post-op pain. Expect maximum pain and swelling at 48-72 hours. Well the block lasted at least 48 hours so no pain then. And since then it’s actually not that bad—like a giant toothache at the knee, with radiating soreness up the thigh and down the leg. Tylenol alternating with Advil pretty much takes care of it.

–ICE ICE ICE!! Oh, how I love my electric ice machine. It’s a pad that wraps around my knee and circulates ice water drawn through tubing from a cooler. Brilliant!

–Take time off, at least 2 weeks! Like a silly person, I’m going back to work tomorrow. I was even sillier initially to think I could have surgery on a Thursday and go back to work Monday! Lesson learned, but hopefully I will never need to apply this learning?

The Jitters

The night before surgery, I wrote in my journal an “In case I die” entry. I told my sister where I left the book, so she would know where to look for the message to my kids in case something bad happened. It’s a little embarrassing to admit, but I imagine I’m not the only mom who has ever felt this way. It was pretty irrational, but hey, it was my first major surgery—anything could happen! Sitting in the cart in pre-op, I got tearful (and still do now), thinking of how much I’d miss the kids, what they would have to go through, how everything would change, if I died. But when the anesthesiologist asked, all I could articulate was, “I keep thinking about all the things I should have done for them this morning—packed their lunches…” He had the perfect words: “It’s never enough.” And with that I felt strangely reassured and absolved.

The MEDS!!

So here’s the most dissociating part of the experience. In pre-op I was handed a little cup with five pills: two 500mg acetaminophen, one 75mg diclofenac, and two 300mg gabapentin. That’s standard pre-emptive pain management, apparently. Then for the femoral and sciatic nerve blocks, the anesthesiologists used bupivicaine and triamcinalone. Once in the OR, they started clindamycin to prevent infection, and then midazolam, fentanyl, and propofol for the sleeping cocktail. Of these nine medications, I had taken exactly three of them ever before. It was a little alarming, even though I knew the indication and rationale for each drug. I found my inner voices exclaiming at once, “Wow, this is totally routine, we have really got it all figured out,” and “HOLY SHIT ARE YOU KIDDING ME NINE MEDICATIONS SIX OF WHICH I HAVE NEVER HAD BEFORE AND YOU’RE JUST GIVING THEM ALL TO ME LIKE IT’S NO BIG DEAL I COULD TOTALLY DIE FROM THIS WHY ISN’T ANYBODY THE LEAST BIT BOTHERED!?!?” And I did just fine, like everybody expected. Fascinating.

Source: http://www.iemoji.com/view/emoji/2488/smileys-people/crazy-face

And whoa, the meds… Apparently it’s a known side effect of propofol to shiver when waking up from it. That was uncomfortable, but even more so was the inability to pee for about 40 minutes, despite having a bladder that felt like it could burst at any minute (I know that could not happen, but literally, you could have bounced a coin off of my lower abdomen it was so full). Thank God for the experienced nurse who offered me hot tea—what a relief! And finally the nerve blocks—amazing. I could flex my hip normally, so I lifted my braced left leg into the car while standing on the right; but lower than that I had neither sensation nor motor control for a full 24 hours. It. Was. Dead. The foot/ankle came back first, with that creepy, stinging, tingly sensation. Then slowly, begrudgingly, the thigh returned. The muscle twitches throughout came mostly at night, as if waking from anesthesia is, of course, a nocturnal activity.

I felt pretty clear-headed after about an hour in recovery, fully coherent and articulate. But man, I could not really focus or hold attention for long at all. I had all kinds of articles saved to read those first two days lying in the recliner, but it was just not happening. My mood was great and I had long periods of alertness. And then I just wanted to sleep–deeply. My body was not only unresponsive in the left lower extremity; it felt limp and weak kind of everywhere, my mind included. Hence the title: Brain-Fried Noodle.

The Pain

Those first two days were fantastic in terms of pain—none whatsoever (thank you, bupivicaine)! And I was on the ice machine 24/7. Since then two pain patterns have emerged. First, the deep ache from having the joint capsule invaded and a tunnel drilled through bone. That’s the giant toothache, almost like a deep itch that wants to get scratched from the inside. The second is a hypersensitivity of the skin where all the bruising is. It’s swollen, tender, and oh-so colorful! And it zings every time I pull on my compression sock, from the ankle to halfway up the thigh. That’s what makes me stop and breathe deeply for several seconds. I figured out today that I’m probably not drinking enough water, which likely contributes to my pain. It’s so ironic, as my primary advice to patients for almost any ailment is to hydrate first. Well, this is me trying to walk the talk. I’m so happy not to have needed opioids (so far), and everything should continue to improve as the tissues heal. HYDRATE!

The Rehab

I swear, I think I have lost 50% of my quad on the left. My physical therapist thinks I’m progressing well, and I’m happy with where I am. This will be a long road and I must monitor my expectations. First, prevent further atrophy while tissues recover initially. Then weight bearing, stability. Then strength, coordination, and eventually back to sport. Patience, diligence, persistence. I’m told PT should make me cry, it’s so painful. Well, it’s definitely making me sweat!

