Everyday Power and Influence

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If you wonder how physicians think and feel, about anything and everything related to medicine, healthcare, economics, parenting, relationships, and life in general, check out KevinMD, an expertly curated blog by physicians all around the world.  I recently read a heartening and important piece on gender equality in medicine.  A pediatrician husband wrote about the stark differences in assumptions about work-life balance for men and women, in “What Does Your Husband Think of You Being a Surgeon?”  Then I came across another article by a male cardiologist, whose wife is also a physician, entitled, “The Gender Gap in Cardiology Is Embarrassing.”  Both men’s wives delayed their medical training, and these husbands bore witness to our culture’s implicit gender bias against their life partners.  I strongly encourage you to read both pieces; they are short and poignant.

—- Please click on the links and at least skim the articles, before continuing here. —-

Now, consider how much more weight and influence these pieces carry, simply because they are written by men.  If you find this difficult, imagine your internal response if they had been written from the women’s perspectives.  Which position is more likely to evoke, “Hmm, interesting,” as opposed to, “What are these women whining about?”

When we consider advocacy, it’s fair think of it as those with more power and influence using these advantages to champion those who have less.  Sure, the less powerful and influential can and do advocate for themselves, but without allies among the advantaged, the message and movement stall and stutter.  Consider slavery and the Civil Rights Movement.  If it were only ever black people advocating for themselves, what would the American racial landscape would look like today?  Think about women’s rights.  There is a reason the United Nations launched the HeforShe campaign.  Self-advocacy is required, but sorely inadequate, to lift people out of oppression.  And let’s be clear: oppression takes many forms, which we often fail recognize or acknowledge.

I have a fantasy about patients advocating for physicians.

I imagine Sally and John*, two friends communing at their favorite coffee shop, one of their regular meetings of mind and soul.  The conversation veers toward healthcare, and Sally starts ranting about how physicians don’t care about patients anymore.  They’re only in it for the money, having sold out to pharma and industry, and they think of themselves as second only to God him(her)self, exercising control over patients’ lives with little regard or actual caring.  In this coffee shop scenario, I as physician have no power or influence.  If I sat there with them, trying to explain how ‘the system’ drives wedges between us doctors and our patients, about how on average doctors spend twice as much time on administrative activities as patient care activities, how 50% of us report burnout, and how our suicide rate is up to 4 times that of the general public, I estimate that I’d likely be seen as whining and making excuses.  In this scenario, facing a (rightfully) prejudiced audience, my voice counts for very little.

Although physicians still enjoy a fair amount of respect and deference in society, our struggles, personal and professional, are still poorly understood by the general public.  I think people are even less cognizant of the insidious and profound detriment that physician burnout and depression have on patient care and the economy at large.  But when doctors describe our adversities to patients, I think we still come across as whining.  Knowing that I write this as a physician, what is your reaction?  Is it closer to, “You live at the top of the food chain, what are you complaining about?” Or rather, “Wow, what’s going on that so many doctors feel so badly, and how could we all help one another?”

Lucky for doctors everywhere, John is my patient and we have a longstanding, collaborative relationship.  He empathizes with Sally’s perspective, as he knows what she has been through medically.  He has also inquired about my work, and understands the systemic frustrations that physicians face in all fields.  Because they are such good friends, John feels comfortable challenging Sally’s skewed assertions.  He describes what he has learned from me, and explains earnestly that all doctors are not, in fact, swine.  Because he is her trusted confidant, she believes him.  Her attitude opens ever so slightly, and she is more likely to acknowledge how physicians and patients alike suffer from our overall healthcare structure.  John is, in this case, the strongest advocate for me and my ilk.

Whenever one of us stands up as a member of a group, and speaks up to our peers on behalf of another group—white people for black people, men for women, Christians, Jews, and Muslims for Muslims, Christians, and Jews, liberals for conservatives, physicians for patients, and vice versa in each case—we are all elevated.  Our mutual compassion and humanity are called forth to heal our divisions.  This is how personal advocacy, how everyday power and influence, works.

