November 10:  Experimental Questions Make Me Better

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NaBloPoMo 2019

What’s the most interesting question your doctor asks?  What effect does it have on you?

I get to ask some really fun and interesting questions of my patients.  They often come about spontaneously, then I realize how helpful they are, and I integrate them into my routine interview.

It was almost ten years ago now that I was seeing a pleasant young woman for the third time.  She had recurrent, nonspecific physical symptoms, and felt down.  She was having a really hard time at work, and it was having a significant impact on her overall health and well-being.  Around the same time I saw another patient, a young man.  He felt well overall, but was also not happy in his job.  I remember casting around in my mind, looking for a quick and easy way to quantify the negative effect of these patients’ negative work experiences on their health.  I can’t remember which visit sparked the 0-10 stress and meaning scale questions, but it was one of them, and then I repeated the questions on the other soon after.  These were my first two, unsuspecting, experimental question subjects.  On a scale of 0 to 10, how high do you rate the overall stress of your work?  That was easy, but I also had to figure out whether there was some benefit that was worth the cost of the stress.  So: On the same scale, how high do you rate the overall meaning of your work to you?  The bottom line is that we can tolerate very high levels of stress if the work is meaningful—for sustainable work, the meaning-to-stress ratio needs to be 1 or greater, and overall meaning is best at 7 or higher.  That year I realized I could create deeper, more helpful, more insight-revealing questions in my patient encounters.

My own work meaning rating rose by at least a couple integers almost immediately.

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Since then I have consistently asked about body signs of stress, resilience practices, the proportions of threat vs. challenge stress at work or home.  Since I last wrote about these questions in 2016, I have continued the experiments.

By 2016 I was also using the elite athlete analogy with my patients, asking every year about habits in the 5 reciprocal domains of health (after talking about stress and meaning at work): Sleep, Exercise, Nutrition, Stress Management, and Relationships.  But after asking the same questions for a couple years in a row, both my patients and I get a little bored.  So in 2017 I went a little deeper in the relationships category.  After confirming marital status, ages and health of children, I started asking, “Tell me about your emotional support network,” because the more I am reminded of the critical importance of emotional support in our health, the less it makes sense to not ask about it directly.

With each additional set of questions, I learn more about my patients. I learn how people understand the questions—sometimes it’s totally different from my own understanding, and the conversation about the meaning and objective of my asking gives me wonderful insights into people.  Patients are remarkably open and honest in their answers, which always reminds me of the honor and privilege of my role as physician.  The answers to these questions are what allow me to imagine my patients in their natural habitats, engaging with their work and the people in their lives.  The answers provide context and texture to the other patterns we uncover in health habits, and we often come together to a better understanding of both the origins and consequences thereof.  I can’t speak for my patients, but I always come away feeling just a little more connected.  I get goosebumps just thinking about it.

This year I’m excited to introduce 4 new questions.  It started out as three.  The third one wasn’t landing quite right initially.  I wasn’t asking what I meant, and I couldn’t quite articulate what I was after.  So I experimented with the wording until I got to the current state:

  1. In the coming year, what do you see as the biggest threat to your health?
  2. What is the biggest asset?
  3. Having answered these, how does this affect your decision making going forward? …And other iterations I can’t remember anymore
  4. One year from now, when we meet again, what do you want to look back and see/say about your health, relationships, and whatever else is important to you?
  5. (then the corollary question that occurred organically once and I then incorporated–) In order to make this vision a reality, what support do you already have or need to recruit?

I have asked these questions since July.  I always think to myself how I would answer for my patients, based on what I know about their circumstances, habits, and biometrics.  About two thirds of the time, our answers are the same.  Patients seem to receive them well, too.  One asked me to email them to him, so now I offer to email them to everybody.

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You might imagine that I think these questions make me a better physician.  That may or may not be true.  All of these questions make me better—a better, more self-aware person—because I also ask them of myself.  What is my meaning:stress ratio today?  This week?  This year?  I assess the threat/challenge ratio of my own life stressors, especially the acute ones.  I have had the same body signs of stress for many years, but in 2019 I may have developed a couple new ones, darn.  What’s the biggest threat to my health?  My hedonist impulses, no question.  The biggest asset?  My Counsel—those best friends and confidants.  What is my vision for my health a year from now?  I only answered that for myself a week ago (and I’ll keep it to myself, thank you).  And what support do I have/need?  I’m still working on that one!  That I don’t already know the answer to this one surprises me—I assumed I knew, but when I sat down to think about it formally, I realize that this may be the missing piece that holds me back from achieving some of my personal health goals.  HUH, how fascinating!  Did I not just write about how I question some of my patients’ ‘Lone Ranger’ method of self-care?  Well hello kettle, I’m pot!

Now, off to ponder some more, yay!

