November 11:  Fierce Optimism Makes Me Better

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On Ozan’s Inner Circle forum today, another member posted about his admiration for Dr. Martin Luther King, Jr.  It reminded me of a favorite MLK quote, which came to mind on Saturday as I prepared for the Better Angels workshop:  “The arc of the moral universe is long but it bends toward justice.”  I have referred to this quote many times over the years, and a phrase that I often add goes something like, “Bend that arc!  Hang on it with all your might!”  Meaning the arc bends toward justice only because we make it so, by working tirelessly for it, by acting visibly in accordance with our core values, and by consistently walking the talk.

I texted my friend the morning of the workshop: “I’m 90% excited, 10% nervous…Maybe 15%…”  Then I thought about the people I know who like the idea(l) of Better Angels, but don’t want to participate.  I thought about my friends who express hopelessness at any possibility that people on opposing political sides can ever connect, that we can actually work together across our differences to get things done.  I thought about the pushback I might get, that the Better Angels mission is futile, a waste of energy and time.  I felt something akin to a tidal wave rise within me, and I texted my friend again, spontaneously, “I intend to make today a day of fierce, infectious optimism.”  At that moment I knew my goal that day was to take every example and experience of kindness, connection, empathy, openness, generosity, magnanimity, conviction, and hope, and channel it to the workshop and its participants.  Because though it was to be a skills workshop, teaching a way of doing, what we really need are all of the qualities I just listed—they are the way of being that brings the skills to bear in the most meaningful ways.

This idea marinated for a couple of hours while I pictured the venue, reviewed the workshop content, made notes about delivery.  I thought again about my friends who feel like our world is crumbling around us, that so much progress made the last century is being eroded.  I completely empathize with this perspective, and I understand how it makes us feel we have to fight, to be aggressive and confrontational, to come at the opposition full force, like a bullet train.  Do they think listening and speaking skills focused on curiosity and openness too passive and ineffective?  Does optimism, the hopefulness and confidence that things will be okay, make me lazy about the issues that matter to me?

Below are the words I texted my friend to describe what I mean by ‘Fierce Optimism’.  Normally I would not share such nascent ideas on the blog, but whatever, it’s all an experiment, who knows what better ideas may come from this early sharing?

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Fierce Optimism Is:

Urgency with Patience

Or should it read, “Urgency without Impatience”?  What I mean here is simply that most things worth doing take a very long time.  All important social movements occurred (and continue) over generations.  At times confrontation and revolution are necessary.  But they are not enough.  Consistent, slow, organic, grass roots change on the local level is what sustains consistent progress, keeps it from regressing.  The acute urgency I feel to address my deep concerns (for instance, the profound rifts in our relationships) drives me to action.  But when that action is directed at another person, I must attune.  I have to set realistic expectations for how much I can move this mountain today.  Pacing myself, practicing persistence with patience, conserves energy and prevents burnout.  It also allows me to look up every once in a while and adjust to my surroundings, adapt to subtle changes, like when someone starts to soften.  If I’m bulldozing with strong words and heavy dogma, I am more likely to plow over and through any crack in the door of someone’s mind that might have swung open freely had I taken a more gentle approach.

Strength with Flexibility

Better Angels does not seek to make everybody—anybody—a moderate.  Rather, the goal is to hold our positions firmly and with principle, and practice seeing why someone else may hold a different position with equally strong principle.  In doing so, two things often happen:  First, by challenging our own beliefs and values, we can reinforce them.  Telling stories about the experiences that led us to our core values reconnects us with their origins, grounds us in and strengthens our own personal truth.  Second, hearing others’ stories helps us broaden our perspective.  Most of the time we only see things from our own point of view—this is our default setting.  But when we share personal experiences, really learn about each other, the curtains open on a vast landscape of understanding that we may never have imagined.  So while I may still hold my goals and objectives firmly, I can more easily release the rigidity of my method, tolerate setbacks with less suffering.  Earlier this year I listened to The Warrior Within by John Little.  He describes Bruce Lee’s life philosophy, which included a metaphor of the bamboo and the oak.  Both are admirably strong, but under intense forces of nature, the oak may break while the bamboo simply bends, sometimes to the ground, but without breaking.  Both stay rooted where they are planted, but one is more resilient.  Listening with openness and curiosity is not weakness.  Allowing for nuance and the possibility that my mind may be changed in some ways, while holding steadfast to my core values, makes me calm, agile, adaptable, and, I think, more effective.

