The Soft Stuff Matters

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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.

28 thoughts on “The Soft Stuff Matters”

  1. This is a strong piece, Catherine, esp seeing doctors in both the administrator and student role. Pam’s post sparked ideas for me as well (I found her via your Liebster nominations!)

    Liked by 1 person

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    • Thanks, Nancy! I’m trying to write and publish more spontaneously, allowing it to all come out on the first try without the usual pre-censoring. The editing afterward is key… I hope my good neighbors will let me know if the results are a lot of verbose drivel! This one felt good. 😊

      Liked by 1 person

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      • I’d be curious what tips/techniques you use to write more quickly. That said, I’m not expecting a magic bullet because I know writing takes time. It’s just that my own efforts take a loooong time…which I’m hoping will improve with practice over time. In the meantime, let me know if you develop some effective mental tricks or find a helpful tool, etc.

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      • Hi Nancy!
        I think one key is to turn off that instant internal CENSOR! I saw a well-timed meme on Facebook just yesterday, after I wrote that comment: “Write without fear. Edit without mercy. ”
        Other than that, I have no great insights! 😜 For myself, for now, I plan to make a more disciplined practice of the fearless writing–not just journaling for myself, but writing with readers in mind more often. Please share any insights you have, too?? 😊😘😁

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  2. Very insightful post. I had a friend in college who I stayed in touch with as he went through medical school and his residency. Since I and his other undergrad friends knew him before he became “Doctor” he was a little more comfortable opening up about the areas in which he was struggling. While keeping up with the new literature and advances in medicine was indeed daunting, I’d say the things that most affected his everyday life (and his quality life) could be catigorized as “soft stuff” on the job… Stuff they never prepared him for in med school, and that they hardly addressed in his residency. He very much felt like he was being thrown in the deep end and being told to swim. Watching him over the years really drove home for me that caregiver burnout isn’t just for the family of the patient. Burnout is a very serious issue for medical professionals as well, and I think it’s a wonderful think you’re doing addressing this issue. Keep it up! There really is a need for there to be room for “the soft stuff” at the table!

    Liked by 1 person

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    • Thank you, Audrey! Your validation will keep me going, I so appreciate it!
      And thank you for sharing your friend’s story. I hear it so often. I hope he is well now? OH and caregiver burnout/fatigue, that is a huge topic, too!! So happy to have you here to share with! Thank you! 😊

      Liked by 1 person

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  3. My favorite line is: Let’s lose the stereotype of the bullet-proof physician, the one who helps all others and never needs help herself. Taking care of self is so important and those in care taking roles often don’t self care. Thank you for writing this article, the conversation must begin.

    Liked by 1 person

    Reply ↓

    • Matt–I LOVE LOVE LOVE IT!!! I highly recommend it because it is: 1. LOW risk. You choose to do as much or as little as you want and there is NO pressure.
      2. Low cost. Just the time and energy which, again, YOU CHOOSE to spend.
      3. HIGH POTENTIAL BENEFIT, and proportional to the time and energy you put in.
      I have found so many amazing people among my classmates, I only wish I did not need to sleep so I could spend more time reading their inspired and inspiring writing!!!
      Does that help? 😉

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  6. As always, beautifully written. Having known many physicians personally and professionally over the years I know how very deeply these parallels to veterans must have resonated with you. The often unrealistic expectations of many of the patients who come to them for help and guidance are difficult to face. Many begin to have unrealistic expectations of themselves and when they can not fulfill those expectations…I have the utmost respect and admiration for what you are doing. Write on!

    Chris

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    • Hi Chris!
      So sorry for the delayed reply, and thank you so much for your encouraging comment! As I think about relationships in medicine, I imagine you to be one of those nurses who saved me in my ICU rotations when I was the clueless medical student or the exhausted resident. So often the doctor-nurse dynamic becomes territorial and adversarial, and it’s such a shame–how much healthier we all could be if we thought of ourselves as ‘team’ more often? Glad to have you on this team! 🙂

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      • Indeed. I was always frustrated by the interns and residents who chose to be superior rather than allow me to help them through their trials. Needing to set up the hierarchy for them was all important. Nurses aren’t the enemy…and if you go into private practice and you can find the right nurse she can make all the difference in your relationships with your patients. Help to build the trust and balance necessary to make your practice function. I love what I’m doing now, but can’t help but feel that all that my past experiences have helped me do it better.

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      • Yes, certainly. Things here are, in many ways, a throw back to a few decades ago. We even have a certain amount of barter for services and co-pays, which is fun and charming. There are fewer practitioners here, though, and it is harder for people to find a good physician. I am very fortunate, where I am, to work with some of the best, but many patients here will put up with a poor bedside manner, longer wait times and other issues that patients in the lower 48 would not.

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  7. Catherine, I just saw this, and wanted to let you know how touched I am! I’m wondering how the in-service you presented went, and if you have had any traction on your ideas for monthly ‘humanist’ sessions. I love your focus—and the passion you bring to your vocation….

    Liked by 1 person

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    • Hi Pam!
      The presentation went well overall. The feedback was positive and all attendees thought it was relevant to their practices. I did not bring up the idea of more non-clinical presentations that day, but I just gave the talk on a webinar tonight and encouraged the audience to advocate in their own organizations for more programming for physician wellness. 😊 Thank you for your encouragement, it means a lot! 😊

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      • I was thinking of you and your work this week. I had coffee with my friend Kim, for whom there are no more treatment possibilities. We had a long talk about the foolish things people say to someone who has a terminal disease, and about the people who just stop talking and visiting completely. That’s my blog topic for Saturday. I am guessing medical doctors must have done kind of training in this, but I have met docs who do it so gracefully and some who simply do not do well! I think part of it is the way our society handles illness…but Kim, who has a sharp wit, didn’t hesitate to share her thoughts on the subject!

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      • Hi Pam!
        I hope Kim finds peace and strength in her experience. I know she must appreciate your friendship and support. I look forward to your post on Saturday!
        Actually, I cannot say we doctors are formally trained in how to communicate with terminally ill patients… In my day our ‘communications’ training was very informal. If you happened to be assigned an effective communicator as teacher, you could learn by his or her example, but there was very little method, if any. I think things are a little different now, better. I hope to have a hand in continuing to improve the system, and turning out effective, empathetic physicians! 🙂

        Liked by 1 person

      • I am surprised there’s no formal training, Cathy! Doctors have to deal with such delicate situations and harrowing times! However, I should, on second thought, not be so surprised… Educators of course should be skilled in handling difficult conversations and I am finding that is the number one need in professional development…ie, Help me learn how to talk about the tough stuff with both students and colleagues…

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      • Unfortunately I think the tendency is to avoid things that make us uncomfortable, and emotional situations top that list, no? One of my dear friends is convinced that we have entered the age of consciousness–that we are all looking inward and to one another for meaning and connection. I think she may be right, though I see many struggling, because it’s hard, scary work. All the more reason to do it together! 🙂

        Liked by 1 person

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