Category Archives: communication

Running Strong In Our Lane

Posted on by
5

photo 1

NaBloPoMo 2018:  What I’m Learning

So the NRA tweets, “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

Hmmm, self-important.  Yes, sometimes.  After four years of college, four years of medical school, up to seven years of residency and then another 3 years of fellowship to earn the privilege of operating on the spines, nerves, organs, and blood vessels of gunshot victims, to maybe give them a chance to stay alive much less walk and talk, I can tolerate a little (just a little) self-importance in my emergency medicine, neurosurgery, trauma surgery, critical care and other colleagues.  They are f*ing rock stars.

Anti-gun.  I have yet to meet any physician, or any person, really, who is wholly anti-gun.  We are pro-gun safety, anti-violence by guns.  We would like for toddlers to not kill their siblings and parents by accident.  We would like for domestic disputes to not escalate to someone shooting their family and then themselves in an impulsive fit of rage.  We would like for depressed and suicidal patients not to actually kill themselves, which is too much easier to do with a firearm than any other method.  We just want to stop being the only country where so many die every year from being shot by guns.

The American College of Physicians (ACP), the internal medicine professional society and my home for professional communion and development, and the largest medical specialty organization, has published an updated position paper on reducing firearm deaths in the US:

In 2015, 9 (the ACP) joined the American College of Surgeons, American College of Obstetricians and Gynecologists, American Public Health Association, American Psychiatric Association, American Academy of Family Physicians, American Academy of Pediatrics, American College of Emergency Physicians, and American Bar Association in a call to action to address gun violence as a public health threat, which was subsequently endorsed by 52 organizations that included clinician organizations, consumer organizations, organizations representing families of gun violence victims, research organizations, public health organizations, and other health advocacy organizations (2). Yet, firearm violence remains a problem—firearm-related mortality rates in the United States are still the highest among high-income countries (3).

Cited in their tweet, the NRA Institute for Legislative Action posted an article (no author identified) picking apart the ACP’s research citations and approach, stating, “This position paper leaves one wondering if the authors reviewed the evidence, or just found works that suited their needs. For all of the bluster about their own important role in the anti-gun movement and all of the misuse of research findings, the ACP makes one thing clear: they respect their own rights and opinions far more than they do those of law-abiding gun owners.”  *sigh*  As I have not read the primary literature on gun mortality and public health myself, I will not comment on that here.  I will just say that I wholeheartedly trust in the integrity of my colleagues and leaders at the ACP.  I’m proud of our advocacy for patients and, more recently, for physicians ourselves and our well-being.

My physician colleagues have posted a multitude of passionate responses on Twitter; you can read them here, here, and here.  And I just now saw this open letter to the NRA from the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) and signed it.  Below are highlights—please take a look.

I admit, I initially responded with profanity at seeing the NRA tweet.  My threshold for swearing is very low these days.  And I wanted to just post screenshots of the anti-NRA tweet storm and let them speak for me.  But that’s not me. I have yet to really decide how I want to design my public platform and conduct on issues like this.  For now, I can just say that tweets and articles like the NRA posted are disappointing.  I don’t want to follow that lead.

* * *

Dear National Rifle Association,

On Wednesday night (11/7/2018), in response to a position paper released by the American College of Physicians (ACP) Reducing Firearm Injuries and Death in the United States, your organization published the statement “Someone should tell self-important anti-gun doctors to stay in their lane.”

On that same day, the CDC published new data indicating that the death toll from gun violence in our nation continues to rise. As we read your demand for us doctors to stay in our lane, we awoke to learn of the 307th mass shooting in 2018 with another 12 innocent lives lost to an entirely preventable cause of death–gun violence.

Every medical professional practicing in the United States has seen enough gun violence firsthand to deeply understand the toll that this public health epidemic is taking on our children, families, and entire communities.

It is long past time for us to acknowledge the epidemic is real, devastating, and has root causes that can be addressed to assuage the damage. We must ALL come together to find meaningful solutions to this very American problem.

We, the undersigned – physicians, nurses, therapists, medical professionals, and other concerned community members – want to tell you that we are absolutely “in our lane” when we propose solutions to prevent death and disability from gun violence.

Our research efforts have been curtailed by your lobbying efforts to Congress. We ask that you join forces with us to find solutions. Help us in our non-partisan, physician-driven research efforts at AFFIRM Research.

We invite you to be part of the solution.

You dismissed the ACP’s position statement on preventing death and injury from gun violence by stating, “Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

We extend our invitation for you to collaborate with us to find workable, effective strategies to diminish the death toll from suicide, homicide, domestic violence, and unintentional shootings for the thousands of Americans who will one day find themselves on the wrong side of a barrel of a gun.

We are not anti-gun. We are anti-bullet hole. Let’s work together.

Join us, or move over! This is our lane.

 

I Hurt My Friend Today

Posted on by
1

DSC_0465

NaBloPoMo 2018:  What I’m Learning

Bummer, it’s no longer November 8.  Well, that’s the humbling kind of week it’s been.

I sat in a meeting with a friend today.  I expressed a perception and opinion about an issue on which she and I have divergent perspectives.  It was early morning (not my best time of day), and I was still emotionally hung over from yesterday.  I spoke up more and louder than usual and may have been a bit aggressive—not toward her or anyone personally, but about my opinion.

