November 7:  Feedback Makes Me Better

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NaBloPoMo 2019

This post is about power.

Two friends provided important feedback on last night’s post, and I am, gratefully, much better for it.

* * * * *

“You are a woman of color?”

My college friend commented on Facebook.  “Are you being serious?”  I asked him.  Yes, he replied.  He went on to point out that he sees the term being used more broadly, and that he thinks it’s been co-opted.  He made me think, which always makes me better.

In the original post, I described myself as a “petite, young, woman of color doctor,” standing up to an older white man. My friend wrote, “I think disadvantage is baked into the term, why else use it?”  Looking back, I admit I was exaggerating.  I had power on my mind, and I was trying to think of all the ways I should not have power in the situation, and yet I absolutely did, and I recognized it.  But labeling myself a person of color, I realize now, was at least somewhat inappropriate.  I have changed the text to “petite, young, Chinese woman doctor.”  I sincerely apologize if I insulted or offended anyone.

In medicine, East Asians are not considered a disadvantaged minority in the conventional sense (although while we are over-represented compared to the general population, we hold proportionally few leadership roles).  In general, however, I would argue that any non-white person in the US may still experience myriad disadvantages, in any field or situation, even if subtle.  At any point in an encounter, even with ‘MD’ and years of training and expertise behind my name, a white man can always hurl some racist, sexist remark to make me feel small.  He could just as easily attack a fellow white man on the basis of weight, sexual orientation, stature, or some other peculiar distinction, but somehow it feels like my white male colleagues just don’t have to think about this possibility as much as I do.  I feel self-conscious about my gender and race every day at work.  That is why this past spring, when I attended a negotiation skills presentation at the American College of Physicians (ACP) national meeting, I felt particularly gratified that the presenters were two East Asian women and one white man.

* * * * *

“You may want to include physicians as victims in your blog.”

A colleague responded to my post by sharing her story of being verbally attacked by a patient.  She was alone, no witnesses, and he treated staff politely, unlike in my story.  She was ‘dumbstruck and said nothing.’  She wrote, “I think as physicians, we are targets for verbal abuse because we have a privileged profession and would look foolish or weak in defending ourselves.”  In other words, since doctors hold such high societal status (power), people think we should just accept being taken down a notch or two?  That if we express an expectation of respect we are lording our status over others and thus even more justifiably open to insult and ridicule?  I see now how this can make a physician feel like a victim of societal stereotypes and expectations.

That said, I think it doesn’t matter what we do for a living; every person has an absolute right to expect respect from anyone else.  Years ago, another older white male patient made a series of passive aggressive remarks in the space of several minutes at the end of a visit.  I felt they were unfair and uncalled for, as I had spent the entire visit doing my best to connect with and care for him.  After a moment of consideration, knowing it was a risk, I was respectfully direct with him.  I repeated his words and told him that they felt like digs.  He admitted that they were and apologized, and congratulated my courage to call him out.  He never came back to see me.  I feel good about how I handled it; was it a power struggle?  I would have been open to cultivating a mutually respectful and honest relationship, had he returned.

Feedback definitely makes me better.  I will never grow if I only attend to my own point of view.  I don’t have to abandon my own perspective when facing an opposing one, and I am not obligated to incorporate anyone else’s point of view.  But if I expect anyone to take my writing and message seriously, I am required to listen to and try to understand any feedback that is offered in good faith.

Thank you, my friends, for keeping me honest and grounded.

November 6:  Caring For the Team Makes Me Better

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NaBloPoMo 2019

“How does he treat you?”

I don’t only ask this question of women whom I suspect of being abused at home.  I also ask my medical assistants.  Not about their domestic partners, but about our patients.

In my first practice, I sat/stood to the left of my medical assistant every day for six years.  It was a cozy (cramped) little counter space stacked with charts from end to end, with a couple of high-wheeley chairs.  Each chart stack had a laminated cover on top:  “For Cheng to Review/Sign,” “For Rose,” “Labs,” and “Messages.”  Charts journeyed from my left to my right/Rose’s left, to the bin under the counter to be filed.  It was incredibly efficient, actually.  I had a handwritten emoji system for indicating (dis)satisfaction with cholesterol and diabetes results.  Rose knew all of my patients and how to communicate sentiments and instructions clearly and lovingly.  She had been an MA since I was a kid; she knew what she was doing.  If a patient had a question on the phone, she could put them on hold and clarify with me, or I could just get on the phone and speak to the patient myself.  We were busy and happy, a well-oiled team-machine.

