Physician as Trainer

“No way, are you kidding me?” I would have said, if asked to do uphill sprint intervals this time last year. I also would never have ridden a bike through traffic and then up a training hill (or ridden a bike at all, really—biking has always scared me), or tried walk/jog/running from the bottom to the top of Ryan Gulch Road in Silverthorne, Colorado, an 800 foot climb over 2.5 miles.

How is it then, that this summer, I did all of these things? I credit my relationship with my trainer, Melissa. I started seeing her in January, 2014. I had thought for a (long) while that I needed to start exercising again, but after 15 sedentary years and two pregnancies, I barely recognized my body or its capabilities. I thought I could train for a few months and be back in shape, doing all things I used to do.

Little did I know what lay ahead in the actual training. First I had to identify some dysfunctional movement patterns I had developed over the years (wait, what do you mean, ‘fire your glutes,’ I’m supposed to be able to do that?), and correct them before loading them with weights and speed. I had to accept how out of shape I actually was, and reconcile the long, uphill path to physical health. And I am not an unhealthy person! I have no chronic medical problems, sleep well, and take no medications. I experience minor aches and pains that are generally attributable and transient. But last year I was afraid to start an exercise program on my own—I knew I needed help.

The first few sessions were fantastic, full of learning and potential. Turns out you can learn to fire your butt muscles in a one hour session—gluteal amnesia can be cured! But as each meeting revealed yet another pattern to be corrected, I got discouraged. How can there be so many things wrong with me, and when can I work out for real, already? After our first interval training session I wound up on the floor, dizzy, nauseated, and disgusted with myself. Later, Melissa demonstrated 14kg kettle bell swings. She told me I would do them, too—yeah, right (smirk)!  And, over time: Turkish get-ups, first ‘naked’ and then with weights, TRX lifting, Rip Stick swinging, planking, running in Kangoo Jumps, jump roping, kettle bell swinging and snatching, hill training on a bike, and, finally, metabolic circuit training that really gets my heart rate up—without ending up on the floor—I have actually done it all.

Why is the relationship key? From the beginning, Melissa has made it safe for me to show up every week, however I’m feeling and whatever is happening. It’s okay to tell her that something we did last week caused me pain. If I feel apprehensive about something she wants me to try, I can say so. She does not judge me, look down on me, or belittle me for what I cannot (or will not) do. She also does not judge herself. That I have pain is not necessarily her fault. Neither is the fact that I push myself to the point of dizziness and nausea. She holds the space for me to bring my concerns, without blaming or getting defensive. She states her observations objectively, of both my movements and how my personality and attitude affect my training. I have a hard time pacing myself, and she helps me monitor for and manage my tendency toward overexertion.

She gives me permission to just bring what I got. We go from there, wherever it is, and see how far we get. I often surprise myself with what I can do! As a result, my confidence and motivation have dramatically increased. These days when she offers a new activity, I say, “Great, let’s try it out!” It’s okay to fail, if that’s what you want to call it, because I always learn something to apply next time. Through it all, I know she is there to coach and support me, without judgment, and always with love.

It takes time and practice to acquire new skills and habits—‘way more than I initially thought! But now I think differently—hills are challenges rather than enemies. I look forward to what I will be able to do next, including uphill sprint intervals at 9000 feet—maybe next time—this time I did them at 5700 feet.

Melissa helps me stay on course in training with knowledge, application, openness and compassion. I can do the same for my patients and their health. When I withhold judgment about patients’ physical and motivational limitations, I make it safe for them to bring their fears and aspirations to every visit. I can meet them where they are each time, and hold space for the inevitable roadblocks: medication side effects, obstacles to behavior change, complications of treatment. We can then find a way through together, because we both know we’re in it for the long haul. Physicians and trainers may have more in common than we think.

I Am A Lone Nut!

At the end of my recent physician burnout/resilience presentation, I stood wondering if it meant anything to anybody. I did my best to follow Nancy Duarte’s structure in her book, Resonate: Make the audience the hero, contrast what is and what could be in story with texture and emotion, sound the call to action and describe the blissful future! Every time I give this talk I feel energized and passionate by the end, but most of the audience looks positively neutral. Thankfully, a few usually approach me afterward with words of praise and I feel somewhat validated. I remind myself, if only one person is moved, then I have made a difference and it was worth presenting.

