Fear, Ego, and Control

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NaBloPoMo 2018:  What I’m Learning

In this post I will attempt to describe some exciting connections between readings from the Harvard Business Review, Dr. Anthony Suchman and colleagues, and Carol Dweck.

An HBR article landed in my inbox this week, catching my inner Imposter’s attention.  The title, “Ego is the Enemy of Good Leadership,” triggered my ‘Is that me?’ reflex.  Because much of the time, I think I’m a pretty good leader (“I’m awesome”).  But I’m forever fearful that my ego will get the best of me and make me exactly the kind of leader I loathe (“I suck”).  I saved the article to read later.

Meanwhile, I continued to Chapter 3 of Leading Change in Healthcare: Authentic, Affirmative, and Courageous Presence.  Basically this chapter deals with earning and building trust.  Chapter subsections include self-awareness, reflection, emotional self-management, clarifying one’s core beliefs, and accepting oneself and others.  In the part on core beliefs, the authors reference Dr. Suchman’s 2006 paper, “Control and relation: two foundational values and their consequences.”  In it, he differentiates between these two ‘foundational world views’:

Control

The beliefs, thoughts and behaviors of the control paradigm are organized around a single core value: that the ultimate state to which one can aspire is one of perfect willfulness and predictability. What one desires happens, with no surprises; all outcomes are intended. For the clinician, the control paradigm is expressed in the questions, ‘‘What do I want to happen here?’’ and ‘‘What’s wrong and how do I fix it?’’  Personal success or failure is judged by the clinical outcome, the extent to which one’s intended outcome was realized.

Relation

In the relation paradigm, the most valued state to which one aspires is one of connection and belonging. In this state, one has a feeling of being part of a larger whole – a team, a learning group, a dance troupe, a community, even the world itself. One’s individual actions seem spontaneously integrated with those of others to a remarkable degree, contributing to the evolution of a higher order process, i.e. one at a higher system level than that of the individuals of which it is comprised…  One asks the question, ‘‘What’s trying to happen here?’’ and, according to one’s best approximation of an answer, seeks to shape others and the world while also remaining open to being shaped oneself. This balance between control and receptivity puts one in the best possible position to recognize and make use of serendipitous events.

In Leading Change the authors write about control, “…This is a fear-based paradigm in which one trusts oneself more than others and holds tightly to power…  It predisposes leaders toward dominance, distracts them from cultivating relationships and leads them to set unrealistic expectations of control.”  And about relation, “This is a trust-based paradigm, anchored in the belief that the sources of order, goodness and meaning lie beyond one’s own creation…  It predisposes leaders to do their best in partnership with others, to attend to the process of relating and to personal experience (their own and others’) and to remain open to possibility.”

When I finally read the HBR article, the message about ego reflected the control paradigm:

Because our ego craves positive attention… when we’re a victim of our own need to be seen as great, we end up being led into making decisions that may be detrimental to ourselves, our people, and our organization.

When we believe we’re the sole architects of our success, we tend to be ruder, more selfish, and more likely to interrupt others. This is especially true in the face of setbacks and criticism. In this way, an inflated ego prevents us from learning from our mistakes and creates a defensive wall that makes it difficult to appreciate the rich lessons we glean from failure.

The ego always looks for information that confirms what it wants to believe [confirmation bias].  Because of this, we lose perspective and end up in a leadership bubble where we only see and hear what we want to. As a result, we lose touch with the people we lead, the culture we are a part of, and ultimately our clients and stakeholders.

Going to bed last night, I wondered, “Is Fear actually driving when we see Ego in charge?”  I think the answer is undoubtedly yes, but it’s more complex than that.  It’s not a fear that we feel consciously, or that we are even aware of.  It’s not sweaty palm, palpitative, panic attack fear.  Rather it’s a deep, visceral, existential fear—of being found out, of not being enough—akin to imposter syndrome, if not exactly that.  Control, Fear, Ego—they all seem lump-able with/in the Fixed mindset, as described by Carol Dweck.  The simplest example of this mindset is when we tell kids how smart they are, they then develop a need to appear smart, lest they lose their identifying label.  So they stop taking risks, trying new things, risking failure.  Their experiences narrow as they, often inadvertently, learn that control of outcome and outward appearance of competence is the primary objective of any endeavor.