As a patient, you have more power than you may realize.  I bet most people don’t necessarily feel adversarial toward doctors.  But they probably don’t necessarily feel allied, either.  What can you, as a patient, do to bridge this gap?  How else could we all, physicians and patients alike, create that essentially healing inter-tribal connection?

*Hypothetical friends

We Failed Her

An excellent and poignant piece by my big brother in medicine.
May we all strive for better transparency and clear communication, with more compassion and less fear, in all of our encounters, but between doctors and patients, especially.

Balance

The alarm sounds, a painful reminder that it’s my week to cover the ICU. I take off my favorite sweatshirt, stripping away its warmth and comfort. I quickly jump into and out of the scalding shower, racing to get ready. Making my way toward the kitchen, I roll my eyes at my teenage daughter who is eating ice cream and waffles for breakfast. Her ride waits out front but before she can escape, I get a rare hug, her wet hair cool as it brushes against my cheek. I spy her melting, unfinished breakfast and I shovel what’s left into my mouth. The cold vanilla ice cream and maple syrup drips down my chin. Wiping away the evidence of my indiscretion, I get into my jeep with the top down. The twenty-minute ride is a guilty pleasure, with the spring air cool across my face. The coffee in my hand…

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Love Letter to My Superstar Friends

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Dear Paul & Joanne*,

I cannot tell you how grateful I am to you both for taking the time to meet me last week.  You came out in the pouring rain, not for a lighthearted night of drinks and karaoke, but to talk charged politics with your tortured, melancholic, liberal friend.  I hope it did not feel too burdensome, and that you would do it again.

It was quite the emotional evening for me, unsettling, sometimes uncomfortable, and also dominated by love.  Joanne, we have known each other about 15 years, and I know you are not a fan of politics in general.  Paul, I know you mostly through your witty holiday cards, and your occasional Facebook posts that often touch on politics.  You lean right, it seems, about as much as I lean left.  You gently called me out when I shared a Trump supporter-shaming video, reminding me to hold myself to a higher standard of discourse on all platforms.  That is why I sought you out.  When you engage, you exemplify the attitude toward political discourse that I aspire to.

I described to Joanne over the phone how distraught I had been since November, something akin to “watching the fabric of my generation’s social progress torn to shreds by a maniacally fomenting, double-machete-wielding narcissist.”  You seemed genuinely surprised and curious—why did this election have such a profoundly tormenting effect on me?  What made millions of people pour into the streets around the world in protest?  I was incredulous at your incredulity, and yet I felt a mutual, loving acceptance between friends who only want each other to be happy and feel secure.

At dinner, I could tell that you both cared acutely about my distress, and wanted to help alleviate it.  You reassured me that the worst case scenarios are highly unlikely to actually happen.  You reminded me that hyperventilation and arm flapping are not productive energy expenditures.  You gently encouraged me about the long, jagged, often meandering, and also inevitable path of social progress, and the importance of taking the long view.

I admit that I felt a little defensive at times, as if anything I said about the origins of my distress would be met with, “You’re overreacting,” and “You’re worried about nothing, please…”  We later agreed that it is never helpful to invalidate someone’s emotional response to a stressor, regardless of whether or not we can relate.  Paul, you are so well-read and convicted about your opinions.  I did not see a point in arguing, as you did not seem interested in debate, and I left feeling disappointed that I had not presented a stronger defense of my liberal ideals.  The whole exchange felt lopsided in favor of your position.  But I did learn from your point of view, which was one of my primary objectives.

Most importantly, our conversation revived my mindfulness practice.  You’re right—energy spent catastrophizing about a hell-on-earth future is energy wasted.  As Michael J. Fox says (I paraphrase), “Don’t spend your time worrying, because if what you’re worried about actually happens, now you’ve lived it twice.”  My energy is better spent in the present, attending to what is, rather than what I fear might be.  And I feel justified in my shock and dismay at what is.  In my opinion, Donald Trump has defiled the presidency and brought our politics to a new moral low that I could never have predicted.  I don’t need to ‘go apeshit’ over the future, as there is plenty of wreckage to confront right now, not the least of which is our collective refusal to engage one another in civil discourse.  I can center, ground, and focus, breathe deeply and engage, one step, one person, or one loving couple, at a time.

