Applying the Wisdom of Atticus Finch

Atticus_and_Tom_Robinson_in_court

“You never really understand a person until you consider things from his point of view—until you climb into his skin and walk around in it.”

–Atticus Finch

To Kill a Mockingbird, by Harper Lee

 

How do you practice and achieve empathy?  How do you notice others doing it?

It’s been on my mind a lot these last two weeks.  Current American politics resembles an interminable abscess, oozing ever more copious and putrid gobs of pus, from ever more unforeseen tracts of deep, diseased tissue.  How can we find any Healing Connection in the midst of all this?

Here’s my answer:  Role play and storytelling.

Role Playing Game Males Lego Duplo Play Build

 

Role Play for the Good

I used to hate role play, and now I jump at any chance to try it!  It all changed through a 7 week teaching workshop I did during my chief resident year, and I am forever grateful for the experience.  Now I regularly use role play to teach motivational interviewing, or MI, to medical students and residents.  Put simply, MI is a counseling technique that focuses on patient autonomy, and aims to reinforce intrinsic motivation for change.  My teaching method has evolved over time, due to my own unexpected experience of ‘climbing into the skin’ of others.

In the beginning I used to play the patient, letting students take turns practicing their MI skills on me.  After a couple of sessions I realized that even though I was pretending, I really felt like the students were earnestly trying to help me change my health habits, or making me feel bad about myself, depending on their proficiency.  So to give them the benefit of this perspective, I had them take turns playing both patient and physician.  The feedback revealed a richer, more insightful experience for all.

In 2015 I attended the Active Lives conference, where my technique was further enlightened.  I got to role play four times with a partner: first as patient, then physician, doing it the ‘wrong’ way (directive, authoritative, confrontational), and again in both roles doing it the ‘right’ way (collaborative, empathetic, nonjudgmental).  I felt the immediate contrast of the four roles emotionally and viscerally.  When all I heard from the doctor was, “Yes, I know you’re busy, but you have to find time to exercise,” and “Why don’t you do this…” and, “You should… You need to… If you don’t, then…” I felt absolutely no impetus to take any of this advice.  But questions like, “How important is it to you to…  How confident are you to… What would it take…what would need to happen in order for you to…” and, “What would life be like if…” invited me to explore possibilities, helped me to imagine and create my own future.  As an authoritative physician, I felt frustrated at my patient’s resistance to my evidence-based and well-intentioned advice.  By contrast, as a collaborative doctor, I feel freed to embark on an improvisational Yes, And adventure to reveal each patient’s personal path to healthier habits.  Now I offer my students the opportunity to experience all four roles.

I remembered this insight evolution last week when I came across a 1970 video of Jane Elliott’s classroom racism experiment.  She divides the class by eye color, asserts that blue-eyed children are better than brown-eyed children on one day, then reverses the premise the next.  While she makes privilege assignments that likely would not fly today, she also debriefs with the kids, helping them identify their assumptions, feelings, actions and reactions—much more authentically and directly than I think we are willing to do today.  She does it all without judging or shaming, pointing out biases and encouraging her students to examine them for themselves.  I admire her for pioneering this exercise, and I bet it affected her students in profound and lasting ways.

storytelling

 

The Importance of Story

Clearly, we cannot possibly depend on such academic practices to develop everyday empathy.  Luckily we now have infinitely easier access to one another’s stories than ever before, which is the next best thing.   Lately I feel a keen new appreciation of the importance of storytelling for conveying experience and stimulating mutual understanding.  Obligingly, the universe (read Facebook) has provided me with numerous testimonies of my fellow humans’ experiences and conditions, and this week they touch me even more acutely.  Here are some of them:

  • Former white supremacists talk about the importance of upholding others’ humanity, even as we denounce their beliefs.
  • A black writer recounts multiple instances of racism over her lifetime, inviting her white high school classmate to imagine and consider how they exemplify his white male privilege.
  • The head of neurosurgery at the Mayo Clinic in Florida tells his story of illegal, then legal immigration, and a subsequent life dream realized.
  • Neil DeGrasse Tyson shares stories of genitals on fire, educators’ responsibility to the electorate, pressure from his black classmate to contribute to ‘the black cause,’ realizing that he is doing just that, and why he wants to be buried instead of cremated (he has changed my mind, by the way).
  • David Duke’s godson credits the college friends who welcomed him despite his pedigree, with helping him defy and shed it.

 

What’s the Point?

The overarching goal here is to intentionally thwart the abstraction and dehumanization of people who are different from ourselves.  Stepping into another person’s shoes, ‘climbing into (their) skin,’ imagining how they feel, and actually feeling it—this is the best protection against bias, prejudice, and discrimination.  Empathy forms the sticky webs of connection that stymie the hymenoptera of hatred mid-flight, or catch us in the face and remind us to look where we’re going.  Where do we want our thoughts, words, actions, and relationships to take us?