When I spoke to editors, writers, and instructors at the Harvard writing conference, they said I should not write for both patients and physicians, I had to pick one. They told me to identify my audience (but keep it broad), and then differentiate myself from all the other authors writing for that audience. It feels like opening a retail shop. What will I sell? Who do I want to shop here? What is my purpose? It’s not to make money; it’s to make a positive impact on the community, to fill a need. Some people will walk in, look around, and walk out without buying anything. That’s okay. If I stay open long enough, they may wonder, ‘What’s so great about her store that she’s still in business? Maybe I should look again.’ They may eventually make a purchase, if they see something of value.

Others will enter, feel immediately at home, and linger in the aisles, soaking up the aesthetics, wishing they had more time to spend. One shiny piece will catch an eye, they’ll snatch it up, and come back as soon as they can, looking for more treasures. They belong here, and so do I. Now I know, I’m not simply writing for patients and physicians; I’m writing for those patients and physicians who, like me, believe that our healthcare system can thrive again only if we all work to reclaim our relationships.

I aim to start a movement.

But one does not accomplish this by barking a generic message to everybody who walks by. Doctors come to noon conference as a routine, a social and academic ritual. We earn one hour of continuing education credit for showing up, staying to the end, and completing the requisite evaluation forms, regardless of how much we actually engage with the presentation content. It occurred to me this time, that there are always a few in the audience primed to receive and respond to my message—they are my tribe. While some parts of my talk may resonate with some people, the whole talk will resonate deeply with those few. They are my target audience. Why? Because they are the ones who will take up the torch, hail the call to action, and participate in the movement now. They feel, like I do, a visceral agitation for this change.

To the attendees who don’t feel it (yet), I must seem like some lone nut, roaming the room and flailing my arms about. They may remember something I say and apply it for a short time, and forget me in a few days. But for my fellow tribe members, my waving and shouting (I don’t really shout) stirs something kindred and profound. They want to wave and shout back, “I get it, I get it! Hallelujah!” They will carry my message with them and share it with anyone who will listen, because it is their message, too. I know because I get this way when I hear someone speak who believes what I believe. It happens at professional meetings; I call it the Hippie-Zealot Conference High.

I get the idea of the ‘lone nut’ from Derek Sivers’ TED talk, “How to Start A Movement.” Sometimes I feel like the one on the amphitheater lawn, dancing unabashedly, provoking expressions of ‘weirdo’ from others. But there will be tribe members there, the townspeople who love my shop. They will get up and dance with me, if only I can connect with them. Maybe all it takes is eye contact, a welcoming smile, or an exuberant gesture to join in. Once they stand up and start dancing, pretty soon the gawkers may feel our collective energy, shuffle cautiously at first, then let loose and get down with abandon. We will all be in relationship for the better.

Derek Sivers calls those tribe members ‘the first followers.’ I prefer to think of them as fellow lone nuts. Lone nut status, especially with a microphone (or megaphone) can feel special, and it also gets lonely. I would much rather live and work among mixed nuts, with complementary and mutually enhancing, yet unique, contributions to the jar.

From now on, when I present on physician resilience, patient-physician relationship, or any other passion, I will make a concerted effort to acknowledge my fellow lone nuts. I will call out to them especially loudly, and invite them personally to join the movement. Then we will all feel empowered to rally the masses, one small circle at a time, until everybody’s up and dancing, happy, strong, and together.

The Soft Stuff Matters

Blogging 101, Assignment #9: Write a post that builds on one of the comments you left yesterday.

It’s from today, but I think it still counts.

If you have not already visited Catching My Drift by Pam Kirst, I highly recommend it. This morning, when I should have been preparing more diligently for my noontime presentation, I found myself drawn into and reflecting on her story, “A Wheel That Never Squeaks.” A college administrator puts together a series of student panels to help faculty address the unique needs of certain groups, such as single moms and students with autism. An advisor asks her to arrange a session for returning veterans, and the story unfolds as she learns from three veteran students about how their military experiences influence their campus lives. One cannot stand the disrespect that a professor tolerates from a fellow student. Another feels a sense of urgency to earn his degree so he may once again serve as breadwinner for his family. The third looks more like a hippie than a soldier, with a long ponytail and body piercings.