Last week Dan Rather wrote my heart on his Facebook page:

The threats, the lies, the willful disregard for the rule of law should be limited to the world of Hollywood caricature. To see this played out each night on the news, to read about ramblings and inconsistencies in justifications for actions that should never have been taken, is to see a moment of great peril for our nation.

I remain, however, an optimist. I see the swellings of civic engagement and action. I hear the voices of those who demand that this subversion of our national ideals shall not stand. I have covered social movements of the past, and never have seen one where so much power and numbers lie on the side of the opposition. This is a clash for the values of our nation. Our destiny is in our hands.

Our nation’s patchy, irregular social fabric may be strained to its limits today, and even torn in some places.  But the threat of real disintegration has brought forth multitudes of weavers and quilters to repair and protect its integrity.  I can acknowledge this ‘collateral beauty’ and contribute my part, through conversations like ours, to help mend the tapestry, and bend that moral arc of the universe more toward justice.

Thank you, my dear friends, for helping me train for this marathon.  You hold me up and make me stronger.  I hope I do the same for you.

Sincerely and with love,

Cathy

 

*Not their real names

To Train Or Not To Train

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My sister and brother-in-law run marathons.  No, wait, they are elite marathon-running machines.  By next weekend, they will have run 150 marathons between them in just a few years, including Ironmans and ultramarathons, in 39 states and at least 7 countries.  They lead training groups for Team to End AIDS and enjoy a loyal following of running enthusiasts and friends.  So you can imagine my honor when they recently told me, “You could totally run a marathon, Cathy.  You’re already more fit than a lot people who start training.”

For a moment I actually considered it, because wouldn’t that be so cool, to enter that elite circle?  Then I quickly remembered: I. Hate. Running.  …For now.  But it got me thinking recently–talking politics may be like marathon training.  Some people really like it and do it well (by ‘well’ I mean they are informed, articulate, respectful, and engaging with people from all points of view—their discourse is elevated).  They resemble my sister and brother-in-law: athletes who consistently perform at the top of their training, with few or no injuries, leading others to follow in similar aspirations.

Other people, however, would sooner feed themselves through a wood chipper than strap on a pair of running shoes, or engage in political discussions.

Most of us are somewhere in the middle, I suspect.  I can run a few miles with my trainer if she makes me–the conversation and scenery distract me and the time goes by faster.  And I know I can slow down or take a rest if I have to–it’s safe.  But I have many other preferred exercise activities.  Could we consider talking politics as the elite marathoning of communication?  It is so hard to do well!

When I think of long distance running my mouth goes dry.  I get short of breath and my knees hurt already.  I feel the incredible slog, one heavy step after another–not at all like what I imagine my family feels, bounding weightlessly like antelopes toward their next PR.  I experience a version of the fight-or-flight response, a visceral sensation of threat: I’ll have blisters everywhere, I’ll never make it to the end, they’ll have to carry me, I’ll have a heart attack and die!

Maybe some people have a similar reaction to politics?  I don’t know enough, it’s too complicated.  It’s overwhelming, I’ll look ignorant, people will judge and shame me before I can even finish a thought.  It’s all so emotional, I can’t handle that, it will only escalate into conflict, my relationships will all be at risk, I’ll lose all my friends!

As you may have read, I have been trying to get some conservative friends to engage face to face.  I am genuinely curious about their points of view; I want to understand.  I want to practice my skills—curiosity, openness, empathy, identifying shared interests, withholding judgment.  Two invitations were initially met with a non-response.  After a follow up call or two, I am scheduled to meet one set of friends for dinner this week, and the other said he was too busy.  I feel like I’m dragging them out running when they would much rather play golf or go bowling.

