Category Archives: communication

November 29:  Reflection Makes Me Better

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NaBloPoMo 2019

How was 2019 for you, friends?

Looking back, what stands out?  What gives you pride and joy?  Guilt and regret?  What’s the best thing you learned?  What do you look forward to the most in 2020?

In the first post of this month, I described my last role play experience, one marked by intensity around domestic violence and dense communication skills practice.  Dr. Orit Kalnieri-Miller led the workshop, and I will forever be grateful for her groundbreaking work incorporating reflective practice in medical education.

Wikipedia says reflective practice is

… the ability to reflect on one’s actions so as to engage in a process of continuous learning.[1] According to one definition it involves “paying critical attention to the practical values and theories which inform everyday actions, by examining practice reflectively and reflexively. This leads to developmental insight”.[2]A key rationale for reflective practice is that experience alone does not necessarily lead to learning; deliberate reflection on experience is essential.[3][4]

Regular reflective practice, I think, is mindfulness in action.

This whole month I have been reflecting.  Looking back, seeking patterns.  What really does make me better?  Better for whom?  For What?  How does it all help me going forward?  I have probed my habits, my relationships, roles, activities, ideals and attitudes.  Writing the reflections every night as a blogging challenge probably does not give each idea much time to sink in.  But now they are recorded.  They are a collection that I can review over time; I can revise, rewrite, and continue the reflection-learning-practice cycle of self-improvement.  Reading past posts reminds me of where I was then, which allows comparison and contrast to today.

I am, still and always, me.  I’m also always learning and changing.  Reflection helps me to know myself better and more deeply, to claim and exercise my authentic agency in service of the causes that matter to me.  Reflection keeps me focused on my Why.  In the coming year, it will help me identify, refine, and enact my next Just Cause.  Very exciting!

But maybe the best part is that reflective practice is not a solitary activity.  When I have any opportunity to get feedback from those whose perspectives I respect, the learning is that much deeper and more meaningful, even (especially) if it challenges and agitates me.  People mirrors do not always show the reflection I want, or the self-delusions I believe–they call me out.  But sometimes they show that I’m living exactly and fully in my integrity and values.  Both are equally valuable.

So I will continue looking for reflections everywhere.  They keep me honest, and that makes me better.

November 22:  Listening to People’s Stories Makes Me Better

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NaBloPoMo 2019

What a long, strange week.  I almost forgot to write a post, just wanted to relax and do nothing.

Looking back, overall it was good. And it was people who held me up, as always.  I had some pretty moving and meaningful conversations with patients, and I really helped some people, I think.  But it was a new acquaintance who really made my day today.

I finally had time to bring my car to the body shop this afternoon.  After an unfortunate encounter with a fire hydrant while backing out of a very poorly planned driveway, my front bumper has been partially detached for about 7 weeks.  Every single person at this shop was remarkably nice—from the lady on the phone, to the young man who so politely offered to move my car when I parked it in totally the wrong place.  The waiting area was clean, neat, and well lit, with comfy, non-holey chairs.  After a short wait, a petite and pleasant woman, maybe 40, introduced herself.  She would provide the estimate on my repairs.  We headed outside.  She pointed to the ledge at the doorway on which I had tripped walking in, so I would not do it again.

After I brought her to the car she said I could go back inside and wait, but I asked to hang out with her, because I like to see what other people do.  I know less than nothing about cars, and I loved that here was a youngish, friendly woman who clearly knew her way around them.  I admired her right away.  She was thorough and conscientious, looking inside and out.  She was also extremely knowledgeable and patient, showing me everything, talking me through the parts and functions, and answering my ignorant questions, down to how the VIN includes the paint mix of the make, model and year.  She stayed with me through the whole process, including walking me out to show me the key drop box, because they can’t fix my car for another two weeks.

Before we said goodbye I could not help myself.  I told her how happy it makes me to see a woman doing a job that I have only seen men do.  She seemed genuinely proud and thankful for the compliment, and I’m glad I said something.  I didn’t mean to make her stand outside in the cold any longer, but she started reflecting and telling me her story.  Turns out this was her first day on her own at this job—I thought she had done it for years already.  Nope.  She had done inventory for a railroad company, and programmed machines that cut industrial dies.  She had worked in shops and factories of various kinds, it sounded like, always surrounded by and holding her own among men.

I asked her if it feels different (and hopefully better?) being a woman in these male-dominated fields now, after all these years.  She thought for a moment (looking completely comfortable, while I had started shivering already).  It almost seemed like she had never considered the question before?  She concluded that her peers and coworkers have never been the problem.  It’s the customers.