The LOVE

*sigh* We really can’t do anything well alone in life, huh? All the advice, all the well wishes, all the texts and messages right before and right after surgery—every single one held me up a little higher. And my mom, who insisted on coming despite my denying the need—now I get it. And thank God for her. Thank you, Ma! Last week would have been quite hellish for us all if not for you! The hubs and kids have been pretty great, too, accommodating my crutches, ice machine, and constant occupation of the chaise side of the sofa. Every day they come home and ask how I am and how they can help. I’ve tried to do what I can—sort laundry, rinse/cut vegetables, instruct our amazing sitter on recipes, pay bills, make sure our DVD machine doesn’t die from under-use… But there is no substitute for a wide and strong support network, and mine is as dense as they get. Thank you, all my friends and family, for all of it.

* * *

Huh… I thought I could accomplish so much more in 8 days off! I fantasized about all kinds of blog posts, reading, correspondence, de-cluttering. Hey, I said fantasy, didn’t I? Oh well, time flies like an arrow, fruit flies like a banana. Things don’t usually turn out the way you plan. Maybe it will be good to slow down for a while, reorganize, reprioritize, focus… For now I gotta get that second set of exercises in tonight and get to bed on time—and hydrate—work tomorrow!

Onward, friends, hope you are all well!

The Only Diet That Works

Posted on February 4, 2018 by Catherine Cheng, MD

Hello Friends!! Oh my gosh, it feels so good to be writing again, like sinking into my favorite squishy armchair, at the campus coffeehouse where I have met my friends since college, to sip, gab, bond, and plot to save the world.

New phase of life, woo hooooooo! And eekgadds. I have long thought of balance as a dynamic state, like that octopus ride at the amusement park. I am the ride, spinning around, raising and lowering each aspect of life in controlled coordination, attending to each car so nobody flies out and gets hurt. With the added responsibility I have taken on at work this year, it feels like I have just agreed to accept a massively overweight rider in that car, and my whole frame now strains to keep everything moving smoothly. At first everything looks normal. But the continuous strain of gravity, mass, and cumulative sheer forces create microfractures in my arms over time. And suddenly one day, something (or everything) may come crashing to the ground. People get hurt. The ride is broken, in need of major repairs, possibly never the same again.

Enter a caption

So better to slow the RPMs now, decrease the amplitude of vertical oscillations. And, increase frequency and intensity of maintenance: inspection, lubrication, computer upgrade, parts replacement. All of this is to say that 2018 is my year of graduate study in life-octopus ride maintenance. Curriculum so far includes a lot of Thomas Rhett songs (“Drink a Little Beer”), communion with close friends, and a resurrection of my spiritual life. I’ got this. [fist bump emoji]

***

Okay so, this is a post I have thought about for weeks and I can finally sit down to write it today/tonight.

Since December, two people have told me, essentially, “Medicine has failed at nutrition.” One person was a good friend, the other a new acquaintance. Both were athletes, well-educated professionals, and thoughtful men. I respect both of them and was intrigued by their assertions (and, honestly, just a little defensive). They pointed to the myriad books, fads, products, news articles, and programs around the country in the last decade or so, all claiming to have the one method for lifelong healthy eating.

Their expressions went something like this: “What’s the deal with gluten? I’ve read Wheat Belly and Grain Brain and now I feel conflicted every time I want to have some bread, even though I feel fine, and I like bread. …Is saturated fat bad or good? On Atkins I can have as much steak and liver as I want, and my cholesterol is supposed to get better. And Bulletproof says I should be drinking butter and coconut oil in my coffee. But my doctors all tell me to minimize red meat and oil in general. …The Inuit people live off of whale blubber, and they have a fraction of the heart disease we have. I used to think I knew how to eat healthy and now I’m not so sure. I’m so confused.”

I was taken aback somewhat by both of these conversations, as I don’t feel confused at all about nutrition and eating. I feel personally tempted, frustrated, vacillating, under-motivated, and/or fat, depending on the day. But professionally I feel informed, confident, and reassured that I can counsel my patients solidly toward optimal health. So wherein lies the disconnect?

In my practice, our approach to nutrition starts with the patient interview. What is your current eating pattern? How does weekend or travel eating differ from regular workdays? How does this pattern either promote or hinder your health and well-being? What are you doing that’s already healthy and where is there room for improvement? What needs to happen in order for you to make small, sustainable behavior changes for optimal health? How important is it to you to do so? The conversations focus on my patients’ own physical, mental, and emotional experiences around food. They have a chance to relate their eating habits to personal and professional goals, and a vision for their best selves.

I have learned that my advice needs to be concrete, specific, and relevant at a granular level. I can roll with Paleo, Atkins, Whole 30, gluten-free, vegetarian, ovo-lacto, oil-less vegan, pescatarian, Mediterranean*, or other diets. There is some good evidence for all of them. But is any one of them the sole antidote to all of our eating poisons? My left brow rises every time I hear someone make this claim. Here’s the key: None of these diets tell us to eat pizza, burgers, chips, cheesy fries, dinner rolls, diet soda, craft beer, loaded nachos, fettucine alfredo, cookies, cake, ice cream, and candy the way most of us do. So what are the underlying origins of my night-time corn chip-cream cheese binges? What strategies can we brainstorm to cut back on my birthday cake consumption between birthdays? Questions like these and the conversations that follow serve my patients far better than my recommending the blood type diet (which I do not).