Conviction with Generosity

This is about the assumptions we make.  Too often we cast ‘the other’ in abstract as sinister, evil, less than.  We hold up the most extreme members of the opposing group as representative of a dull and dumb monolith.  We oversimplify and overgeneralize, and then approach any individual we identify as belonging to that group as an assembly line package, a completely known entity.  We think we know all about them already, even if we have never met them, just because they identify today as “Red” or “Blue.”  In so doing, we make ourselves small.  We become exactly as narrow minded and prejudiced as the folks we accuse on the other side.  How ironic.  Now more than ever, we need generosity.  In my mind this encompasses empathy, vulnerability, sincerity, humility and a willingness to allow the complete humanity of every other person, regardless of their political, religious, racial, cultural, or any other persuasion.  Conviction without generosity too easily becomes tyranny, for individuals as well as organizations and governments.

*sigh*

Well, like I said, these ideas were just born two days ago.  Have I expressed them at all coherently?  Have I shown you intuitively apprehensible paradoxes?  Can you feel the dynamic balance of agitation and peace?  Tension without anxiety?  Potential and kinetic energy?  If not, that’s okay.  I’ll keep working on it.  That’s the essential outcome of Fierce Optimism, after all—we keep working, steadily, to bend that arc.

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November 10:  Experimental Questions Make Me Better

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What’s the most interesting question your doctor asks?  What effect does it have on you?

I get to ask some really fun and interesting questions of my patients.  They often come about spontaneously, then I realize how helpful they are, and I integrate them into my routine interview.

It was almost ten years ago now that I was seeing a pleasant young woman for the third time.  She had recurrent, nonspecific physical symptoms, and felt down.  She was having a really hard time at work, and it was having a significant impact on her overall health and well-being.  Around the same time I saw another patient, a young man.  He felt well overall, but was also not happy in his job.  I remember casting around in my mind, looking for a quick and easy way to quantify the negative effect of these patients’ negative work experiences on their health.  I can’t remember which visit sparked the 0-10 stress and meaning scale questions, but it was one of them, and then I repeated the questions on the other soon after.  These were my first two, unsuspecting, experimental question subjects.  On a scale of 0 to 10, how high do you rate the overall stress of your work?  That was easy, but I also had to figure out whether there was some benefit that was worth the cost of the stress.  So: On the same scale, how high do you rate the overall meaning of your work to you?  The bottom line is that we can tolerate very high levels of stress if the work is meaningful—for sustainable work, the meaning-to-stress ratio needs to be 1 or greater, and overall meaning is best at 7 or higher.  That year I realized I could create deeper, more helpful, more insight-revealing questions in my patient encounters.

My own work meaning rating rose by at least a couple integers almost immediately.

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Since then I have consistently asked about body signs of stress, resilience practices, the proportions of threat vs. challenge stress at work or home.  Since I last wrote about these questions in 2016, I have continued the experiments.

By 2016 I was also using the elite athlete analogy with my patients, asking every year about habits in the 5 reciprocal domains of health (after talking about stress and meaning at work): Sleep, Exercise, Nutrition, Stress Management, and Relationships.  But after asking the same questions for a couple years in a row, both my patients and I get a little bored.  So in 2017 I went a little deeper in the relationships category.  After confirming marital status, ages and health of children, I started asking, “Tell me about your emotional support network,” because the more I am reminded of the critical importance of emotional support in our health, the less it makes sense to not ask about it directly.

