November 23:  Range Makes Me Better

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NaBloPoMo 2019

One of my teachers in med school told me why he loves primary care.  He said at any time, he can decide he wants to be more expert in something and do it for a while, like managing all of his patients’ thyroid illnesses, rather than referring to endocrinologists.  Then when he gets tired of that, he can start referring again and do something else, like nonsurgical orthopaedics.  That was over 20 years ago…  The complexity of both medical knowledge and practice has expanded exponentially since then, so I wonder if he still thinks this way?

Regardless, I agree.  Being a generalist affords me tremendous flexibility and freedom to explore and apply from all fields of medicine.  While I could never approach the expertise of my specialist colleagues, I get to (and to a large extent am expected to) learn a little about everything.  That breadth of exposure and knowledge makes every workday unique and stimulating.  This week, I’m listening to Range by David Epstein, a book that validates everything about my generalist, boundary-spanning life.  From the book description:

Range makes a compelling case for actively cultivating inefficiency. Failing a test is the best way to learn. Frequent quitters end up with the most fulfilling careers. The most impactful inventors cross domains rather than deepening their knowledge in a single area. 

I feel validated about this because I’ve never been especially good at any one thing (except today I’d say I’m an exceptionally good communicator, though that’s a highly subjective and biased self-assessment).  I have, however, observed, explored, tried and experienced myriad things, and I have always seen this as an asset.  And now a New York Times bestseller affirms it. Yay!

Growing up bilingual and bicultural gave me a huge advantage for living and working in an increasingly diverse global society.  Before I started piano, I learned classical Chinese painting in two styles, as well as Chinese folk dancing.  I started skiing in elementary school, volleyball in middle school, golf in college, and in my 40s have picked up kettle bells, yoga, and TRX.  I learn coaching techniques from being coached.  I learn about leadership from reading and interrogating my patients who are leaders, and now actually leading some folks.  I interact with information through podcasts, audiobooks, paper books and journals, and online formats.  I read New England Journal of Medicine and Harvard Business Review, Annals of Internal Medicine and Fast Company, Journal of the American Medical Association and Psychology Today.  I prefer nonfiction, but I recently joined a book club and read my first novel in many years.  My music playlist includes Dierks Bently, Camila Cabello, Bruce Hornsby, Shawn Mendes, Miranda Lambert, Sara Bareilles, The Piano Guys, Mamma Mia and The Greatest Showman soundtracks, John Denver, and Pink.  I attend conferences focused on clinical medicine as well as communication.  I speak to audiences of physicians, business leaders, and designers. I make washi tape cards and moderate Better Angels communication workshops.  It’s kind of an eclectic list of activity; please forgive my self-centered navel gazing here.

If you make a similar list for yourself, I bet it will be more diverse than you think.  How does this help you, make you better?

Epstein posits that generalists’ advantage lies in their ability and propensity to see deep relational connections between diverse domains, use analogical thinking, and practice ‘active open mindedness.’  He also provides multiple examples of when specialists’ narrow perspective hinders creativity and innovation, and even effective problem solving.  Throughout, however, he acknowledges the complementary, yin-yang relationship between focus on the specific and wide-ranging view of the broad.  The book just makes my ENFP heart sing.

I honestly believe range makes me better…  For no other reason than giving me a life full of new and exciting experiences to write about on a blog.

 

November 17:  Elasticity Makes Me Better

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NaBloPoMo 2019

What was school like for you growing up?  Were you bored?  Confused?  Frustrated?  I had a pretty easy time, but many of my classmates did not, even the ‘smart’ ones.

In high school I was on the speech team.  One of my events was persuasive speaking.  I chose one year to advocate for teachers to broaden their teaching styles to match a wider variety of learning styles.  I used the Gregorc Mindstyle Delineator as an example of how styles can vary (mine is Abstract Random, go figure).  It was an interesting thesis and I sincerely believed what I wrote and presented in those 8 minutes each weekend.

Thirty years later, I wonder how much I walk this talk of meeting people where they need me.  Simply asking the question, raising my awareness, makes me better.

Parenting.  It doesn’t matter how many parenting books you read or how well you think your parents raised you.  General principles apply, of course.  But every kid is unique, and we parents do better when we realize that the methods we use for anything on kid #1 won’t necessarily work with kid #2, #3, an onward.  Flexibility is key to a happy and functional household, for getting out the door every morning without yelling.

Marriage:  According to the Dr. John Gottman, about two-thirds of marital problems are perpetual, meaning they will never actually resolve.  So how do couples stay together successfully?  Among other things, they learn to accept one another and work around the hard stuff.  At least partially, we have to soften our rigidities, learn to bend and sway, embrace the supple, intimate dance of commitment.