I have realized: we don’t all have to keep up with every day’s new political freak shows.  We don’t all need to be the debate champions of our particular ideology.  Not everybody has to be a marathoner.

HOWEVER:

We all need exercise.  The body is built to move.  Regular physical activity, as we all know, reduces our risks of obesity, diabetes, and heart disease.  Did you also know it can decrease depression, dementia, and even cancer?  So pick your sport—just do some kind of movement every day!

Similarly, 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.

So if you’re not a runner/marathoner, what do you do?  What is your thing, how often do you engage, and what keeps you coming back?  If you hate talking politics, how else are you already a great communicator?

Maybe you’re a natural at getting your toddler/tween/teen to see the wisdom of the rules and getting their buy-in to follow them.

Maybe you can always help your boss and coworker iron out their differences because you can understand both sides (are you in HR?).

Maybe you like to debate the merits of the Marvel Comic Universe vs. DC—and you could argue both sides because it’s just more interesting that way.

We all have areas where we shine, where we contribute to the tribe through words and actions.

I have picked up some tips along the way:

  1. Validate people’s feelings, even if you don’t agree with their position or behavior.
  2. Stay open to the 2% truth of an opposing philosophy or idea.
  3. Withhold judgment on the whole person even though they espouse an ideology you despise, at least until you know from multiple encounters that they have no shred of kindness or humanity in them.
  4. Look for what you have in common with people, and choose to focus there more than on how you differ.

So even if you’re not an elite running machine like my sister and brother-in-law, or you’re not your community’s foremost political pundit, know that your other training matters.

I may complete a marathon someday…  Never say never.  For now I’m happy to stick with my TRX, kettle bells, 7 minute and Betty Rocker workouts (once again, I have no financial interests in any of these businesses).  I appreciate my family’s invitation to run, and I respectfully decline at this time.  Similarly, I will try to be more mindful about inadvertently pressuring people to talk politics.  It’s never meant to be adversarial, only a bid for connection—I’m looking for training buddies!

I don’t need everybody to talk politics.  But I do need everybody to practice excellent communication, especially in political discourse.

We all need that.

Two Buttock Riding

 

Continued from last week…

My objective for the coaching session was to figure out where I really want to put my energy for the foreseeable future.  I felt essentially torn between my paraprofessional activities (writing and speaking on physician health, patient-physician relationship, bridging silos in medicine) and my nascent political activism (community involvement, calling and writing to Congress, thinking of running for office someday??).  It felt like I should choose, and yet something told me they could be integrated.

Highlights from the call:

What is your goal for the end of this session?

Clarity and direction; movement.  Readiness to act.

How close are you already?

85-90%

How will you know when you have it?

Hard to describe…  It will be a dual certainty, like choosing furniture, knowing whether I like a person: cognitive and visceral.  It will feel decisive.

How are you feeling now?

Overwhelmed, distracted.  [Recall Doug the dog, in the movie, “Up”—Squirrel!]  OMG there is too much to keep up with: Healthcare, Russia, immigration, refugees, border security, Russia, EPA, what-the-hell-did-he-just-say-and-what-the-hell-does-that-mean?, racism, misogyny, intolerance, Russia, free speech, NIH funding, science, climate change, women’s rights, the Persisterhood, congressional seats up for grabs across the country, and oh yeah, the rest of my actual life.  Every day five new things to look up, articles on both left and right to compare notes, filtering facts from spin, trying to stake independent and educated positions backed by evidence!  GAAAAHH!

What would happen if you didn’t do that?

I do what do, spend hours a day reading and trying to engage in discussion (in person and on social media), in order to be credible in my conversations, to engage from a place deeper than superficial rhetoric or simple emotional reactivity.  My big fear: If I don’t do it, I will become one of those loud-mouthed, uninformed ranters who has no evidence for my broad-brush, oversimplified generalizations and ad hominem attacks.

What is the 98% truth about that?