Furthermore, leading proponents of each of these diets also emphasize the importance of concurrent self-care in the other realms of health: Exercise, Sleep, Stress Management, and Relationships. Diet and nutrition are vitally important for health, but they do not occur in a vacuum. All of our health behaviors need to be assessed in their combined context, and recommendations are best made with circumstances, preferences, logistics, and access in mind.

If you’re an elite athlete whose diet is already 99% cleaner than the rest of us, yes, maybe there is a subtle difference between medical diets that will affect your performance and sports longevity. Then again, maybe not. And you are also likely attending to your needs for training, rest, recovery, and stress management. So you’re probably good either way.

For us regular people, the only diet that works is the one we can stick to, that doesn’t cost us inordinate amounts of psychic energy to maintain, and that actually makes us healthier. How can we tell we’re healthier? We may feel: lighter on our feet, increased energy, more regular bowel movements, clearer skin. When we see our doctors (as we all should, ahem) they may find we have lower blood pressure, lower body fat, smaller waist circumference, lower fasting and overall glucose, lower LDL and triglycerides, and an overall brighter aura and vibe.

So maybe keep Michael Pollan’s words in mind as a general guideline: “Eat food. Not too much. Mostly plants.” I would add: Eat foods as close to how they occur in nature as possible. If you can tell what leaf/seed/grain it is by looking at it, it’s probably better than if you cannot. Harvest/kill it, cook it (or not), eat it. The fewer steps the better. Eat often and slowly with people you love. Help each other moderate the junk. Enjoy your food. Life is short. Strive for an eating life that adds joy and delight to your whole being, both immediately and in the long term.

Onward, my friends.

*I have no financial, philosophical, or other interests in any of these or other diet programs, products, centers, providers, etc.

200th Post: The Best of Healing Through Connection

Posted on January 6, 2018 by Catherine Cheng, MD

Happy New Year, my friends! May 2018 bring us all health, joy, connection, and learning! And may we all look back one year from now feeling more empathy and compassion, and enjoying better relationships than ever before.

If you are new to this blog, welcome! I hope you find something that resonates. If you are an old friend, thank you for your support, feedback, and encouragement the last 32 months. As I reread the last 199 posts this past week, my favorite parts were the thoughtful and enlightening comments. I never imagined I could make friends writing a blog and yet here we are, connected, engaged, and holding one another up.

What have you discovered about your own writing when you go back and read? Turns out I have a pretty consistent theme—it’s all about relationships. Relationships require awareness, insight, active engagement, negotiation, and adaptation. This is no less true in our relationships with ourselves than with others. I have divided my favorite posts below into three categories: Health & Self-Care, Physician-Patient Relationship, and Relationships and Communication in general. Though I have written pieces on politics and healthcare, I realize that these are critical arenas in which to explore relationships, and not my primary areas of focus in and of themselves.

2018 brings big new projects and responsibilities, yay! So of course there will be big new challenges, also yay! Looking ahead, I commit to my self-care practices with renewed motivation:

Get to bed by 11:30 every night—Coach Christine has permission to call me out if I’m caught Facebooking past this time.
Maintain 4+ workouts per week. An aging body needs regular vigorous movement!
Keep up with therapy and resume regular coaching calls—reflect internally and project my best self outwardly.
Maximize intake of stems, stalks, leaves, and fruit; minimize refined sugars.
Nurture my ties to my tribes. They hold me up so I can do my best for those whom I lead.

The coming year will also require pulling back on certain things in order to maintain sanity. While I refuse to renounce my Facebook use altogether, I have already decreased daily hours spent. And though I still strive to maintain social/political awareness and activism, I will engage less with opposing voices on social media. The costs, I have learned, far outweigh the benefits. I would much rather take a politically oppositional friend out to lunch, or even fly to meet them, and have far more meaningful conversations in person.

For now, I plan also to scale back on the blog. I’ll continue to write, of course, but likely more in the form of stream-of-consciousness journaling, brain-dumping, and snail mail letters to friends. I expect that once in a while one of these activities will yield a post or two, and I hope to catch them by the tail and publish them before they escape the moment. I leave here the list of my favorite posts to date. Please feel free to dip in and out, leave new comments, and share links. I suspect I will be drawn back to the page before long, as I already have a list of ideas for future posts. But in case it’s longer than I anticipate, please know that I appreciate every view, every like, every comment, and every connection.

Thank you for stopping by and taking the time to read. And may you take something away that makes you glad you came.

Sincerely,

Cathy Cheng

Health and Self-Care

The Sh*tpile /May 2015

https://catherinechengmd.com/2015/05/01/the-shtpile/

Everybody has one. We inherit large parts of it from our parents, whose parents passed theirs down, etc. Life experiences add mass and odor as we grow up. It sits squarely in the middle of the house of our existence. For the most part, we simply live our lives around it, walking past every day, careful not to knock any pieces off. The surface gets dry and crusty; we grow accustomed to the smell.

