Caring for One Another

Posted on March 1, 2020 by Catherine Cheng, MD

Last Saturday a patient cared about me.

He had severe abdominal pain that had kept him up all night and he needed advice. By the time we agreed on a plan he had apologized, at least three times, for ‘bugging’ me on the weekend.

I explained that it’s okay to ask for help on weekends. I’m happy to help if I can, and the relationship is the most meaningful part of my work. I also thanked him for not abusing that relationship—for not taking me for granted, for seeing me not as a transactional service provider, but as a person with a life outside of work.

When we feel seen and appreciated, life is easier to take and we function better.

* * * * *

Recently I’m thinking about organizational values and mission statements.

For the most part I find them superficial and unhelpful, wordy and convoluted.

As I consider the team I have led the past two years, I feel proud that although we have not formally written mission or values statements, we are nonetheless clear on both. We define them in succinct language, gauge how we manifest them through action, and reconcile behaviors, conflicts, and initiatives against them regularly.

Our values, collectively adopted one year ago:

Fun, joy, creativity
Collaboration and Connection
Accountability
Kindness and Compassion

Reviewing the list, I see that caring for one another serves as the foundation for this house. This applies both to the team’s inner work, as well as anything facing outward toward patients.

It is of course our responsibility as professional caregivers to manage ourselves and show up our best for our patients. I expect patients to treat our team with respect, but we should not necessarily feel entitled to their caring about us, per se. It is our job to care for them; the relationship is inherently imbalanced in that way. In order to do that well, we the team must also care for and support one another in service of our vocation.

So every once in a while, when a patient expresses genuine caring for me or a member of the team, in addition to appreciation for a job well done, it really brightens our day. It keeps us going. It makes all the unappreciative, and even abusive, encounters worth it.

Thus, we march on. We remember why we do this work and we hold each other up.

* * * * *

Please know how much your expressions of affirmation matter to your medical team.

We’re all here caring for each other in this life. The more we can remember that and act on it, the better off we will all be, no?

What I’m Learning About Equity

Posted on January 26, 2020 by Catherine Cheng, MD

My friends, I am humbled this weekend.

A year ago I agreed to present on culture change to the inaugural WEL cohort, a group of 18 amazing women physician leaders. I had no idea at the time what an honor and privilege this would be. This would be the last in person meeting of their 18 month training on Wellness, Equity, and Leadership. Having just completed my own 10 month leadership training, I empathized acutely with the bittersweet bonding and pending farewell among these sisters.

For two days I received infinitely more than I offered, and I saw again how membership in a mutually respectful, supportive, and empowering tribe can transform any individual from star to superstar. Truly, these women were superstars before this tribe was formed; but whereas before we probably only needed dark sunglasses in their presence, now we need welder’s masks.

Gender, race, socioeconomic status, mental health status—these factors among others are all subject to unconscious bias and thus discrimination, in all arenas of society. These WEL women will have a hand in changing that for the better, of this I am certain. I’m so proud to know them all.

The night before my presentation, I messaged my friend who has helped me think more deeply about these issues in the past year. I wrote, “It reminds me of your idea of approaching inclusion first, which I now see as wide psychological safety. As you said, there can be a room full of white men and all may not feel included. And in my mind, that precludes true, open and honest collaboration and productivity. It prevents any forward movement toward diversity or equity. When we don’t feel safe we revert to scarcity and survival thinking. We look out only for ourselves. Nothing good happens here.”

What about the one Old White Guy (OWG) among women, how does he feel? Dr. Clif Knight, Senior Vice President of Education for the American Academy of Family Physicans and WEL steering committee member, owned this distinction this week. He reported his recent self-identification as ‘a HeForShe.’ My heart leapt for joy. Later I took him by the lapels and shook him (gently), practically yelling that I was so excited, and wished for him to recruit all of his OWG friends to the cause.