 

November 9:  Steady Pacing Makes Me Better

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NaBloPoMo 2019

*sigh*

I’m not a swimmer or a runner, but isn’t there something in these athletes’ training about breathing, pacing, and strategies for long distance endurance?   The last 22 days have felt like a physical, mental, and emotional marathon of sorts.  I’ll spare you the list of meetings, engagements, and tasks—you may have already read about them!  Looking back, I realize I have had to live every day in acute mindfulness, attending to whatever was right in front of me in the moment, including the unexpected.  Prioritizing was key, completing one task/event/conversation before moving onto the next.  I had to put my head down for some parts, come up for breath and a brief aerial view, then dive deep again.  Today I crossed a finish line, and I feel proud.

I started my journey with Better Angels in May of this year, at a skills workshop.  Since then I have attended two additional workshops, one that was featured on the Van Jones Show.  I committed to moderator training, and today I led my first skills workshop.  I had the honor of working with the three Wonder Women who ran the workshop back in May.  They prepared me so generously, so kindly, and I am forever grateful.

There was a hiccup, though.  When we initially arranged with the Wilmette Public Library for the event, we mistakenly told them the event would last two hours.  The workshop is designed to last 2.5 hours.  We could not change the website or registration, so we meticulously shaved 24 minutes from the schedule.  We warned participants of our impending heavy handedness on time, and dove in.  Mande and I set timers on our phones for each segment.  Mary Lynn gave me hand signals from the back of the room (though I did not always look or see).  I had the handy timeline that Sharon typed out for us all.  We ran ahead at times and behind at others, and ended right at 4:06pm, as planned.  We kept pace.  Engagement and discussion was lively, and attendees gave overwhelmingly positive feedback.  Many people stayed afterward to talk more, explore ways to get involved, and exchange information.  We were invited to present at other organizations.  Overall we felt it was a wild success.

Workshop timeline 11-9-19

Everything was a group effort these last three weeks. Each meeting, workshop, video call, or presentation, whether for the American College of Physicians, my clinical practice sites, or Better Angels, required a team of people, each with delegated and specified roles and task lists.  We all had to agree on timelines and deadlines.  Text, email, Zoom; more email and text—it felt like running through a Venn diagram of relay races, passing batons in and out of each circle as I crossed from one to another.  I had to pace myself, and also match the pace of others as I came alongside.

Having a calendar with everything written in one place definitely helped.  I keep a checklist of every task, no matter how small, and carry it with me everywhere.  Excellent hydration is key for optimal mental and physical performance—I’m always reminded when I forget.  Timely, frequent, and clear communication—need I say more?  All of these practices help me plan and maintain a steady pace, checking off the list, completing each day, each trip, each week, slowly, surely, and competently.

Now I can slow down, breathe deep, and tread more lightly for a little while.  Every athlete, even an amateur, requires rest and recovery between races.  Once again I dedicate this month of daily blogging—a quintessential practice in steady pacing—to all those who go before me, showing me how it’s done.  Thank you.

 

 

The Status of Women, 1999-2019

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What happens for men when women speak Feminism?

I intend to ask this question to more men in my life from now on.  What do you hear as Feminism?  Where do you think it comes from?  What do you think women are trying to accomplish by talking about equity and representation?  What moves a man to ally with women in this movement?  What keeps him from doing so?  What are the risks, costs, and benefits for us all when he does and does not?

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Women in Sports

The US Women have just won their fourth World Cup Soccer title, kicking balls and ass, I like to say.  What an accomplishment, and how far they’ve come since winning the first ever Women’s World Cup in 1991, the year I graduated high school.  I don’t follow soccer, but as an American woman, this victory carries meaning for me.  At halftime this morning I read about Brandi Chastain, the 1999 US World Cup champion midfielder who famously, spontaneously, took off her jersey in unadulterated celebration after firing the winning penalty kick in double overtime against China to win it all.  The New York Times featured her story yesterday, commenting on the evolution of our perceptions and treatment of female athletes over these 20 years:

In that pivotal moment of arrival for women’s team sports in the United States and around the world, viewers saw Chastain removing her jersey and twirling it like a lariat, spinning around and falling to her knees, pumping her arms in exultant triumph. What resulted was perhaps the most iconic photograph ever taken of a female athlete, a depiction of pure spontaneous joy.

It was a moment of freedom and liberation, Marlene Bjornsrud, a longtime women’s coach and an influential sports executive, once told me. She called it a “casting off the burden of everything that kept us down and said, ‘You can’t do that because you are a woman.’ It was a moment that screamed, ‘Yes, I can.’”