How Health Begets Health /November 2015

https://catherinechengmd.com/2015/11/07/how-health-begets-health/

As the kids and I sat waiting to get their flu vaccines this morning, I heard someone blow their nose. It was that thick mucus blowing that feels, at the same time, both gross and gratifying. I took a deep breath through my unobstructed nostrils and looked happily at my uninfected children.

Setting Intensions for 2016 /January 2016

https://catherinechengmd.com/2016/01/01/setting-intentions-for-2016/

This year I realized my body’s inevitable march toward menopause, a stark and sudden awareness. It came to me sometime in the spring, and I felt a keen jolt of motivation to prepare. After 13 years of practice, I recognize two characteristics of women who suffer the least through this dramatic hormonal transition.

So You Want to Lose Weight /March 2016

https://catherinechengmd.com/2016/03/12/so-you-want-to-lose-weight-the-four-as-of-goal-setting/

We set weight loss goals all the time, all of us—physicians included. We choose a number on the scale—an outcome—that represents our better selves, however we see it. I suggest today that behavior-oriented goals, rather than outcomes-oriented ones, lead to far greater and more meaningful success. How much are we really in control of what we weigh, day to day?

Never and Now /April 2016

https://catherinechengmd.com/2016/04/17/atozchallenge-never-and-now/

And, there is another important practice to overcoming the Nevers: Mindfulness, the practice of the Now. Never is about the future or the past. Often it’s a shadowy, catastrophizing perspective of things. But we cannot predict the future, despite our arrogant human certainty. And we cannot live every day to come based solely on what has already happened or not happened. Circumstances and attitudes change. Landscapes change—at times literally, and in an instant. We evolve, we learn, we grow. How can we be so sure that Never is real?

Yes, And! /April 2016

https://catherinechengmd.com/2016/04/30/atozchallenge-yes-and/

The goal is to open our minds, allow possibilities, expand our boundaries, and encourage creativity. I can still see her smile, the gleaming light of engagement and anticipation in her eyes. I also remember my own hesitation and self-consciousness. What do you mean, pimple on my forehead? Is it really about to burst?

On the Critical Importance of Self-Care /November 2016

https://catherinechengmd.com/2016/11/06/1638/

Technology and other advances have created a world of 24/7 hyper-stimulation, global comparisons of productivity and innovation, and immense pressures to be perfect, or at least appear so. Men and women live under constant scrutiny and competition… I see, hear, and feel it from my patients every day—the anxiety, the uncertainty, the angst. The suffering is real, if not totally tangible.

On the Second Arrow /November 2016

https://catherinechengmd.com/2016/11/11/on-the-second-arrow/

Eventually, breathing, we can let go the negativity, pull the arrow out. Breathe. When assailed by another first arrow, see the second arrow coming and sidestep. Breathe. Keep breathing. Practice self-compassion and forgiveness.

On Readiness /November 2016

https://catherinechengmd.com/2016/11/16/on-readiness/

I confess I am guilty of impatience and judgment. When I see your uncontrolled, lifestyle-related medical problems, and you resist behavior change, I feel frustrated. I know you feel it, too. But know that I don’t blame you. The point is: we don’t make changes until we are ready.

Walking the Talk /July 2017

https://catherinechengmd.com/2017/07/09/walking-the-talk/

18 months ago I wrote about my plan for maximizing menopause preparedness. As with so many missions, this one has experienced both successes and failures.

Just Do It My Butt /November 2017

https://catherinechengmd.com/2017/11/06/just-do-it-my-butt/

Medical systems which include dieticians, exercise physiologists, and health psychologists can deploy these team members to support patients in their health journeys. But does your doctor’s office have this kind of set up? Does your insurance pay for these services?

Citius, Altius, Fortius! /November 2015

https://catherinechengmd.com/2015/11/09/citius-altius-fortius/

Every day I live in awe of the astounding miracle that is the human body. It is the quintessential integrated machine. Almost every part serves a unique and essential purpose in normal daily function, and the parameters for such function are incredibly narrow. But take something out, wound something else, or trash multiple systems at once, and the whole assembly adapts around the insults, automatically, without any action or awareness on our part. The body’s compensatory mechanisms exemplify the resilience and tenacity of nature, no doubt about it.

Dance For Your Health /November 2017

https://catherinechengmd.com/2017/11/16/dance-for-your-health/

So basically, dancing activates key areas of the brain and body in an orchestrated fashion, igniting motion, joy, connection, exhilaration, sensory integration, creativity, passion, cardiovascular elasticity, and fun. How could this not make us all younger?

Physician-Patient Relationship

The Premise /April 2015

https://catherinechengmd.com/2015/04/14/hello-world/

Patients and physicians have control over one thing above all else: our relationship with each other. Relationships live and die by communication. Barriers on the obstacle course of patient-physician communication loom large and formidable. Our system fails us over and again. And it falls to each of us, not the system, to find our way to connection and healing relationships.