I thought again about my friend above, also an OWG. I know him to be kind, generous, respectful of women and a genuine ally. What about his idea of working on inclusion first? After a long, deep conversation with one of my new WEL friends, with whom I’m also thinking about equity issues for Asian-American physicians, a new insight dawned on me, and I wrote to her: “Practicing inclusion INCLUDES the OWG ‘oppressor’! 😱 If we talk only about him needing to include others, while we make him feel excluded himself, how can we ever expect to enroll him in our cause or even behave in the way we ask? We do how we feel. And when we feel threatened and marginalized, especially from a place of loss, we act accordingly…”

Another new WEL friend, Dr. Dawn Sears, has already taken this idea to heart and made an impact in her community, elevating women’s and men’s awareness of gender disparity in medicine, and helping them fight it together. Check out her powerful presentation to colleagues here, full of evidence as well as unsettling personal stories. In it she directly and kindly addresses the men in the audience, informing and inviting them to join the fight, for all our sakes. She names the contrarian men who have held her up on her professional journey, defying gender bias and paving their own HeForShe way for others. She includes men in order to enroll them in the movement. I encourage all to view the talk—find out how you, as colleague, patient, and all around good citizen, man or woman, can help improve the system for us all.

Once again I thought about my friend. I wrote to him again: “I wonder if I inadvertently made you feel excluded, or at least ‘other’d’ when I asked you to read Feminist Fight Club*. DUH, the intended audience for that book is women.” He was gracious and encouraging in his response, and I look forward to continuing our conversation for a long while.

Tonight I feel wildly optimistic. So many strong, visible, articulate, creative, powerful and loving people all over the place, all working to make the world better for all of us, WOW. We will make a difference, my friends. We are not only allies; we are accomplices. If we go together, we can do anything.

Onward, friends. We’ got lots to do.

*He made an earnest, good faith effort, and did not finish the book.

Friendsourcing Motivation

Posted on January 19, 2020 by Catherine Cheng, MD

Sunrise, Sylvan Dale Guest Ranch, Loveland, Colorado. Photo courtesy of Dr. Anne Dixon

Greetings, friends! How goes it, halfway through January of the New Year? How are you doing with those resolutions? I always feel conflicted about announcing such commitments, preferring to call them ‘intentions’ (see here, here, here, and here!). I’ve read too many articles dismissing resolutions as mindless, unhelpful, and ultimately a waste of energy. And yet, the start of a new year naturally prompts reflection and renewed motivation for self-improvement, which are good things.

Once again, taking a more nuanced view helps here. It’s not that resolutions are bad. It’s that we need to be thoughtful and realistic about them, as the linked article above suggests. Whatever we call them, commitments to behavior change can lead us to transformation. But it’s anything but simple or easy!

My post on experimental questions got a boost in views this past week. I wonder what prompted that? I wish I knew who was reading it and why, what they think, and what it means to them? Since that post was published, I have continued to ask my 4 newest questions, of both patients and myself. The recent traffic on that post parallels the evolution in my own reflections and answers:

In the coming year, what do you see as the biggest threat to your health?

My hedonist impulses, no question: Ice cream and office sweets, mostly, but also online washi tape sales and paper, clothing, and shoe stores.

What is the biggest asset?

My friends, also no question, my pit crew. They encourage me, keep me honest, and lend perspective. They teach me and inspire me. They hold me up.

One year from now, what do you want to look back and be able to say about what’s important to you?

In January 2021, I want to look back and say that I got fit again, that I regained the exercise discipline I lost in 2019. I got control of my eating, decreased my sugar intake by at least half. I put my phone down and was more present with my kids. I was more intentional and executed better on how I spend my time and energy overall. I exercised agency over my life better than ever before.

What support (external to yourself) do you already have and/or may still need to recruit, in order to make that vision a reality?

On November 10 when I posted these questions, I honestly had not answered this one yet. It was harder than I had anticipated. Since then, as I continue to ask patients, I see that I’m not the only one stymied. My first response resembled my patients’, something akin to, “Well, I just have to do it.” We type-A, independent peeps often rely first and foremost on ourselves. We don’t ask for help. And even though I have written and spoken ad nauseum about the importance of support, I found it difficult to identify my own need for it. This is why I have added the ‘external to yourself’ clarification to the question. Support comes from somewhere or someone else. And we all do better when we have it.

***

Friendsourcing Motivation

The whole time, the answer was right there in front of me. The biggest asset to my health is my friends. We know that social support (sometimes in the form of peer pressure) can be the key to success in behavior change. Why else would people attend Weight Watchers meetings, or to go AA? I need a workout buddy and a healthy eating buddy, I realized—I can tap my assets! Eureka!

Easier said than done, however. Who should I ask? What should it look like? Over a month or so, I worked out my specifications:

I need support from friends, not strangers (thus fitness classes will probably not be my jam)
I don’t want to be constrained by schedules with my buddies—flexibility is key
I need a two-way arrangement—someone who also has a goal that I can support them in
The arrangement must be concrete and accountable, but not feel oppressive

Tadaaaaah—Habit Share*!

