Monthly Archives: November 2019

November 8:  My Students Make Me Better

Posted on by
5

IMG_1928

NaBloPoMo 2019

Oh how I love my medical students!

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

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

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

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

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

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

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

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

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

November 7:  Feedback Makes Me Better

Posted on by
2

IMG_0150

NaBloPoMo 2019

This post is about power.

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

* * * * *

“You are a woman of color?”

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

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

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

* * * * *

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

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

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

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

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

November 6:  Caring For the Team Makes Me Better

Posted on by
11

IMG_2624

NaBloPoMo 2019

“How does he treat you?”

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

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

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

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

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

IMG_2066

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

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

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