Back in August I listened to Dweck’s book, having heard about it and already embraced its theory in the last few years.  I had already started making the connection between fear and fixed mindset, but this day I saw a sudden, reciprocal relationship between fixed mindset, confirmation bias, and imposter syndrome.  I love when these lightning bolt moments happen—I was in my car on the way to work, and this triad came to me.  As soon as I parked and turned off the engine I tore into my bag for the journal I carry with me everywhere and scrawled the diagram as fast as I could, as if the idea would evaporate if I didn’t get it down in ink.  Later I added the comparison to Growth mindset—holding space for learning, integration, and possibility.  I held it in mind for a while, and then forgot it (which is okay—that’s why I wrote it down!).  Then today, putting together this post in my head, I remembered it with excitement.

8-31 triad update

The point of it all is that we are at our best, both individually and as groups, when we are in right relationship with ourselves and one another.  It all starts with relationship with self.  If I live in fear of being found out as flawed or imperfect, then I project that fear onto others.  I act out in an effort to control how others perceive me—when in reality I have no control over that whatsoever.  The negative perception of my ‘Ego’ by others then provokes myriad responses including fear, insecurity, false deference, resentment, disloyalty, and subversion, and the team falls into disarray.  If, on the other hand, I cultivate self-love and connection with others, I never feel that I am going it alone.  I am an integral member of a high-functioning, mutually respectful team, one in which I can admit my weaknesses and maximize my strengths.  We all feel confident that we can handle whatever adversity comes our way, and we rise to each and every occasion–together.

I’m still putting it all together, working out how it translates into daily behaviors, actions, and decisions.  For now I’m definitely paying closer attention to my feelings, especially in conflict, and taking a lot more deep breaths before speaking or replying to triggering emails.  I ask a lot more clarifying questions.  I try to make the most generous assumptions about people’s intentions, and remember always that we are on the same team—Team Humanity.

More learning happening around the clock, I say!  Hoping to articulate better in the sharing hereafter…

What do you think about all of this, does it make any sense at all??

Debate Prep

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Debate Prep

NaBloPoMo 2018:  What I’m Learning

Families gathering for Thanksgiving present a perfect opportunity to practice some excellent communication skills.  How we each show up—generous, combative, kind, resentful, curious, or judgmental—will determine our experience and that of those around us.

For this post, I refer to a short, accessible list of tips for conducting ourselves optimally among friends and family with whom we disagree.  It’s from The American Interest in February 2016, “The Seven Habits of Highly Depolarizing People” by David Blankenhorn.  I recently joined an organization he founded, Better Angels, “a bipartisan citizen’s movement to unify our divided nation.”  I list here his 7 habits and my interpretation thereof.

1.      Criticize from within.  “In other words, criticize the other—whether person, group, or society—on the basis of something you have in common.”  This is where DB invokes Abraham Lincoln’s reference to “the better angels of our nature” in his first Inaugural address.  Honestly I don’t know what he means here, but I have decided to take it as a recommendation to find common ground.  For instance, maybe we can all agree that our current healthcare system is deeply flawed and needs reform, and start our debate there.

2.      Look for goods in conflict.  Rather than accepting any false dichotomy of all good and right (your position) versus all bad and wrong (my position), which is the definition of polarizing, we can look for what’s good and right on both sides.  As a progressive, my opinions and positions revolve around inclusion, equality, and lifting up the oppressed.  I imagine my conservative friends’ chief concerns are individual autonomy, personal responsibility, and preservation of traditions.  If we withhold our usual default judgments of one another, we can recognize the importance of each and all of these core values.  We can also hold space for how they sometimes compete and conflict.

3.      Count higher than two.  Again, away with the false dichotomies and binary, all-or-nothing thinking.  We can do better than oversimplified arguments like single payer versus free market healthcare, or “You want a capitalist free for all” versus “You want to strangle us all with regulations.”  This point feels like a natural progression from the first two.  If we can first agree on some common perspectives, and allow that the ‘other side’ has at least one valid point of view, then we may be more likely to look together toward a more nuanced conversation/negotiation about potential solutions.

4.      Doubt.  This one is about humility.  We must practice holding space for the possibility that we don’t know everything, that we could be wrong about something, or a lot of things.  This is admitting that we each always have something to learn, and we may need to evolve and adapt our position based on some new learning.  “Doubt—the concern that my views may not be entirely correct—is the true friend of wisdom and (along with empathy, to which it’s related) the greatest enemy of polarization…  Doubt often supports true convictions based on realistic foundations, just as doubtlessness is nearly always an intellectual disability, a form of blindness.”

