The Importance of Peer Support

IMG_2151

What a privilege to present again to a group of smart, creative, fun, and engaging designers on Friday.  This time I was asked to address burnout, as so many folks are feeling overwhelmed and stressed.  I did my homework on stress and burnout in the creative fields, and found enough similarities in medicine to feel like a credible speaker.  “It’s not just a job, it’s a way of life,” seemed to capture how we see our respective vocations.

I presented a brief mini-lecture on self-care practices, including habit formation and maintenance in the 5 reciprocal domains of health, and narrative awareness.  The latter is always something we can do when we find ourselves in untenable circumstances:  Ask ourselves what story we tell about the situation, how that story compounds our suffering, and then tell a new story that does nothing to change the objective reality, but can dramatically improve our personal experience of it.  I have learned from work in physician burnout that people don’t just want to be told how to fix themselves.  They want someone to address the problems of the system that oppresses them.  So that’s where I tried to go next.

I started with an Appreciative Inquiry (AI) exercise.  In small groups, I asked participants to share team success stories, and listen for recurring themes around what’s already great about their teams, their work, and their organization.  Words like openness, flexibility, and “we have leaders, not bosses” made the Post-It easel list.  Then, in this headspace, I asked the groups to identify issues they wanted to address.  Instructions were to find important, urgent, and solvable challenges.  Guiding questions included, “Why will the organization be better if it’s addressed?” and “What does better look like?”

Similar to the AI results, common issues arose from multiple groups.  There was general consensus, reviewing the list at the end of 20 minutes, that overall work satisfaction would improve with less digital and more face to face communication, better project clarity, and taking better care of the shared spaces.  I would meet with team leaders and show them the list later in the day.

IMG_1939

When I opened the floor to questions, a self-proclaimed ‘Debbie Downer’ presented a query that I will ponder for many months as I prepare upcoming talks:  “When you ask someone how they’re doing and they say they feel like they’re drinking from a firehose, telling them to adjust their attitude is probably not helpful…  How can we change things that are not in our control?” The Universe had prepared me for this question by sending a new mentor who taught me to ask, “Who owns the things we don’t control?”  Thank you, my loving Cosmos.

I only partially answered Debbie’s question by suggesting she think about how she might influence the owner(s), how she might impact decisions being made in those spaces.  I segued too quickly, I’m afraid, to the question that I wanted to ask the group:  “When someone asks you how you are and you express that you are overwhelmed and drowning, what is a helpful response?”  I thought the discussion that ensued was productive…  It seemed to stimulate people’s intrinsic empathy and compassion.  We recognized the importance of feeling connected, that I’m not the only one feeling this way.  People recognized the relief found in just speaking aloud the list of stressors to a sincere and empathic listener.  We also talked about being prepared to hold space for any potential answer when we ask, “How are you?”  Even if we have no control over the flow out of the fire hose, maybe we can take turns holding the nozzle steady, and at a slightly oblique angle for each drinker, so it doesn’t have to knock us all over when we try to take a gulp.

I had a chance to talk to Debbie a little later (Cosmos offering me a second chance, Thank You Again), and we agreed that stress and burnout, in both medicine and design, are best addressed at both the individual and systems levels.  We can each start with personal accountability for our own experience of the system.  Then we can decide how we show up in the system each day.  We can choose, at any time, to either participate passively in the status quo (which is what we all need to do sometimes), or find a way, however small, to advocate effectively for change.

The latter is much better done with peers, with friends.  Take time to connect (no lunch meetings, let’s just eat together!).  Share stories.  What do we love about this work?  What’s already great?  How could it [realistically] be even better?  How can we help one another, including our leaders, envision and pave the way there?  Who else needs to be enrolled?