What Are You Looking For? /April 2015

https://catherinechengmd.com/2015/04/22/what-are-you-looking-for/

My mind’s eye saw hers widen with disappointment, then anger, her posture turn aggressive. My inner conflict escalated quickly: Sacrifice the rapport I had just established in the name of antibiotic stewardship, or give in to the misguided pleas of a wrung out fellow working mom, and contribute personally to the scourge of antibiotic overuse and resistance?

More Than Enough Love /June 2015

https://catherinechengmd.com/2015/06/20/more-than-enough-love/

Like parenting, the path of medical practice is not paved with lollipops and ice cream. It’s more like an uphill dirt road with pits and grooves, erratic weather, and hairpin turns that make you dizzy and nauseated. It can also offer astoundingly beautiful scenery along the way—like parenting.

Help Me Help You /July 2015

https://catherinechengmd.com/2015/07/10/help-me-help-you/

When you feel that disconnect, like I have left Best Me somewhere else and you’re not getting what you need, what will you do? Will you yell and storm away? Smile to my face and then write a scathing, anonymous Yelp review? What would you do if I were your spouse, colleague, friend, or child? You and I are in a relationship, not unlike these.

Closing the Satisfaction Gap /July 2015

https://catherinechengmd.com/2015/07/20/the-thorn-in-our-collective-side/

This patient gave Dr. K the best possible feedback: An objective observation about a behavior, her subjective interpretation of it, and its consequence for their relationship. This is how we communicate evaluations to medical students on their performance in clinical rotations. There is no reason why it should stop at the end of training; it’s just that the evaluators have changed.

The Burnout Crucible /September 2015

https://catherinechengmd.com/2015/09/20/the-burnout-crucible/

Maybe it’s a moot point, whether it’s better to never burn out or to burn out and relight. We’re all here doing our best every day. Maybe it’s more important to just cut ourselves and one another a little slack sometimes, have compassion for aggressors while calling out their unjust behaviors, and offer everybody the benefit of the doubt, especially when we’re all stressed out.

What Makes You Think You Can Trust Me? /February 2016

https://catherinechengmd.com/2016/02/01/what-makes-you-think-you-can-trust-me/

Trust is the cornerstone of any meaningful relationship. The patient-physician relationship is no exception. It takes time and presence to cultivate. These are big investments, and if we are willing to make them, the returns can literally save us.

I am Edna Mode /February 2016

https://catherinechengmd.com/2016/02/20/i-am-edna-mode/

Clearly, Edna trained in the School of Tough Love. Fortunately for you, I have also studied empathy, compassion, and motivational interviewing. I can help you persist. I have patience for your journey. I can be your pillar of consistency. Edna is nothing if not consistent!

Humbling and Honoring /April 2016

https://catherinechengmd.com/2016/04/09/humbling-and-honoring/

I get to choose when I am willing to donate my time and energy to the free clinic—everything I do there is on my own terms. The patients there have no such choices. If they want care, they have to show up—early—on the day the clinic is open, regardless of what else is going on in their lives. There are no appointments, and almost no continuity with providers. It’s a completely different world from where I make my living, on the Gold Coast of Chicago.

On Mutual Respect /November 2016

https://catherinechengmd.com/2016/11/05/on-mutual-respect/

To Patients Who Abuse Medical Staff: Let me be clear: That is not okay.

No Substitute for Time /November 2017

https://catherinechengmd.com/2017/11/03/no-substitute-for-time/

“More information about the value of a physician-patient encounter will always be found in the content of their communication than in what they ultimately do. The difference in… physicians’ behaviors will not be found in any database, electronic medical record, or machine-learning algorithm. I have yet to see data on the contextual information from a history of the present illness in any data set or quality improvement initiative.”

Dr. Jerkface In Context: Healing the physician-patient relationship /November 2017

https://catherinechengmd.com/2017/11/25/dr-jerkface-in-context-healing-the-patient-physician-relationship/

Do patients care about doctors’ suffering? If they knew how the system harms physicians, would they have compassion for us? What about if they knew how physician burnout and dissatisfaction directly affects their quality of care, all of it negatively? What would move patients to stand up with and for doctors? This is my goal for the indefinite future: to help us, patients and physicians, the end users of our medical system, stand up with and for one another, for positive systems change.

Relationships and Communication

Gratitude, Generosity, and Peace /July 2015

https://catherinechengmd.com/2015/07/30/gratitude-and-generosity/

When I feel grateful, there is enough. I am enough. Even just saying the word, seeing it on the screen, brings me to a more peaceful state of mind and body.

Warrior Pride and a Plea for Kindness /December 2015

https://catherinechengmd.com/2015/12/13/warrior-pride-and-a-plea-for-kindness/

There is no substitute for a face-to-face conversation, and the time and energy it takes to have one. It requires a certain degree of tolerance, and an unspoken contract of civility and courtesy. We must choose carefully with whom we are willing to undertake such a venture. And perhaps most importantly, we must be clear about our objective(s). Do we really expect to change someone’s fundamentally held political or religious beliefs? How realistic is that? What other purpose, what other good, could possibly come from such conversations?