Teaching:  Not all students learn best by watching.  Not all learn best by doing.  Or by hearing, mimicking, or competing.  Luckily, medical education gives trainees multiple platforms on which to acquire the necessary knowledge and skills to care for patients.  For all its flaws, our profession actually does well here.  I’m happy that I realized this in my own experience.  When I precept students in clinic, they shadow, scribe, see patients alone or lead a joint encounter, so they can experience the work from different perspectives.  I think this mutual versatility and adaptability makes us all better.

Patient Care:  Over the years I have accumulated myriad articles and books to share with patients.  But not everybody’s a reader like me.  Not everybody wants to meditate or journal.  Some people do better with a personal trainer, others in spin class.  It’s my job to assess how each patient is most likely to succeed in health habit optimization, and present the most appropriate resources for consideration.  Primary care definitely does not work with a one size fits all approach.  So now I include audiobooks, podcasts, phone apps, and YouTube videos in my repertoire of medical information sharing.  I am blunt when it’s needed, and also gentle and diplomatic.  I can speak from the head and the heart, often both at the same time.

Speaking Engagements:  Here is where my elasticity has grown the most in recent years.  For the first decade of my career, I still used the expository presentation style I learned in high school.  Thankfully in 2014, I watched Nancy Duarte’s TED talk on transformative oral presentations, and then read her book, Resonate, in 2015.  Make the audience the hero, she says.  Tell a story, contrast what is with what could be, paint the vision of the blissful future clearly.  Engage people’s emotions and aspirations.

This is not easily done with Power Point decks full of words.  But words are my medium!  I had to add color, diagrams, cartoons, photographs.  I started making my presentations more interactive, between myself and the audience, and between audience members themselves.  Now I have people stand up and move their bodies.  I may bring raisins to my next talk and do a mindful eating exercise.  I need to learn how to embed music and videos into my slides.

What is the objective in all of these relationships?  It’s connection.  How do we best connect?  We reach out.  We extend ourselves to others—make ourselves relaxed, flexible, spring-like.  That is how we gather people closer.  It’s not formless or weak.  A strong elastic maintains its integrity even under high tension.  But it must be stretched often, or it becomes stiff, brittle, and ultimately ineffectual.

 

November 16:  Loving Subversion Makes Me Better

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NaBloPoMo 2019

Friends, do you already follow Seth Godin’s blog?  His post from Thursday stirred something a little irreverent in me.  It was about ‘allies and accomplices’:

To be an ally means that you won’t get in the way, and, if you are able to, you’ll try to help.

To become an accomplice, though, means that you’ve risked something, sacrificed something and put yourself on the hook as well.

We need more allies, in all the work we do. Allies can open doors and help us feel a lot less alone.

But finding an accomplice–that’s an extraordinary leap forward.

I thought immediately about my fellow Better Angels volunteers.  We have all committed time, talent, and treasure to the depolarizing of America.  We do it in public, in front of audiences and cameras, to reporters and members of our communities.  We openly challenge the prevailing culture of ad hominem, oversimplification, and overgeneralization.  We all come to it from our own internal optimism and hope.  But in the face of entrenched polarization and a culture of self-protection above all, we could never make any headway as individuals.  It is only together—as mutual accomplices—that we can truly claim and exercise our collective agency.

I feel even more buoyed by Ozan’s latest post.  He describes a series of well-known studies showing that people will organize themselves into in-groups and out-groups with remarkable loyalty, even around random and arbitrary distinctions like taste in abstract art.  This, of course, carries grave and important implications for prejudice and discrimination.  Ozan then points to two exemplars of the opposite, Dr. Martin Luther King, Jr. and Barack Obama.  In their most famous orations (see links), these remarkable leaders speak directly to what unites us as the foundation for solving our problems, rather than what divides us.

MLK:  The marvelous new militancy which has engulfed the Negro community must not lead us to a distrust of all white people, for many of our white brothers, as evidenced by their presence here today, have come to realize that their destiny is tied up with our destiny. They have come to realize that their freedom is inextricably bound to our freedom. We cannot walk alone.

Obama:  The pundits, the pundits like to slice and dice our country into red states and blue States: red states for Republicans, blue States for Democrats. But I’ve got news for them, too. We worship an awesome God in the blue states, and we don’t like federal agents poking around our libraries in the red states.  We coach little league in the blue states and, yes, we’ve got some gay friends in the red states.

I get goosebumps just reading the words.

It really feels like a loving subversion—of cynicism, scarcity, antagonism, and fear.

Who’s not better for that?