My meeting with the team leaders was less structured.  I worried that they left feeling disappointed because I did not offer more concrete advice on personal resilience practices for leaders, and ‘how to lead’ teams in burnout.  But over the hour, I felt no desire or need to lecture.  I queried various aspects of their self- and team awareness, personal resilience practices, and communication.  We briefly reviewed the issues list from the morning workshop, and I left with confidence that they would take it seriously.  It also occurred to me that these designated leaders were already supporting one another in their efforts to lead intentionally, effectively, and compassionately.  Maybe they have also felt overwhelmed sometimes.  Maybe it was also good for them just to talk it out with each other this day.  Maybe we can all do this for one another a little more often.

 

Tribe, Community, and Mission to Connect

berries figs regina 9-2019

Fruit for Regina’s sweet galettes.  These are tiger figs, available at Trader Joe’s. 🙂

Friends, don’t you love those synthesis/cohesion moments when all of a sudden something important to you—a passion, a core value, a project—is validated from multiple angles?  That happened for me this weekend and I am positively giddy from it!

Tribe

My new group of medical students promises to be just as engaging and fun as every other I’ve had, yay!  They are only three rotations into their third year and already wise beyond their training.  This month we discussed tribalism.  They considered stereotypes, barriers to overcoming them, and how they might lead by example.  And they identified experiences in which such barriers are already breaking down.  “Finding your people” came up as both an aspirational as well as a potentially divisive ideal.  We discussed the benefits of ‘We’re Great!’ and the risks of ‘They Suck’ attitudes.  The conversation did not veer into political arenas, but it crossed my mind.  I tried to point out how the skills of professionalism we address in medical training apply well beyond the bedside and medical teams.  Our tribal memberships can save us and also keep us from living fully.  I’m so grateful to have these reminders on a regular basis.

Community

Some of you may notice I reference Ozan Varol increasingly this year (see coda below for why I think he’s so great).  I started following him in the winter after reading his post on why facts don’t change people’s minds.  This summer I joined his Inner Circle, a private forum of diverse and like-minded folks who subscribe to Ozan’s newsletter and wish to connect.  Yesterday Ozan generously hosted a conference call for three of us to get feedback on current projects.  At 2:00pm Central Daylight Time, I logged on from Chicago.  I met Ozan and his wife in Portland, OR.  J, a Canadian, called in from the Dominican Republic, where she has lived the past 24 years.  C, an organizational psychologist interested in humane-ness in the workplace, logged on from Germany.  And R, an education leader working on emotional intelligence workshops for schoolteachers, called in at 12:00am from India.  C, R, and I presented our projects and everybody gave generous, honest, and encouraging feedback to help us all do and be our best.  I could hardly contain my enthusiasm, gesticulating wildly and barely staying in the webcam frame sometimes.

I wrote to Ozan afterward:  “I’m still wrapping my brain around what you have done here–stimulated so many people to think more critically and also openly… Convened a community of us all and given us a forum to interact, at our own pace and in our own words, from around the world… and invited us to help one another, to contribute to lives that we would never otherwise touch…  What a privilege, a pleasure, and an absolutely ecstatic experience!!!”

Mission to Connect

I think it’s fair to say that part of Ozan’s mission is to connect people.  But not just for the sake of connection—to make us all more thoughtful, curious, and collaborative beings.  A man after my own heart!

Maybe my passion for such connection stems in part from my immigrant roots?  Today my daughter and I embarked on another food adventure at home:  Onigiri and chong you bing (but ours are much easier than the linked recipe!).  The former turned out to be less labor-intensive than I expected, so we made a bunch, both salmon and chicken versions.

onigiri chicken

Tonight’s teriyaki chicken onigiri selection

My Korean-American friend of 20 years, Regina, posted photos of her own culinary accomplishments today—savory and sweet galettes.  Mei and I may try those next!  Our ensuing text thread included my laments about the unhealthiness of onion pancakes (but oh, salt, fat, and starch—yummo!).  Her kind reply: “Making food together with your kids, carrying on food culture, bonding, it’s a win-win!!”  I knew I loved her for good reason.  And how lovely that we have stayed in touch all this time!  If not for that, I could never have recruited her to join my work team this year.  And holy cow, talk about a win-win!  Her kindness, generosity, curiosity, openness, and conscientiousness have elevated the team even higher than we could have dreamed—Thank you, Regina!  What a blessing our connection has been for so many.