Some lines that grabbed me:

“The message was always the same: We want to help our students succeed.  We are not going to dumb it down for anyone, but we do want to work with unique situations.”

“Lesson number one, she thought to herself.  Lose the stereotype of what I think a returning veteran looks like.”

“Did you notice they all sat facing the door?  Returning veterans find it very hard to sit with their backs to a door–it goes against all their training.”

I encourage you to read the whole story, if you haven’t already. For me, it brought multiple aspects of physicians’ work into specific relief.

My comment:  “I’m getting ready to present today on physician burnout and resilience. Continuing education at this hospital occurs every Monday around lunch. Wouldn’t it be great if every month or so, one of those sessions were devoted to some humanist aspect of practice? Who are our patients? What are they dealing with outside of their medical problems? How can we best serve them? And holy cow, what would a panel of patients say to an audience of doctors??”

I have given versions of my burnout/resilience talk three times before today, each time to a different audience. Today was in a community hospital, to about 20 or so primary care physicians and some subspecialists. It was their weekly noon conference, with hot food provided. As the doctors trickled into the basement conference room, we spoke casually about burnout—so much regulation, administrative red tape, stress. Suicide came up–one doctor mentioned that he himself knew three doctors who all took their own lives. When I asked the Continuing Medical Education coordinator how often they have a presentation on non-clinical topics, she said maybe once or twice a year. Does this surprise you?

The breadth and depth of medical knowledge grows exponentially these days. Even in subspecialties, physicians must work harder to keep up with updated guidelines, new technologies, and patient expectations. So it makes sense that ‘continuing education’ would center around the ‘hard’ stuff—clinical knowledge and practice.

But what about the ‘soft’ stuff? Do we assume that all physicians just know how to manage their relationships with patients, staff, and colleagues? With themselves? That they practice optimal strategies for maintaining their own well-being, in this complex and demanding healthcare environment?

At first I thought of practicing physicians as the faculty in the college story, in need of learning how better to connect with their diverse patients. I want to go to grand rounds and hear from a panel of patients with autism about their experience in our healthcare system. I want a case manager to show me the resources available for my patients whose insurance does not cover mental health services. I want to connect with my colleagues in other specialties, learn how I can best prepare my patients to see them in consultation, and know the rationale behind their decisions. I see my own presentation as an attempt to fill this gap, inviting my colleagues to consider ways they can take charge of their own happiness at work.

On further reflection, I see my colleagues also as the returning veteran students. In the story, they are the ‘wheels that never squeak.’ Their training and mindset preclude them from complaining, even while they feel severe discomfort in their classroom surroundings. Similarly, many physicians experience great distress at work but don’t let on. For most of us, effective self-care is never role modeled in our training, let alone explicitly taught. If we express fatigue, sadness, or feeling overwhelmed, we are often shamed as being weak, rather than encouraged and shown how to overcome these challenges. Some of us become the ‘non-squeaking wheel,’ with deadly consequences. The suicide rate for physicians is estimated to be 1.4 to 4 times greater than the general population.

“The message was always the same: We want to help our students succeed.  We are not going to dumb it down for anyone, but we do want to work with unique situations.”  When we sanction conversations and conferences around the soft stuff, we validate its importance. We want our patients to succeed by helping them understand their illnesses and treatments. We want our physicians to succeed by giving them the tools to communicate and connect effectively with patients. This serves everybody; it’s a win-win.

“Lesson number one, she thought to herself.  Lose the stereotype of what I think a returning veteran looks like.”  Let’s lose the stereotype of the bullet-proof physician, the one who helps all others and never needs help herself. Let’s lose the stereotype of the lazy patient, who cares less about his health than his doctor does. Let’s find ways to know each other’s challenges, and see one another as individuals who deserve our full attention and honest caring.

“Did you notice they all sat facing the door?  Returning veterans find it very hard to sit with their backs to a door–it goes against all their training.” What do we need to notice about one another? What details do we miss in our daily routines that, if we knew, could help us connect and heal one another?