With each additional set of questions, I learn more about my patients. I learn how people understand the questions—sometimes it’s totally different from my own understanding, and the conversation about the meaning and objective of my asking gives me wonderful insights into people.  Patients are remarkably open and honest in their answers, which always reminds me of the honor and privilege of my role as physician.  The answers to these questions are what allow me to imagine my patients in their natural habitats, engaging with their work and the people in their lives.  The answers provide context and texture to the other patterns we uncover in health habits, and we often come together to a better understanding of both the origins and consequences thereof.  I can’t speak for my patients, but I always come away feeling just a little more connected.  I get goosebumps just thinking about it.

This year I’m excited to introduce 4 new questions.  It started out as three.  The third one wasn’t landing quite right initially.  I wasn’t asking what I meant, and I couldn’t quite articulate what I was after.  So I experimented with the wording until I got to the current state:

  1. In the coming year, what do you see as the biggest threat to your health?
  2. What is the biggest asset?
  3. Having answered these, how does this affect your decision making going forward? …And other iterations I can’t remember anymore
  4. One year from now, when we meet again, what do you want to look back and see/say about your health, relationships, and whatever else is important to you?
  5. (then the corollary question that occurred organically once and I then incorporated–) In order to make this vision a reality, what support do you already have or need to recruit?

I have asked these questions since July.  I always think to myself how I would answer for my patients, based on what I know about their circumstances, habits, and biometrics.  About two thirds of the time, our answers are the same.  Patients seem to receive them well, too.  One asked me to email them to him, so now I offer to email them to everybody.

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You might imagine that I think these questions make me a better physician.  That may or may not be true.  All of these questions make me better—a better, more self-aware person—because I also ask them of myself.  What is my meaning:stress ratio today?  This week?  This year?  I assess the threat/challenge ratio of my own life stressors, especially the acute ones.  I have had the same body signs of stress for many years, but in 2019 I may have developed a couple new ones, darn.  What’s the biggest threat to my health?  My hedonist impulses, no question.  The biggest asset?  My Counsel—those best friends and confidants.  What is my vision for my health a year from now?  I only answered that for myself a week ago (and I’ll keep it to myself, thank you).  And what support do I have/need?  I’m still working on that one!  That I don’t already know the answer to this one surprises me—I assumed I knew, but when I sat down to think about it formally, I realize that this may be the missing piece that holds me back from achieving some of my personal health goals.  HUH, how fascinating!  Did I not just write about how I question some of my patients’ ‘Lone Ranger’ method of self-care?  Well hello kettle, I’m pot!

Now, off to ponder some more, yay!

 

November 9:  Steady Pacing Makes Me Better

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*sigh*

I’m not a swimmer or a runner, but isn’t there something in these athletes’ training about breathing, pacing, and strategies for long distance endurance?   The last 22 days have felt like a physical, mental, and emotional marathon of sorts.  I’ll spare you the list of meetings, engagements, and tasks—you may have already read about them!  Looking back, I realize I have had to live every day in acute mindfulness, attending to whatever was right in front of me in the moment, including the unexpected.  Prioritizing was key, completing one task/event/conversation before moving onto the next.  I had to put my head down for some parts, come up for breath and a brief aerial view, then dive deep again.  Today I crossed a finish line, and I feel proud.

I started my journey with Better Angels in May of this year, at a skills workshop.  Since then I have attended two additional workshops, one that was featured on the Van Jones Show.  I committed to moderator training, and today I led my first skills workshop.  I had the honor of working with the three Wonder Women who ran the workshop back in May.  They prepared me so generously, so kindly, and I am forever grateful.

There was a hiccup, though.  When we initially arranged with the Wilmette Public Library for the event, we mistakenly told them the event would last two hours.  The workshop is designed to last 2.5 hours.  We could not change the website or registration, so we meticulously shaved 24 minutes from the schedule.  We warned participants of our impending heavy handedness on time, and dove in.  Mande and I set timers on our phones for each segment.  Mary Lynn gave me hand signals from the back of the room (though I did not always look or see).  I had the handy timeline that Sharon typed out for us all.  We ran ahead at times and behind at others, and ended right at 4:06pm, as planned.  We kept pace.  Engagement and discussion was lively, and attendees gave overwhelmingly positive feedback.  Many people stayed afterward to talk more, explore ways to get involved, and exchange information.  We were invited to present at other organizations.  Overall we felt it was a wild success.