I imagine a world of colorfully flawed humans, who acknowledge our biases openly and honestly; who recognize the risks that those biases carry; who accept ourselves, warts on soles and souls and all; who commit to a lifetime of extending that acceptance to one another; and who understand that it is our relationships, all of them, that kill us or save us.

So let’s play and tell—and feel and listen.  Really,  it’ll be good for all of us.

 

Only Love Can Win

Lily Pad Lake trail weather coming

Holy hell, what a week.  How are you feeling?  Most people I know express some combination of shock, resignation, rage, disbelief, hopelessness, gloom, and resentment.  I’m trying hard to practice Radical Acceptance.  It’s similar to the second arrow principle, in that at the very least, it lessens my own suffering from our collective circumstance.  But more than that, it allows me to focus more on what I will do, than seethe around my negative reactions.

I’m thinking of the Twitter account named Yes, You’re Racist.  Apparently the owner wants to identify the white supremacists who marched in Charlottesville, to publicly shame them and possibly get them fired from work. At least one person has lost his job based on a photo posted to the account.  What do you think about this?  I admit, my first reaction was positive.  Yes, call them out, make them accountable, I thought.  But then I wonder what good will this do?  Will the guy who got fired from the hot dog place suddenly think it was morally wrong to attend the march?  Or will he interpret his employer’s action as further proof that the liberal left conspires to restrict free speech and assembly, thereby deepening his animosity toward anyone who opposes his views from the left?  Will it open any space in his mind to consider why white supremacy is wrong, or help him acquire empathy or compassion toward any marginalized group?  Or won’t it just drive his racist expressions underground?  Doesn’t public shaming like this run the risk of re-closeting these people, so their grievances foment in the dark, only to be released again under pressure, in some act of overt violence?

I think about the fights between marchers and anti-protestors—between those who wish to incite violence, and those who succumb to the provocation.  To be clear, the Neo-Nazi, white supremacist marchers who descended on Charlottesville represent a vile and unacceptable set of ideas.  They are the villains.  And, fighting violence with violence is never a good solution.

So, we ask, what can we do?  How do we respond?  Maybe it’s because I’m on vacation this week, communing with nature in the mountains and watching the annual Perseid meteor shower from 10,000 feet, on a clear, literally stellar night, surrounded and awed by our millennia-old universe.  It keeps me from stalking Facebook quite so many hours a day, and gives good perspective.  I feel somehow more capable of saying, This is how things are.  It sucks.  It’s wrong.  And I can still make a difference.

In the end, I believe Only Love Can Win.  Blaming, shaming, belittling, and otherwise demeaning people for certain beliefs, actions, or associations—hating them—does not help.  What does help is offering compassion and empathy, and listening to understand.  I know I have said and written it many times, and I know many will argue that now is not the time to ‘get soft.’  But believe me, practicing love in the face of hate is anything but soft.  Let me share some resources that illustrate this, and that hold me up.  This is a very long post, and I hope you will stick with me ‘til the end.

Ai

Agape Love

Maria Popova, curator of the illuminating blog Brain Pickings, inspires me with her summary of Dr. Martin Luther King’s 1958 essay “An Experiment in Love.”  I refer to this article often since January 20.  Dr. King explores six tenets of nonviolent resistance (below).  It reminds me that while I vehemently oppose bigotry, racism, sexism, misogyny, xenophobia, and fascism, I can do it with a peaceful heart, full of love for humanity, and with faith that even my small contribution of said love can make a difference.  Here are the highlights of her piece, MLK’s words quoted:

  1. Nonviolent resistance is not passive cowardice. “For while the nonviolent resister is passive in the sense that he is not physically aggressive toward his opponent, his mind and his emotions are always active, constantly seeking to persuade his opponent that he is wrong. The method is passive physically but strongly active spiritually. It is not passive non-resistance to evil, it is active nonviolent resistance to evil.”
  2. The goal is connection. “Nonviolence … does not seek to defeat or humiliate the opponent, but to win his friendship and understanding. The nonviolent resister must often express his protest through noncooperation or boycotts, but he realizes that these are not ends themselves; they are merely means to awaken a sense of moral shame in the opponent. The end is redemption and reconciliation. The aftermath of nonviolence is the creation of the beloved community, while the aftermath of violence is tragic bitterness.”
  3. Separate the people from problem (as William Ury et al would say). “The attack is directed against forces of evil rather than against persons who happen to be doing the evil. It is the evil that the nonviolent resister seeks to defeat, not the persons victimized by the evil… [Regarding racial injustice:] We are out to defeat injustice and not white persons who may be unjust.”
  4. Be prepared to pay the cost. “The nonviolent resister is willing to accept violence if necessary, but never to inflict it. He does not seek to dodge jail.”
  5. Manage thyself. Do not allow yourself to descend to the depths of hate while you fight hate itself.  Cultivate love instead.  “The nonviolent resister not only refuses to shoot his opponent but he also refuses to hate him. At the center of nonviolence stands the principle of love…To retaliate in kind would do nothing but intensify the existence of hate in the universe. Along the way of life, someone must have sense enough and morality enough to cut off the chain of hate. This can only be done by projecting the ethic of love to the center of our lives.  This is Agape love…  Agape means understanding, redeeming good will for all men. It is an overflowing love which is purely spontaneous, unmotivated, groundless, and creative… Another basic point about agape is that it springs from the need of the other person… The Negro must love the white man, because the white man needs his love to remove his tensions, insecurities, and fears… Agape is not a weak, passive love. It is love in action… Agape is a willingness to go to any length to restore community… It is a willingness to forgive, not seven times, but seventy times seven to restore community.”
  6. Hope.  “Nonviolent resistance … is based on the conviction that the universe is on the side of justice. Consequently, the believer in nonviolence has deep faith in the future. This faith is another reason why the nonviolent resister can accept suffering without retaliation. For he knows that in his struggle for justice he has cosmic companionship.”