One day as I came up to my spot at the counter, I noticed an unusual sound next to me, like a distant, scratchy loudspeaker.  I turned and saw Rose holding the phone receiver about an inch from her ear.  The sound was my patient, yelling profanities at her so loudly I could hear his words from two feet away.  I can’t remember what the issue was, but he was obviously upset, and taking it out on her.  It surprised me because I had only known him to be sweet, respectful, and grateful.  Maybe he was just having a bad day?  I looked at Rose, who rolled her eyes and exhaled heavily.  I asked her to put him on hold so she could catch me up.  Apparently this had been going on longer than I knew, and she had not told me.  Had I not come upon it in real time, she may never have told me.  She would have simply tolerated it.

I picked up the call and declared myself.  He was the usual, respectful and calm patient I had always known.  I answered his medical questions.  Then I told him firmly that he did not have the right to treat anyone in my office the way he had just treated Rose.  I think there may have been some excuses and then an apology.  I made it clear that if he abused my team again, he would be discharged from the practice.  He agreed and apologized again.

That was my first opportunity to stand up for my team as an attending.  I will forever remember it.  I was a petite, young, Chinese woman doctor, speaking to a white man decades older than myself.  I stood up for my medical assistant, a woman of color and a couple decades older than me.  She had felt powerless to stand up for herself to his verbally vomitous abuse.  All I had to do was pick up the phone and say, “Mr. Soandso, this is Dr. Cheng.”  He never yelled at Rose or anyone in the office again, to my knowledge.  How could I have this much power, and why had nobody asked me to wield it in their defense before?  It was just accepted that patients could yell and scream at our staff, with no consequences?

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We recently discussed abusive patients during our regular doctors’ meeting at my current practice.  Immediately I thought, HELL NO.  The good news was that our team members feel safe reporting incidents to our managers and physicians.  My partners and I have all had to call patients to clarify our expectations of respect.  We understand that illness is stressful.  We understand that our healthcare system, especially at a large, bureaucratic institution, causes frustration, even rage.  However, none of that ever justifies or entitles a patient, or anyone, to belittle, dehumanize, or otherwise degrade another person, and especially not a team member who is doing their best to help–ever.  At this meeting, gratifyingly, we all voiced definitive confirmation that we fully support our team, and we will, without hesitation, educate and/or discharge any patient who violates our team’s right to a collegial and non-threatening work environment.

Even as I write this, I shake a little with rage and outrage at these patients’ behavior.  I can feel tightness and tension in my chest and abdomen, my breath quicker and shallower than its usual resting state.  I wonder if this triggers me because my mom is a nurse and I have seen how patients in the hospital abuse nurses.  I also know how women physicians are mistaken for nurses and thus ignored or dismissed, even by female patients.  I have known racism and sexism first hand.  But as a physician, I’m in a position to not have to tolerate it.  By virtue of two letters after my name, I have the power to protect my team, with authority.  And I work with other physicians who also recognize both this power and its attendant responsibility.

I hope our team feels protected, defended, and loved by us docs.  We may be the default work unit leaders, but they do the lion’s share of work that allows our practice to run as smoothly and successfully as it does.  They are who let me do my work as well as I do.  I depend on them every day.  So caring for them absolutely makes me better, makes us all better.

 

November 2: Reading Makes Me Better

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NaBloPoMo 2019

Today I share a Facebook comment series I wrote in response to a prompt from a progressive friend, in its original form.  His post made me look up and read 7 additional articles, all of which I linked in my comments.  In the end I became more aware of my own biases, and recommitted to finding common ground with people who think differently from me.  So I think reading makes me better.  What think you?

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Friend’s post:  (Cathy):  I’d be interested in your perspective on this article in terms of your work to bridge divides and create civil conversations.   [Wall Street Journal slide deck describing the economic basis of party divisions in the US—it’s a fast click through which I recommend.]