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Everything was a group effort these last three weeks. Each meeting, workshop, video call, or presentation, whether for the American College of Physicians, my clinical practice sites, or Better Angels, required a team of people, each with delegated and specified roles and task lists.  We all had to agree on timelines and deadlines.  Text, email, Zoom; more email and text—it felt like running through a Venn diagram of relay races, passing batons in and out of each circle as I crossed from one to another.  I had to pace myself, and also match the pace of others as I came alongside.

Having a calendar with everything written in one place definitely helped.  I keep a checklist of every task, no matter how small, and carry it with me everywhere.  Excellent hydration is key for optimal mental and physical performance—I’m always reminded when I forget.  Timely, frequent, and clear communication—need I say more?  All of these practices help me plan and maintain a steady pace, checking off the list, completing each day, each trip, each week, slowly, surely, and competently.

Now I can slow down, breathe deep, and tread more lightly for a little while.  Every athlete, even an amateur, requires rest and recovery between races.  Once again I dedicate this month of daily blogging—a quintessential practice in steady pacing—to all those who go before me, showing me how it’s done.  Thank you.

 

 

November 8:  My Students Make Me Better

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Oh how I love my medical students!

Every other year I meet a new group of about 10 third year students, at the dawn of their clinical careers.  What a privilege!  I lead a monthly small group for a class called Personal Transition to the Profession.  I have written about this honor before, describing how

  1. My only job in this class is to love these students into the amazing doctors they are meant to be
  2. They help me see physician burnout from different perspectives
  3. Their experience of medical culture resonates with my own

Monthly group meetings are just enough to start to know any one person after two years, and then they disperse and I grieve the loss, just until my new group starts.  After ten years of stimulating conversations on professionalism and the humanity of medicine, I still feel anxious about my impact on these bright, insightful learners.  Did I do a good job?  Did I make a difference?  Did their time with me matter at all, or was it a monthly waste of time?

This June, I finally faced these questions head-on during a coaching call with Christine.  What are my strengths, what value do I bring?  How can I distill the central learning objective each month?  How can I connect more effectively?  We settled on some ideas for setting expectations and being more direct about goals and touchstones.  I instituted check-ins at the beginning of each meeting, something I should have started years ago.

This month’s topic was open; students were invited to write and discuss whatever was on their minds.  Blog posts and check-in comments resonated around words like exhaustion, sleep, and longing for connection.  So rather than delve into the content of their writing, I simply asked how I could help.  One student, ever honest and forthright, said, “let us go home and get to bed.”  The air felt heavy, almost forlorn… but not hopeless.  I found myself monologuing a few minutes about appreciative inquiry, and finally asked them, a little desperately, “What is the most loving thing someone has said to you this week?” and then, “or how have you felt loved this week?”

Slowly, small vignettes of connection, meaning, and hope emerged.  The student who wanted to get home to bed had received an email from a former preceptor, whose patient finally started and stayed on much needed antidepressant medication, which the doctor attributed to our student’s contact with the patient during his primary care rotation.  Another’s parents had driven into the city early in the morning to lend her their laptop after she had spilled water on hers.  Other students had connected with family members and friends, who expressed pride and encouragement.  Once again I was overcome with love for these young colleagues, and I could not help but tell them:  I have one job here, and that is to make sure you know you’re loved in your training.  I am not here to evaluate you.  You will all finish, you will all succeed.  In the time I have with you, my only objective is to hold you up in the process.  I made sure they all have my cell phone number.  I encouraged them to call me if they ever need anything.

Two students (and one’s wife) came to my house for dinner tonight.  It was supposed to be everybody, but I neglected to send a confirmation email so people weren’t quite sure if I meant my invitation last month (probably because I had planned for them to come over last month and then cancelled on them that week).  We ordered pizza and salad, I fried some potstickers, and we sat around the kitchen island with my kids, just talking.  We are all nerds.  We love to read, to learn.  S’s wife is a resident at my former hospital, and knows my friends there.  They have a book club there now, and this year’s theme is wellness.  She asked for suggestions, so I lent her my copy of My Grandfather’s Blessings.  She and S also borrowed our season one DVDs of The Big Bang Theory.