On Belay /April 2016

https://catherinechengmd.com/2016/04/02/on-belay/

The interview starts with the two men talking about Hank Williams’ troubled life, his ‘formidable demons,’ as Hiddleston puts it. He expresses compassion for this, as I have seen him do in previous interviews about other characters he has portrayed. He describes how Williams rose to stardom quickly, but ‘with no real support, no one to anchor him.’ Funny how he uses that word, anchor—like belayer.

Opposition and Openness /April 2016

https://catherinechengmd.com/2016/04/20/atozchallenge-opposition-and-openness/

When I look at the list of definitions of oppose, I feel tired. When I think of the energy it takes to constantly stand against something, I feel listless and drained. Fighting, resisting, combatting, Obstructing, standing in the way, hindering, disputing, dissenting, contradicting—it’s exhausting. I think of times when I meet someone new and all they talk about are the things they hate, that they can’t stand, that they want changed. I cannot wait to get away and find levity.

Every Day a Revolution /April 2016

https://catherinechengmd.com/2016/04/22/atozchallenge-every-day-a-revolution/

Like the turning of an incandescent light bulb, gently, patiently, and consistently in one direction, the steady work of activists eventually leads to sudden and intense illumination. Darkness becomes light, cold spaces are warmed.

Withhold Judgment /April 2016

https://catherinechengmd.com/2016/04/29/atozchallenge-withhold-judgment/

After all of this exploration, conversation, debate, research, and observation, once again I conclude that one of the most important practices for inner peace is to Withhold Judgment. Not all judgment, and not indefinitely, but much and for a while.

Playing My Part /May 2016

https://catherinechengmd.com/2016/05/22/playing-my-part/

Given the awesome support network with which I am blessed, I feel an impulse to do something more with my writing—to amplify and project all this love and connection back out onto the world for some positive purpose. But how can my words possibly make a difference?

Holding the Space for Personal Acts of Peace—On Listening /July 2016

https://catherinechengmd.com/2016/07/11/holding-the-space-for-personal-acts-of-peace-listening/

I know I will not do justice to all the complexities of our issues in one blog post, but I ask your forbearance for my interpretation, as it has led me to greater conviction for what I can do, I, one person.

Holding the Space for Our Suffering to Heal Us /September 2016

https://catherinechengmd.com/2016/09/22/holding-the-space-for-our-suffering-to-heal-us/

For a moment we felt stuck, we connection seekers. I looked at our leader. His expression conveyed nothing but humility and empathy. His posture conveyed resolution. Despite our deep longing, he refused to lead us into treacherously thorny fields, because he knew he did not have the time to bring us safely through to the other side. But he also allowed us to process, invited us to consider how else we could collectively resolve our unease.

On the Golden Positivity Ratio /November 2016

https://catherinechengmd.com/2016/11/25/on-the-golden-positivity-ratio/

I remembered something about healthy relationships maintaining a 3:1 ratio of positive to negative interactions. Turns out it’s actually 5:1, widely attributed to observations by Dr. John Gottman, renowned marriage and relationship psychologist. I think the same thing applies in other realms, too, such as self-talk—a reflection of our relationships with ourselves. It’s not a far leap to see how this idea pertains to news, social media, and any other human interactions.

Train to Withstand the Discomfort /February 2017

https://catherinechengmd.com/2017/02/20/train-to-withstand-the-discomfort/

We all know the satisfaction and comfort of echo chambers. Seeing, hearing, and reading that which validates our existing positions feels so good. But the farther we regress here, the harder it becomes to tolerate a dissenting view. We must resist this temptation; we are called to be more disciplined than this.

To Train or Not to Train /May 2017

https://catherinechengmd.com/2017/05/08/to-train-or-not-to-train/

…even if we don’t all talk politics, we all need effective communication skills, especially in the arenas of conflict resolution, negotiation, parenting (which encompasses them all), and the like. We are social beings—we only survive by cooperating and living well within our tribes, and by tribes living well among one another. That can only happen if we practice getting along.

Tribal Pride and Tribalism /November 2017

https://catherinechengmd.com/2017/11/29/tribal-pride-and-tribalism/

We all need our tribes. Belonging is an essential human need. To fit in, feel understood and accepted, secure—these are necessary for whole person health. And when our tribes have purpose beyond survival, provide meaning greater than simple self-preservation, our membership feels that much more valuable to us. But what happens when tribes pit themselves against one another? How are we all harmed when we veer from “We’re great!” toward “They suck”?

An Early Resolution

Posted on December 1, 2017 by Catherine Cheng, MD

NaBloPoMo 2017: Field Notes from a Life in Medicine—Last Post

It’s December 1 here in Chicago, but I have almost 2 hours before midnight in California, and 5 hours in Hawaii, so I’m still counting this post as on time. Meh whatever, it’s my blog and I can do what I want—last post for NaBloPoMo 2017, woo hoooooooooo!!