5.      Specify.  Avoid and shun overgeneralization.  Blankenhorn invites us to consider four ways to do this.

a.      Practice a “persistent skepticism about categories.”  Left and Right, Conservative and Liberal, even Republican and Democrat—avoid labeling as if all members of each of these categories or groups are carbon copies of all others.  “It’s… worth remembering that, in many cases, creative and categorical thinking are at odds with each other.”  Think about your friends who listen to both country and hip hop music, or those who are socially liberal and fiscally conservative.  Pigeonholing serves nobody.

b.      Consider each issue separately and on its own terms.  Avoid applying broad and heavy ideological frameworks to topics like healthcare, gun violence, immigration, or LGBTQ rights.  Again, this practice depends on the other habits: finding common ground, counting higher than two.

c.      Privilege the specific assertion (including the empirically valid generalization) over the general assertion.  To me this means evidence.  It means objective data; we must find facts that we agree to be demonstrably true, on which we agree to found our debate.  We are allowed to have and state our opinions, but we must acknowledge that they are opinions and not necessarily empiric truth.

d.      Rely first and foremost on inductive reasoning.  [Deductive reasoning works from the more general to the more specific…Inductive reasoning works the other way, moving from specific observations to broader generalizations and theories.]  This method of thinking and speaking, I think, may be less susceptible to bias, especially if we try our best to be objective in our observations.  It is the difference between “you have a fever, severe fatigue, and body aches that started all of a sudden; you were recently in close contact with someone eventually diagnosed with influenza, and you were not vaccinated—you probably have flu” and “flu is going around, you feel sick, you must have the flu.”

In general these practices are extremely difficult, and require significant attention and effort.  In the face of relationships with emotional baggage, raised armor, and close quarters, they feel that much more challenging and impossible.

6.      Qualify (in most cases).  Allow for our statements and assertions to be less definitive, more nuanced.  This is a corollary to practicing doubt.  Prepare to hold space for exceptions, to discuss how one size of anything really does not fit all, and things are never as simple and clear-cut as we would like.  “Of course, in today’s world of dueling talking points and partisan political warfare, qualifying—in the sense modifying or limiting, often by giving exceptions—is frequently treated as a sign of insufficient zeal and perhaps even wimpiness.  But for the serious mind, the opposite is true.  To qualify is to demonstrate competence.  And for the highly depolarizing person, to err is human; to qualify, to divine.”

7.      Keep the conversation going.  Relationships live and die by communication.  Communication is complex and difficult.  If we are to save and nurture our families and democracy, we must exert the energy to speak kindly, listen for understanding, seek shared goals, and see one another as fellow worthy humans rather than abstract enemies.  Avoidance may keep things quiet, but it does not facilitate true peace.  Engagement does not necessarily mandate confrontation.  We must learn to do this better.

I return to this list often, and find myself straying from the practices in my everyday thoughts and interactions.  Right now I’m really working on not calling people names in my head, so I’m less likely to do it out loud or on social media.  This is what I expect of visitors to my Facebook page, so I feel obligated to walk the talk.  Some days I fail—the plane goes down in crimson flames of ad hominem contempt and rage.  Nobody’s perfect.  So that’s why lists are helpful.  Should we expect to uphold all seven habits equally well all the time?  No.  And our families, communities, and country will be better for our honest efforts anyway.

 

 

Perspective Taking

Born a Crime

NaBloPoMo 2018:  What I’m Learning

I’m thinking a lot about empathy lately.  I am less cynical today than I might have been a few months ago, maybe.  I have uttered the words, “People suck” more this year than any other year in my life, perhaps.  But maybe writing about things I’m for rather than things I’m against, or reflecting on things I have learned and am learning, and from whom I’m learning them, has given me some hope.

Another person who gives me hope is Trevor Noah.  I mentioned in the first post of this month that I listened to his book, Born A Crime.  He really is an impressive and worldly young man, and I look forward to following his career and life for a while yet.

The best part about the book is the accents and impressions that Trevor does throughout his reading.  I have not actually read the book, but I am sure that hearing it on Audible is much, much better.  The second best part about the book is the actual book.  It’s a memoir, you must hear it!  In a series of non-chronological and yet expertly woven stories, he describes his childhood and adolescence in South Africa, son of a black Xhosa mother and white Swiss-German father.  Apartheid, outright racism, family conflict, domestic abuse and violence, crime, he lived it all.  Any of it would have probably killed me—jumping out of moving cars, for instance.  But he tells it both matter-of-factly, and with tremendous love.  I don’t mean that he loved all the terrible things that happened to him; rather I feel he has a deep and abiding love of humanity.  He accepts that it all happened and made him who he is today; I hear no resentment or bitterness.  He especially reveres his mother, and rightly so, she is a total Badass Mama Goddess.  I won’t give any of it away, you just gotta hear the book, she is UH-MAZING.  She is the best part of the book.