My comments:

Thanks for sharing, (Friend)! Okay, I will take the time to make a long comment thread, as this is really interesting to me. Thank you for asking the question you did–I’ll get to it eventually! First: The information presented in this slide show is consistent with what I have read before. The facts presented are real. And they are incomplete. It looks at differences between districts, which is the best way to highlight division. I think this is a direct consequence of gerrymandering, which is designed exactly to create districts that will reliably vote one way or another. And we have all seen the US map showing blue clustered around big cities and red everywhere else. AND, this report ignores the glaring truth that despite the economic divisions by district and income, a much larger proportion of the top 1% is either declared or leans Republican than Democrat (though not necessarily more conservative):  https://news.gallup.com/poll/151310/u.s.-republican-not-conservative.aspx

Gallup 1% 2011

Second: The suburbs are where Reds/Blues live amongst one another, and this report ignores them, pretty much. That said, even without gerrymandering, we Americans have sorted ourselves ideologically. Bill Bishop wrote a fascinating book that details the economic and social evolution, _The Big Sort_ (listened to the whole book a year ago, I highly recommend it): http://www.thebigsort.com/home.php

I think suburbs are where work like Better Angels has the most potential to spark civil discourse, except that people are hesitant to engage, for fear of upsetting the tenuous and silent politeness that constrains their ability to talk openly about politics. That cultural noose is hard to untie.

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[Below are a] couple of other links that have additional demographic information that gives context and texture to the WSJ slide deck. The point of all of this is that when we I read articles that start out with nihilistic, Vader-like proclamations of “America’s political polarization is almost complete,” I see an implicit agenda to actively contribute to that polarization for the good of the publisher. Brené Brown reminds us to beware of those who tell us things are absolute, either/or. Reality is almost never this dichotomous, and whenever we hear it is, we should look for who benefits from us thinking it is. Economic demographics of Democrats: https://www.debt.org/…/economic-demographics-democrats/

Economic demographics of Republicans: https://www.debt.org/…/economic-demographics-democrats/

Okay finally, to answer your question, on my “perspective on this article in terms of (my) work to bridge divides and create civil conversations”: My favorite visual is this table from the first article I linked to. In some ways we are ‘almost completely’ divided, as the Vader article posits. In other ways, we are not. I think of the surveys showing a majority of Americans being in favor of background checks for gun ownership, in agreement that abortion is generally not something we want happening all the time. I think of all of the conversations I have with pretty much any other human, and how we are all 90% more alike than different. But this article and 90% of the articles we see highlight the other 10% of differences, and worse, the most vehement and violent expressions of those differences. So my perspective on this article is that it contributes significantly, if not blatantly, to the division it reports. And it does not serve us in any way. And, I hope I would have the same response if it were published by the New York Times. 😉

top 1% demographics 2011

HANG ON. I just saw that this favorite article I cited is from 2011. I have found a couple of more recent ones; will review and continue the thread….

vox welthy dems 2016

Okay, here is an article from 2016 by a poli-sci expert who, [Bill Bishop-style], explains well the progressive evolution of the top 4%. Very interesting:  https://www.vox.com/…/6/3/11843780/democrats-wealthy-party

And hey, here is one from Forbes this year, which quotes the author of the Vox article, highlighting how a sizable number of Republicans actually align ideologically with Democratic policies:

“The fact that lower-income Republicans, largely known as the ‘basket of deplorables,’ support more social spending and taxing the rich was a key takeaway from this year’s report, says Lee Drutman, senior fellow on the political reform program at New America, a Washington D.C.-based think tank… ‘It is pretty striking that about a fifth of Republicans had views closer to the median Democrat than their own party,’ he says. ‘A lot of them actually want a sizeable social welfare state. It’s a little bit of a puzzle why they don’t vote for the Democratic Party, other than long-standing cultural ties maybe and other ballot issues. What we have here is just one of the two parties stands out to have a bunch of its supporters in opposition to some of the party’s economic platforms but still gives them their vote.’” https://www.forbes.com/sites/kenrapoza/2019/06/24/how-democrats-and-republicans-differ-on-matters-of-wealth–equality/#13e06ab8702f

More from the Forbes article:

“But when looked at closer, a plurality of voters (72%) across the spectrum said the government should provide tax credits for low-income workers. Some 60% are in favor of raising the minimum wage, and 58% were in favor of raising taxes for those families earning over $200,000 a year.

“Across party lines, Democrats were the ones who were most interested in a higher tax burden for the wealthy, though it is unclear if they considered themselves to be part of the income group that would be hit with higher taxation in a more progressive tax structure.

“An overwhelming majority (79%) of Democrats earning under $40,000 a year wanted to tax the rich more. Democratic Party voters earning over $80,000 were 83% on board with taxing higher incomes at higher rates. For Republicans earning under $40,000, 45% were in favor of taxing the rich. Republicans who earned over $80,000 didn’t like the idea. Only 23% were in favor.”

[In conclusion:]  Complexity does not make for headlines, sadly, and we should take this into account when we read and share. Thanks for posting on my page and asking the question, [Friend], you have made me think and thus made me better! 😀