moths on poop

10 Ways to Fight Hate

One of the first pieces I read after the events on Saturday was this article from the Southern Poverty Law Center, listing ten ways to fight hate.  So while I carry that peaceful heart full of Agape love, these are the concrete things I can do right now (highlights quoted):

“The good news is, all over the country people are fighting hate, standing up to promote tolerance and inclusion. More often than not, when hate flares up, good people rise up against it — often in greater numbers and with stronger voices.”

  1. Act
  2. Join Forces
  3. Support the Victims
  4. Speak Up

“Do not debate hate group members in conflict-driven forums. Instead, speak up in ways that draw attention away from hate, toward unity.

“Goodness has a First Amendment right, too. We urge you to denounce hate groups and hate crimes and to spread the truth about hate’s threat to a pluralistic society. An informed and unified community is the best defense against hate.

“You can spread tolerance through social media and websites, church bulletins, door-to-door fliers, letters to the editor, and print advertisements. Hate shrivels under strong light. Beneath their neo-Nazi exteriors, hatemongers are cowards and are surprisingly subject to public pressure and ostracism.

  1. Educate Yourself

“Most hate crimes…are not committed by members of hate groups; the Southern Poverty Law Center estimates fewer than 5 percent. Many hate crimes are committed by young males acting alone or in small groups, often for thrills. While these perpetrators may act independently, they are sometimes influenced by the dehumanizing rhetoric and propaganda of hate groups.”

  1. Create An Alternative

“Do not attend a hate rally. As much as you might like to physically show your opposition to hate, confrontations serve only the perpetrators. They also burden law enforcement with protecting hatemongers from otherwise law-abiding citizens. If an event featuring a hate group, avowed separatist or extremist is coming to your college campus, hold a unity rally on a different part of campus. Invite campus clubs, sororities, fraternities and athletic organizations to support your efforts.

“Every act of hatred should be met with an act of love and unity. Many communities facing a hate group rally have held alternative events at the same hour, some distance away, emphasizing strength in community and diversity. They have included forums, parades, and unity fairs featuring speakers, food, music, exhibits, and entertainment. These events give people a safe outlet for the frustration and anger they want to vent. As a woman at a Spokane, Washington, human rights rally put it, “Being passive is something I don’t want to do. I need to make some kind of commitment to human rights.”

  1. Pressure Leaders

Form relationships with community leaders before a hate incident occurs.

Encourage leaders to name the problem.

Push leaders when they show bias or fail to act. [And do it respectfully—ad hominem never helps.]

  1. Stay Engaged
  2. Teach Acceptance

“Bias is learned in childhood. By age 3, children can be aware of racial differences and may have the perception that ‘white’ is desirable. By age 12, they can hold stereotypes about ethnic, racial, and religious groups, or LGBT people. Because stereotypes underlie hate, and because almost half of all hate crimes are committed by young men under 20, tolerance education is critical.”

  1. Dig Deeper

“Look inside yourself for biases and stereotypes.

“We all grow up with prejudices. Acknowledging them — and working through them — can be a scary and difficult process. It’s also one of the most important steps toward breaking down the walls of silence that allow intolerance to grow. Luckily, we all possess the power to overcome our ignorance and fear, and to influence our children, peers, and communities.”

VICE screenshot

Breathe Deep, Stay on the Path, and Engage

How would you confront a white supremacist in person, face to face?  Would you share a meal with him/her?  I saw this video clip on Facebook, of a young Chinese-American man, Eddie Huang, sitting down to dinner with Jared Taylor, an older, white nationalist man, and founder of American Renaissance, to discuss Taylor’s perspective.  The American Renaissance site espouses genetic differences in intelligence and the propensity to commit crimes between races, among other things.  Taylor states that historically, Europeans have “killed more people per capita” than any other group, and attributes this to them being “more technologically advanced.”  He voted for 45 because his policies would “slow the dispossession of whites in America.”  He says he wants to keep whites a majority in the United States, or else they “no longer control our own destiny.”