Okay so, when was the last time you gave another driver the finger? I can’t even remember myself, maybe high school? Definitely by the end of college I had stopped, and I can honestly say I probably only ever did it a handful of times. In college I was in a car with friends and the driver cheerily wagged his finger at another car that had cut us off. He didn’t get angry, but rather acknowledged the rudeness with humor. At least I thought it was humorous. So I’ve been doing it ever since—but with varying degrees of good humor.

Last week I was driving to work (you know what’s coming). As I approached an intersection about 1.5 car lengths behind the sedan in front of me, where we had no stop sign but the cross street did, I could see a car inching out at the corner. I anticipated that it would try to make a turn after the car in front of me passed, thereby causing me to have to slow down. Sure enough that’s what happened, and I wagged my finger. I suppose my intent was to shame, I’m embarrassed to write. If I were that driver, I might have felt ashamed, and also annoyed at the gesture. He, in turn, showed me a stiff, straight middle finger, accompanied by an unmistakable expression of the very same message—eye contact and all.

That hurt my feelings, I’m also embarrassed to report. Not quite sure why I’m embarrassed—because I kind of deserved it, or because we’re not supposed to let stuff like this get to us? Whatever, it felt bad and I didn’t like it. After reflecting over the next mile or so, I decided that from now on I will simply treat other drivers with kindness first, regardless of the crazy antics they perpetrate on the roads (and let me tell you, in Chicago it can get pretty crazy). That is the resolution that makes me feel the best. And now I’m even more embarrassed and ashamed because this is pretty much how my mom treats all drivers (all people, really) since I can remember. Well, better late than never.

I’m trying to remember how I came to this conclusion, because it took like quick-drying super glue, and I have abided by it firmly ever since. I tried to imagine myself in that driver’s place. What would make me in such a hurry that I would intentionally inconvenience another driver, who has the right of way, to get going just a few seconds sooner? Was he really late for work, or to see a sick relative in the hospital? Was he just an impatient driver in general? Regardless, was my finger wagging helpful to either of us? Would it make him less likely to do the same thing again? Maybe it would have been better if I had waved, offered some grace and generosity of spirit? If I were him, I would certainly appreciate that more than a pompous finger wagging.

Exercising patience and generosity on the roads is easier said than done, though, am I right? Surely I cannot be the only one challenged by this? Now that I think more about it, maybe my embarrassment at feeling hurt by his gesture relates to the fact that society tells us in a lot of ways that we’re not supposed to treat other drivers as human—and thus not be affected by them. Jockey for position, don’t let ‘em in, fuck ‘em. Stupid gestures should mean nothing, because we’re simply expected to treat one another like garbage. It feels like this when I let someone in my lane and they don’t wave. No acknowledgement, no appreciation. That doesn’t feel good, and it’s not who I am.

Long ago I realized that I almost never need to get anywhere so urgently that I need to cut people off or risk my safety, or that of my passengers, in the car. Whenever I see someone signaling to get in my lane, I almost always make space for them. I try to avoid entering intersections I cannot clear, because I hate when cars do that and cause gridlock, especially at rush hour. But somehow I didn’t see the finger wag as contrary to these other acts of driving courtesy—in this respect I guess I was stuck in the ‘fuck ‘em’ mentality. So it makes sense that after experiencing the other side, and so emphatically, I realized that the only thing to do for my integrity is to reject that behavior altogether.

So, no more finger wagging. Maybe I’ll take a deep breath and find some other, more neutral expression? It feels necessary to acknowledge my own frustration, but not necessarily to project it on the other person. Maybe I need a mantra. *Deep breath* “You be safe now.” *Deep breath* “You do you, I’ll do me.” *Deep breath* “Thank you for not hitting me.” *Deep breath* “I remind myself that you are a fellow human being, and we are all here doing the best we can.” Maybe a more succinct version of that last one. I’ll work on it. I’m sure I’ll be working on it for a long time yet.

_ _ _

Thanks to all who have read along this month, it’s been fun! Now onto holiday cards, each of which I will once again attempt to write by hand this year. It just feels like the right thing to do, and I get to break out my fun colored pens. In case I don’t make it back in time, Happy Holidays to all, and best wishes in 2018 and beyond!

Comfort Food

Posted on November 30, 2017 by Catherine Cheng, MD

NaBloPoMo 2017: Field Notes from a Life in Medicine

There is just something about rice that comforts us Asians. This morning I got up early and spent all morning with my hosts in the Department of Surgery. My presentation went well, as did a leadership and communication session I helped lead with the department chair. But I only snacked on trail mix, and by the time I met my friend for sushi in the afternoon, I was starving. The tuna, salmon, and yellowtail sashimi came with a nice, round bowl of rice, and I was in heaven. The smooth, cool texture of the fish, the pungent bite of wasabi, and the dampening, flavor blending effect of soft white rice—every bite was a true pleasure.

Coming back from the west I connected in Denver, happily landing at Concourse C, where they have a bank of restaurants serving hot food. I never do this, but tonight I made a beeline for Big Bowl. No wraps, salads, snack boxes, or tabouleh this time. I wanted rice and stir fry. They served up one of those black takeout containers with the clear lids, filled with food, and I ate the whole damn thing. It was just so satisfying, and so odd because Chinese food is usually the last thing I want when I eat out.