My new German friend C is thinking of launching a blog to explore humane-ness and its effects and importance in the work environment.  She thinks maybe next year.  Yesterday Ozan and I both encouraged her to start now.  Asked whether I would follow, I said HELL YES.  Not only will writing about her topic develop her ideas and thesis faster; the interface with fellow readers and writers on a blog, the opportunity to join a community of thinkers, and the connection with folks from who knows where, doing who knows what amazing things, may very well yield untold treasures of relationship and development—as it has for me—so why wait?

Tonight my heart bursts with gratitude for membership in such thriving, complex, diverse and overlapping tribes.  I treasure the various communities that welcome me and give me a chance to contribute.  And my mission to make as many and meaningful connections as possible between all people stands validated and sustained once again.

Onward, my friends.  As Simon Sinek says, Together Is Better.

 

Ozan about

Why Ozan’s So Great:

  1. Humility.  So many bloggers and podcasters are so full of themselves.  It’s obnoxious.  They may have expertise and knowledge, maybe even wisdom.  But I cannot get past my aversion to their ego.  I have no such issue with Ozan. 🙂
  2. Goldilocks content.  The blogs are the perfect length!  Enough words to make his point eloquently, and not so many that I lose interest before the end.  He contacts subscribers at just the right frequency–weekly emails and biweekly podcasts.  And the newsletters are also the perfect blend of blog, quote, and other interesting material.  So many other authors inundate the inbox that I first ignore and then unsubscribe.  Ozan has really found the perfect touch.
  3. Resonance.  Though Ozan’s podcast topic is failure, what he really addresses is humanity in all of our complexity and fascinating ironies.  I LOVE that!  And he does it nonjudgmentally, always from the perspective of curiosity and learning.  I really respect that–the generosity of spirit and growth, exploratory mindset.
  4. Consistency and reliability.  Ozan is clearly disciplined and intentional when it comes to this work (and so I imagine he is also this way in life).  His podcast script has a reassuring cadence and authenticity to it.  When he says he’ll reply to all messages, he actually replies (that is what most impresses me about him–his responsiveness and how he makes me feel like I matter).  He says he will update us on something and then he does.  All in all a truly stand up and stand out guy among so many!

 

All Hail Your Dark Side

IMG_2099

What triggers you?

I don’t mean your pet peeves (please, stop using “there’s” when speaking about anything in the plural).  I mean what gets under your skin and affects you viscerally, really hijacks you?  I’m talking about the thing that escalates you so fast or intensely it’s like an out of body experience—you know you’re overreacting, you know it’s irrational, and yet all you can do is sit by and watch it unfold, powerless to control or direct it.

I had the pleasure of self-witnessing two such episodes recently, and it’s all so fascinating I had to write about them!

Bad Mom

A leader whom I deeply respect has asked me twice, in separate conversations, with slightly different words, how I manage my time.  The second time his words were, “How do you prioritize?”  Interestingly, I immediately altered his question in my mind to What do I prioritize?  I answered easily both times about strategies for handling emails, task lists, time with family, workouts, etc.  But after the second time I started to worry.  What’s behind this questioning?  Is he worried for me about something here?  Does he think I’m neglecting my family for work, and/or my clinical duties for all the extracurricular stuff?  Does he think I can’t handle it?

Over the next several days I had to chuckle with that sly, knowing expression when I realized it didn’t really matter what he was thinking.  The question, repeated, was a stealth trigger for my Bad Mom fear.  It wasn’t that I worried about his concern for my work life balance.  It’s that I was worried for it, and that I secretly question, more than I like to admit, whether my kids really feel loved enough by me.  This despite my previous blog post claiming that I actually don’t question it!  Blaaaaahahaha, how cosmically ironic!  Looking back, the article that incited that post touched pretty much the same trigger, and it has taken me this long to see it (better late than never).  How fascinating!