No, actually, the best part of the book is Noah’s ability to convey his understanding of everybody’s perspective in his life.  He translates for us the mindset of his independent mother, his stoic father, his wise grandmother, his friends from various, sometimes opposing, ethnic groups, and his hotheaded stepfather, among others.  At the same time he describes unbelievable atrocities committed by others, he does not vilify them.  There is never a hint of victimhood in a life story full of loss, poverty, and violence.  Hearing his perspective, and then his explanations of various other people’s perspectives, I was reminded that everybody’s point of view is shaped by so many things that I cannot possibly know even a part of it.  Every single human is a product and a manifestation of all of their genes, environment, experiences, and influences.  Every single one of us is unique.  And yet, most of the time, I make assumptions about what other people think, how they feel, what must motivate them, as if I know.  I think we all do this more than we’d like to admit.  I just wrote yesterday about how we humans have the capacity to relate, despite our disparate experiences.  Today I consider the flip side of that, which is ‘othering’ people by ignoring shared humanity, denying that capacity, repressing it.

Trevor Noah practices perspective taking as a routine.  I think that’s what makes him such a gifted comedian.  Comedy shows us our foibles so we might reflect but not so much that we feel shame.  He did this beautifully recently speaking about the migrant caravan from Honduras:

I’ve noticed other news networks in America specifically seem to focus on what the caravan means for America, and less on what the caravan means to the people in the caravan. 

He recalls growing up in South Africa, seeing news about Zimbabwe during the worst times of Robert Mugabe’s rule.  South Africans understood why Zimbabweans were leaving the country and coming to South Africa.  They may or may not have wanted them to come, but they nevertheless related to the motivations for migration.  He contrasts this with how Central American migrants are painted as threatening criminals, coming to pillage and plunder America.  This prevents us from acknowledging our shared humanity, from seeing ourselves in those around us.  It divides us unnecessarily and to the detriment of us all.

I have done a poor job explaining Trevor Noah’s comedic and humanitarian genius.  But seriously, just read (no, listen to!) his book, and watch his Between the Scenes videos on Facebook.  They are uplifting and fun.

Good night!

The Feels Are Good

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NaBloPoMo 2018:  What I’m Learning

I’ve been working for many years now on feeling my feelings rather than thinking them.  Rationality and analysis in service of self-awareness and understanding are great, but I have tried too long to will my hard feelings away, or experience them all as anger rather than what they really are—sadness, shame, fear, etc.

With books like The Art of Possibility, Mindsight, and Rising Strong, after multiple readings, along with years of therapy, I have acquired the skills to allow these feelings to emerge, engage, and pass.  I understand much better now the purpose of emotions: they are simply signals.  They are meant to draw our attention to something meaningful in our existence.  This could be a threat, a connection, a relationship, anything.  We modern humans spend a lot of time judging our emotions (and thus one another’s), trying to suppress the ones that make us feel bad, masking them, numbing them, and offloading them.  For whatever reason, we are not good at simply allowing them, learning from them, and letting them go.

I started following Nate Green on Facebook just before he deactivated his page.  He now communicates with readers through email newsletters, and his is one of the few I actually read.  This week he sent a rare second message, linking to his recent article for Men’s Health, “There Will Be Tears: Inside the Retreat Where Men Purge Toxic Emotions.”  If you read nothing else this weekend, read this.

Nate participates in an Evryman retreat in Big Sky, Montana, a project “aimed at teaching men how to access and express their emotions.”  When I saw the headline I felt a squirming in my gut, which surprised me.  We, especially we women, are always urging men to be more ‘in touch’ with their feelings, right?  Don’t we always want our men to be more sensitive and caring, more empathic and expressive?  Don’t we want them to role model all of this for our children, especially our boys?

Nate describes the retreat and its exercises:

My thoughts are racing. I shift my feet. Andrew shifts his. We continue to stare at each other. Finally, Andrew takes a deep breath and speaks. “If you really knew me, you’d know that I smoke too much pot and use it as a coping mechanism. And you would know I’m ashamed of it.”