 

 

 

November 11:  Fierce Optimism Makes Me Better

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NaBloPoMo 2019

On Ozan’s Inner Circle forum today, another member posted about his admiration for Dr. Martin Luther King, Jr.  It reminded me of a favorite MLK quote, which came to mind on Saturday as I prepared for the Better Angels workshop:  “The arc of the moral universe is long but it bends toward justice.”  I have referred to this quote many times over the years, and a phrase that I often add goes something like, “Bend that arc!  Hang on it with all your might!”  Meaning the arc bends toward justice only because we make it so, by working tirelessly for it, by acting visibly in accordance with our core values, and by consistently walking the talk.

I texted my friend the morning of the workshop: “I’m 90% excited, 10% nervous…Maybe 15%…”  Then I thought about the people I know who like the idea(l) of Better Angels, but don’t want to participate.  I thought about my friends who express hopelessness at any possibility that people on opposing political sides can ever connect, that we can actually work together across our differences to get things done.  I thought about the pushback I might get, that the Better Angels mission is futile, a waste of energy and time.  I felt something akin to a tidal wave rise within me, and I texted my friend again, spontaneously, “I intend to make today a day of fierce, infectious optimism.”  At that moment I knew my goal that day was to take every example and experience of kindness, connection, empathy, openness, generosity, magnanimity, conviction, and hope, and channel it to the workshop and its participants.  Because though it was to be a skills workshop, teaching a way of doing, what we really need are all of the qualities I just listed—they are the way of being that brings the skills to bear in the most meaningful ways.

This idea marinated for a couple of hours while I pictured the venue, reviewed the workshop content, made notes about delivery.  I thought again about my friends who feel like our world is crumbling around us, that so much progress made the last century is being eroded.  I completely empathize with this perspective, and I understand how it makes us feel we have to fight, to be aggressive and confrontational, to come at the opposition full force, like a bullet train.  Do they think listening and speaking skills focused on curiosity and openness too passive and ineffective?  Does optimism, the hopefulness and confidence that things will be okay, make me lazy about the issues that matter to me?

Below are the words I texted my friend to describe what I mean by ‘Fierce Optimism’.  Normally I would not share such nascent ideas on the blog, but whatever, it’s all an experiment, who knows what better ideas may come from this early sharing?

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Fierce Optimism Is:

Urgency with Patience

Or should it read, “Urgency without Impatience”?  What I mean here is simply that most things worth doing take a very long time.  All important social movements occurred (and continue) over generations.  At times confrontation and revolution are necessary.  But they are not enough.  Consistent, slow, organic, grass roots change on the local level is what sustains consistent progress, keeps it from regressing.  The acute urgency I feel to address my deep concerns (for instance, the profound rifts in our relationships) drives me to action.  But when that action is directed at another person, I must attune.  I have to set realistic expectations for how much I can move this mountain today.  Pacing myself, practicing persistence with patience, conserves energy and prevents burnout.  It also allows me to look up every once in a while and adjust to my surroundings, adapt to subtle changes, like when someone starts to soften.  If I’m bulldozing with strong words and heavy dogma, I am more likely to plow over and through any crack in the door of someone’s mind that might have swung open freely had I taken a more gentle approach.

Strength with Flexibility

Better Angels does not seek to make everybody—anybody—a moderate.  Rather, the goal is to hold our positions firmly and with principle, and practice seeing why someone else may hold a different position with equally strong principle.  In doing so, two things often happen:  First, by challenging our own beliefs and values, we can reinforce them.  Telling stories about the experiences that led us to our core values reconnects us with their origins, grounds us in and strengthens our own personal truth.  Second, hearing others’ stories helps us broaden our perspective.  Most of the time we only see things from our own point of view—this is our default setting.  But when we share personal experiences, really learn about each other, the curtains open on a vast landscape of understanding that we may never have imagined.  So while I may still hold my goals and objectives firmly, I can more easily release the rigidity of my method, tolerate setbacks with less suffering.  Earlier this year I listened to The Warrior Within by John Little.  He describes Bruce Lee’s life philosophy, which included a metaphor of the bamboo and the oak.  Both are admirably strong, but under intense forces of nature, the oak may break while the bamboo simply bends, sometimes to the ground, but without breaking.  Both stay rooted where they are planted, but one is more resilient.  Listening with openness and curiosity is not weakness.  Allowing for nuance and the possibility that my mind may be changed in some ways, while holding steadfast to my core values, makes me calm, agile, adaptable, and, I think, more effective.