She kept talking, as if the subsequent story had been waiting days for a sympathetic ear.  In her last days of training, a man brought in a car with severe rear body damage, clearly from a collision.  He gave her a history, she made her appraisal, and he was suspicious and dismissive toward her the whole time.  To assuage him, she brought her trainer to review the case, whose assessment and recommendations were the same as hers.  This time the customer told a different story—admitted to lying to her, basically—and accepted the trainer’s evaluation.  No apology, no remorse, no respect.  She was still affected by it today, and upset with herself that she had let him get under her skin.  Whatever, she said in the end, she’s here to do a job, and there will always be people who underestimate her because of her sex.  Thankfully her trainer was an ally, which made me proud of the good men in our midst.

This woman’s life experience, though clearly different from mine, felt relatable and real to me.  In those few minutes, in the waning daylight of a brisk fall evening in Chicago, surrounded by broken cars, I felt solidarity with and pride for her.  It made me better for reminding me once again of our shared humanity:  Hers, mine, my patients’, those crazy drivers on Wednesday, even her lying customer.

We’re all here doing our best with what we’ got.  I firmly believe this, but sometimes I forget.  Hearing folks’ stories always brings me back.  So I’m thankful for them.

 

November 17:  Elasticity Makes Me Better

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NaBloPoMo 2019

What was school like for you growing up?  Were you bored?  Confused?  Frustrated?  I had a pretty easy time, but many of my classmates did not, even the ‘smart’ ones.

In high school I was on the speech team.  One of my events was persuasive speaking.  I chose one year to advocate for teachers to broaden their teaching styles to match a wider variety of learning styles.  I used the Gregorc Mindstyle Delineator as an example of how styles can vary (mine is Abstract Random, go figure).  It was an interesting thesis and I sincerely believed what I wrote and presented in those 8 minutes each weekend.

Thirty years later, I wonder how much I walk this talk of meeting people where they need me.  Simply asking the question, raising my awareness, makes me better.

Parenting.  It doesn’t matter how many parenting books you read or how well you think your parents raised you.  General principles apply, of course.  But every kid is unique, and we parents do better when we realize that the methods we use for anything on kid #1 won’t necessarily work with kid #2, #3, an onward.  Flexibility is key to a happy and functional household, for getting out the door every morning without yelling.

Marriage:  According to the Dr. John Gottman, about two-thirds of marital problems are perpetual, meaning they will never actually resolve.  So how do couples stay together successfully?  Among other things, they learn to accept one another and work around the hard stuff.  At least partially, we have to soften our rigidities, learn to bend and sway, embrace the supple, intimate dance of commitment.

Teaching:  Not all students learn best by watching.  Not all learn best by doing.  Or by hearing, mimicking, or competing.  Luckily, medical education gives trainees multiple platforms on which to acquire the necessary knowledge and skills to care for patients.  For all its flaws, our profession actually does well here.  I’m happy that I realized this in my own experience.  When I precept students in clinic, they shadow, scribe, see patients alone or lead a joint encounter, so they can experience the work from different perspectives.  I think this mutual versatility and adaptability makes us all better.

Patient Care:  Over the years I have accumulated myriad articles and books to share with patients.  But not everybody’s a reader like me.  Not everybody wants to meditate or journal.  Some people do better with a personal trainer, others in spin class.  It’s my job to assess how each patient is most likely to succeed in health habit optimization, and present the most appropriate resources for consideration.  Primary care definitely does not work with a one size fits all approach.  So now I include audiobooks, podcasts, phone apps, and YouTube videos in my repertoire of medical information sharing.  I am blunt when it’s needed, and also gentle and diplomatic.  I can speak from the head and the heart, often both at the same time.

Speaking Engagements:  Here is where my elasticity has grown the most in recent years.  For the first decade of my career, I still used the expository presentation style I learned in high school.  Thankfully in 2014, I watched Nancy Duarte’s TED talk on transformative oral presentations, and then read her book, Resonate, in 2015.  Make the audience the hero, she says.  Tell a story, contrast what is with what could be, paint the vision of the blissful future clearly.  Engage people’s emotions and aspirations.

This is not easily done with Power Point decks full of words.  But words are my medium!  I had to add color, diagrams, cartoons, photographs.  I started making my presentations more interactive, between myself and the audience, and between audience members themselves.  Now I have people stand up and move their bodies.  I may bring raisins to my next talk and do a mindful eating exercise.  I need to learn how to embed music and videos into my slides.

What is the objective in all of these relationships?  It’s connection.  How do we best connect?  We reach out.  We extend ourselves to others—make ourselves relaxed, flexible, spring-like.  That is how we gather people closer.  It’s not formless or weak.  A strong elastic maintains its integrity even under high tension.  But it must be stretched often, or it becomes stiff, brittle, and ultimately ineffectual.