Welcoming 2021

It’s almost here, friends, a New Year!

What lessons and mementos will you hold in front, what light guides you?

Tonight I consider the landscape and path ahead.  What do I look forward to, and how do I want to be?  How will I approach relationships, media, leadership, projects, and health?  How will I challenge myself?  On the last blog post of 2021, what do I want to look back and be able to write about what’s important to me in the year past?

Relationships:  Always work to do here.  Some will require more vulnerability, which is scary.  In others I will work to overcome booth pride and self-doubt—maybe that is the ultimate paradox of imposter syndrome?  At my best I exemplify curiosity, humility, generosity, honesty, and kindness.  In the hardest moments I must cultivate non-judgment, empathy, and patience. I will scrutinize my inner narratives and assumptions, and look always to connect.

Media:  Ask. More. Questions.  What is the writer/reporter/source’s objective?  What is their bias?  What is mine?  Where/how can I access primary data in full context?  How should I be willing, and how willing should I be, to learn, change, and grow from what I take in?  How will this make me better, and to what end?  To practice thoughtful discernment—before, during, and after consumption—that’s the goal.

Leadership:  What do people need from me, individually and as a group?  How can I best also lead those who lead me?  In 2020 I completed a 360 evaluation; the feedback has served me well, and I review it often.  In 2021 I commit to stepping out of my default styles more often.  I will nurture my I, S, T, and J sides and attune better to those who live at these frequencies.  Goal:  To help my people and organizations advance toward our full potential, always aligned with and in service of our deepest core values.

Projects:  Assuming the invitations continue, this could be hard.  Every new presentation, paper, group, conference, and class, in my mind, is another exciting opportunity to learn, synthesize, integrate, and connect!  But I can’t do everything, and I must stop “screwing your future self,” as Ozan puts it, by overcommitting. 

Health:  Walk the talk.  Sleep, Exercise, Nutrition, Stress Management, and Relationships.  After all this time, defining health in terms of these five reciprocal domains continues to bring clarity and direction for both my patients and me.  I’m learning about keystone habits, which I bet will help all of us in the coming year.  Thankfully, not every domain goes to hell at the same time, and all behaviors are subject to change.  Goal for 2021 is to fortify healthy habits in each domain, especially the weak ones, to make them less susceptible to derailers.

Coda – Some last thoughts for the year

Books:  This week I started and finished Matthew McConaughey’s Greenlights on Audible in about 36 hours.  I don’t know if his hoots and whistles are written in the book, but they and he are a riot to hear on audio.  What a master storyteller!  And the life lessons are valuable, too, offered with humor and confident humility—highly recommend.

Since I shared my 2020 book list last week, friends have made myriad suggestions that are now in the queue for 2021:

The Naked Now by Richard Rohr

Upstream by Dan Heath

Nonviolent Communication by Marshall Rosenberg

Who You Are: The Science of Connectedness by Michael J. Spivey

You’re Not Listening: What You’re Missing and Why It Matters by Kate Murphy

Thinking In Bets by Annie Duke

Out of Our Minds: Learning to Be Creative by Ken Robinson

The Coddling of the American Mind by Greg Lukainoff and Johathan Haidt

The Long Game by Mitch McConnell

I’ve considered reading that last two for a few years now, and always avoided it.  Didn’t want to be uncomfortable.  In 2021 I commit to training in discomfort, to learn and broaden perspective.

Songs:  A friend solicited a playlist to bridge what has been to what can be.  Here are my contributions.

Do What You Can, Bon Jovi

May We All, Florida Georgia Line

Burn the White Flag, Joseph

Stand By You, Rachel Platten

No I In Beer, Brad Paisley

Days Like This, Van Morrison

The Mountain, Dierks Bentley

From Now On, The Greatest Showman Soundtrack

Dancing Queen, ABBA

What’s on your lists?

COVID Vaccine:  I recommend it.  After reassurance that my colleagues at higher risk than I who wanted it have gotten it, I got my first dose of the Pfizer/BioNtech vaccine yesterday.  34 hours out now, I have minimal, focal, and superficial arm soreness at the injection site and no other symptoms.  I did my usual HIIT workout tonight without limitation.  Read this concise and user friendly guide to the mRNA vaccines by Pfizer/BioNtech and Moderna, with references to data on safety and efficacy.  To see when you will likely be eligible to receive the vaccine, refer to this slide deck from the CDC, also concise and easy to read.  There are many months yet ahead to stay vigilant and mindful, though.  Cases and deaths will continue to rise before receding, especially with all of the people still traveling for the holidays.  Please continue all of your best COVID exposure precautions, for all our sakes. 

So much lies out of our control, friends.  And yet we all still have all kinds of agency.  We get to shape our future.  Let us all use our personal power for good, shall we?  At the end of each day may we look back and forward on myriad words and acts of kindness, generosity, humility, and connection, rather than judgment, ridicule, derision, and exclusion.  That’s how we can make 2021 infinitely better than 2020.

No Wonder I’m Burned Out!

Once again, I ask my friends:  How are you? 

I am not great!!  Neck, back and head pain, insomnia, low mood, and the worst case of stress eating in a couple years—GRRRRRRRR!  *deep breath*  …So, like a good primary care doctor (she says with tongue in cheek), I evaluate and treat myself.

