Category Archives: Health

On Finding Meaning

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NaBloPoMo 2016, Letters to Patients, Day 8

To Patients Seeking Meaning:

Try the Three Question Journal.

One of my favorite parts of a new patient encounter is when we talk about your work.  Not only hearing about what you do (as I wrote on Day 3), but what it means to you.  I ask you to rate your overall work stress on a scale of zero to ten.  Then I ask you to rate the overall meaning of your work (to you, not to others), on the same scale.  I’m looking for meaning to rate higher than stress, and above 6 in general.  This ratio, I have observed, represents a sustainable and fulfilling work life.  When I hear you articulate your passions and intentions at work, it inspires me, too.

Some of you realize suddenly that the meaning you once felt has faded, and you get pensive.  Or you tersely state that your work holds no meaning whatsoever, other than as a source of income.  This is where I usually pause for a few seconds to feel out where the conversation will go.  Should I screen you for depression?  Should we explore or move on?  My meaning comes from these inflection points.

Given that we spend most of our waking hours, most days of the week, at our jobs, I assert that it’s worth trying to maximize our sense of meaning.  Why not be happy and fulfilled at work, if you can?  I also assert that this is something we can and should choose, for our health and that of those around us.

My friend Liz recently re-introduced me to an exercise that may help.  It’s from Rachel Remen, physician and author of two deeply moving books, Kitchen Table Wisdom and My Grandfather’s Blessings.  It’s called the Three Question Journal.  You can find background and detailed instructions on her website here.  Basically it’s a daily practice of finding three things in your encounters:

  1. Something that surprised you
  2. Something that touched your heart
  3. Something that inspired you

Many of you may think this is a waste of time, frivolous, meaningless.  You have more important and pressing things to do.  I admit, I am not a consistent practitioner.  I feel anxious: What if I can’t find anything?  That must mean I’m mindless, cold, and utterly un-inspire-able.  Remen says this is okay— “DO NOT BECOME DISCOURAGED!!   Many people find that for a little while the answers to all three questions are exactly the same:  NOTHING, NOTHING and NOTHING.”

Wouldn’t it be so much better to be able to answer with, “This, THIS, and oh my God, THIS!!”  Every day?

We have 22 more days of November.  If you comment that you will challenge yourself to this practice every day for the rest of the month, so will I.  And we can compare notes along the way.  Whattaya say?

 

On the Lightness of Moving the Body

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NaBloPoMo 2016, Letters to Patients, Day 7

To Patients Who Struggle With Exercise:

Anything is better than nothing!

Are you a natural exerciser?  Do you move your body every day because you just can’t help it, as opposed to the rest of us, who do it occasionally because we know we ‘should?’  If so, this post is not for you.  But I do have a request:  The next time you’re with us, the unnatural exercisers, don’t judge us.  We are secretly inspired and awed by you, even as we hate you.  Your active non-judgment, which serves as passive encouragement, may be just enough to lower our threshold for doing something.

Okay so, for the rest of us:  How can we overcome the exercise barrier?  Wouldn’tcha know it, I have a suggestion!  Wait for it…  Do anything!  It sounds silly, right?  Too simple?  I have learned that simple is key, and silly can be fun.  Three years ago I was decidedly a non-exerciser.  In early 2014 I connected with a personal trainer and have since rediscovered my inner athlete, one baby step at a time.

Our initial sessions focused on awakening my core (apparently I had gluteal amnesia).  I never knew I could break a sweat holding a simple yoga pose.  I got discouraged at the prolonged lack of progress in cardiovascular endurance and strength.  But little by little, I could do more.  Early last year I downloaded a free workout app and aimed to exercise 7 minutes (read: get through one circuit, however feebly), 3 times a week.  Holy cow, how humbling to discover how 30 seconds of jumping jacks could make me so breathless?  Suffice it to say, I established an unequivocally low baseline.  But somehow I was able to let go the judgment of the failure to be fit already.  I congratulated myself for trying at all, and decided to keep going.  I bet I can get better, I thought.

And that’s the point:  We can always get better.  So often we don’t even try because our expectations are unattainably, if unintentionally, high.  We can tell because it feels pointless.  The workaround is to set our expectations stupendously low, guaranteed success-low, simple- and silly-low…  Then trust that iterative success will drive progressive improvement.  By mid-year I had a smiley sticker for every week, mission accomplished.  This year I set a new goal: 5 times a week, 3 times ‘intense.’  Don’t get the smiley stickers every week, but now it feels positively abnormal to not move for more than one day.  That progress is remarkably gratifying.

When we take our short-term goals more lightly, we allow for the freedom of modifications (push-ups on the knees at first) and trial and error.  We become open to previously unseen options.  We live in the present and appreciate what we can accomplish already today.

If it helps, read this article and repeat to yourself, “Floss one tooth, ” or “One push-up.”  ONWARD!

 

 

On the Critical Importance of Self-Care

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NaBloPoMo 2016, Letters to Patients, Day 6

To Patients Who Feel Overwhelmed:

Put your own mask on first!

In my spare time, I go around talking to other doctors about how to take care of ourselves.  You may or may not be aware of physician burnout.  It’s quite the trendy topic in medical circles these days, and not in a good way.  Over 50% of physicians report at least one symptom of burnout (emotional exhaustion, depersonalization, or low sense of personal accomplishment), higher than the general population.  Physicians also kill themselves at much higher rates than the general population.  I’m grateful for the opportunity to study and speak on physician health and well-being, because it informs my practice in ways I had not anticipated.

To be clear, physician burnout is not a problem of personal weakness on the part of doctors themselves.  The healthcare system in the United States has evolved to such a dysfunctional state that some of its best and brightest find themselves despondent, depressed, and ready to quit.  And yet, we are called to persevere in the system as it is, even as we strive to improve it.

I see the same pattern in American society generally.  Technology and other advances have created a world of 24/7 hyper-stimulation, global comparisons of productivity and innovation, and immense pressures to be perfect, or at least appear so.  Men and women live under constant scrutiny and competition.  Do I make enough money?  Is my work impressive enough (to others)?  Are my children in the right activities?  Am I doing enough?  I see, hear, and feel it from my patients every day—the anxiety, the uncertainty, the angst.  The suffering is real, if not totally tangible.

For those of you whose exercise routines hold you up, how quickly do you abandon your workouts when things get really busy?  What about quality time with your friends?  What about your painting, knitting, writing, reading, skating, volleyball, music, and sleep?  Everybody recharges a different way, but I see a common pattern of ignoring the low battery alerts and pushing ourselves to empty—physicians and patients alike.

Our systems need to change, no doubt.  Medicine, business, education, politics…  We need to get clear about what and whom we really serve.  In medicine, I believe physicians should lead the movement toward a more humane internal culture.  There is no way we can take excellent care of our patients if we are not well ourselves, and we cannot wait for corporate leaders and policy makers to advocate for us.  The same is true for you, our patients.  What do you need to be healthy?  What can you change in your habits, environment, and relationships to meet these needs?  And in making such changes, what positive ripple effects could you have on those around you?  Can you lead by example?

If we all put our own masks on first, like they say on airplanes, how many other people’s masks could we help with?