On our sunrise walks in Loveland last weekend, two friends from LOH and I agreed to be one another’s buddies. It was perfect—we all wanted the same things; we just needed an easy way to connect. One of us, the youngest, most tech-savvy one, found the Habit Share app. It’s free and perfect. We each define our own goals, and simply share them with each other online. We receive notifications when our friends check in, and we send messages of encouragement and solidarity. It’s perfect! I have already shared the app with patients and other friends, and am now connected to two more friends. Our habits range from exercise to reading, to flossing.

Holy COW, what a difference! Just knowing that I’m tracking my goals, and that my friends are seeing and supporting me, it’s been exponentially easier to motivate and execute these seven days than the entire past year. It’s easy, aesthetically pleasing, costs no money, and connects me with people I love. It is–wait for it–PERFECT!

I know, I know, it’s only been a week. Who knows what all of our app screens will look like in another week, a month, or three months from now? Will we all still be connected and holding each other up in a year? Who can say? But what’s the utility of thinking that far ahead? Yesterday I set the new goal of getting up early once a week to write. Today I can check it off. I still have a chance to say no to ice cream, work out, turn off my phone apps by 10pm, and floss! My friends will know when I do it, and they won’t judge me if I don’t. It’s all good, and we can all take it one day at a time.

So, what support (external to yourself) do you have, or may still need to recruit, to make your best-self vision a reality?

*I have no financial or other interests in this business. In fact, I want to contact them to give them feedback about how to make it better, but I cannot find a ‘contact’ page on their website…

All Good Things Must End

Posted on January 12, 2020 by Catherine Cheng, MD

Setting moon, Sylvan Dale Guest Ranch, Loveland, Colorado. Photo courtesy of Dr. Karen Cornell

Friends, Leading Organizations to Health has graduated Cohort 11, the Class of 2020.

Ten months ago I started at my Hogwarts, the leadership training program that has definitely made me a better leader. But more importantly, it made me nine amazing new friends and a much better person. Today, on the last day of the last retreat, it all came together in the most beautiful way, and I am beyond grateful.

These ten months were the best elective educational experience of my life—they really gave college and med school a run for their money. We immersed in a curriculum dense with abstract concepts of interpersonal communication and organizational change management. We then translated the theories into tangible skills in an experiential learning lab, applied to specific challenges brought by my 7 cohort mates and me. Over four in-person retreats and monthly Zoom calls, we shared, supported, and coached one another in the tenets of relationship-centered leadership.

We bonded in a similar way to residents on call: Gathered for training, bringing different backgrounds and perspectives, participating in a common curriculum but each with a unique learning path, eventually to disperse and practice in different settings across the country. We eight now share a connection of stories and struggle that nobody else can know. We are a tribe.

Thus, I grieved the goodbyes long before we arrived in Loveland this last time. But I also trusted our master facilitators to help me manage this, by both their loving and authentic presence and the very structure of the program, which is founded on contemplation and self-awareness. I also felt an abiding faith in the friendships we all grew this past year. As with my best friends from college and medical school, I knew we would maintain contact and connection, just in a different way. We can’t stay in the nest forever—now is the time to fly.

In thoughtfully constructed journaling exercises and discussion groups, we reflected, consolidated, and synthesized ten months of learning. We also examined our personal and professional evolution over this time, growth and movement in fluidity and complexity. We explored aspirations and imagined the future state of this work in our natural habitats. Finally, we sat in a closing circle. Having each shared our own reflections, the group offered each friend observations, affirmations, and well wishes in what I can only describe as the most loving communion. Each person’s strengths were articulated and amplified. We acknowledged one another’s challenges. We celebrated each other’s engagement, perseverance, contributions and triumphs. Finally, sustained mutual support was extended around the circle, wholeheartedly and without qualification.

In my opinion, we formed the kind of community that we all want to lead. Tony and Diane led us all by example, deliberately, artfully, and mindfully. They live the principles they teach; they lovingly and patiently showed us the way. In the end we discovered our own capacity to each write our own next chapter(s). By making us feel seen, heard, understood, accepted and loved these ten months, our teachers inspired us to do the same for others. And that is the strongest foundation for building our houses of positive change agency.

Now we go forth. We’ got this.

Onward from 2019: Learnings and Intentions

Posted on December 31, 2019 by Catherine Cheng, MD

Friends! WHAT a year, no? How are you feeling here at the end?

