Monthly Archives: November 2021

Choose Your Cohorts Wisely

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Who do you want in your boat out at sea?

NaBloPoMo 2021:  Do Good, Kid

Who are or have been the most influential people in your life?  Did you choose them for that purpose, or did they just happen to you?

Looking back on clinical rotations throughout medical school and residency, I still smile or shudder.  We had fun and learned eagerly on my general pediatrics team, when the attending regularly took us outside for teaching rounds.  On another rotation, we missed teaching conferences for hospital rounds all month, and every day was moral drudgery.  The culture, explicit and implicit, of any group, large or small, determines the bulk of the experiences among the people in it.

We do not choose our families of origin, nor our acquaintances of proximity early in life.  In adolescence, forces beyond our comprehension push us in and out of social groups, often at high mental and emotional cost.  If we are lucky, we find and can stick with people who stimulate us, challenge us to think and learn, and help us discover our best selves.  Who did you have growing up who did this for you?

At some point as adults, we need to take responsibility for our social contacts.  If I hang out with people who overeat and overdrink when I really want to lose weight and get healthy, I need to ask myself some important questions. It’s not that they intend to sabotage my efforts at self-care.  They are who they are and do what they do for their own reasons.  But I cannot underestimate their influence on me when I’m with them.  The human need for acceptance and belonging is primal, and manifests primarily in group norms.  No matter our fervent intentions and strong core values, given enough time and exposure, we are all at risk for succumbing to the pressures of conformity.  So when we have an opportunity to select our tribal membership(s), such as for work, it’s better to be clear about what kind of culture we value, and whether our choices align with that standard.

The older I get, the less energy I have to waste. How will I spend this precious resource—my time and attention? What value can I bring to my relationships, and how will they feed me in return? Straight up social reciprocity is a natural human trait, but I’m aiming higher. I want to be my best self and make a meaningful contribution, and I seek others who want the same. Once we find each other and recognize that shared, greater goal—that higher ethos—our mutual return on investment in relationship becomes synergistic and exponential, and benefits more than just ourselves. We are better, together, for society at large.

Focus, goals, and personalities evolve over a lifetime.  Mutually enriching relationships in a previous life phase may wane in significance over time.  Or we may grow closer with age, flourishing in parallel rather than divergence.  I think either is okay, if it’s done with awareness, intention, and grace.  Cultivating meaningful relationships is a lifelong practice in these three skills.  If we find and run with others committed to this lifelong training, then we may all realize the fruits of its mastery–or at least of progress–faster, and hopefully with a little less suffering and a lot more fulfillment.

Judge Judiciously

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NaBloPoMo 2021:  Do Good, Kid

The person who cuts you off in traffic is not (necessarily) an a**hole; nor is the person who voted for the other candidate (necessarily) stupid, evil, or out to destroy the country.  These are judgments we make, knowing nothing else about people, driven too often by a toxic cocktail of negative emotion and prejudice.  I wrote a few days ago about resisting early closure and asking more and better questions, in order to come to better conclusions—to make better judgments.

What good does it do us to judge quickly?  It feels decisive and righteous, for one thing.  It can make our decisions easier and faster when we don’t stop and question our assumptions and biases, or examine the influence of our own emotional baggage.  We get to dwell in the comfortable, if somewhat distorted, status quo of our own worldview, perhaps oblivious to the unintended impact of all that we ignore and dismiss.  This works for a while, maybe.

But we’ve probably all experienced that humbling moment when we realize how a snap judgment led us seriously astray.  What did it cost us?  Perhaps we lost a great job opportunity, or damaged a relationship that we care about.  Did we ruin a negotiation?  Maybe we lost someone’s trust, which we may never fully earn back. 

I’m not saying we should never make judgments.  Decisions must be made, after all.  Hiring, firing, mergers and acquisitions, voting, marriage—all human relationships and collaborations require us to dance, sometimes in elaborate steps of give and take, call and response, and iterative, reciprocal disclosures and choices. I think drawing premature, oversimplified conclusions closes more doors than it opens, especially in our minds.