Our group will meet at a local restaurant after next month’s class.  We will plan (better) another evening meal at my house in the spring.  In the meantime, I will extend an invitation to each of them to come down if they ever need a break from school, a change of scenery, or just to feel a little extra love.  I have been where they are, and I remember how much I appreciated the empathy and compassion of my elders in the profession.  I still do.

How does this all make me better?  In medicine we talk all the time about the calling to care for patients.  But caring for one another, our colleagues and trainees, is equally important.  It keeps us and our souls whole, feeds us so we can keep doing the work.  My students recharge me, inspire me, and keep me young.  What an absolute honor to know them.

November 7:  Feedback Makes Me Better

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This post is about power.

Two friends provided important feedback on last night’s post, and I am, gratefully, much better for it.

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“You are a woman of color?”

My college friend commented on Facebook.  “Are you being serious?”  I asked him.  Yes, he replied.  He went on to point out that he sees the term being used more broadly, and that he thinks it’s been co-opted.  He made me think, which always makes me better.

In the original post, I described myself as a “petite, young, woman of color doctor,” standing up to an older white man. My friend wrote, “I think disadvantage is baked into the term, why else use it?”  Looking back, I admit I was exaggerating.  I had power on my mind, and I was trying to think of all the ways I should not have power in the situation, and yet I absolutely did, and I recognized it.  But labeling myself a person of color, I realize now, was at least somewhat inappropriate.  I have changed the text to “petite, young, Chinese woman doctor.”  I sincerely apologize if I insulted or offended anyone.

In medicine, East Asians are not considered a disadvantaged minority in the conventional sense (although while we are over-represented compared to the general population, we hold proportionally few leadership roles).  In general, however, I would argue that any non-white person in the US may still experience myriad disadvantages, in any field or situation, even if subtle.  At any point in an encounter, even with ‘MD’ and years of training and expertise behind my name, a white man can always hurl some racist, sexist remark to make me feel small.  He could just as easily attack a fellow white man on the basis of weight, sexual orientation, stature, or some other peculiar distinction, but somehow it feels like my white male colleagues just don’t have to think about this possibility as much as I do.  I feel self-conscious about my gender and race every day at work.  That is why this past spring, when I attended a negotiation skills presentation at the American College of Physicians (ACP) national meeting, I felt particularly gratified that the presenters were two East Asian women and one white man.

* * * * *

“You may want to include physicians as victims in your blog.”

A colleague responded to my post by sharing her story of being verbally attacked by a patient.  She was alone, no witnesses, and he treated staff politely, unlike in my story.  She was ‘dumbstruck and said nothing.’  She wrote, “I think as physicians, we are targets for verbal abuse because we have a privileged profession and would look foolish or weak in defending ourselves.”  In other words, since doctors hold such high societal status (power), people think we should just accept being taken down a notch or two?  That if we express an expectation of respect we are lording our status over others and thus even more justifiably open to insult and ridicule?  I see now how this can make a physician feel like a victim of societal stereotypes and expectations.

That said, I think it doesn’t matter what we do for a living; every person has an absolute right to expect respect from anyone else.  Years ago, another older white male patient made a series of passive aggressive remarks in the space of several minutes at the end of a visit.  I felt they were unfair and uncalled for, as I had spent the entire visit doing my best to connect with and care for him.  After a moment of consideration, knowing it was a risk, I was respectfully direct with him.  I repeated his words and told him that they felt like digs.  He admitted that they were and apologized, and congratulated my courage to call him out.  He never came back to see me.  I feel good about how I handled it; was it a power struggle?  I would have been open to cultivating a mutually respectful and honest relationship, had he returned.

