Category Archives: leadership

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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The Importance of Peer Support

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What a privilege to present again to a group of smart, creative, fun, and engaging designers on Friday.  This time I was asked to address burnout, as so many folks are feeling overwhelmed and stressed.  I did my homework on stress and burnout in the creative fields, and found enough similarities in medicine to feel like a credible speaker.  “It’s not just a job, it’s a way of life,” seemed to capture how we see our respective vocations.

I presented a brief mini-lecture on self-care practices, including habit formation and maintenance in the 5 reciprocal domains of health, and narrative awareness.  The latter is always something we can do when we find ourselves in untenable circumstances:  Ask ourselves what story we tell about the situation, how that story compounds our suffering, and then tell a new story that does nothing to change the objective reality, but can dramatically improve our personal experience of it.  I have learned from work in physician burnout that people don’t just want to be told how to fix themselves.  They want someone to address the problems of the system that oppresses them.  So that’s where I tried to go next.

I started with an Appreciative Inquiry (AI) exercise.  In small groups, I asked participants to share team success stories, and listen for recurring themes around what’s already great about their teams, their work, and their organization.  Words like openness, flexibility, and “we have leaders, not bosses” made the Post-It easel list.  Then, in this headspace, I asked the groups to identify issues they wanted to address.  Instructions were to find important, urgent, and solvable challenges.  Guiding questions included, “Why will the organization be better if it’s addressed?” and “What does better look like?”

Similar to the AI results, common issues arose from multiple groups.  There was general consensus, reviewing the list at the end of 20 minutes, that overall work satisfaction would improve with less digital and more face to face communication, better project clarity, and taking better care of the shared spaces.  I would meet with team leaders and show them the list later in the day.

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When I opened the floor to questions, a self-proclaimed ‘Debbie Downer’ presented a query that I will ponder for many months as I prepare upcoming talks:  “When you ask someone how they’re doing and they say they feel like they’re drinking from a firehose, telling them to adjust their attitude is probably not helpful…  How can we change things that are not in our control?” The Universe had prepared me for this question by sending a new mentor who taught me to ask, “Who owns the things we don’t control?”  Thank you, my loving Cosmos.

I only partially answered Debbie’s question by suggesting she think about how she might influence the owner(s), how she might impact decisions being made in those spaces.  I segued too quickly, I’m afraid, to the question that I wanted to ask the group:  “When someone asks you how you are and you express that you are overwhelmed and drowning, what is a helpful response?”  I thought the discussion that ensued was productive…  It seemed to stimulate people’s intrinsic empathy and compassion.  We recognized the importance of feeling connected, that I’m not the only one feeling this way.  People recognized the relief found in just speaking aloud the list of stressors to a sincere and empathic listener.  We also talked about being prepared to hold space for any potential answer when we ask, “How are you?”  Even if we have no control over the flow out of the fire hose, maybe we can take turns holding the nozzle steady, and at a slightly oblique angle for each drinker, so it doesn’t have to knock us all over when we try to take a gulp.

I had a chance to talk to Debbie a little later (Cosmos offering me a second chance, Thank You Again), and we agreed that stress and burnout, in both medicine and design, are best addressed at both the individual and systems levels.  We can each start with personal accountability for our own experience of the system.  Then we can decide how we show up in the system each day.  We can choose, at any time, to either participate passively in the status quo (which is what we all need to do sometimes), or find a way, however small, to advocate effectively for change.

The latter is much better done with peers, with friends.  Take time to connect (no lunch meetings, let’s just eat together!).  Share stories.  What do we love about this work?  What’s already great?  How could it [realistically] be even better?  How can we help one another, including our leaders, envision and pave the way there?  Who else needs to be enrolled?

My meeting with the team leaders was less structured.  I worried that they left feeling disappointed because I did not offer more concrete advice on personal resilience practices for leaders, and ‘how to lead’ teams in burnout.  But over the hour, I felt no desire or need to lecture.  I queried various aspects of their self- and team awareness, personal resilience practices, and communication.  We briefly reviewed the issues list from the morning workshop, and I left with confidence that they would take it seriously.  It also occurred to me that these designated leaders were already supporting one another in their efforts to lead intentionally, effectively, and compassionately.  Maybe they have also felt overwhelmed sometimes.  Maybe it was also good for them just to talk it out with each other this day.  Maybe we can all do this for one another a little more often.