Thank you, Pam, for giving me more to ponder. I hope I can contribute to these conversations and make our system function better for both patients and doctors.

Liebster Award Nomination!

My most humble and sincere thanks to Nicola Auckland and Kat Myrman for nominating me for the Liebster Award!  What better way to end Week 2 of Blogging 101 than to exchange this kind of acknowledgement and encouragement?  Thank you, thank you!

I feel like I’ve just moved into a wonderful new town, with throngs of welcoming neighbors, all who own unique and beautiful shops filling the diverse downtown square.  I have to work, but my mind wanders to downtown, trying to remember which stores I want to visit afterward.  I can’t wait for the weekend, to explore all I want!  Thank you, my fellow bloggers, for your warm welcome!  I will set up my own shop here, and continue getting to know the neighbors, day by day.

I hereby nominate some of you, as per nomination rules (see below).  I know some of you have been mentioned already, but I want to add my acknowledgement of your excellent work!  Here’s to our amazing little (not so little?) town, and may we have a collective positive impact on our world!

  1. Nicola Auckland writes fiction.  I normally don’t read fiction, but her ‘attempts’ at creative writing grabbed me instantly and made me follow!
  2. Kat Myrman writes everything with wonder and wisdom.  You can get poems or recipes, check out her blog!
  3. Sandy Sue shares her experiences living with bipolar disorder, in the most articulate and insightful ways I have ever encountered.  I intend to learn much from her.
  4. Nancy Faerber was one of the first blogging neighbors to extend a welcome when I moved onto the block.  Her thoughtful writing helps me reflect and connect.
  5. Pam Kirst, a fellow pen and paper enthusiast, has much wisdom to share–a teacher, mother, writer, and thinker.
  6. Audrey D Cunningham writes about her faith, its origins and evolution, and keeps it simple, like PB&J.
  7. Donna Cameron may be my sister from another life.  She writes with deep conviction that her mission in life is to make the world a better place.  I think it’s working.
  8. Michelle, another student of the Inner Work, challenges me to learn and apply everyday lessons.  She validates the struggle to live authentically, to Walk the Talk, with compassion and kindness.
  9. Anand is my new friend on WordPress!  A prolific blogger driven by love and wonder, whose apt blog title “Vibrant” only begins to describe his blogging presence.
  10. James provides comic relief from the daily grind, especially when I imagine his words in a British accent.
  11. Rachel Griffin, a young woman, shares her complex life with humor, poetry, and art.  And she uses emoticons, a woman after my own heart.

My Answers to Questions from Kat:

  1. If you could interview one person from history, who would that be? …Nelson Mandela, Maya Angelou, Abraham Lincoln, Martin Luther King, Jr., Elizabeth Blackwell, Margaret Thatcher, Madeline Albright, Richard Feynman, can’t decide.
  2. What makes you happy?  …To see my kids happy, being in nature, communing with my tribe(s).
  3. Pick a number from 1 to 10. Now tell me why. …8.  It’s round and smooth, and looks like the symbol for infinity–no beginning, no end, all connected, forever.
  4. If you could live anywhere, where would it be?  …Summit County, Colorado.
  5. What inspires you to write?  …Life and all its complexities.
  6. What is your favorite color?  …All shades of blue.
  7. What types of books to you most often choose to read?  …Psychology, emotional intelligence, memoirs and writings of people I admire.
  8. What is your astrological sign?  …Leo.  Some would say Virgo, but I’m a Leo, trust me.
  9. Dogs or Cats?  …Dogs.
  10. What is your favorite song?  …”Ticks,” by Brad Paisley.
  11. When you are not writing, how do you spend your days?  …Thinking about writing, seeing patients, thinking about patients, parenting, thinking about parenting, connecting with friends, trying to live in the moment, wherever and whatever I’m doing…

My Answers to Questions from Nicola:

  1. What was the most inspiring book you read?  …_The Art of Possibility_ by Rosamund Stone Zander and Benjamin Zander since 2009, and now also _Start With Why_ by Simon Sinek.  I read and listen to them both again and again.
  2. What song gets you “pumped”?  …”Beer For My Horses” by Toby Keith and Willie Nelson, and almost anything by Brad Paisley.
  3. How have you created meaning in your life?  …By maintaining excellent connections with fellow students of the Inner Work.
  4. What are you working on at the moment?  …My blog as platform for a future book, building awesome collaborations with a diverse group of amazing people.
  5. Any other interests besides writing/ blogging?  …Making greeting cards, public speaking, reading, communing with friends.
  6. What is you favourite time of the year?  …All times that are not winter in Chicago.
  7. What do you enjoy most about blogging?  …The community.
  8. Do you believe in love at first sight?  …Yes.
  9. Are you multi-lingual or know parts of a few others?  …Yes.
  10. If you had live this life again on repeat, would you?  …Yes.
  11. Who was your first follower on WordPress?  …Linda at The Task At Hand.

Below are my questions for the people I nominated (I vote that previously nominated bloggers may claim exemption, if they wish!).  Please feel free to comment your answers to any or all, regardless of your nomination status! 🙂

  1. What inspires you?
  2. How do you aim to inspire others?
  3. What do you most admire in a leader?
  4. What gives you meaning in your work?
  5. What personality trait has been the most enduring and representative of you?
  6. What genre of movie do you like best, and how has it evolved over your adult life?
  7. Who is your hero?
  8. Where do you feel most at peace?
  9. What song makes you sing along out loud, and/or break into dance?
  10. What do you want people to remember most about you after meeting you for the first time?
  11. What are you most proud of?

Once again, my most sincere thanks to all of my neighbors and classmates.  Planning to live here a while! 🙂

The rules:

  1. Make a post thanking and linking the person who nominated you.
    Include the Liebster Award sticker in the post too.
  2. Nominate 5 -10 other bloggers who you feel are worthy of this award. Let them know they have been nominated by commenting on one of their posts. You can also nominate the person who nominated you.
  3. Ensure all of these bloggers have less than 200 followers.
  4. Answer the eleven questions asked to you by the person who nominated you, and make eleven questions of your own for your nominees or you may use the same questions.
  5. Lastly, COPY these rules in your post.

Who Are You and Why Have You Come?

Is that a line from a movie?  No, it’s assignment #4 for Blogging 101, “Identify Your Audience: Publish a post you’d like your ideal audience member to read, and include a new-to-you element in it.”  Okay, here goes!

Welcome back, how was your week?  What phenomenal doctor-patient encounters did you experience, witness, or hear about since we last met?  What made them so?  Or maybe they were less than stellar…  I wouldn’t be surprised, unfortunately.  What made them so, and what can be done to make them better?

If you think the physician-patient relationship plays an essential role in our healthcare system and patients’ overall wellness, please read on.  If you think this relationship also plays a central role in physician wellness, welcome!  So do I.  Maybe you are a physician.  Most likely you have been a patient, or a patient’s family member, somewhere along the way.  I know you could be both.  It doesn’t matter, if you think the physician-patient relationship is important, and you want to help make it better for yourself and others, then I’m writing to you!

For a moment, think of our healthcare system as a vast, dense forest on a dark, moonless night.  It’s early fall in the Rockies, crisp and chilly tonight.  You are either the physician or the patient, and you are here alone, tasked with finding your counterpart, somewhere else in the forest.  Maybe you’ve never been here before, and you’re scared.  You’ve only heard about it, or walked through in virtual simulations.  Maybe you’ve hiked here many times already, and feel quite confident–cocky, even.  But every encounter in this forest is unique.  Insurance plans, drug formularies, government regulations, and technology can alter the topography like lightning strikes and wildfires–and almost as quickly.

The objective is to find your way to each other, and then journey together to the place in the forest where at least the patient can camp in health.  If you really work well together, then the doctor will also find solace in that spot.  What would that look like?  What will you need?

You’ll need to identify dangers in the forest–most of which you cannot control.  They will affect you both in different ways, and it will help if you know the potential consequences ahead of time, for yourself as well as the other.  You’ll need to learn each other’s strengths, vulnerabilities, tendencies, and talents.  You’ll need to know your own needs and limits, and those of your partner.  And wouldn’t it be great if you had a map and a plan?