Feedback definitely makes me better.  I will never grow if I only attend to my own point of view.  I don’t have to abandon my own perspective when facing an opposing one, and I am not obligated to incorporate anyone else’s point of view.  But if I expect anyone to take my writing and message seriously, I am required to listen to and try to understand any feedback that is offered in good faith.

Thank you, my friends, for keeping me honest and grounded.

November 6:  Caring For the Team Makes Me Better

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“How does he treat you?”

I don’t only ask this question of women whom I suspect of being abused at home.  I also ask my medical assistants.  Not about their domestic partners, but about our patients.

In my first practice, I sat/stood to the left of my medical assistant every day for six years.  It was a cozy (cramped) little counter space stacked with charts from end to end, with a couple of high-wheeley chairs.  Each chart stack had a laminated cover on top:  “For Cheng to Review/Sign,” “For Rose,” “Labs,” and “Messages.”  Charts journeyed from my left to my right/Rose’s left, to the bin under the counter to be filed.  It was incredibly efficient, actually.  I had a handwritten emoji system for indicating (dis)satisfaction with cholesterol and diabetes results.  Rose knew all of my patients and how to communicate sentiments and instructions clearly and lovingly.  She had been an MA since I was a kid; she knew what she was doing.  If a patient had a question on the phone, she could put them on hold and clarify with me, or I could just get on the phone and speak to the patient myself.  We were busy and happy, a well-oiled team-machine.

One day as I came up to my spot at the counter, I noticed an unusual sound next to me, like a distant, scratchy loudspeaker.  I turned and saw Rose holding the phone receiver about an inch from her ear.  The sound was my patient, yelling profanities at her so loudly I could hear his words from two feet away.  I can’t remember what the issue was, but he was obviously upset, and taking it out on her.  It surprised me because I had only known him to be sweet, respectful, and grateful.  Maybe he was just having a bad day?  I looked at Rose, who rolled her eyes and exhaled heavily.  I asked her to put him on hold so she could catch me up.  Apparently this had been going on longer than I knew, and she had not told me.  Had I not come upon it in real time, she may never have told me.  She would have simply tolerated it.

I picked up the call and declared myself.  He was the usual, respectful and calm patient I had always known.  I answered his medical questions.  Then I told him firmly that he did not have the right to treat anyone in my office the way he had just treated Rose.  I think there may have been some excuses and then an apology.  I made it clear that if he abused my team again, he would be discharged from the practice.  He agreed and apologized again.

That was my first opportunity to stand up for my team as an attending.  I will forever remember it.  I was a petite, young, Chinese woman doctor, speaking to a white man decades older than myself.  I stood up for my medical assistant, a woman of color and a couple decades older than me.  She had felt powerless to stand up for herself to his verbally vomitous abuse.  All I had to do was pick up the phone and say, “Mr. Soandso, this is Dr. Cheng.”  He never yelled at Rose or anyone in the office again, to my knowledge.  How could I have this much power, and why had nobody asked me to wield it in their defense before?  It was just accepted that patients could yell and scream at our staff, with no consequences?

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We recently discussed abusive patients during our regular doctors’ meeting at my current practice.  Immediately I thought, HELL NO.  The good news was that our team members feel safe reporting incidents to our managers and physicians.  My partners and I have all had to call patients to clarify our expectations of respect.  We understand that illness is stressful.  We understand that our healthcare system, especially at a large, bureaucratic institution, causes frustration, even rage.  However, none of that ever justifies or entitles a patient, or anyone, to belittle, dehumanize, or otherwise degrade another person, and especially not a team member who is doing their best to help–ever.  At this meeting, gratifyingly, we all voiced definitive confirmation that we fully support our team, and we will, without hesitation, educate and/or discharge any patient who violates our team’s right to a collegial and non-threatening work environment.

Even as I write this, I shake a little with rage and outrage at these patients’ behavior.  I can feel tightness and tension in my chest and abdomen, my breath quicker and shallower than its usual resting state.  I wonder if this triggers me because my mom is a nurse and I have seen how patients in the hospital abuse nurses.  I also know how women physicians are mistaken for nurses and thus ignored or dismissed, even by female patients.  I have known racism and sexism first hand.  But as a physician, I’m in a position to not have to tolerate it.  By virtue of two letters after my name, I have the power to protect my team, with authority.  And I work with other physicians who also recognize both this power and its attendant responsibility.