His gaze lowers, embarrassed. He looks back up and we lock eyes. Now it’s my turn.

“If you really knew me, you’d know that I sometimes drink too much alcohol and it worries me.”

I have never spoken those words out loud before. I instantly feel lighter, like a giant
weight I didn’t even know was there has been lifted. Andrew smiles, happy to not be alone in his confession.

“Thanks,” he says.

“Thank you,” I say.

…To our left and right are 16 other men, paired off just like us. Behind us sits a gigantic log cabin that will be our home for the next two nights. After that, we’ll carry 50-pound packs into the backcountry of Yellowstone National Park, where we’ll walk and sleep among the grizzlies, mosquitoes, and stars for three more nights.

We all met maybe an hour ago.

Yikes.  I’m pretty emotionally confident and open, and this would be hard for me.  Imagine (or maybe you don’t have to) how hard it would be for outwardly strong, independent, and stoic men to do this.  What would it take for you men to go on a retreat like this?  Women, how do you picture the men in your life going through something like this?  How would we react if our men disclosed their innermost fears to us, cried openly in front of us, at home, at work, on the field?

For a long time I did not understand how hard this is for men.  I thought they were all just shallow and simply did not have emotions (other than anger and sarcasm).  In Daring Greatly Brené Brown writes how she learned about the severe threat that vulnerability really is for men.  After one of her presentations she was approached by an older man, a husband and father of her superfans.  He pointed out to her that though we say we want men to show more vulnerability, the moment any man does, he immediately pays a steep price.  I like to think we would welcome it, but I have a feeling many of us would react with shock and dismay, at least initially.  We complain about how women are perceived as weak and ‘hysterical’ when showing emotion, and if I’m honest, I might feel the same or worse about a man doing it.

So our mission should be to make it okay for all of us, men included, to ‘be emotional.’  That does not mean losing control and acting out.  It does not mean using emotions as an excuse for abusive behaviors.  It means allowing and holding space for our common human experiences to affect us at our core, and acknowledging how it feels.  It means helping each other breathe and walk through it all, holding each other up through the hard parts.  In Rising Strong and Dare to Lead, Brown takes us through steps she and her team have developed for working through hard emotions, called the Reckoning, Rumbling, and Revolution.  I’m getting really good at the first step, also known as the Shitty First Draft.

I know I have included multiple links here with minimal explanation.  It’s late.  And you can click and read at your leisure.  Or maybe you don’t need to; maybe you know exactly what I’m referring to and you march with the same mission already.  If so, let’s connect.  Let’s find all of us who understand the profound need for this shift in culture and society.  Let us form a chorus and sing loudly to whomever will listen, and make the world better for all of us—men, women, children—all of us for one another.

 

Less Phone, More BOOKS!

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NaBloPoMo 2018: What I’m Learning

Hi, I’m Cathy, and I’m addicted to my phone.

Last month I finally decided to do something about it, mostly so I could be more present to the kids.  It’s been a fascinating journey so far, and I’m proud to say I’ve already made progress.  First I banned Facebook after 6pm.  That went well until I traveled.  Then I took the Facebook app off of my phone.  The withdrawl continues to spike at times.  I also notice that I use other things to substitute—New York Times, email, Washington Post, email, WordPress Reader, email.  I notice an anxiety, a frustration, a kind of crazed, darting hankering– I crave that dopamine hit.

The awareness of it all, however, and the commitment to get disentangled from my screen, has cleared space for a recently dormant impulse to surface afresh:

READ!

* * *

At the conference last month I was turned on to the idea of complexity (or chaos) theory and how it relates to fixing physician burnout and turning our whole medical system around.  It was positively mind-blowing (for me—most others did not seem quite as lit).  The speaker was Anthony Suchman, my newest hero.  Some highlight ideas:

  • Every system is perfectly designed to get exactly the results it gets. Our current healthcare system evolved to this point precisely from serial and cumulative decisions made over years, even though the current state was never the intent.
  • We think of organizations as machines, with predictable, linear consequences of adjustments in one part or another. This is rarely how organizations (of people) actually work.  Rather, we can think of organizations as conversations, and let go our expectations of particular outcomes, the illusion of total control.  We can let things unfold and go where the outcomes lead us, all while holding to core values and goals.
  • Patterns are (re)created in each moment, and also self-organizing. So at the same time that a pattern (eg culture) seems inevitable and self-propagating, sometimes small, almost imperceptible perturbations can create new and dramatic cascades that lead to transformation (the butterfly effect).
  • Emergent Design thus embraces the approach of “finding answers we are willing to not know,” trusting that we will get where we need to go simply because we are paying attention (or that’s how I interpret it today).