Conviction with Generosity

This is about the assumptions we make.  Too often we cast ‘the other’ in abstract as sinister, evil, less than.  We hold up the most extreme members of the opposing group as representative of a dull and dumb monolith.  We oversimplify and overgeneralize, and then approach any individual we identify as belonging to that group as an assembly line package, a completely known entity.  We think we know all about them already, even if we have never met them, just because they identify today as “Red” or “Blue.”  In so doing, we make ourselves small.  We become exactly as narrow minded and prejudiced as the folks we accuse on the other side.  How ironic.  Now more than ever, we need generosity.  In my mind this encompasses empathy, vulnerability, sincerity, humility and a willingness to allow the complete humanity of every other person, regardless of their political, religious, racial, cultural, or any other persuasion.  Conviction without generosity too easily becomes tyranny, for individuals as well as organizations and governments.

*sigh*

Well, like I said, these ideas were just born two days ago.  Have I expressed them at all coherently?  Have I shown you intuitively apprehensible paradoxes?  Can you feel the dynamic balance of agitation and peace?  Tension without anxiety?  Potential and kinetic energy?  If not, that’s okay.  I’ll keep working on it.  That’s the essential outcome of Fierce Optimism, after all—we keep working, steadily, to bend that arc.

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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 5:  Peer Coaches Make Me Better

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NaBloPoMo 2019

When you’re working through a challenge, who helps you?  What is it about them, how are they most helpful?  How not?

Through the years I have learned what I can get from certain people.  I know to call this person when I need validation, that person when I need a devil’s advocate.  I also know which people to avoid altogether—those who cannot be trusted with my vulnerability or confidence.

But when I need to hold space and tension with an issue, to patiently look at it from different angles and process the perspectives, I look to my peer coaches.  I feel gratitude and gladness for these friends today, after my LOH group had our monthly peer coaching call.  As we progress through our 10 month leadership training, we take tenets and skills home from each retreat to practice.  Monthly Zoom calls have no agenda, other than to reconvene, share, and mutually support.  Every time I come away appreciating just a little more how nothing in life—work, personal things, social context—can really be separated from anything else.

These friends are not my first or only coaches, however.  In 2005 I started working with Christine, my life coach.  Every session, 14 years later, is still transformative.  How is this possible?  Curiosity.  Christine coaches every call squarely and unwaveringly from this perspective.  It was not long before I realized how powerfully this method could alter my own encounters with patients.

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The best coaches have no preformed or decisive answers.  They have the uncanny ability to ask the best questions–Open, Honest Questions (OHQs)–which then lead clients to their own best answers.  They help frame and reframe problems.  They point us to alternate perspectives and help us open our minds to narratives other than the ones we too often grip so desperately.  It was my second year in practice when I started asking coaching questions to patients, and I have never since feared any symptom, syndrome, or answer.  When there is no clear diagnosis or answer for someone’s distress, I can just keep asking until something helpful emerges.  Most often it’s not a single piece of information that gives clarity; rather, it’s the story that materializes.  Coaching skills help me help my patients find and tell their stories of health and wellness, illness and pain, agency and action.

Here are the tenets of true Open, Honest Questions, from the LOH syllabus:

  • The best single mark of an honest, open question is that the questioner does not know the answer and is not leading toward a particular answer.
  • Ask questions aimed at helping the other person come to a deeper understanding (help them access their own inner teacher).
  • Ask questions that are brief and to the point without adding background considerations and rationale—which make a question into a speech.
  • Ask questions that go to the person as well as the problem or story—for example, questions about feelings as well as about facts.
  • Trust your intuition in asking questions. Inviting metaphors or images can open feelings, new lines of thinking, and unexpected possibilities.
  • Try to avoid questions with yes-no, right-wrong answers.
  • Avoid advice disguised as questions.

My best friends are my peer coaches.  And now I have my LOH cohort-mates.  We make no judgments about one another’s circumstances, feelings, or experiences.  We make the most generous assumptions about our motives.  Our role in each other’s lives is almost never to give advice; rather it is to hold space, listen reflectively, offer moral support, hold up core values, and help one another query thoughtfully and honestly.

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Questions asked and reflective statements made on the call today:

  • If you left work tomorrow with enough money to be unemployed for 6 months, what would you do?
  • How does it feel to speak (your issue) out loud?
  • When you think about current state compared to past, how does it feel physically in your body?
  • Sounds like you’re working on a core tension.
  • What do I/you want now?
  • What’s roiling around in you?
  • Who around you can get creative with you?

We each bring diverse questions and challenges to each call.  But somehow we always relate deeply, and listening/querying helps us each learn from every other.  Today I saw central themes emerge around identity, contribution, voice, and meaning.

In the end, I think there are few things more important in life than meaning and connection.  These are the gifts from my peer coaches, and they always make me better, no question.

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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.  HumanityThe 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…