In this post: 3 key learnings, 3 high intentions, and my 6 recommended life readings.

What resonates with you?

What would you add?

For a thoughtful and inspiring look on the coming year, check out Donna Cameron’s post from yesterday.

3 Key Learnings of 2019

Complexity

“When we try to pick out anything by itself, we find it hitched to everything else in the Universe.” –John Muir

“All that you touch, you change. All that you change, changes you.” –Octavia Butler

We all live in inextricable connection, like it or not, know it or not, want it or not. Every interaction has potential for benefit and harm, and the scale is exponential. Some may find this idea daunting, overwhelming, or untenable. I find it reassuring. The idea that some cosmic life thread connects us all, that we are made of the same stuff today as that which existed at the dawn of the universe—this gives me peace. It encourages me that everything I do in good faith could make a difference. You really never know how far a small gesture or sharing will reach for good.

The 3 Tenets of Relationship-Centered Leadership

Not so much learnings as a synthesis from LOH training, these are the current foundation statements of my personal and aspirational leadership tenets (iterations likely to evolve over time):

Founded on curiosity, connection, and fidelity to a people-centered mission
Attendant to the relational impacts of all decisions, local and global
Respectful of norms and also agile and adaptive to the changing needs of the system

Having defined these ideals for myself, I am now fully accountable to them. And I hold them as a standard for those who lead me.

Being >> Saying or Doing

Saying and doing compassionate, empathic, and kind things are necessary and noble. And they are not enough. These actions ring hollow without honest sincerity behind them. People feel us before they hear our words. Our authentic presence, positive or negative, originates from within. It manifests in posture, facial expression (overt and subtle, intentional and subconscious), movement, and tone and cadence of voice. Fake it ‘til you make it—saying and doing things because we know we ‘should’—only gets us so far. We humans possess a keen sense of genuineness—it’s a survival instinct. If we accept that a meaningful, productive life and effective leadership in particular, require strong, trusting relationships, then we must cultivate true compassion, empathy, and kindness. That means suspending judgment, managing assumptions, and holding openness to having our perspective changed by all that we encounter (see first key learning above), among other things. This may be life’s penultimate challenge—our role models include Mother Theresa and the Dalai Lama.

3 High Intentions for 2020

Continue to ask more and listen better for people’s personal and unique meaning making—not just patients but all people—attend to souls
Let go perfection
1. All relationships are not great, and it’s not all my fault
2. Some people/relationships and circumstances challenge my best self and skills more than others
3. It’s the honest, sincere, good faith effort, and the learning from imperfection and failed attempts that matter
4. Some relationships are better ended
Guard against judgment, arrogance, and cynicism

6 Recommended Life Readings—the 6 most personally impactful books I have read in the last decade:

The Art of Possibility by Rosamund Stone Zander and Benjamin Zander. Scarcity thinking, competition, and looking out for number one hold us all back. Stepping fully into our central selves, claiming our full collective agency for creativity and collaboration, and manifesting all the good we are capable of—that is the discovery of this book for me.

Start With Why by Simon Sinek. In my opinion, the most eloquent and resonant writing on the purpose-driven life. The freedom and creativity that flows forth therefrom—it all just gives me goosebumps. Sinek’s The Infinite Game may eventually make this list too, once I have integrated its content and learnings more fully.

Rising Strong by Brené Brown. Strength and vulnerability, confidence and shame, individuality and belonging—these are the essential human paradoxes that Sister Brené reconciles with gritty aplomb through real life stories as well as grounded theory research.

Big Magic by Elizabeth Gilbert. Be you, all you, all in. Love thyself—flaws, failures, and falls all included. Make things. Because that is what we are put here to do, for ourselves and for one another.

Leadership and Self-Deception by The Arbinger Institute. Perhaps no book explains the profound importance of being better in order to do better, better than this. And it took me almost all year to really comprehend, and then begin to apprehend, the concept.

Being Mortal by Atul Gawande, MD. I started and finished this one on vacation this past week. Dr. Gawande is my favorite physician writer. I consider this book required reading for all physicians for sure, but really for all people . “The death rate from life is 100%,” a wise patient once told me. In modern western society and culture, multiple intertwined and complex forces hamstring our ability to live and die well and at peace. This book is a brilliant compilation of heartrending personal and professional stories, neatly folded with history, research, and practical information for improving this sad state of things. It is also a guide to the hard conversations that we all should really have—now. It has both validated what I already do in my practice, and profoundly changed how I will do things hereafter. Thank you, Dr. Gawande.