This theory that everything within a system both results from and also contributes to the whole system (a fractal) validates an idea I have been advocating to my patients for years, and that I continue to personally relearn ad nauseam: It’s all connected.  The most concrete examples are Sleep, Exercise, Nutrition, Stress Management, and Relationships—I used to call them the 5 Realms of Health; now I call them the 5 Reciprocal Domains.  Each one is inextricably connected to every other one, and they all move in concert, with subtle or dramatic dynamics.

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I browsed around my local bookstore a couple weeks ago and came across a colorful title on the shelf: Emergent Strategy by Adrienne Maree Brown.  So of course I snatched it up.  The blurb says:

Inspired by Octavia Butler’s explorations of our human relationship to change, Emergent Strategy is radical self-help, society-help, and planet-help designed to shape the futures we want to live.  Change is constant.  The world is in a continual state of flux.  It is a stream of ever-mutating, emergent patterns.  Rather than steel ourselves against such change, this book invites us to feel, map, assess, and learn from the swirling patterns around us in order to better understand and influence them as they happen.  This is a resolutely materialist “spirituality” based equally on science and science fiction, a visionary incantation to transform that which ultimately transforms us.

Holy cow, YAAAAS!!  I could not wait to read it!  So I bought it, along with Make Trouble by Cecile Richards, What If This Were Enough? By Heather Havrilesky, and The Dharma of “The Princess Bride” by Ethan Nichtern.  I had also ordered Leading Change in Healthcare, coauthored by Dr. Suchman and two others.  That copy arrived last week.

Suchman 1

I feel this as all part of a slow turn, getting off my phone and diving into books again.  I’m so excited.  I have done this before—buy a bunch of books and never read them.  They occupy whole shelves in my bedroom.  But I honestly feel a transformation coming on.  Yesterday I spent a couple hours reading, researching, and writing the blog post, then I turned off the computer and opened Brown’s book.  I read through the long introduction and resonated with sentences like, “Emergence is the way complex systems and patterns arise out of a multiplicity of relatively simple interactions.”  This is a quote from Complex Adaptive Leadership: Embracing Paradox and Uncertainty by Nick Obolensky (which I have also now ordered).  I also love (ha!), “Perhaps humans’ core function is love.  Love leads us to observe in a much deeper way than any other emotion.”  Also:

all that you touch

you change

all that you change

changes you

the only lasting truth

is change

god is change

That is a quote from Parable of the Sower by Octavia Butler.

Then before bed I opened Suchman et al’s book and found these words, also in the introduction:

Complexity theory here is enriched by the focus on relationships [Hallelujah!], rather than the more traditional reference to science.  “Relationship-Centered Care” is a way of thinking that brings love and all that is personal into a world, the world of healthcare, that is mostly interested in more control and more data-based, evidence-based practices.

The point is made throughout that administrators cannot bring real change into their healthcare institutions without going through change themselves.

(The book describes) the relationship-centered social dynamics that are at the heart of Lean and a major source of this method’s success.  Unfortunately, these social dynamics are overshadowed or even displaced by the analytic technique in some Lean implementations, compromising results.

Suchman 2

So I’m learning about new ways to think on change.   It’s changing how I approach trying to change my patterns, how I see my relationship to them, how I see all relationships.  Wow.

All of this to say, I feel a deeply personal, yet global and cosmic impulse for growth, for transformation—a shift into more mindful and intentional use of my time and energy, and how I manifest it outward.  Less distraction, more focus.  Less incidental information consumption, more integrated learning and coordinated application.  Less phone, more BOOKS.

What will be the outcome?  I have no idea, that’s what makes it so exciting and wonderful!  Onward!

 

It Must Be True Because…

Spider web South Shore 8-23-14

NaBloPoMo 2018:  What I’m Learning

Funny how fear crops up sometimes.  It’s especially distressing when you fear your own ‘team.’  But we are here to learn and grow, so we step forward. My point in this post is to practice critical appraisal of research data before accepting or integrating it; especially if I am biased toward it.