Afterward I asked her, “Was I too bitchy?”  I was querying her impressions of how my words and expressions landed on others.  Turns out I had really hurt her personally, and I had no idea.  The fantastic news is this friend shares my values of honesty, empathy, and open communication, so we talked it through in the afternoon.  Even though we had discussed the issue before, today we took more time.  We each listened hard and heard, more clearly than before, details about how decisions were made and how messages were received and perceived.  We dug deeper into underlying snags in relationships between groups, the culture and mindset of team members, and the dynamics that basically hamstrung everybody’s best efforts in the situation.

In the end we agreed that we’re all doing the best we can, and we also have a lot to learn from one another.  We acknowledged that there is room for everybody to own their shit a little more, and that calling a ‘my bad’ and ‘do-over’ of some parts may be the best way to make amends and move forward with more trust and cohesion.  We agreed that we could all benefit from more conversation, acknowledgement, transparency, empathy, attention to people’s feelings and mindset, and mutual understanding.  We brainstormed about what that all might look like; I got kinda excited.

At the end of the conversation we congratulated ourselves on both our courage to give each other some hard feedback, and how we were able to listen with love and generosity of spirit.  Maybe it was easier because we are friends.  But it’s the practice when it’s easy that prepares us for when it’s hard, right?  I’m so proud of us; we really lived into our best relationship potential today.  We walked our talk.  Nobody witnessed it, but we know what we did.  [fist bump, high five emojis]

Here’s to friends holding each other accountable for the consequences of our words and actions, and upholding each other to be our best selves. I wish you all more friends like this.

The Hard Conversations

Posted on by
Reply

DSC_0694

NaBloPoMo 2018:  What I’m Learning

Life is about learning.  Learning requires acknowledging lack of skill, knowledge, understanding, or all three and more.  Boundaries, curiosity and non-judgment make it so much easier; too bad we tend to lose these natural traits (or they are trained out of us) early in life.  Then we have to relearn them as skills.  What happens when we reacquire boundaries, curiosity and non-judgment?  We get much better at having the hard conversations.  What makes conversations hard?  Not sure?  Just think of the conversations we avoid.  What are we actually avoiding?

I resist apologizing when I don’t want to admit that I misunderstood, that I made wrong assumptions that led to behaviors that hurt people, that I was not my best self.  I worry that people will think less of me and not trust me, not include me in the future.

I avoid giving negative feedback because I don’t know how the other person will take it.  Will they crumble in a heap of self-flagellating despair?  Will they lash out and attack me, verbally or physically, threatening my safety?  Will they disparage me to others, try to split our colleagues between us, sow discord and undermine our culture?  I worry that I will lose control of the situation.

We resist conversations about politics, religion, and issues like abortion because they can escalate in a nanosecond, filled with emotional tumult.  These are precisely the exchanges during which we blow past all of our boundaries for civility, language, tone of voice, and rhetoric.  We lose all interest in understanding what the other person thinks or, more importantly, how they feel.  We stop relating.  We judge everything out of their mouths as oppositional, ignorant, and unworthy.  We worry that we will lose our status, self-efficacy, agency, or our friends.

* * *

My friend Earnestine * has migraines.  Over the years she has worked out their patterns: timing, location, aura, duration, and triggers.  She hydrates, protects her sleep, and, most importantly, manages her stress with vigilance.  This way she generally avoids medications and keeps her symptoms under good control.  Recently she got caught in an unavoidably stressful situation with family.  A migraine hit her like a Mack truck out of nowhere.  She could barely walk, stumbling around, hanging onto walls and railings.  Her speech may have been slurred.  Thankfully she was able to escape to a friend’s house.  Her childhood friend, also a sufferer of headaches, offered her a handful of pills—her own prescription medications.  Earnestine struggled for the right words, and not just because her head was splitting.  If she refused, would she offend her friend, who has just rescued her from serious family chaos?  Would she trigger indignation, anger, resentment, rejection?  E found her personal values and boundaries tested, unexpectedly.  She felt ambivalent, as the core values of connection with a friend and right use of substances clashed.  She desperately desired relief from her pain, and she also needed to set an example for her boys, who were watching her response—what would she want them to do if one of their friends offered them ‘relief’?  Somehow through the fog, she found a way to acknowledge her friend’s generosity, and also explain that she was not comfortable taking someone else’s prescription medication.  She maintained her boundaries and stayed curious to monitor her friend’s and her boys’ responses.  Since that time, she continues to hold her friend in non-judgment, understanding that although she would not ever do the same, her friend’s intentions were loving.

I tell this story because I see it as a perfect example of boundaries, curiosity, and non-judgment in action:  Holding space for one’s own needs while attending to the needs of others and our relationship with them (both her friend and her sons).  Earnestine practices honoring her boundaries, which can, in some ways, be equated with her core values.  When they are challenged, she can stay in curiosity and explore the feelings that get triggered. She can withhold judgment on the feelings and simply experience them in the present moment, asking what they are trying to tell her.

This combination of boundaries, curiosity, and non-judgment, practiced regularly in small, everyday things, prepares us to face the harder situations and conversations with greater confidence.  We can trust ourselves, even if we don’t walk into any given situation knowing the right answer, to find it when we need it.  On the other side, these skills help us look back with fewer regrets, because we brought our best selves at the time.

I have learned to recognize opportunities to practice these skills, and now I resist apologizing, giving negative feedback, and talking about politics a lot less.  In fact, these are precisely the scenarios in which I can really test and hone my skills—sharpen them and improve my relational dexterity.  I almost look forward to them—sometimes.

It’s all a continuous journey, is it not?  Will we always face our fears with heroic courage and the perfect words and behaviors?  Hell. No.  AND, every day is a new chance to try.  What hard conversation might we come closer to doing better tomorrow?

*Not her real name