In my defense, I really do think I’m a good mom—mostly.  But like being a good leader, it’s definitely not always easy, and that I question my competence/proficiency/mastery does not necessarily detract from my real, ever developing, occasionally flourishing skill set.  Thanks to this new awareness of the Bad Mom Trigger, I have adjusted my strategies and tools, and rebalanced, for now, time and energy between work and home.  I look forward to receiving more gracefully the signals for future opportunities to readjust.

Canned and Rote

Last year I was leaving an evening work gathering.  A nice man saw me departing, got out of his seat, and approached me, apparently to introduce himself.  He said he had heard my ‘shtick’ something something something—I did not really hear anything else, as my abhorrence of that word had made me stop listening.  I think I was polite, and I exited with as few words exchanged as possible.

Readers of this blog know how much I admire Brené Brown.  Followers of Brené also know that her work is always evolving, new theories testing, refining, and building on prior ones, always with deeper and more meaningful understanding and application in relationships.  So I was deeply offended when I recently heard someone refer to her presentations as ‘shtick’ and ‘spiel.’  These words feel dismissive, mocking, and pejorative to me.  I have only heard them used in a disrespectful way about a speaker or their speech.  But why should I be so offended on Brené’s behalf?  She knows the value of her work; she does not need me to defend her.

Of course, as usual, it hit me later:  I identify with Sister Brené, so I took these words personally.  To me, shtick and spiel are how we describe presentations, and thus people, who stopped learning and growing long ago.  We utter these words and roll our eyes at having heard it all before—nothing new here, folks.  David Litt has said that when preparing a presentation ask yourself, what is the one thing you want someone in your audience to tell their friend about your speech the next day?  If the words ‘shtick’ or ‘spiel’ appeared within a hundred yards of someone describing my work—if someone thought I had not prepared but just shown up with canned, stagnant drivel—I would be mortified.  I pride myself on constant learning, self-awareness, and self-improvement.  I want every audience to feel that my presentation was uniquely relevant to them, that I worked hard to meet them exactly where they needed me.

I understand that everybody may not see or hear these words the way I do.  I can respect that and monitor/manage my reactions from now on.  But wanna trigger me?  Tell me you heard my spiel.  Go ahead, I dare you.

IMG_1568

Debbie Ford and Your Dark Side

OH it’s all so funny, the things that trigger us.  Because if we don’t laugh we will absolutely cry.  Or pick fights with our spouses that last weeks on end.  That’s what happened to me when I read The Dark Side of the Light Chasers about 10 years ago.  I was young yet in my adult development journey, and I had a few (just a few) more emotional hang ups than I have now.  On page 69 of the paperback edition she lists negative words like greedy, liar, sleazy and freak, and suggests an exercise:

Take a few minutes and identify any words that have an emotional charge for you.  Say out loud, “I am _____.”  If you can say it without any emotional charge, then move to the next word.  Write down the words that you dislike or react to.  If you are not sure that the word has any charge for you, close your eyes for a minute and meditate on the word.  Repeat it to yourself a few times out loud and ask yourself how you’d really feel if someone you respected called you this word.  If you’d be angry or upset, write it down.  Also spend some time thinking about words that are not on this list that run your life or cause you pain.

I didn’t get through the whole book back then, so I don’t know what she wrote about ‘embracing your dark side,’ ‘reinterpreting yourself,’ and ‘letting your own light shine.’  But I think I have figured it out for myself, at least a little bit.  It’s about self-compassion, acceptance, growth mindset, forgiveness, connection, learning, and joy.