I ask patients to rate the stress and meaning of their work and then compare:  Is work overall more stressful than meaningful, or the other way around?  It helps me assess the sustainability of their work life, and gives me insight into their values and priorities.  In recent years when I’ve asked myself, the answer is consistent: moderate stress, HIGH meaning.  Today it’s high stress, less high meaning.  For the first time in a long while, work is not necessarily more meaningful than stressful.  Yikes.

Stress:  It’s COVID. 

Meaning:  I ask patients how they derive personal fulfillment and meaning from work.   I recently asked myself again.  It’s twofold:   Relationships and Efficacy.

Relationships: I am your primary care doctor. Sometimes I’m your therapist, your cheerleader, your drill sergeant, and your accountability buddy. I have always loved this, even on the hardest days. But this year, I am also a resolute public health advocate. Sometimes that rubs you the wrong way, because I tell you things you don’t like. I recommend against flying. Don’t eat at restaurants. Don’t gather with your family for the holidays. Don’t go to church. Stay home for 14 days after an exposure. I interrogate your COVID precaution practices. Then I dissect and judge them (not you), thank you on behalf of humanity, and admonish you to persist, longer and longer, for all our sakes. It kinda puts a damper on our relationship.

Efficacy:  I. Help. People.  It’s my calling!  Hemorrhoids?  No problem.  Back pain?  I’ got this (yer back, that is).  Viral gastro?  Migraine? Core instability, palpitations, paresthesia, GERD, thyroid nodule—even  depression and anxiety—I can make a good plan for all of these things.  I can walk you through it, reassure you, and help you feel better, even when I can’t fix the problem. 

Not so with COVID.  How did you get it, when you were so careful?  If the test is negative there’s still a 20-30% chance you’re infected if the scenario is high risk, but I can’t say for sure.  If you’re sick, how long will it last?  Will it get worse before it gets better?  How much worse?  Will you have lasting symptoms or long term health problems?  How long does immunity from illness or vaccine last?  I cannot lie:  I. Don’t. Know.  I will stay with you through it, but I can’t even satisfy your most basic questions, while you sit alone at home coughing, short of breath, unable to see or touch your loved ones, sipping ginger ale because you throw up anything else.  I can’t help.  And it kills me.

On top of that, I’m not doing any good as a public health champion, either!  Have I changed any of your behaviors?  Have I made even an iota of difference in my community to stop the spread?  All signs say NO.  I’m failing left and right.  No wonder I’m eating so much.

Burnout

Burnout is widely understood to have three key components: 1. Emotional Exhaustion, 2. Cynicism/Depersonalization, and 3. Reduced Personal Efficacy. Studies of physicians generally show that while we often score high on the first two, we do better with the third. I think not anymore. Burnout affected about half of all physicians in all specialties a few years ago, but had improved due to widespread research, awareness, and advocacy for systemic change led by professional societies such as the American College of Physicians and the American Academy of Family Practice. But think about 2020: Whatever emotional exhaustion my emergency medicine and critical care colleagues felt before, caring for the sickest of the sick, likely pales in comparison to the horrors of this pandemic. When their health systems ignored their pleas for PPE and then laid them off, making remaining docs work that much harder, and when they saw people partying and spreading virus all over the place, could you blame them for getting cynical? And though we’ve learned so much and fatality rates are lower now than in March, imagine going to work every day to watch patient after patient suffer and die alone, despite your and your team’s best efforts. We can no longer count on efficacy to save our morale.

Re-ignition

So how do we hold it together? Well DUH, it’s about connection! I had not felt this bad in a long time, but I’m better now, thanks to my peeps. They’re everywhere, and we hold each other up. Texting a meme here, venting (a lot) over there, and generally being present for one another, sharing, even embracing, the deep suck of the morass. Because this too shall pass… Like a kidney stone, as they say.

The only way out is through.  The best way through is together. 

I haven’t thought, said, or written that in a while.  It’s not that I forgot.  I got overwhelmed.  Happens to the best of us. 

Pandemic Lesson #1: Flexibility

NaBloPoMo 2020 – Today’s Lesson

What have you had to be flexible about this year?  What has this taught you?

It’s not that we cannot make plans anymore.  It’s that we must be willing and able to change them, quickly and effectively, if we want to actually get anything done.  Move all primary care and primary/secondary education online?  Done.  Stop flying?  Okay.  Come back to work and school?  Sure.  Wait no, outbreak, go home again, please?  Fine.  Postpone big vacation 3…6 months… indefinitely…  *sigh*…we can deal.

Many of my patients are actually thriving in the new work from home normal.  Without the constant travel, jetlag, business dinners (the quadruple threat to acid reflux:  late, fatty, large, and full of alcohol), and long commutes, they sleep more and better, spend more time with family, exercise more, and eat healthier.  If all goes well, my executive health job may be obsolete in the next decade, hallelujah! 

Not everybody’s doing well, of course.  60% of the workforce still shows up in person; risk, stress, and burnout are very real, and escalating.  The people who are well are those with choice.  They are the privileged ones.

Most of us still don’t know how the new work life balance will look in the coming years, but we hope to retain and expand the flexibility that has given us some sense of agency and control.  Check out this episode of Hidden Brain to hear a Stanford work from home researcher on implications of this augmented world for all of us. 

What flexibility do you wish for in 2021?

Agency and control in the midst of a global pandemic—how ironic!  Pandemic lesson #2 may be Paradox and Polarities… The last 2020 NaBlo…  Wait for it…