I imagined myself in Eddie’s shoes, and I could not fathom how I could stomach this conversation while eating.  Actually I think he stops, while Taylor continues to eat—Chinese food.  I don’t know anything about Eddie Huang other than what I see in this video, and I admire him.  He sits down and engages respectfully, thoughtfully, and firmly, with a person who basically thinks he does not deserve to be an American.  Could you do that?  I’m not sure I could.  And what would the world be like if we all trained to do exactly this?

Thank you for reading to the end.  My point here is that we can oppose and resist more effectively than with rage, shame, and violence.  I know I won’t make everybody put down their clubs and fists with my small words, but this is where I stand, and I commit to speaking my stance as much and as loudly as possible.  I pledge to do my best always to profess what I am for, more than what I am against.  I commit to a practice of Agape love, Radical Acceptance, Mindfulness, and Peaceful, Respectful Activism.  I would love your company on this journey.

 

Love You Into Being

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A couple of weeks ago I met my new medical students.  These 10-12 trainees will be my small group for the next two years.  We will meet monthly to discuss the soft stuff of medical training—hierarchy, tribalism, death and dying, medical errors, difficult patients, etc.  Some call it “third year medical student support group.”  This is my 6th year of the pleasure and privilege (I inherited my first group halfway through, when their previous preceptor moved out of state).

With each successive group I am ever more amazed at the students’ level of insight.  They articulate compassion, humility, and maturity that I don’t think I had at their level of training. Or maybe it’s because we did not have classes like this to explore such things when I came up (or maybe I don’t remember?).  More and I more I see my role as facilitator more than teacher.  I am not here to impart medical knowledge.  Rather, it is my job to stimulate exploration, conversation, and meaning.  It’s so freeing, really—there is no standardized test to teach to.  And yet I see it as my responsibility to help prepare these gifted young people to face the greatest challenge and reward of the profession: human relationships.

I feel no fear or trepidation.  We cannot ‘fail’ at this class, any of us.  Because the point of it is simply for everybody to participate, contribute, consider, and learn—myself included.  Each month the students are given questions to answer in the form of a blog post.  For example, “Recall an example of inspiring or regrettable behavior that you witnessed by a physician.  Describe the situation, and its impact on you, the team, and/or the patient.”  I read them all and facilitate discussion, tying together common themes and asking probing questions.  My primary objective is to help them maintain the thoughtfulness and humanity that led them to medicine in the first place.  Medical training has evolved in the past 20 years, for the better in some ways, not so much in others.  One way we do much better nowadays is recognizing the hidden curriculum, and shining light on its effects, both positive and negative, through classes like this.

We all have those teachers who made a difference in our lives—or at least I hope we all do.  I have multiple: Mrs. Cobb, 4th grade; Mr. Alt, 7th grade math; Ms. Townsend (now Ms. Anna), 7th grade English; Ms. Sanborn, 7th grade social studies; Mrs. Stahlhut, 9th grade geometry; Mrs. Summers, 10th grade English; Coach Knafelc, varsity volleyball; Dr. Woodruff, primary care preceptor; Dr. Roach, intern clinic preceptor; Dr. Tynus, chief resident program director.  My mom is one of these teachers, also.  She leads nursing students in their clinical rotations.  I have seen her student feedback forms—they love her.  And it wasn’t until I heard her talk about her students that I realized why they love her and what makes her so effective—she loves them first.  Teaching is often compared to parenting.  Our parents, at their best, see our potential and love us into our best selves.  They cheer us, support us, redirect us, and admonish us.  They show us the potential rewards of our highest aspirations.  If we’re lucky, they role model their best selves for us to emulate.

All of my best teachers did (do) this for me.  I’m friends with many of them to this day, and I still learn from them in almost every encounter.  I love them because I feel loved by them.  They held space for my ignorance and imperfections.  I always knew that they knew that my best self was more than the last paper I wrote, the last test I aced, or the last patient encounter I botched.  To them, my peers and I were not simply students.  We were fellow humans on a journey of mutual discovery, and they were simply a little farther along on the path.

This is my aspiration as a teacher, to live up to the example of all those who loved me into the best version of myself today.  This kind of love allows for growth and evolution, from student to colleague, to friend, and fellow educator.  This is not something attending physicians typically express to medical students, positive evolution of medical education notwithstanding.  But when I met this new group, I was overcome by love for them.  So I told them.  “If you take away nothing else from our two years together, I want you to have felt loved by me.  I wish to love you into the best doctors you can be.  That is my only job here.”  Or something like that.  It was impulsive and possibly high risk.  But it was the most honest thing I could say in that moment, my most authentic expression of my highest goal for my time with them.  I only get to see them once a month, and I want them to be crystal clear about what I am here to do.  We have lots to cover these two years, so much to learn and apply.  And love is the best thing I can offer to hold us all up through it.

