Monthly Archives: June 2023

What I Wish For Us

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What a privilege to do what I do. Every day I get to meet new people, learn new things, apply my own well-developed knowledge and expertise in fun and interesting new ways. My skills are continually sharpened by each novel interaction, and both confidence and humility are strengthened as well.

Before each full day physical, I ask patients about their highest goals for the day. Their answers can usually be paraphrased thusly:

“I’m looking for a comprehensive assessment of my current state of health, including risks. Let’s identify where habits are healthy, so I can protect/strengthen them. Then discover areas of vulnerability and potential improvement, and co-create a relevant, actionable plan to optimize patterns in the five reciprocal domains of health (Sleep, Exercise, Nutrition, Stress management, and Relationships).”

People get excited (maybe that’s too strong–intrigued, perhaps) to understand the complex interrelationships among patterns and fluctuations within and between the domains, both conscious and unconscious, including extrinsic/environmental/circumstancial factors and their insidious influences. They often start the encounter focused on the biometrics: cholesterol, body fat, etc. And if I do my job well, they leave also attending to the salient behaviors and all of their adjuvant drivers. My reward is when someone leaves the day feeling they were seen and known as a whole person, in their current context. Even better if I can also help them see and know themselves this way more easily.

I recently read Kate Murphy’s You’re Not Listening, which helps me do my job that much better. I was gratified to see that I was familiar and facile with many of the concepts and skills she discusses in the book. It’s not just about making eye contact, repeating people’s words back to them, and voicing sounds that may indicate listening, like ‘uh-huh,’, ‘right.’ It’s about being truly present, listening as a way of being before doing, putting aside our own prejudices, assumptions, judgments, and expectations as much as possible, attuning to the person in front of us–true listening is a practice in deep presence. Easier said than done! And always worth the effort for deeper connection. This connection makes the medical encounter a profound win-win.

Don’t all people deserve this kind of physician-patient relationship? Isn’t the primary care doctor’s job to inform, educate, explore, and conference with people, to help them enact their own health intentions ever more easily and confidently? As your doctor, I wish to help you recruit all the support you need for healthy decision making, to moderate overt and heavy effort–make the healthy path the path of least resistance. It takes a village! Humanities researchers have known for generations now that our behaviors and decisions are heavily dependent on our circumstances, environmental cues, and real time mental state (the more fatigued and stressed [and who is not severely fatigued and stressed right now??], the exponentially harder it is to resist the most immediately gratifying, comforting, and self-soothing behaviors). So it all just makes me wonder, at times with severe agitation: Why do we, as a society, make it so hard for us all to live healthily? Why do we make healthy food, childcare, and mental healthcare so inaccessible and expensive? Why do we make people work 3/5 of their waking hours at jobs that confine them to chairs and screens? Why do we shame and punish people for taking time for medical appointments and care? Why do we blame individuals, telling them both explicitly and implicitly how they are not aware enough, not doing enough, not good enough, when everybody is just doing their best in chaotic, inefficient, and inhumane systems of everything? ACK.

My corporate executive patient population is microscopic compared to the general population, and privileged to the extreme. Current state in American healthcare means that only the uber wealthy, highest status workers can access the care that I so luxuriously provide. I say every day how I have the sweetest gig in all of primary care. I understand and appreciate this deeply, and wonder honestly about its sustainability.

I wish for my patients to leave every annual physical feeling empowered to exercise your agency where the energy will be most efficient and effective, so that by one year from now you can come back and report how much healthier you feel, and why, owning your own actions and appreciating the help you got along the way. And if you’re not feeling healthier, we can talk it through, trouble shoot, and make a new plan. To this end, we doctors need the time, space, and resources to really know you, our patients, to understand the barriers to and facilitators of your best health habits and how it all intersects and evolves over time. Time is really the key here–there is no substitute for the time it takes to be fully present and to listen to the stories–to hear what is said and not said, attune to the subtle nonverbal cues, process it all and consider the best next open, honest, loving question. And then to hold temporal and personal space for thoughtful engagement. How and what we clinicians ask, and the energy we bring to each query, influence deeply (if not straight up determine) the answers we get, and thus the accuracy of our understanding, and the effectiveness and impact of our whole plan of care. Maybe I understood this early on, and that’s why I used to run 45 minutes late in a regular primary care clinic.

So how can we rebalance? As medical knowledge expands exponentially in volume and complexity, and our systems widen and dehumanize the distance between patients and their doctors (even more than when I wrote my ‘About’ page on this blog 8 years ago), how can we restore the close, personal, and healing energetic exhcange between us all?

I have no answers! Alas, our deeply broken and counterproductive healthcare system may be the quintessential complex-adaptive challenge. It requires leaders who can hold tension without anxiety, paradox and polarity without animosity, and patience and courage for experimental, iterative change.

Meanwhile, we workers and consumers of the system must find ways to connect and hold ourselves up, to get through the morass together. What I wish is that we all give ourselves and one another, including the folks who ‘run’ our broken systems, a little grace. I truly believe we are all doing our best. AND we can do better. Maybe it starts by simply listening a little better.

