Category Archives: gratitude

Medicine:  Science + Humanity = Professional Pride

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Lots of learning this month, friends.  I’m overwhelmed and overjoyed, and proud of my profession.

It’s too much to write about in one post, but I will try all the same, in order of occurrence.

18 October 2019

Once again I had the privilege of meeting with medical students, this time to discuss their experience of leadership in medicine.  As is my new custom, I started with an appreciative inquiry exercise: What is the best thing about medicine, WHY do you do this?  One of their responses:

“The medical encounter is a unique combination of compassion and intellect—the conversation is my favorite thing, and that I also get to help.”

19 October 2019

Looking through the basement bookshelf, I came across my medical school application from 1994.  The general application included a one page personal statement, in which I wrote:

“Science, and the human body in particular, have always fascinated me… In practice, while I pursue the challenge of each new patient’s illness, I want to share with them my enthusiasm for the science of medicine…  But being a doctor involves more than curing people’s illnesses…  It is the job of the physician to reassure and comfort the patient…  In my practice I will…do my best to communicate with (patients) in terms they will accept.  The best way to comfort people is to relate to them.  I believe this skill will make me understand not only patients’ medical needs, but their emotional and psychological needs as well…  I hope to keep learning from my patients in the future.”

Turns out I’ve been both a science nerd, and also thinking and writing about relationships and connection for a while now, go figure.

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25-26 October 2019

This year’s ACP Illinois Chapter Meeting was the best one in recent years, in my humble opinion.  I’m so proud that under the leadership of our Northern Region Governer, Dr. Suja Mathew, we were able to present a robust clinical education conference, as is the ACP tradition.  Along with sessions on diabetes, heart failure, office orthopaedics, and cancer survivorship, however, we also included sessions on critical social and public health issues, such as diversity/inclusion, the impact of social media, firearm injury and death, medical marijuana, trauma-informed care, and sexual harassment in the workplace.  Esteemed colleagues from across the country came to share their expertise.  Here are just a few examples of Science + Humanity, in action every day in our work:

Diabetes

Science:  We now understand that it’s the wide swings in blood sugar, and especially very low sugar, that lead to end organ damage.  We have new classes of drugs with novel mechanisms of action.  They decrease the burden of glucose control on pancreas cells, and also seem to prevent heart failure in some patients.  Humanity:  All diabetic patients need education—face to face time with a trained professional who can teach them about the disease and how to manage it. Even the most highly educated and most well-informed person cannot automatically know how to be a diabetes patient without the help of these medical team members.  More and more, diabetes care in particular is a team sport, and our collective skills get better every year.

Cancer

Science: We are curing cancer.  There are more survivors now than ever before, thanks to targeted genetic and immunotherapy and minimally invasive surgery, among other treatments.  Humanity:  Survivorship starts at the time of diagnosis, and cancer patients have both unique and diverse needs and concerns.  Complications from treatment such as neuropathy and heart failure can occur years out from treatment, and the psychosocial consequences for patients and their families can be lasting and transformative.  The better we understand this as their care teams, the healthier and happier our patients will be.

Childhood Trauma

Science: Since the 1970s, cumulative evidence shows that Adverse Childhood Experiences and trauma correlate with an increased risk of negative health behaviors, mental illness, chronic diseases such as diabetes and heart disease, decreased academic performance, limited professional productivity, and early death.  And they appear to affect each of these outcomes independently.  In the Tree of ACEs, branches and leaves represent the interpersonal experiences.  We are only starting to understand the roles played by Adverse Collective Historical Events (slavery, genocide, mass incarceration, forced displacements)—the soil, and Adverse Community Environments (poverty, violence)—the roots.  Humanity:  The key factor that correlates with escape from the early mortality path from ACEs is a stable and nurturing relationship with an adult caregiver.  As healthcare providers, we have a unique and important part to play in the healing of all ACEs—our patients’ and our own—and all evidence points to the quality of our patient-provider relationships as foundation—no surprise.