Maybe it’s because I’m overtired. I traveled three times in three weeks in October, to Colorado, then San Francisco, then DC. I connected with amazing people, old friends and new, and my brain was saturated with nature, love, and learning. I also had multiple projects going on at home in that time. This month I have stuck with my commitment to post here every day save one, keeping me up too late most nights. I have presented to colleagues twice, traveling once to do it. It’s been four weeks since I hurt my knee (complete ACL tear, now confirmed, with minor meniscal tears associated), I’m still limping, and my left quad is visibly–stunningly–atrophied. All in all, it’s been a physically, mentally, and emotionally grueling couple of months. I don’t regret most of it, except maybe going to volleyball that night when I probably should have gone to bed. Grrr.

So it makes sense tonight that I’m attracted to ramen with a poached egg, chicken and vegetable soup, rice, stir fry, and oily fish. They are warm, substantive, and satisfying, without feeling heavy or gluttonous. I don’t feel guilty after eating them—these are my true comfort foods.

Thankfully, I have no more travel until Christmas and no presentations for two months. One more NaBloPoMo post tomorrow and 2017 is in the books. I’ve accomplished a lot, and definitely enough, this fall. I can get off this treadmill in another day or so, and start the knee rehab in earnest—a whole new and fascinating experience! Patience will be the challenge, perseverance the goal, and mindfulness the primary coping tool. Now I just need to get home and get some sleep.

Tribal Pride and Tribalism

Posted on November 29, 2017 by Catherine Cheng, MD

NaBloPoMo 2017: Field Notes from a Life in Medicine

What tribes do you belong to? How do they serve you, and you them? How not?

I think of this today as I have traveled out of state to speak to a Department of Surgery on physician well-being. I wonder how often they have internists present at their Grand Rounds? What a tremendous honor, I’m so excited to be here! I hope my talk will be useful and memorable, as I represent my field and my institution, in addition to myself. In the talk I describe the central tenets of Tribal Leadership and culture, and how to elevate ours in medicine.

So I’m thinking tonight about tribal pride and tribalism—the benefits and risks of belonging.

Of course I’m thinking now of intra-professional tribalism: Surgery vs. Medicine vs. Anesthesia vs. OB/gyne vs. Psychiatry. Each specialty has its culture and priorities, strengths and focus. Ask any of us in public and we will extol each other’s virtues and profess how we are all needed and equally valuable. Behind closed doors, though, internists will call orthopods dumb carpenters; surgeons describe internists’ stethoscopes as flea collars, and the list of pejoratives goes on. Maybe I’m too cynical? My interactions with colleagues in other fields are usually very professional and friendly—until they are not. I have experienced condescension and outright hostility before. But can I attribute it to tribalism—that general, abstracted “I’m better than you because of what I do” attitude—or to individual assholery? Or maybe those docs are just burned out? As with most things, it’s probably a combination. Based on what my medical students tell me, negative energy between specialties definitely thrives in some corners of our profession. Third year medical students are like foster children rotating between dysfunctional homes of the same extended family—hearing from each why all the others suck.

So what can we do about this? Should we actively police people’s thoughts and words in their private moments? I mean part of feeling “We’re Great!” kind of involves comparing ourselves with others and feeling better than, right? Isn’t some level of competition good for driving innovation and excellence? Should we even embrace this aspect of tribal pride? It certainly does not appear to be diminishing, and I have a feeling it’s just human nature, so probably futile to fight it.

I wonder why we have this need to feel better than. Is it fear? A sense of scarcity? As if there is not enough recognition to go around? Like the pie of appreciation is finite, and if you get more I necessarily get less? Intellectually we recognize that we are all needed, we all contribute. But emotionally somehow we still feel this need to put down, have power over, stand in front. And it’s not just in medicine. I see it in men vs. women, doctors vs. nurses, liberals vs. conservatives, and between racial and ethnic groups. It makes me tired.

But maybe we can manage it better. Maybe we can be more open and honest about our tribal tensions, bring them into the light. Yes, I think surgeons can be arrogant. And that’s okay to a certain extent—it takes a certain level of egotism to cut into people, and when things start going wrong in the OR, I think that trait can help make surgeons decisive and appropriately commanding when necessary. I imagine surgeons get impatient with all the talking we internists engage in. So many words, so little action, they might think. And yet they understand that words are how we communicate with patients, how we foster understanding and trust. Maybe we can all do a better job of acknowledging one another’s strengths and contributions out loud and in front of our peers (and learners). The more we say and hear such things, the more we internalize the ideals.

Tomorrow I get to spend a morning with surgical attendings and residents. I hope to contribute to their learning during my hour long presentation, but I really look forward to my own learning, to expanding my understanding and exposure to parts of my profession that I don’t normally see. I’m humbled at the opportunity, and I will look for more chances to bring together colleagues from divergent fields. If we commit, we can connect our tribes and form a more cohesive profession. That is my dream for future generations of doctors—to be freed from infighting and empowered to collaborate at the highest levels, for the benefit of us all.