Every light casts a shadow, and we need both light and dark for balance in life.  I’m learning to hold it all a little more lightly (ha! Pun!).  Debbie Ford felt too heavy for me ten years ago.  I’m looking for a new book this week.  Maybe I’ll pick hers up again and see how it feels.  …Makes me a little nervous, actually.  I wonder what I’ll find this time?

We Are Really Bad At This

turkey human car tracks

Sylvan Dale Guest Ranch, Loveland, Colorado, March 2019

How many truly meaningful and fulfilling conversations do you have in a day?

How many such relationships do you have?

Though I wrote my Pit Crew post almost a year ago, its ideas recur regularly.  I have linked to it on multiple subsequent posts.  I share it with patients and reference it in conversations often.  My patients are leaders of large corporations and organizations.  My colleagues and I lead teams in the hospital, the medical group, and the medical school.  My friends lead their families and communities.  When I think about our health and its consequences, it’s about taking care of those for whom we are responsible, ourselves included.

Are you generally the one who always takes care of others?  How does this affect your style and effectiveness as a leader?

Who Takes Care of You?

I estimate that about 20% of the time when I ask this question, my patients say that nobody takes care of them; they do it themselves.  They don’t mean that nobody cares about them.  It’s that they don’t really depend on anyone for counsel and/or support.  They hold everything together themselves.  I always have mixed feelings when the conversation takes this turn.  On one hand I feel admiration and respect, especially when they seem generally healthy—apparently unaffected by physical, mental, and emotional dysfunction.  On the other, I get curious.  How do they sustain this Lone Ranger method?  And what does it cost them?  I believe we all need tight, vulnerable, and safe connections through which we can get raw and real, and work through life’s ultimately messy sh*t.  We need others, even if it’s only one or two, to help us truly hold it all together.  My default assumption is that if we don’t have such connections, we are not living into our full potential.

And today I feel cynical.  I think we are getting really, really bad at taking care of each other.

Driving to work this week I wondered to myself, why do we feel the dearth of mental health services so acutely these days?  Is it that more of us are living on the psychological razor’s edge of mental health and illness?  Are we not diagnosably mentally ill but simply, profoundly, stressed to our limits of sanity and function?  Is that why none of my patients can get in to see a psychiatrist or therapist for weeks to months?  Is that why physicians are increasingly leaving the profession and killing ourselves?  Why do we feel so hopeless?

It’s easy to blame social media.  And I do, partially.  The cruelest irony lives here.  My non-evidence based impression is that cyberbullying bears equally life-threatening consequences as face to face bullying.  If you know of evidence to support or refute this premise, please share.  Negative interactions on social media, which rage so easily like wildfires, are now understood to contribute significantly to the rise in loneliness across the country.  Worse, cultivating truly positive relationships via social media is much harder and more complex, even deceptive.   So on balance the risks and harms of social media may far outweigh the benefits.  There simply is no substitute for personal, physical contact, for sharing the same space, breathing the same air, experiencing another’s full presence.

Worse yet, too often we can’t even get that right!  Ozan Varol wrote about this in his last post, “3 Ways to Be Insufferable In Coversation.”  They are:  1. Always turn the conversation back to yourself; 2. Pretend to listen; and 3. Ask no questions.  How many people have you already met today who do this on the regular?  If you’re honest, how many times today have you committed these relational sins?  It’s okay, we all do it sometimes.  As GI Joe says, knowing is half the battle.  The other half is doing something about it!

IMG_1547

Smart Museum of Art, Chicago, July 2019

So what do we do?

First, Attend.  Pay attention.  How much time do I spend on social media?  What do I get out of it?  When does Fear Of Missing Out (FOMO) drive my scrolling?  Am I really connecting?  Or am I stalking, comparing, judging, flaming, agitating the echo chamber, and otherwise wasting time and energy?  How can I set alerts and redirect my routine?