Gun Violence

Science: In 2012 33,000 people died from firearm injuries (it was up to 40,000 in 2018); 62% of these deaths were suicides.  That same year there were 62,000 nonfatal firearm injuries, 72% of which were assault, 5% self-inflicted, and 17% unintentional.  Higher rates of gun ownership correlate with higher rates of death from firearm injuries.  States with both background checks and waiting periods have lower rates of suicide by firearm compared to those with background checks only.  It is still unclear whether states with more lax concealed carry laws have different rates of firearm related deaths compared to stricter states.  Humanity: Though mass shootings dominate the media, the majority of deaths from firearms are self-inflicted.  The acute impulsivity of mental illness, combined with an accessible, loaded firearm, destroys lives—whole families and communities at a time.  Our job as physician advocates is to not alienate gun owners, and rather enroll and recruit their help to address the factors that take our friends and loved ones from us.  It’s not an Us vs. Them fight over rights.  It’s a shared challenge to create policy that honors our unique national history and culture, and also effectively addresses our public health crises.  Here is where our highest notions of collaboration, respect, and shared purpose must be exercised.

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27-30 October 2019

Today I arrived in San Diego for the International Conference on Communication in Healthcare, my first time at this meeting.  Many of the sessions will present research on effective ways to teach communication skills to trainees, factors that impact health literacy, and methods for measuring effective communication.  This conference is all about the science of communication in healthcare.  And it’s also about the humanity.  The first plenary speaker was Dr. Lisa Fitzpatrick, who interviews people on the streets of DC in her series, “Dr. Lisa on the Street.”  The videos show over an over how people feel ignored and dismissed by our healthcare system, and how unsafe it is for them to admit what they don’t know or ask questions.  This is one of the only meetings I have attended at which patients are invited to present and voice their perspective.  At the end of this session one patient attendee stood up and spoke words that will guide me throughout this week and my career:  “Doctors may have all the education in the world, and if you cannot talk to your patients in a way that makes them trust you, it really doesn’t matter.”

Sessions I plan to attend:

Moving Health Care from a Team of Experts to an Expert Team

How to Become an Effective Advocate for Humanism in Your Healthcare Organization

Collaboration and Communication Across Multidisciplinary Healthcare Teams

Civility Ninjas:  A Field Guide to Improving Colleague-Colleague Interactions

Understanding and Addressing Mistrust

Shared Decision-Making as Ethical Practice

Thanks for reading to the end, friends.  I know it was a lot.  As I age I learn to hold patience as well as eagerness, absorbing the input as well as creating my own, integrated outputs for good.  How lucky I am to have so many amazing people to keep me company on the journey!

Four days to NaBloPoMo, my fifth attempt, HOLY COW!  Better get to bed…

The Mark You Make

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Friends, Ozan has written another book!  I know it may seem like it, but he’s not paying me to promote his work, really!  He has offered perks for Inner Circle members, however, like an advance digital copy for preordering, and signed copies when the book is released next April.  In considering what I would ask him to inscribe to my friends in the books I will give them, I realized yet another evocative dimension of my relationships.

If you were to describe your friendships to a third party, or make a meaningful introduction in service of connecting two amazing people, what would you say?  I call it ‘connecting fellow Awesomes,’ and it’s always a pleasure and privilege to serve in this capacity.  I thought to ask Ozan to write to one friend something like, “Cathy thinks the world of you—happy to make such a positive new connection!”  Then I thought, this friend has really made a mark on me.  Then I thought of the mark Ozan has also made, in just 9 months of virtual contact.  And then my mind was blown with the realization of my cosmically marked-up self—the finger, hand, and footprints of all those whom I have contacted.

Years ago I attended the orthopaedic surgery resident graduation dinner with my husband, a happy and fun annual event.  At the end, mingling with faculty and trainees, one of the graduates looked at me and his eyes widened.  “You’re Dr. Cheng!  You were my teaching attending during my third year medicine rotation [7 years prior] at [the hospital where I used to work]!”  I was gratified that his expression was cheerful, rather than distressed or awkward, surprise.  He went on to tell me that I held the team to a high standard of discussion, and that he appreciated my presence and teaching.  I will always remember this encounter with pride and appreciation.

In the past year three patients from my past have resurfaced and told me the positive difference I made it their lives.  I remembered two of them so clearly, both their faces and their names (after 20 years and thousands of patients, I can usually only remember one or other).  Talking to each of them reminded me of all that we had been through together, and I was glad that I had done my job well.