BI fox news worse 2012

A fellow progressive Facebook group member posted this photo with a message of glee and encouraging everybody to disseminate.  I admit I also initially felt justified and righteous when I saw it.  But something kept me from sharing on my own page.  I should do this more often, perhaps—let something marinate for 24 hours before sharing, just to make sure it’s really something I want to engage with.  I ended up commenting that I think we should be careful about disseminating this kind of oversimplified graphic, as the data may not justify the claim.  I await the angry backlash.

After reading the article in Business Insider from whence the figure came, I had more questions than answers.  What are  Farleigh Dickinson University and Public Mind, anyway?  “Researchers asked 1,185 random nationwide respondents what news sources they had consumed in the past week and then asked them questions about events in the U.S. and abroad.”  What were the questions?  How were they chosen, and how do we know they represent broader knowledge of current events?  “With all else being equal, people who watched no news were expected to answer 1.28 [out of 5] correctly; those watching only Sunday morning shows figured at 1.52; those watching only ‘The Daily Show figured at 1.60; and those just listening to NPR were expected to correctly answer 1.97 [out of 4—why the ask one less for this?] international questions.”  Are these differences statistically significant?  And regardless, if the best we can do is answer less than 40% of domestic questions correctly, yikes.  How do we know this actually represents the population?  How does this data compare to similar research findings, maybe ones published in higher caliber, peer-reviewed journals?

The Business Insider article did link to the study report it referenced. I consider this to be a sign of responsible journalism—I look for it in the publications I read—access to the primary literature, so I can dissect and interpret ‘data’ for myself.  Turns out the study was a follow up in 2012 of an initial survey done in 2011 that reported similar findings.  The specific questions and statistical methods are included, as well as discussion of the results.  And while it’s not as rigorous as I am used to reading in peer-reviewed scientific journals, with sections for abstract, background, hypothesis, methods, results, discussion, and conclusion, I could follow the language and rationale of the authors, for the most part. I think they could have done a better job making a distinction between correlation and causation.  I also wished for a discussion addressing implications of the data and recommendations for further study.

Interestingly, I found a Forbes article entitled, “A Rigorous Scientific Look Into the ‘Fox News Effect.’”  I thought it was going to answer all of the questions I asked above.  It started out appropriately skeptical:

In 2012, a Fairleigh Dickinson University survey reported that Fox News viewers were less informed about current events than people who didn’t follow the news at all. The survey had asked current events questions like “Which party has the most seats in the House of Representatives?” and also asked what source of news people followed. The Fox viewers’ current events scores were in the basement. This finding was immediately trumpeted by the liberal media—by Fox, not so much—and has since become known as the Fox News effect. It conjures the image of Fox News as a black hole that sucks facts out of viewers’ heads.

I got excited when I read:

I have done similar surveys, both of current events and more general knowledge. In my research too, Fox News viewers scored the lowest of over 30 popular news sources (though Fox viewers did at least score better than those saying they didn’t follow the news). The chart’s horizontal black lines with tick marks indicate the margins of statistical error. Last Week Tonight with John Oliver, a news satire, had the best-informed viewers.

Turns out the rigor of this scientific look at the FDU data amounted to not much more than pointing out that correlation does not prove causation.  The author, William Poundstone, is a prolific non-fiction author and biographer of Carl Sagan, so I imagine he has formidable expertise parsing research data, though I don’t see any published research or surveys of his own.

In the end I’m satisfied, because I have done my homework on this topic.  I feel righteous again because, this time, I extricated myself from ‘liberal lemming’ (is that a thing? If not then I just coined it) mindset…  But it took some time.  And writing about it has cost me some psychic energy for organization and expression.

As I write this it occurs to me that it would be much more time efficient to just not believe anything I see or hear on any media platform—just be skeptical about everything and leave it at that.  Huh…  Nope.  That feels too much like willful blindness, which does not align with my core values.  It’s worth taking several minutes sometimes and disengagement, to verify the quality of what I take in on a daily basis.  I hereby commit to making this a regular practice.  I’ll let you know when I find anything really worthy of integration and dissemination.

 

How Not to Engage

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NaBloPoMo 2018: What I’m Learning

My friend Alex* posted about being a nurse and how she loves it despite having to always hold her pee, skip lunch, and get bled on, puked on, peed on, and yelled at, all while missing her family and taking care of yours.  One of her friends, we will call him Greg, commented that until nurses unionize and demand professional respect ‘just like physicians,’ nothing will change.