Support for the Inner Work

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Things were a little crazy this week.  I have an idea for a post and still have not sat down to write it out.  But I want to share something that came out on my Facebook page (of course) tonight.  One of the reasons I love writing is that insights pop out when you least expect them.  Writing exchanged with others is even better, because those insights are then shared, and their meaning amplifies.

I posted this article from the Washington Post yesterday: “Nearly half of liberals don’t even like to be around Trump supporters.”  It’s a summary of a recent Pew Research Center survey, which finds that 47% of liberal Democrats “say that if a friend supported Trump, it would actually put a strain on their friendship.”  It posits, among other things, that liberals are less tolerant of dissenting ideas because they are clustered in urban areas, lending to louder echo chambers.  By contrast, only 13% of Republicans answered that “a friend’s support of Hillary Clinton would strain their friendship.”

From the survey report:…Nearly nine months after the election, most people (59%) say it is ‘stressful and frustrating’ to talk about politics with people who have a different opinion of Trump than they do; just 35% find such conversations ‘interesting and informative.'”

I consider myself a socially heavily left-leaning, fiscally centrist Independent, but I identify more with liberals than conservatives, by a large margin.  This article made me sad, that my ‘tribe’ shows itself to be much more intolerant and judgmental than I would like.

I posted this comment along with the article:

Ooohh, so much data here, so much potential for blame, and also for self-exploration. Humbling, no question.
“Be extra kind with your comments on this one please, friends. No need to reopen barely scabbed wounds. I mean for my page to be a safe place for all of us to engage. We are all in it together, and the sooner we *all* figure out how to deal with 45 and one another, the better we will all be.
“Also, I’m bummed that Asians are always left out of the data set.”

I got some comments from my liberal friends about how hard it is to talk to Trump supporters, so much so that they avoid talking politics with those friends altogether.  But one friend exemplified my aspiration for all of us.  She wrote:

“… I recently had dinner with a very close friend who voted for Trump. Typically I think I’m a really good listener, listening with curiosity and a desire to raise the conversation and all involved to a higher level. However, when our conversation turned to politics I found myself cutting her off, getting defensive and bordering on being critical of her. I was horrified by my own behavior. I think this article hits on it – the support or opposition of Trump feels like less of a political stance and more of a statement of a person’s values and morals. I don’t think that’s necessarily true- I think a large population of Trump voters (my friend included) were actually voting against Washington more than for Trump. While I can’t get behind Trump I can get behind a vote to change the system. I wonder what might happen if more of us looked for what we can stand behind together?! Thank you for continuing to be a voice for this movement!”

Exactly!  Immediately I felt connected to my friend in a higher calling, and a shared struggle.  I replied:

“(My dear friend), I derive so much of my strength and curiosity from you. How many of us can own up publicly about our own flaws and failures, like you did here? And I know you know I use the word failure in the most empathetic and loving, mutually understanding way. I think that is the first step–complete humility and openness to our own imperfection. It’s so fucking hard. And I’m so lucky to have friends like you, (these four other dear friends), and others… I know now, better late than never, that we cannot do this work without unwaveringly reliable support, no matter how motivated we are.  And for those of us who are already well-supported, I think it’s our responsibility to look outward and support others. You never know when or where someone may be standing on the edge of openness, and when your small gesture of encouragement may nudge them on. Thank you for your loving support, my soul sister!”

It really is true, we cannot dig deep and bring out our best selves by ourselves.  We are meant to hold one another up and accountable, to bring out the best in each other.  It breaks my heart when I interview patients, and learn how sparse and frail their emotional support networks are.  There is no stereotype for this scenario, it can happen to the best of us.  Past experiences, circumstances, timing, life events—they can all combine to undermine our relationships, thereby weakening our capacity for self-awareness and exploration.  So we fall back on default modes of defensiveness, righteousness, denial, and blame.  Whether it’s quitting smoking, sticking to a healthy eating plan, or elevating our political discourse, we are truly stronger together.

I share this tonight because I so admire my friend for owning her whole self.  I am so grateful to her for sharing her imperfections and vulnerability with humility and hopefulness.  She gives me strength to keep going, despite how fucking hard it is.  And I hope I can do the same for many, many others.

Walking the Talk

BVF ben downhill

The Journey and the Struggle

18 months ago I wrote about my plan for maximizing menopause preparedness.  As with so many missions, this one has experienced both successes and failures.  Since January 2016, I have grooved my exercise routine in the most awesome way.  I am all over the TRX, doing Spiderman push-ups, incline presses, pistols and more.  I get my cardio intervals and I’m foam rolling.  I feel stronger now than at any time since high school, and I’m proud of this accomplishment.