But what about those for whom I have not been a great doctor?  I have had my fair share of patients who left me, for various reasons.  I know I have been seriously disappointing for many.  I wonder how many times I have contributed to patients’ negative overall experience of medicine, and further widened the divide between doctors and patients in our fraught and flawed healthcare system?  Sometimes I look back on my early years of practice and cringe a little—all the writing I do now on empathy, compassion, curiosity, openness, and humility results from years of lessons learned in real time, on real people.  I’m definitely much more adept at it all now than in the beginning.  And I’m still learning—I still get triggered, still fall into old, counterproductive thought and behavior patterns.  Sometimes it feels like I will never be good enough, or enough in general.

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I also think about the people whose marks on me were/are hurtful, dismissive, and otherwise wounding.  It reminds me of carvings I see in the trunks of the beautiful aspens I walked among this weekend.  Did the folks who made them set out to harm the trees?  If they thought the tree might die from their knife marks, would they think twice?  Maybe they were overcome with their profound experience in nature and just wanted to mark it in some way, especially if they shared it with someone they loved (so may initials with plus signs and hearts)?  Sometimes we just want or need to be right, competent, respected, and acknowledged.  So we mark our encounters with stubbornness, aggression, or even violence (in its many forms, overt and cloaked).  Like the strong and flexible aspens, I bear scars from such encounters and still continue to thrive.  Such marks have taught me how to care for myself, and also how not to be toward others.

In the end, how do I reconcile these relationship phenomena?  Sometimes we can see and know the mark we make on others.  Many times we cannot.  Nobody is perfect.  My whole life I will scrape and nick those around me, hopefully never with malicious intent.  I can only hope for their generosity and grace, and forgiveness.

Sister Brené Brown, once again, helps me continue.  In her book Rising Strong, she describes a choice, a mental attitude, that can help us all suffer less.  If you have not read or heard the book, I highly recommend it—it’s my favorite of the 5 of her books I have read.  Assume, she says (with the help of her pediatrician husband), that we are all doing the best we can.  That’s it.  We are all imperfect.  Our circumstances mess with us, our patterns mess with each other, and sometimes it can feel like a strange and inexplicable miracle that we have not all killed one another already.  But choosing to give each other this one, simple, and at times colossally difficult benefit of the doubt, could be what saves us all.

We simply cannot extricate ourselves from each other.  So we can just do your best to take care of one another.  And be prepared to apologize, early and often.

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Tribe, Community, and Mission to Connect

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Fruit for Regina’s sweet galettes.  These are tiger figs, available at Trader Joe’s. 🙂

Friends, don’t you love those synthesis/cohesion moments when all of a sudden something important to you—a passion, a core value, a project—is validated from multiple angles?  That happened for me this weekend and I am positively giddy from it!

Tribe

My new group of medical students promises to be just as engaging and fun as every other I’ve had, yay!  They are only three rotations into their third year and already wise beyond their training.  This month we discussed tribalism.  They considered stereotypes, barriers to overcoming them, and how they might lead by example.  And they identified experiences in which such barriers are already breaking down.  “Finding your people” came up as both an aspirational as well as a potentially divisive ideal.  We discussed the benefits of ‘We’re Great!’ and the risks of ‘They Suck’ attitudes.  The conversation did not veer into political arenas, but it crossed my mind.  I tried to point out how the skills of professionalism we address in medical training apply well beyond the bedside and medical teams.  Our tribal memberships can save us and also keep us from living fully.  I’m so grateful to have these reminders on a regular basis.

Community

Some of you may notice I reference Ozan Varol increasingly this year (see coda below for why I think he’s so great).  I started following him in the winter after reading his post on why facts don’t change people’s minds.  This summer I joined his Inner Circle, a private forum of diverse and like-minded folks who subscribe to Ozan’s newsletter and wish to connect.  Yesterday Ozan generously hosted a conference call for three of us to get feedback on current projects.  At 2:00pm Central Daylight Time, I logged on from Chicago.  I met Ozan and his wife in Portland, OR.  J, a Canadian, called in from the Dominican Republic, where she has lived the past 24 years.  C, an organizational psychologist interested in humane-ness in the workplace, logged on from Germany.  And R, an education leader working on emotional intelligence workshops for schoolteachers, called in at 12:00am from India.  C, R, and I presented our projects and everybody gave generous, honest, and encouraging feedback to help us all do and be our best.  I could hardly contain my enthusiasm, gesticulating wildly and barely staying in the webcam frame sometimes.