My impulsive (GRRR!) response:  “Trust me, physicians are struggling, too. I propose that we stand up for one another. Then we’d really be a strong force. And in the end it benefits us all–doctors, nurses, patients, the whole care team and, most importantly, patients. Also, I don’t know of any unions that physicians can join, but there are ones that nurses can: https://nurse.org/articles/pros-and-cons-nursing-unions/”  Okay, I know, saying, “Trust me,” is not a good way to get someone to trust or listen to you.  And my reply was defensive in its origin.  I sincerely believe what I wrote, though, that allied advocacy is an untapped force for good in medicine.  Physicians, patients, nurses, all healthcare professionals—why should we not actively support one another in all of our efforts to achieve a more cohesive, efficient, fair, and collaborative system, one that works better for all of us?  Why can we not embrace our connections and combine our voices to call for change?

Greg replied that basically he does not believe that physicians are “struggling,” and he does not see how we would stand up for one another.  After Alex described that I’m a physician “who will always help the nurses,” he wrote that doctors “can’t be in the business of supporting nurses.”  That we should “be in the business of supporting” ourselves, and “from all the research I’ve ever seen, they’ve continued to do a pretty good job of it.  Good for them.”  He expressed support for physicians’ right to advocate for ourselves.  In each reply, he continued to make his point that nurses should unionize.

I find this thread fascinating.  There are so many ways Greg and I could interpret each other’s replies.  When he talks about demanding respect ‘like physicians’ through unions, what benefits and outcomes does he imagine will follow?  When I say “struggling,” I wonder what he thinks I mean?  Actually he asks me, “How exactly are physicians struggling?”  He goes on to write, “Nurses are nurses and should be for nurses.”  All of his comments and the tone I inferred from them caused me to beg off of the thread.  Too bad, it might have been an interesting conversation—if we could have it in person.  Maybe we can later.

But it motivated me to look up some information to post here, in case anybody wonders ‘how physicians are struggling.’  The answer is burnout, depression, suicide, and leaving work that we love because it simply costs us too much—and I mean costs other than money.

Physician burnout is well described and referenced.

Doctors suffer from burnout in especially high numbers, according to the study, which was designed to offer a representative snapshot of doctors and the general U.S. working population. Nearly half of U.S. physicians – 49 percent – meet the definition for overall burnout, compared with 28 percent of other U.S. workers. More than 54 percent of doctors have at least one symptom of burnout, a more detailed analysis found.

Doctors also register more than one and a half times the general working public’s rates of emotional exhaustion and depersonalization. Working a median 50 hours per week, their satisfaction with work-life balance is far lower than that of others: 36 percent versus 61 percent.

medscape burnout causes 2018

Medscape Survey 2018

There are myriad causes for physician burnout, and most of them lie in the system, not in our inherent lack of resilience or because of some intrinsic defect in our collective character.  The electronic health record has accelerated our dissatisfaction with work.  It does so by creating innumerable clicks to accomplish menial tasks, burdening us with data entry that detracts from actual medical decision making and patient care, and putting a physical barrier between us and our patients, further separating us in relationship.  Burned out and dissatisfied doctors are distracted, less empathetic, and aloof, and we may even make more mistakes.  And when we aren’t well, our patients aren’t well.

A 2015 Mayo Clinic study reported that roughly 40 percent of physicians suffer depression each year and almost 7 percent had considered suicide within the prior 12 months. It is estimated that 300 to 400 doctors take their lives every year.

The pain and suffering those statistics only hint at is bad enough. But they are compounded by findings that burnout corrodes the doctor-patient relationship, resulting in lower levels of patient satisfaction, job satisfaction and productivity, as well as higher levels of medical errors and disruptive behavior.

Burnout is also connected to the decision to switch jobs or leave medicine altogether — an ominous trend as the U.S. experiences a growing doctor shortage.

 

I have not addressed here the challenges that nurses face every day.  My mom is a nurse, and I have worked with nurses my whole career.  I see how they are treated by the system and by patients, and also by us physicians.  And yes, my extracurricular activities focus solely on advocating for physician health and well-being.  Maybe I should learn more about nurse burnout and job satisfaction, and figure out ways to advocate for my nursing friends and colleagues better.

Or maybe it’s too much to ask for groups to stick up for one another.  Maybe Greg is right, and it should be every tribe for itself, let others take care of their own.  Maybe it doesn’t do any good for people to know how and how much doctors “struggle.”  I don’t know.  But I have learned now not to instigate such debates on my friends’ pages on social media.

*Not her real name