Not likely to happen.  That’s just not me, I don’t do that.  I always look for evidence to back up what I say, and when I don’t have it, I own up.  If I don’t know what I’m talking about, I listen more and ask more questions, or I don’t engage until I have something useful to contribute.

And the 2% truth?

There is still a risk.  I may spew sometimes—when I get triggered and e(motionally)-hijacked.  I feel particularly susceptible right now, with all of my core values and our generation’s social progress seemingly under attack.

AND, I never live here.  I may wallow a few days (1-2 weeks, max), stewing in cynicism and resentment.  But I always rise up, usually with the help of others, with writing, and with time.  I always come out having learned something, and resolving to apply the learning (usually about myself and my relationships) to whatever comes next.

***

Insights gained:

I’m okay.

In reviewing my time spent on my screens each day, I realize most of it edifies me and connects my mental dots of current events, social science, and personal meaning.  I know not to spend time on baseless rants and otherwise rhetorical opinion pieces.  I choose articles with links to data, history, and primary sources, and ones that challenge my thinking or oppose my positions (sometimes).  I look for nuance, complexity, examples of collaboration and compassionate leadership.  This is what I spend my time and energy on; it broadens my perspectives and integrates the knowledge and ideas I already have.  It fosters my own creativity and philosophy.  This is who I am.

It’s the blog.

This is what I want to spend my energy on.  It’s my platform, my thing.  All the paraprofessional stuff I do was born of this: What gives doctors meaning is the relationships we get in our work—mostly with patients, but also with one another and society at large—status, respect, contribution.  Physician, wellness/resilience, the intersection of health and leadership, bridging silos (physicians, nurses, pharmacists, insurers, hospital administrators)—it’s all about relationships.  And, so is politics.

Therefore, I will use this blog for all of it. I can share my letters to Congress.  I can continue to write about physician-patient relationship.  I know I have written about this before, but somehow it required some reinforcement:  It’s all connected, and it’s all me.

FEAR.

Of course, that’s what really holds me back (yup, written about that before, too).  Fear of attack, rejection, overwhelming engagement obligation and getting sucked into negative, counterproductive exchanges with strangers.  Fear that I have nothing useful to say.  Someone else has already said it better and reached more people.  Who am I to think that my words matter?  It’s all so paralyzing.

I got this.  

I’m ready.  It’s time.  Because: Nothing I say or write, at work or on Facebook or anywhere, is anything I would not say or write in public.  Integrity is important to me—to be the same person in private that I am in public.  I’ve been practicing, and getting better, as evidenced by the civil exchanges I facilitate on my Facebook page (which I will also share more of), bringing together friends from different walks of life in meaningful conversation.  We exchange important ideas, always concluding cordially, all relationships intact and even, I daresay, strengthened.

And, my blog is my space.  I get to manage who comes on (into my house), and I make the rules for how we engage (no poop flinging).  I don’t comment on public sites like Washington Post or New York Times, or large Facebook groups (usually) because that is like leaping into a flash mob of the worst kind.  There is no meaningful exchange or benefit for anyone.  Here, threads can be more personal, meaningful, and transformative.

***

New Goals:

Shift the Boundaries.

I can push my fearful limits and present myself more confidently to the world.  I can choose to plant more color and texture in my front yard.  I can also dig it up and throw it out if I realize it clashes with the house.  It’s all good.  And I must also mind the costs, especially to my family.  So, I can bring them closer by putting the screens out of arms’ reach when I’m with them.  Easier said than done, and definitely worth the effort.

Focus on the WHY.

It’s all about cultivating productive, contributory relationships–first with myself, then with others, and then between all of us, for more peace, love, and joy for us all.

Publish Weekly.

If this is where I want to put my energy, then I want to have something to show for it.  Plus, it’s therapeutic.  Writing calms me, which I need now more than ever, as you can see.  For now I can stop chasing conference presentations, formal leadership roles, Daily Actions to prove I am an engaged citizen.  I can simply write when I am moved—and I am always moved—and share it here.

See you next week!