Title IX was signed into law by President Nixon in 1972, one year before I was born.  So I took it for granted that girls could play sports just like boys in school—not every sport, but most.  I also took for granted the inherent assumptions about women in athletics—that we cannot be as fast, as strong, or as competitive as men.  I have so much more appreciation now for icons like Billy Jean King, Martina Navratilova, and Pat Summitt. I think about the WNBA, and women coaching in the NBA, NHL, and NFL, and I marvel at how far we have come.  Take a look at this timeline of women’s sports in the US to get a fuller perspective.  I know many will say we have a long way yet to go.  But today, let us joyfully celebrate all that we have accomplished already.  Wahoo!! [fist bump and dancing woman emojis]

 

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Journal of Bone and Joint Surgery, January 2012

Women at Work

I’m thinking about the culture of orthopaedic surgery.  In the twenty years since I graduated from medical school, I see more and more women in this field (as well as other surgical specialties), which makes me proud.  While women comprise only 5% of practicing orthopaedic surgeons, 15% of American orthopaedic residents are now women, which is roughly double the percentage in 1999.  But what’s it like to be a woman in orthopaedics?  How do these women present, perhaps differently, at work compared to in their personal lives?  Is it truly safe for them to be themselves as surgeons?  The American Orthopaedic Association held their annual meeting recently.  My orthopod friend returned from the conference and commented that the rare women leaders in his field seem ‘fierce’ and ‘tough’—but in a good way?  It struck him to wonder if they are just like that in general, or do they have to be that way to navigate their male-dominated specialty.  He wondered how they would be seen if they displayed sensitivity and emotion, “because a man can be seen as sensitive and kind” and not only does it cost him nothing, his social status is likely to be elevated because of it.  My friend was not sure this is the case for his female colleagues, and he seemed both empathetic and powerless at the idea.  Looks like gender parity may take a bit longer in medicine than in sports.

At work in general, women’s status varies considerably.  But research points to common issues such a 22% pay gap and too few women in leadership (5% of US corporate CEOs), though these are improving.  One need not look far for abundant evidence that having more women on the corporate team improves earnings and morale.  Much is also written on strategies for improving gender equity at work.  Two of my favorites are exit interviews and work-life balance initiatives for all employees, not just women.  But as I wrote last week, it’s not just about including women as participants in the workforce.  It’s about truly appreciating the diversity of experience, biology, and contribution that women bring to any group they serve.

 

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Women and Men

There is no way I can do justice to this topic in the remainder of this post.  So let me just share some ideas and resources I will continue to explore in the months and years to come.

I asked at the beginning what happens for men when women speak Feminism.  A corollary question is what happens for all of us when we hear the words ‘toxic masculinity’?  My guess is men get defensive and women get aggressive.  Personally I love the phrase because it’s so incisively descriptive.  But it can also be a flashpoint phrase, one that immediately incites conflict and emotional hijack.  Let me be clear: toxic masculinity does not imply that men and manhood are toxic by nature.  Quite the contrary, the phrase refers to a culture of expectations of men that is just as toxic for men as it is for women.  Male surgeons may well benefit from being sensitive and kind, but not too much so, lest they be seen as weak.  This is a vast oversimplification, by the way; the history and complexity of toxic masculinity are explored articulately here.

Readers of this blog know how much I love Brené Brown.  Her explanations of how shame (where toxic masculinity is born) manifests and organizes around gender—and why it is toxic for both men and women–are the most poignant and real.  Read her first hand comments to Ms. magazine here, and a stay-at-home dad writer’s interpretation of them here.  If you seek a nonjudgmental, objective, and real-life exploration of the complex dynamics between men and women, read The Gifts of Imperfection and Daring Greatly.  Sister (she’s not old enough to be Aunt) Brené’s books are the most accessible form of evidence-based, all-around relationship advice I have ever read, and I’m so grateful for her.  From the Ms. Interview:

What role do you think vulnerability played in the #MeToo movement?

Know what I love about the #MeToo movement?—and, me too—I thought until I was 25 or 30, that sexual harassment was just the price of entry.  The greatest casualty of trauma is the ability to be vulnerable. So this #MeToo movement is re-defining and re-claiming vulnerability, and putting vulnerability in the context it belongs in, which is power and courage. 

 What gives you hope?

The thing that scares me about the world today is the same thing that gives me hope. I believe we’re witnessing white male power over. It’s making its last stand right now. And it’s scary because last stands are dangerous, and people get very backed into a corner. I think this is the last stand, and that we’re going to see a shift, mercifully, from white male power to inclusive power with it too. And I think from that paradigm, we can do anything, change anything, and be anything. 

And it’s not just women who can claim agency against misogyny and sexism.  Men who identify as feminists serve as allies for gender equity and respect.  But men can also help themselves and each other break free from the restraints of machismo and chauvinism.  Movements like The Good Men Project and Evryman give men a forum for honest, vulnerable emotional expression and connection.  Just like women surgeons and corporate executives, all men need inclusive spaces where they can feel true belonging, where they are free to be all of themselves—hard emotions and all—for all our sakes.

Men I admire in this space include Nate Green, Ozan Varol, and David Brooks.

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To lift my spirits here at the end of this long post, I’m listening to a song on repeat: Woman, Amen by Dierks Bentley.  It’s such a shining anthem of a man’s unabashed love and appreciation for his partner.  I can also imagine modifying the lyrics and hearing Faith Hill singing about her man Tim McGraw.

Thanks for reading to the end, friends.

Our relationships kill us or save us, and we really need to be better at taking care of each other, locally and globally.  We, men and women alike, are all in this together, inextricably, in sickness and in health, forever.

Only Love can save us.  Let’s get on it.