I have just described the ideal physician-patient relationship.  How can we do all of this?  With tools, I say!  We would never enter a forest to camp at night without the appropriate gear.  So why do we so often enter the physician-patient relationship in this way?  Until very recently, physicians received almost no formal training on effective communication and interpersonal skills.  I think we were expected either to be thusly gifted by virtue of being smart enough to get into medical school, or to ‘pick it up’ along the way.  I also think patients’ expectations today vary so widely based on personal experience and circumstances, that sometimes it’s a miracle that we understand each other at all.

The tools I explore in this blog–mindfulness, compassion, empathy, reflective listening, patience, self-awareness, stress-management, collaboration, and others—are intended for patient and physician campers alike, but only the ones truly interested in achieving the objective above—finding one another, walking together, and finding the best place for both parties to set up camp and stay a while.

I seek fellow campers! Tell me your stories! Show me the tools that work for you! What have you learned? What advice have you for our frightened novices or frustrated (disillusioned, burned out, cynical) elders? Let us find one another, clear our own authentic spaces in the dark forest, and build our campsites intentionally, deliberately, with respect for one another and the forest ecosystem. Once we have our eco-friendly doctor-patient camps firmly established, maybe we can start to clean up the litter and pollution in the forest, too—but that might be another blog…

Who Am I and Why Am I Here?

I’m a student again!  Blogging 101 is the first class I have taken in maybe decades.  This is my first assignment–Introduce Yourself to the World.

I’m a writer! Since I can remember, I’ve written. I learned about mail in second grade and cheerily wrote letters to our student teacher, Miss Bruce, all summer. I think postage was about $0.05 back then. I passed notes to friends in middle school. I looked forward to writing essays in high school, and always felt a rush as I typed them late at night. I submitted a paper on the contribution of Chinese workers to the Transcontinental Railroad to The Concord Review after graduation—ya gotta love writing to spend summer vacation doing that! Intermediate Composition, which I took in my junior year at Northwestern, taught by Charles Yarnoff, was a turning point for me. I learned that quarter the true great potential of words, and that I could wield them. That was 21 years ago, and this past winter, when I received the brochure for a writing conference for healthcare professionals at Harvard, my soul leapt for joy and I knew I stood at the threshold of something big. Thursday morning, before for the conference started, I had no intention of blogging. By Saturday afternoon I was scrambling to secure a domain name from my phone on the cab ride to the airport. It is time.

I’m a physician, wife, mom, daughter of immigrants, almost native Coloradoan, and lover of nature and Brad Paisley! Turns out, as I reflect, I’m also a connector. Growing up I merged Chinese and American culture into my own expression of self, which has served me well. At work I became interested in integrative medicine, and today I stand confidently with one foot each in the conventional and complementary medicine hemispheres. I can sit in a room with people from different backgrounds and with divergent interests, and find common goals.

I’m here on WordPress to connect patients and physicians again! Technology, pharmaceuticals, and large medical organizations all contribute greatly to the fight against disease and disability, but they often get in the way of the patient-physician relationship. And it is only our relationships that truly heal. I have a specific point of view on this (see my first post), and blogging allows me to express it freely, in hopes of connecting with others to share and discuss.

When I go home to Colorado, I like to visit Red Rocks, the renowned natural amphitheater. The great iron-laden land formations inspire and soothe me. Once I happened upon a Native American drumming circle on stage. It was the middle of a typically sunny Colorado day, with tourists milling about, and local athletes taking advantage of the seating steps for interval training. The timbre of the drumbeats impressed me, and vibrated to my core. This is how I see my blogging. I beat my drum to my own authentic rhythm. The blogosphere is my amphitheater, which I share with other drummers from around the world. When those striking resonant sound waves find me, we drum in coherence. Our collective rhythms synergize and create a movement of communication and mutual respect, toward the health and well-being of patients and physicians alike. Wouldn’t that be great?

If I keep it up, by one year from now, I hope my style and content will have matured a little.  I look forward to making more friends in the blogosphere, and learning about people’s experiences in our healthcare system.  I want to contribute to productive dialogue and mindfulness of the common humanity that, in my opinion, should lie at the heart of all healthcare.