*sigh*

The eating, on the other hand, continues to be a challenge.  Earlier this year a patient looked at me without expression, and stated bluntly that I had gained 8.7 pounds since the last time he saw me.  Right after that’s kind of inappropriate, I thought, well, he’s right, I have been gaining weight.  Last March I wrote about weight loss strategy, thinking mainly about my exercise habit formation.  Sadly, my own weight has gone opposite to the desired direction, despite an honest attempt at adherence to my own advice.  Evidence suggests that weight loss really is about 80% diet and 20% exercise.  But sometimes you can only focus on one thing at a time.

Back in 2008, when I finished nursing, I thought, I can get my body back!  I knew I was not going to exercise, and I had no energy to police my food choices.  But I also knew I was eating too much, so I decided to just cut my portions in half.  It felt easy, decisive, and empowering.  I lost 25 pounds in 9 months, and got down to my wedding weight.  But eventually I acknowledged that though I was thin, I was squishy.  So I connected with my trainer in 2014, the primary goal being to get moving without injuring myself.  Right now I’m up 17# since my nadir in 2009, though I’m much more fit than the last time I lived at this weight.

Talking the Walk

I’ve always had a love-love relationship with food, and it shows in my weight/habitus.  I notice also that my own state of mind and body has influenced the advice I offer to patients.  Before I exercised regularly I spoke to patients a lot more about diet; now it’s more balanced.  One patient brought it up recently.  He asked, “What about the doctors who smoke, or the obese ones, how can they advise anybody about healthy habits?”  I’ve thought a lot about it, so I was ready to answer.  To me, there are three main options, all of which I have tried.

Disclaim.  We doctors can rely on our authority to tell people what to do to get healthier.  They notice our fat rolls, or smell cigarette smoke on us.  They see the dark circles under our eyes and surmise that we don’t sleep enough.  Maybe they can tell we don’t exercise.  But we admonish them to eat less and move more.  We say (subconsciously) to ourselves, “Do what I say, not what I do.”

Avoid.  Rather than give lifestyle advice at all, we can focus on prescriptions and referrals.  We feel we have no place instructing patients to eat more leaves, go to the gym, or quit smoking, when we don’t even do so ourselves.  So we don’t even bother, feeling like hypocrites.

I think both of these responses are rooted in shame and perfectionism.  And I think we should not fault physicians for choosing them—that would be meta-shaming–never helpful.  These are normal, human responses to our professional training and expectations.  Physicians have long held positions of authority and expertise.  Until very recently, our relationships with patients were mostly paternalistic.  But with burgeoning access to information, a culture evolving (rightly) toward patient autonomy, and physicians experiencing historically high levels of burnout and suicide, we cannot afford to burden ourselves with the illusion that we must be perfect in order to be credible.

Connect.  I think the healthiest response, for both patients and physicians, is for us doctors to acknowledge our own struggles; to empathize with the difficulty, the conflict, and the utter disappointment of not being able to control our actions and choices as we would like.  I think patients don’t expect us to be perfect.  But they do want us to be human and relatable.  I often find myself saying, “I know that feeling,” or, “Yep, that’s my weakness, too,” or, “Oh, and what about x-y-z?  That’s my problem!”  Only once has a patient said to me, “Shame on you!”  He was a perfectionist himself; I didn’t take it personally.

I stress eat. I eat when I’m bored.  I eat late at night, and I love sugar, starch, salt, and fat.  The struggle is real, and I know it all too well.  So when I ask you, “What small changes can you commit to in the next month?” believe me, I’m asking myself also.  And if you tell me something that has worked for you, I’ll probably try it.  I still think my ‘4 A’s of goal setting’ apply: Assessable, Actionable, Attainable, and Accountable.  I just haven’t found my 4A formula for eating yet.  But lately I have taken a more lighthearted approach to healthy eating trials.  Nothing is life or death, and I know iterative changes are best.  If one thing doesn’t work, hopefully I can learn something and move on to the next.  No dessert on weekdays.  Vegetarian on days I work.  No eating after 8pm.  No starch at dinner…  Meh, none of it seems to stick yet.  Even my cut-it-in-half strategy doesn’t appeal to me these days.  It’s so frustrating!  And it’s also okay, because I know I’m doing my best, just like my patients are.  We can all just take it a little more lightly, one step at a time.

So by the time menopause actually hits, I’m confident that I will be prepared to meet it, with grace and maybe a little irreverence.  I’m learning to judge myself (and thus others) a little more gently.  I’m learning to love my body, whatever shape it’s in.  After all, it’s the only one I’ll have this time around, and I need to maintain it for the long haul.  Turns out, my patients have been my best companions and consultants on the journey.

 

 

 

 

“Friendversary”

IMG_2341

It’s all worth it, hallelujah!