*****

Best wishes for Peace, Joy, Love, and Connection to all.

We Must Go Together

Posted on December 22, 2019 by Catherine Cheng, MD

How will you celebrate this week, friends?

What do you leave behind, and what do you look forward to?

The sentiments on the front of this Christmas card, created in 2017, align with my core values and my Why: to cultivate the most meaningful, heart-connected relationships between all people. The last four years have taught me much on this journey—about American political geography, economic and tribal dynamics, and my personal trigger patterns. 2020 feels daunting and high risk to me; I approach it with caution, and also with Fierce Optimism.

I feel prepared and trained for whatever lies ahead, as I know I have my strong social and emotional ties to lean on. They may prove tested and strained in the months ahead, and I feel confident they will hold. Because in the end, however divergent our political or economic leanings, I firmly believe that what unites us infinitely outweighs what divides us. I keep coming back to our shared humanity—that we all love our children, wish to hand down to them a world in peace; that we all want all of us to live in happiness and security. This belief is what keeps me going, what makes me continue to reach out and attempt to connect.

We have much work to do my friends, many frayed patches of social fabric to mend. And I honestly believe we can only do it—we can do anything—if we go together. Just think of that time when you thought something was impossible—and somehow you pulled it out. I bet you had help, no?

The road will be long and arduous. We will stumble and fall, we will argue. We will fight. We will also share breathtakingly beautiful vistas, and numerous moments of sublime love and communion. Let us meditate on the latter—on all that is good—let us seek it and acknowledge it in one another with eyes, hearts, and voices wide open and out loud. Let us harness that energy and put it in front, guiding our attitudes, words and actions, toward ourselves and all those we encounter.

May this holiday season, this time of reflection and preparation, reconnect us with the whole human family. Connect on every plain, every mountain, every island; in every school, (church), and statehouse; in every city, village, community, and home of our little blue planet.

May we do better in 2020 and beyond.

November 28: Gratitude Makes Me Better

Posted on November 28, 2019 by Catherine Cheng, MD

NaBloPoMo 2019

Haha, DUH!

How cliché to write about gratitude on Thanksgiving, right? Kind of feels like professing love on Valentine’s Day. At the same time it’s nice that we have a day designated to acknowledge all that we are thankful for, it also feels a bit contrived, perhaps?

But seriously, gratitude really does make us all better. Read more about this here and here. In summary, practicing gratitude seems to correlate with improved physical and psychological well-being, better sleep, increased empathy and self-esteem, and decreased aggression. But how do we feel this on a daily basis?

As some of you know, I started a daily thank you note practice in January. I’m proud to say that on average, I have written at least one note per day since I made the commitment. Occasionally a few days go by and I write none. But many days I write multiple. I love to use my washi tape cards, but sometimes it’s an email or Facebook message, other times I post on a website or in feedback comments to a company. It’s become a habit now. Every day I feel gratitude acutely. I recognize the people who make a positive difference in my life, repeatedly, reliably, and without expectation of anything in return. My expression of gratitude connects us further, holding us all up through days of mundane grinding. If I use my washi tape cards there’s also a flourish of color in there. This practice has given me leave to reach out to authors, companies, people and organizations who may not otherwise know the positive impact they have on any given individual. It feels good.

Tonight I’m grateful for so many things—nature, the most meaningful work I can imagine, all of my first world comforts and resources. But no question, I am most thankful for people. My parents, holy cow. My sisters, husband, children, extended family. My friends—the family I choose. Colleagues, students, patients. Fellow activists and volunteers. Challengers and worthy rivals.

I will pay more attention and reflection to this last group in the coming year. When I accepted my new leadership role two years ago, Coach Christine had me identify my ‘allies.’ Of course all of my loving, supportive friends and family came to mind first. But Christine also pointed out the challengers—those who vex me, the thorns in my side, the dissenters–they are also allies. Of course! Some of my best growth and progress is born of struggle, interpersonal and otherwise. So how can I be but grateful for the people in my life who make it a little harder? Whatever doesn’t kill us, right?

I hope you all had a loving, delicious, and fulfilling Thanksgiving, friends. May we all carry some of this warmth and connection forward through the holiday season and beyond. We only have one another. We will not always agree. We will all struggle. We can only do our best every day. Grateful for each day to try to do better, again and again.

Healing Through Connection

The Inner Work of Physician-Patient Relationship…And Other Things

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