I hope our team feels protected, defended, and loved by us docs.  We may be the default work unit leaders, but they do the lion’s share of work that allows our practice to run as smoothly and successfully as it does.  They are who let me do my work as well as I do.  I depend on them every day.  So caring for them absolutely makes me better, makes us all better.

 

November 5:  Peer Coaches Make Me Better

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When you’re working through a challenge, who helps you?  What is it about them, how are they most helpful?  How not?

Through the years I have learned what I can get from certain people.  I know to call this person when I need validation, that person when I need a devil’s advocate.  I also know which people to avoid altogether—those who cannot be trusted with my vulnerability or confidence.

But when I need to hold space and tension with an issue, to patiently look at it from different angles and process the perspectives, I look to my peer coaches.  I feel gratitude and gladness for these friends today, after my LOH group had our monthly peer coaching call.  As we progress through our 10 month leadership training, we take tenets and skills home from each retreat to practice.  Monthly Zoom calls have no agenda, other than to reconvene, share, and mutually support.  Every time I come away appreciating just a little more how nothing in life—work, personal things, social context—can really be separated from anything else.

These friends are not my first or only coaches, however.  In 2005 I started working with Christine, my life coach.  Every session, 14 years later, is still transformative.  How is this possible?  Curiosity.  Christine coaches every call squarely and unwaveringly from this perspective.  It was not long before I realized how powerfully this method could alter my own encounters with patients.

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The best coaches have no preformed or decisive answers.  They have the uncanny ability to ask the best questions–Open, Honest Questions (OHQs)–which then lead clients to their own best answers.  They help frame and reframe problems.  They point us to alternate perspectives and help us open our minds to narratives other than the ones we too often grip so desperately.  It was my second year in practice when I started asking coaching questions to patients, and I have never since feared any symptom, syndrome, or answer.  When there is no clear diagnosis or answer for someone’s distress, I can just keep asking until something helpful emerges.  Most often it’s not a single piece of information that gives clarity; rather, it’s the story that materializes.  Coaching skills help me help my patients find and tell their stories of health and wellness, illness and pain, agency and action.

Here are the tenets of true Open, Honest Questions, from the LOH syllabus:

  • The best single mark of an honest, open question is that the questioner does not know the answer and is not leading toward a particular answer.
  • Ask questions aimed at helping the other person come to a deeper understanding (help them access their own inner teacher).
  • Ask questions that are brief and to the point without adding background considerations and rationale—which make a question into a speech.
  • Ask questions that go to the person as well as the problem or story—for example, questions about feelings as well as about facts.
  • Trust your intuition in asking questions. Inviting metaphors or images can open feelings, new lines of thinking, and unexpected possibilities.
  • Try to avoid questions with yes-no, right-wrong answers.
  • Avoid advice disguised as questions.

My best friends are my peer coaches.  And now I have my LOH cohort-mates.  We make no judgments about one another’s circumstances, feelings, or experiences.  We make the most generous assumptions about our motives.  Our role in each other’s lives is almost never to give advice; rather it is to hold space, listen reflectively, offer moral support, hold up core values, and help one another query thoughtfully and honestly.

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Questions asked and reflective statements made on the call today:

  • If you left work tomorrow with enough money to be unemployed for 6 months, what would you do?
  • How does it feel to speak (your issue) out loud?
  • When you think about current state compared to past, how does it feel physically in your body?
  • Sounds like you’re working on a core tension.
  • What do I/you want now?
  • What’s roiling around in you?
  • Who around you can get creative with you?

We each bring diverse questions and challenges to each call.  But somehow we always relate deeply, and listening/querying helps us each learn from every other.  Today I saw central themes emerge around identity, contribution, voice, and meaning.

In the end, I think there are few things more important in life than meaning and connection.  These are the gifts from my peer coaches, and they always make me better, no question.

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