Those of you who read this blog regularly know that I spend inordinate amounts of time on Facebook.  I struggle with the balance–hours spent face to phone reading articles, engaging with friends over politics, healthcare, and nature photos, and also work, chores, and quality time with the family.  One of the people I interact with most meaningfully online is a high school classmate.  He and I were friendly acquaintances back then, and I assumed at graduation that I would never see him and most of my classmates again.  I will call him Al.

A while ago, through a mutual Facebook friend, I saw a post by Al saying that he wished to have civil conversations on politics with people who did not share his views.  I immediately sent a friend request, which he promptly accepted.  My rule is that I will be friends with people on FB who are already my friends, or with whom I want to actively cultivate friendships.  Al was definitely the latter, based solely on his proclaimed desire for civil discourse.  This week was our two year Facebook Friendversary.  I know because he shared the notification, which I had not received.

In the first year our exchanges could be awkward, and sometimes felt tense (on my end).  I noticed that while I often asked him to elaborate on his thoughts and positions, he rarely asked me.  I often felt unheard and lectured to.  I considered giving up on the relationship.  Why bother, I thought, we live in separate states, we disagree on everything, and it’s just too stressful—I’m not even sure he cares what I think.  A year ago I posted about a conversation we had about white male privilege.  I decided to maintain our online friendship because despite the tension and discomfort, the exchange had given me new insights into managing the tension and discomfort.

These two years we have discussed transgender bathroom legislation, affirmative action, unconscious gender bias, racism, and climate change, among other things.  We have always been civil, and conversations feel more relaxed and congenial these days.  Al types more words now than he used to, he asks me what I think about things, and has expressed more consideration for my point of view in this second year.  It moved me when he wrote that when his coworker came to work distraught and crying over the presidential election, he hugged her.  [For the record, my friend is a Republican and not necessarily a Trump supporter.]  Throughout our intereactions, I have always remembered my fundamental assumptions of this man, whom I don’t actually know that well: That he is a kind and honest person, that he wants all people to enjoy happy, healthy lives, that he has natural unconscious biases as I do (and these do not make us bad people), and that he is sincerely interested in my point of view.

Our most recent exchange almost brought me to tears because I finally felt fully seen, heard, and understood by this person who barely knew me 25 years ago, lives 800 miles away, and whose life experiences lie surely on the other end of any spectrum from mine.  I share the thread below.

So many people decry social media, and rightfully so.  It’s too easy to descend into mindless flaming and impulsive ad hominem attacks from the safety of a screen and keyboard.  And I still struggle with the time sink and distraction.  But today I feel good about my SoMe usage.  To me, this two year, ‘virtual’ friendship I have cultivated feels as real as any other.  I hope Al feels similarly.  I look forward to the next two years and beyond on Facebook, and perhaps an in-person encounter in the foreseeable future.

***

On Being Wrong

CC:  OH MY GOD YEESSS!!
If you are serious about or remotely interested in self-awareness and connecting better with your fellow humans, understanding this idea, even if only intuitively, is a fundamental requirement.

https://wwwted.com/talks/julia_galef_why_you_think_you_re_right_even_if_you_re_wrong

[Julia Galef’s TED talk on soldier vs. scout mindset, and how holding either influences how and whether we examine our beliefs]

 

AL:  Have you seen this?

https://www.ted.com/talks/kathryn_schulz_on_being_wrong

[Kathryn Schultz’s TED talk on embracing our fallibility]

 

CC:  I have not!  Will view soon!

AL:  I eagerly await your thoughts on it. It’s dang near life changing.

CC:  I watched it! And I will happily tell you my thoughts, but since you posted it and made the ‘damn near life changing’ claim, I request that you go first. And if you could also comment on the talk from the original post–feel free to go all expository–that would be great, also! I promise to reply in kind!

AL:  It was the line that feeling wrong is the same a feeling right. And the idea at how unreliable your feelings are. But I really like questioning one’s sense of rightness.

CC:  Follow up question: how has this talk changed your own approach to ‘feeling right,” or how you engage with people with whom you disagree?

AL:  I can’t say I’ve completely abandoned my feeling of rightness. It’s just so nice to feel right. But I try to loosen my grip on the feeling of rightness and make fewer assumptions.

CC:  Thank you. I hear you, it is so delicious to feel right–to feel *righteous*… And I like this, “loosen my grip on the feeling of rightness” (and righteousness?). What assumptions are you making less, may I ask?

AL:  I can’t think of general areas right off the top of my head. But more often than before I try to remind myself I don’t have all the facts and there could be something I don’t know. This has to do more with interpersonal interactions. Like I try not to act on my initial assumption of someone else’s motivations.

