Why I Take the Scenic Route

Posted on February 12, 2023 by Catherine Cheng, MD

I-70 or 285?

I ask myself every time I leave Centennial, on my way to Silverthorne. If I have time and nobody in the car who will complain, I always choose 285. It takes at least 45 minutes longer, and it’s a much prettier drive. Thanks to dear friend Rachel who took me this way the first time in 2012, I have now stopped at state parks I never knew existed and passed through beautiful valleys and plains that take my breath away. Less traffic also makes for a more relaxing, even contemplative ride, which I appreciate more and more. Fun turns that open up around the bend to expansive landscapes never get old, and depending on time of year or day, and of course weather, I never know what I’m going to get. Every time, I am richly rewarded with yet a new perspective on the path, the journey–this iteration of the way. I get to explore and learn, to savor and revel. I learn what exits lead to which trails, where to get gas, and where to stop for the best views.

I have the sweetest gig any primary care doctor could hope for. With 5% of a typical full time patient panel, I have the greatest luxury in all of medicine: time.

When someone presents with classic signs and symptoms of a well-described and well-understood condition, it’s okay to take the highway of standard testing and conventional treatment. When the story and picture are less clear and straight, we need to slow down, look around, listen harder, wander the side roads. What’s rustling in the bushes? What path was taken to get here, and what roadblock(s) encountered along the way? What equipment do we anticipate needing as we proceed, and will we know how to use it?

Sometimes even the clear and straight path turns icy, muddy, or otherwise unexpectedly obstructed. This is when knowledge of alternate routes really pays off; even better if those routes are familiar. So often I take extra time talking to patients, even when I think I know what’s happening. I ask more questions to flesh out the story fully, to learn more. Have you had this before? What’s same/different about it this time? What was the context? What made you call me about it? How much is this bothering you? What are you worried about? What’s going on in your life now that may have triggered this? What else is happening? What do you think is going on, what story are you telling? Anything else?

I never know what I’ll learn in these meandering exchanges; most of the time I just get to know my patient a little better. That’s worth so much in itself. And eventually, I have learned, all of this accumulated familiarity matters. My ‘impression and plan’ for any given problem can evolve quickly over a history and physical exam, sometimes taking sharp turns. And it’s the best feeling when my patient and I can look at each other and say, “Wait, remember when…?” and it sheds light from the past on what’s happening today.

Today’s objective may be relief of pain and discomfort. Depending on the severity and urgency of the problem, we may race to that end speeding on the freeway. Our journey together as physician and patient, however, is more like a long and winding road trip. We have much to explore, if we travel together long enough. When you’re not in pain and have some time, we can take the scenic route together, get to know each other better. All of the photos, wildflowers, stories, and memories we collect along the way just make the trip, and our connection, that much more beautiful.

Use Your Signals: It Matters

Posted on January 30, 2023 by Catherine Cheng, MD

A car stopped on the street in front of me yesterday. Then its hazard lights came on. I was so grateful, because then I knew what to expect and do! HALLELUJAH, THANK YOU!

Brake. Turn. Reverse. Hazard. High beam. Our cars are designed with signals to make our intentions and actions on the road efficiently and effectively communicable.

Car going straight goes before car turning at a stop sign. If both cars are going straight then the one on the right goes first. No changing lanes in an intersection. DO NOT ENTER AN INTERSECTION YOU CANNOT CLEAR. Our traffic laws are designed to make vehicular interactions uniform and safe.

And yet, much like passengers during air flight, drivers seem to disregard any and all conventions of safety and courtesy more and more every year. We disregard one another.

“Always make eye contact.”

The most important safety lesson I learned from the Susan G Komen Breast Cancer 3-day in 2002 was to always make eye contact with drivers at intersections, before crossing the street. I had never thought discreetly about it before, and suddenly it made total sense; I adopted the practice immediately and fully.

20+ years later now, I see this as yet another practice in relationship (of course!). It’s not just about safety, though that is the primary goal, for both pedestrian and driver. Nobody wants an accident. When we make eye contact, we see each other and negotiate our interaction–our relationship–if only nonverbally and in a second or two.

All of these practices–using car signals, following traffic law, and acknowledging one another while out and about–connect us as fellow humans. By offering other drivers and pedestrians the courtesy of a signal, a gesture of invitation to cross, or God forbid a wave and a smile of gratitude when someone lets us pass or merge, we make the world a little less cold, a little more personal, and a lot better, one small and significant interaction at a time.

Imagine if we all treated one another like someone we care about while out on the road? Imagine if we all actually cared for one another, just because we are all here, fellow humans, doing our best to get through this crazy, chaotic life with a little more dignity and a little less suffering?

Imagine if we all used our readily available, efficient, direct, and effective communication tools to signal our intentions, needs, and caring for one another off the road, too?

Wow, what an amazing world this might be.

New on HTC: The Bit Post; Choices

Posted on January 25, 2023 by Catherine Cheng, MD

Friends, every once in a while I have moments of relative wisdom and avid connection. Often it comes while responding to patient questions, sometimes on the phone, sometimes on email or portal messaging, and very often over text. So many posts on this blog started as these little, ‘bit’ insights. I marinate them, stir them around, turn them like a Rubik’s cube, until they’re so convoluted that it takes another, longer period to unravel them again to be ‘worthy’ to post.

So tonight I’m trying something new: the Bit Post. When moved, after brief and thoughtful enough consideration, I give myself permission to post these small notes, as is and with just enough background, just to share, in case they resonate with anyone. I feel an urge to engage here on the blog more frequently and lightheartedly, with less perfectionism and self-doubt. So we will see how this goes!

I sent the message below after a dear patient apologized for some behaviors that appear to have led to suboptimal blood test results. They made a self-judgmental comment about their life. I could feel their guilt and maybe some shame. So I replied honestly, as I wrestle with many of the same challenges. The example I give happened just last night.

So we go together, my patients and I. We are all here doing our best!!

Onward, my friends—ODOMOBaaT!

“Your life is what it is. Your choices are what they are, influenced by many circumstantial factors that vary day to day, moment to moment. No need to apologize to me—I’m not you!
“I have a rapidly evolving perspective recently on how I counsel people on habit and behavior change anymore.
“I’m here to inform and advise, not to judge. All of our choices are trade offs made in real time. I overeat tonight because I’m with friends and enjoying the food and that is more important to me in this moment than losing weight. I may regret it later and I’m not consistent at slowing down and asking myself when the weight later becomes equally important to me as dessert now. You see?
“We just have to own both our choices and their consequences.
“My goal is to have the fewest possible regrets when I die. I wish that for you too, but only you can know what choices will get you there.
“Makes sense?”