I wrote to Ozan afterward:  “I’m still wrapping my brain around what you have done here–stimulated so many people to think more critically and also openly… Convened a community of us all and given us a forum to interact, at our own pace and in our own words, from around the world… and invited us to help one another, to contribute to lives that we would never otherwise touch…  What a privilege, a pleasure, and an absolutely ecstatic experience!!!”

Mission to Connect

I think it’s fair to say that part of Ozan’s mission is to connect people.  But not just for the sake of connection—to make us all more thoughtful, curious, and collaborative beings.  A man after my own heart!

Maybe my passion for such connection stems in part from my immigrant roots?  Today my daughter and I embarked on another food adventure at home:  Onigiri and chong you bing (but ours are much easier than the linked recipe!).  The former turned out to be less labor-intensive than I expected, so we made a bunch, both salmon and chicken versions.

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Tonight’s teriyaki chicken onigiri selection

My Korean-American friend of 20 years, Regina, posted photos of her own culinary accomplishments today—savory and sweet galettes.  Mei and I may try those next!  Our ensuing text thread included my laments about the unhealthiness of onion pancakes (but oh, salt, fat, and starch—yummo!).  Her kind reply: “Making food together with your kids, carrying on food culture, bonding, it’s a win-win!!”  I knew I loved her for good reason.  And how lovely that we have stayed in touch all this time!  If not for that, I could never have recruited her to join my work team this year.  And holy cow, talk about a win-win!  Her kindness, generosity, curiosity, openness, and conscientiousness have elevated the team even higher than we could have dreamed—Thank you, Regina!  What a blessing our connection has been for so many.

My new German friend C is thinking of launching a blog to explore humane-ness and its effects and importance in the work environment.  She thinks maybe next year.  Yesterday Ozan and I both encouraged her to start now.  Asked whether I would follow, I said HELL YES.  Not only will writing about her topic develop her ideas and thesis faster; the interface with fellow readers and writers on a blog, the opportunity to join a community of thinkers, and the connection with folks from who knows where, doing who knows what amazing things, may very well yield untold treasures of relationship and development—as it has for me—so why wait?

Tonight my heart bursts with gratitude for membership in such thriving, complex, diverse and overlapping tribes.  I treasure the various communities that welcome me and give me a chance to contribute.  And my mission to make as many and meaningful connections as possible between all people stands validated and sustained once again.

Onward, my friends.  As Simon Sinek says, Together Is Better.

 

Ozan about

Why Ozan’s So Great:

  1. Humility.  So many bloggers and podcasters are so full of themselves.  It’s obnoxious.  They may have expertise and knowledge, maybe even wisdom.  But I cannot get past my aversion to their ego.  I have no such issue with Ozan. 🙂
  2. Goldilocks content.  The blogs are the perfect length!  Enough words to make his point eloquently, and not so many that I lose interest before the end.  He contacts subscribers at just the right frequency–weekly emails and biweekly podcasts.  And the newsletters are also the perfect blend of blog, quote, and other interesting material.  So many other authors inundate the inbox that I first ignore and then unsubscribe.  Ozan has really found the perfect touch.
  3. Resonance.  Though Ozan’s podcast topic is failure, what he really addresses is humanity in all of our complexity and fascinating ironies.  I LOVE that!  And he does it nonjudgmentally, always from the perspective of curiosity and learning.  I really respect that–the generosity of spirit and growth, exploratory mindset.
  4. Consistency and reliability.  Ozan is clearly disciplined and intentional when it comes to this work (and so I imagine he is also this way in life).  His podcast script has a reassuring cadence and authenticity to it.  When he says he’ll reply to all messages, he actually replies (that is what most impresses me about him–his responsiveness and how he makes me feel like I matter).  He says he will update us on something and then he does.  All in all a truly stand up and stand out guy among so many!