[I ‘loved’ this reply]

 

CC:  I am not sure you could ever know how happy it makes me to read this. This is all I ever want from people–to just slow down, withhold judgment *a little*, especially about one other’s motivations. It has taken me too long to learn that everybody has a unique and VALID personal story, and that elements of that story always influence how we approach any problem or circumstance, for better or worse. The more open we can be to one another in this way, the fewer and less contentious our conflicts will be, I am CONVINCED. And, it’s sooooo much easier said than done. And, the first step is an awareness of its importance. The second step is an intention and commitment to practice, no matter how many times we fail, and/or others fail. I have to go see a patient now… Maybe I’ll write more. But really, I’m almost in tears right now. I feel vindicated, in a way. Thank you.

[Al ‘loved this reply.]

Everyday Power and Influence

Wailea beach

If you wonder how physicians think and feel, about anything and everything related to medicine, healthcare, economics, parenting, relationships, and life in general, check out KevinMD, an expertly curated blog by physicians all around the world.  I recently read a heartening and important piece on gender equality in medicine.  A pediatrician husband wrote about the stark differences in assumptions about work-life balance for men and women, in “What Does Your Husband Think of You Being a Surgeon?”  Then I came across another article by a male cardiologist, whose wife is also a physician, entitled, “The Gender Gap in Cardiology Is Embarrassing.”  Both men’s wives delayed their medical training, and these husbands bore witness to our culture’s implicit gender bias against their life partners.  I strongly encourage you to read both pieces; they are short and poignant.

—- Please click on the links and at least skim the articles, before continuing here. —-

Now, consider how much more weight and influence these pieces carry, simply because they are written by men.  If you find this difficult, imagine your internal response if they had been written from the women’s perspectives.  Which position is more likely to evoke, “Hmm, interesting,” as opposed to, “What are these women whining about?”

When we consider advocacy, it’s fair think of it as those with more power and influence using these advantages to champion those who have less.  Sure, the less powerful and influential can and do advocate for themselves, but without allies among the advantaged, the message and movement stall and stutter.  Consider slavery and the Civil Rights Movement.  If it were only ever black people advocating for themselves, what would the American racial landscape would look like today?  Think about women’s rights.  There is a reason the United Nations launched the HeforShe campaign.  Self-advocacy is required, but sorely inadequate, to lift people out of oppression.  And let’s be clear: oppression takes many forms, which we often fail recognize or acknowledge.

I have a fantasy about patients advocating for physicians.

I imagine Sally and John*, two friends communing at their favorite coffee shop, one of their regular meetings of mind and soul.  The conversation veers toward healthcare, and Sally starts ranting about how physicians don’t care about patients anymore.  They’re only in it for the money, having sold out to pharma and industry, and they think of themselves as second only to God him(her)self, exercising control over patients’ lives with little regard or actual caring.  In this coffee shop scenario, I as physician have no power or influence.  If I sat there with them, trying to explain how ‘the system’ drives wedges between us doctors and our patients, about how on average doctors spend twice as much time on administrative activities as patient care activities, how 50% of us report burnout, and how our suicide rate is up to 4 times that of the general public, I estimate that I’d likely be seen as whining and making excuses.  In this scenario, facing a (rightfully) prejudiced audience, my voice counts for very little.

Although physicians still enjoy a fair amount of respect and deference in society, our struggles, personal and professional, are still poorly understood by the general public.  I think people are even less cognizant of the insidious and profound detriment that physician burnout and depression have on patient care and the economy at large.  But when doctors describe our adversities to patients, I think we still come across as whining.  Knowing that I write this as a physician, what is your reaction?  Is it closer to, “You live at the top of the food chain, what are you complaining about?” Or rather, “Wow, what’s going on that so many doctors feel so badly, and how could we all help one another?”

Lucky for doctors everywhere, John is my patient and we have a longstanding, collaborative relationship.  He empathizes with Sally’s perspective, as he knows what she has been through medically.  He has also inquired about my work, and understands the systemic frustrations that physicians face in all fields.  Because they are such good friends, John feels comfortable challenging Sally’s skewed assertions.  He describes what he has learned from me, and explains earnestly that all doctors are not, in fact, swine.  Because he is her trusted confidant, she believes him.  Her attitude opens ever so slightly, and she is more likely to acknowledge how physicians and patients alike suffer from our overall healthcare structure.  John is, in this case, the strongest advocate for me and my ilk.

Whenever one of us stands up as a member of a group, and speaks up to our peers on behalf of another group—white people for black people, men for women, Christians, Jews, and Muslims for Muslims, Christians, and Jews, liberals for conservatives, physicians for patients, and vice versa in each case—we are all elevated.  Our mutual compassion and humanity are called forth to heal our divisions.  This is how personal advocacy, how everyday power and influence, works.

As a patient, you have more power than you may realize.  I bet most people don’t necessarily feel adversarial toward doctors.  But they probably don’t necessarily feel allied, either.  What can you, as a patient, do to bridge this gap?  How else could we all, physicians and patients alike, create that essentially healing inter-tribal connection?

*Hypothetical friends