Second, Intend.  What is the best use of my time?  If I want to see how my friends are doing, rather than check my Facebook feed, why not call them up?  Send a text, photo, or—gasp—a handwritten note just to say hi, I’m thinking of you?  It may cost you time, energy, and $0.55 in postage.  But aren’t your real friends worth the investment?  You can do it on social media too—if you slow down and think about it first.  Consider the return—brightening someone’s day, feeling that personal connection.  Dopamine drives FOMO, and is also associated with addictive behaviors.  Bonding behaviors elevate oxytocin, the hormone that mediates empathy, safety, and connection.  There is even evidence that higher levels of oxytocin correlate with increased longevity of romantic relationships, or even a person’s own life span (could not find a reliable, peer-reviewed source for this claim—I just believe it intuitively).

Third, Get Curious.  This was the first skill I (re)learned in life coaching, ‘way back in 2005, and it serves me well every single day.  If we let go of the competitive, scarcity-based thinking that surrounds us, what more could we learn?  What novel and inspiring stories could we hear from anyone we meet, or even our closest friends?  If we listen to understand rather than to reload and refute or one-up, what vexing problems could we solve, together?  Just wondering about it makes me feel lighter and more optimistic, what about you?

Subscribe to Ozan’s newsletter, the Weekly Contrarian, to get his list of solutions to conversation insufferability this Thursday, 9am Central Time (I have no financial interests in Ozan’s site; I just really admire his work and the community of critical thinkers he has convened).  And today, I challenge us all:  Monitor our attitudes and facial expressions.  Manage our self-absorption for a few minutes at a time.  Look strangers in the eye and smile as if they’re already our friends.  Ask a Facebook friend what they did this weekend that really made them feel alive and well.  Let’s all get our caring on, shall we?

 

On Labor Day

IMG_1530

For a New Position

May your new work excite your heart,

Kindle in your mind a creativity

To journey beyond the old limits

Of all that has become wearisome.

 

May this work challenge you toward

New frontiers that will emerge

As you begin to approach them,

Calling forth from you the full force

And depth of your undiscovered gifts.

 

May the work fit the rhythms of your soul,

Enabling you to draw from the invisible

New ideas and a vision that will inspire.

 

Remember to be kind

To those who work for you,

Endeavor to remain aware

Of the quiet world

That lives behind each face.

 

Be fair in your expectations,

Compassionate in your criticism.

May you have the grace of encouragement

To awaken the gift in the other’s heart,

Building in them the confidence

To follow the call of the gift.

 

May you come to know that work

Which emerges from the mind of love

Will have beauty and form.

 

May this new work be worthy

Of the energy of your heart

And the light of your thought.

 

May your work assume

A proper space in your life;

Instead of owning or using you,

May it challenge and refine you,

Bringing you every day further

Into the wonder of your heart.

 

–John O’Donohue, from To Bless the Space Between Us

 

I know Labor Day is not about doctors, but I’m thinking about all workers and how we each relate to our work.  I discovered the poem above earlier this summer and loved it.  Rereading it this weekend, it resonated even more deeply and I shared it with some friends.  Since taking on a new leadership role about 20 months ago, it feels like I have really lived into these aspirations, as if the cosmos has held this blessing for me a while already.  I was primed for the call; I summoned every skill and insight I already possessed; still the learning curve has proven steep.   And no success is achieved alone!  The steady, honest, and loving support I enjoy from so many humbles me beyond expression.

Our practice recently welcomed new physicians and staff, and I will soon share this piece with the whole team.  Even for us veterans, it never hurts to look at our everyday work with new eyes, as if approaching it for the first time.

I hope O’Donohue’s words above speak to you in your chosen vocation, even if your occupation does not fulfill all of these lofty ideals (it’s kind of a lot of pressure to put on a job).  I wish you work that is much more meaningful than stressful.  If that’s not the case, I hope for you an effective and peace-giving way to reconcile this and find great meaning elsewhere in life.

And I thank you for the work you do, whatever it is.