Magnetize Thyself

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“Your vibe attracts your tribe.”

What is my vibe, I wonder? How do others experience me? What moves us each to approach one another?

It’s been six months since I wrote about feeling liberated to be more authentically and fully expressive of my thoughts and observations. I feel freed to take up more space, be all me, all in, whatever I’m doing. As a result, my encounters and interactions with many people, patients especially, are that much deeper and more meaningful. In this time, I also seem to have attracted and strengthened connections with a number of like-minded and like-hearted folks. It feels joyfully cosmic.

I met the team at Ethos Training Systems three years ago, and stayed on their periphery. I officially joined the community this April, moved by some immutable force, and made fast friends with the coaches. I also feel right at home among my gym classmates. I rejoined Instagram a few weeks ago in order to see the workout videos, and found Coach Jacob’s page. To see posts of a thoughtful, generous, humble, and loving young man, or if you just want some uplift one day, hop on over and read his reflections, watch his videos. I learn so much from Jacob, in more domains than fitness. It reinforces for me the value of making friends with people much younger than myself. The generation ‘gap’ invites attention and exploration, an ebullient mutual bridging. I am convinced we each have something important to offer the other.

Last month I reconnected with Steve, one of my favorite people in high school. Looking back, he was one of the first people with whom I could do joyfully deep philosophical banter, and also talk science. He went to college on a physics scholarship, and now flourishes as a tenured philosophy and religion professor. We met for lunch after over 30 years, and it was as if no time had passed. We humans are who we are from a very young age, and we also continually change and evolve throughout our lives. It’s such a lovely paradox, and I’m finding folks left and right who embrace it like I do–the connections reminding me of formative atomic collisions.

Colleague introduced me to Hilary, an energetic and effusive somatic psychotherapist. It took us a while to connect in person, yet we both persisted in the effort. I felt pulled–called to gather with her. We both feel first hand as well as vicariously, the immense pressure and burnout borne by our fellow healthcare workers. We understand intuitively that COVID was just an oceanic tremor; the myriad recurring tsunami waves of consequences are yet to hit, and we brace for it, personally and professionally. Meanwhile, we both ascribe to Isaac Asimov’s words: “I continue to try and I continue, indefatiguably, to reach out. There’s no way I can single-handedly save the world or, perhaps, even make a perceptible difference–but how ashamed I would be to let a day pass without making one more effort. …I have to make my life worthwhile to myself, if to no one else and writing these essays is one of the chief ways I can accomplish this task.” Like me, Hilary sees and feels her potential in multiple domains at once, gets excited about them all, and must self-regulate. She chooses to embark now on a writing journey. I think I was placed on her path to walk in solidarity with her, while we share, support, and learn from each other. We agree to buy Colleague a drink for bringing us together, right here and right now, just when we both needed.

“People don’t buy what you do, they buy why you do it,” Simon Sinek says. It’s about resonance. My Why grows ever clearer, and I manifest it with increasing power and momentum (and hopefully without too much ego). I am definitely attracting my tribe, finding people with whom my Why vibrates strongly. I compare myself to a magnet more often every month–one with rising energy. The tribe grows, maybe approaching critical mass for effecting positive change through relational leadership. But even if not, the coalescence feels profoundly meaningful.

Useful Repulsion

If I am a magnet, then there are elements (people) I will repel, and/or will repel me. I can name, with some regret, friends who have exited my life. Sometimes my bids for initial connection with people I admire get rejected, which doesn’t feel good. Why don’t they like me? Others approach me, and I feel neither spark nor interest, so I politely keep my distance, eventually falling out of orbit. It’s limbic, visceral, irrational, and organic. I have learned to take it all in stride. Not all friendships, relationships, and connections are meant to be, or to last forever. Neither, though, are separations. You just never know. So I resolve to stay open to shifts in whatever polarities are at play, for repulsion now to become attraction later, and vice versa. Anything is possibile.

I have a few longstanding relationships, however, which I will not exit and that yet feel consistently repulsive in one way or another–dissonant, counter, antithetical. How do I reconcile this? What is the cosmic purpose here? I have decided to see it as a form and source of movement, as with Maglev trains or levitating globes. My counterparts and I, like these magnetic objects, are held in sustained proximity by both attractive and repulsive forces of the relationships themselves, based on the positions and polar orientations of our respective magnets. As a result, I am impelled forward, I like to think in personal growth. Or I’m held in place, suspended in stability within which I may spin and bounce–there is security here, even if movement is restricted in some dimensions. Anyway, it’s a fun and encouraging way to think of myself–as a magnet that naturally both atrracts and repels, creating both potential and kinetic energy.

As I continue to step into and stand straight and strong in my core values and life purpose, I understand and accept that my relationships will self-organize accordingly. As I attract some, I will necessarily repel others. Sometimes the latter is painful. Still, the rewards of magnetizing myself this way far outweigh the costs.