So when is judgment required and important?  What makes judgment ‘good’?  I think it’s when our core values are at stake and at play.  I witness someone lying because telling the truth is costly or painful.  I know that another person says they believe one thing, and yet their actions speak differently, for whatever reason(s).  Does a given decision before me align with my core values of honesty, integrity, fairness, inclusion, kindness, and generosity?  If not, I can judge the action, and not necessarily the person who makes it, as dishonest, lacking integrity, unfair, exclusionary, unkind, or selfish.  If I make a judgment, I should be willing to defend it with conviction.  In my mind that means employing both evidence and sound reason, not just escalating emotions—unless, of course, I am aware that my judgment comes from exactly the latter.

This is an all too human foible that we would all do well to recognize.  When we see someone judging suddenly and severely, we can ask, ‘What core value, belief, or identity do they feel being violated here?’  This type of judgment can rarely be reasoned away with evidence to its contrary.  Read The Culture Puzzle by Moussa, Newberry, and Urban, Why We’re Polarized by Ezra Klein, and The Power of Us by Van Bavel and Packer, to see how our various strongly held identities trigger intense emotional hijack when we feel them to be threatened.  Under such conditions we slide into tribalist survival mode, aggressively attacking our perceived attacker, elephants loose, operating in fixed rationalization the whole way. 

If we can take a few deep breaths and withhold our own judgment for a moment, exercise some curiosity, empathy, and compassion, and not take their words and attitude personally (especially if they are judging and attacking us), perhaps we could see them as a fellow human, get a glimpse of what really matters to them, and appreciate why they’re so riled up. Maybe we could even learn something new. We can de-escalate. And once we do that, we can render wholly unnecessary our need to judge in return. How liberating.

Ask For Help

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NaBloPoMo 2021:  Do Good, Kid

I bet most practicing physicians can remember a time in their training when, not totally sure of what they were doing, they had to choose:  Ask for help, or go it alone?

Medical culture can give a learner some serious psychological whiplash.  In training, we are told at the same time explicitly that we should ask for help (we are novices, after all), and also implicitly that we should already know everything, that asking for help is weak and makes us inadequate.  It can be a dangerous paradox to navigate, especially when patients’ lives may be at stake.  Do I really know what I’m doing?  I know this attending will make fun of me for asking, say it’s a stupid question.  Is it a competence or a confidence problem?  Do I risk diminishing my reputation or making a mistake?  Bad things happen when we choose pride over safety.

* * *

I need for some extra help at home, but it’s not conventional.   Care.com has not been helpful.  Then EUREKA, it occurs to me, I have a whole network of smart, connected, creative friends whose combined life experience could yield some shining hidden treasures in this hunt.  So I queried them all at once via email; the response was immediate, and just the trove that I needed.  Considerations here, resources there, and insightful questions that broadened my perspective on what I need.  When we ask for help from a loving community or tribe, we get so much more than information.  We receive encouragement and learn about our friends.  We strengthen our connections, which feeds both the helpers and the helped in meaningful ways that really last.

* * *

One profound benefit of COVID, if you could call it that, is significantly improved access to metal healthcare.  The isolation and loneliness, the utter chaos wrought by pandemic living, has pushed so many of us to the edge of our sanity.  But precisely because of the pandemic, now we can do our therapy sessions remotely, by phone or video.  No more carving out commute and parking time once a week, among other obstacles.  Pre-COVID, therapists and medical clinicians were never reimbursed adequately for remote care, so we thought it could never be done, no matter how much it would serve both practitioners and patients.  Non-synchronous, online psychotherapy thankfully had its advent in recent years, so now more people can connect with mental health professionals from home or work, at their own convenience, making contact exponentially easier.  Cost and availability still keep many from getting the help they need, but many more are connecting now than before.  I have said for a while now that we should each just be assigned a therapist at birth.  Life is hard, and we don’t always learn the coping skills we need from our families or at school.  Mental health professionals today are like fifth generation hardware store owners—they possess evolving and historical knowledge.  They wield myriad tools to help us solve problems; they can show us how our own plumbing works.  They help us learn which hammer or wrench to choose when we see, hear, or feel something off in our house.  But we have to seek them out, to ask for their help.

What have you been facing all alone lately?  Who could help you?  When will you ask them?