Hopey, Changey Hero Making

Posted on November 9, 2017 by Catherine Cheng, MD

NaBloPoMo 2017: Field Notes from a Life in Medicine, Day 8

Funny how I just wrote last night about connecting new dots to old dots. It just happened again tonight! A couple of weeks ago I responded to an online ad for an IVY Ideas Night with David Litt, author of Thanks Obama: My Hopey, Changey White House Years, entitled, “How to Inspire, Persuade, and Entertain.” Litt was a senior speechwriter for President Obama, so I thought I could learn new tips for presentations, and feel a little closer to the president whom I miss so much.

I’ve done public speaking since eighth grade, when our speech teacher first taught us abdominal breathing and I discovered the thrill of holding the attention of a room full of people with only my words. I work at an academic medical center and I hold zero publications, but my CV documents over 10 years of professional presentations to various audiences. I thought I was pretty good at this speaking thing.

Three years ago I came across this TED talk by Nancy Duarte, whose ‘secret structure’ of great presentations I have used since I subsequently read her book, Resonate. Essentially, she recommends that we invite audiences on adventure stories, create active tension between what is and what could be, and most importantly, make the audience the hero. I have done this better and worse since then, but I always recognize the framework when I see it. Those familiar with this blog know that I am also a fan of Simon Sinek, whose central message is that we perform at our best when we are crystal clear about our Why. “People don’t buy what you do, they buy Why you do it,” he says. Barack Obama employs both authors’ principles with eloquence and finesse, which I noticed reading We Are The Change We Seek, a collection of his speeches as president. The best speeches delivered in this construction create audiences who are inspired, motivated, and empowered to hail a meaningful call to action.

That’s basically what David Litt conveyed tonight. When asked what advice he was given that served him best, he said, “Imagine someone in your audience will tell their friend tomorrow about your talk. What is the one thing you want them to say about it?” What is the Why of your talk? Even though he no longer writes speeches for the most powerful person in the world, he expressed a desire to continue inspiring, empowering, and promoting personal agency in all whom his work touches. Make each and every audience member their own hero.

It turns out, however, that this approach applies to much more than public speaking. On my 50 hour, 500 mile, aspen-pursuing weekend in Colorado last month, I described to my dear friend my favorite moments at work. At the end of a patient’s day-long physical, after I have spent 90 minutes listening to their stories of weight gain and loss, work transitions and complex family dynamics, and reviewing their biometrics and blood test results, I meet with them for an additional 30 minutes to debrief. This is when I present an integrated action plan compiled by the nutritionist, exercise physiologist, and myself. It is a bulleted summary of our conversations throughout the day, centered on the patient’s core values and self-determined short and long term health goals, and crafted with their full participation. I get to reflect back to my patients all that I see them doing well, and shine light on areas for potential improvement. It’s an opportunity to explore the possible—to Aim High, Aim Higher, as the United States Air Force exhorts. I often present the plan with phrases like, “Strong work!” “You’ got this,” and “Can’t wait to see what the coming year brings!” My friend turned to me as we wound through autumn gold in the Rocky Mountains, a bit tearfully, and said, “You make them the hero of their own story.” Yeah, I do, I thought, and I got a little teary, too.

Words are powerful. They are our primary tool for relating to each other, for making another person feel seen, heard, understood, accepted, and loved. You don’t have to be a public speaker or a presidential speechwriter to make a positive difference with your words. At work, in your family, with your friends, with people on the street and in the elevator—what is the one thing you want someone to remember from their encounter with you?

Whole Physician Health: Standing at the Precipice

Posted on September 28, 2017 by Catherine Cheng, MD

I published the post below two years ago, and all of it applies even more so today. This week I presented to my department chairs and hospital administration leaders on the importance of addressing physician burnout and well-being. There is a growing sense of urgency around this, some even starting to call it a crisis.

Still, I feel hopeful. Darkest before the dawn, right? Reveal it to heal it, my wise friend says. Physician burnout research has exposed and dissected the problem for 20 years, and now we shift our attention toward solutions.

I will attend the American Conference on Physician Health and the CENTILE Conference next month. I cannot wait to commune with my tribe again, explore and learn, and return to my home institution with tools to build our own program of Whole Physician Health. While we focus on physician health in its own right, we must always remember that it can never be achieved without strong, tight, and fierce connections with all of our fellow caregivers. When we attain this, all of us, especially our patients, are elevated and healed.

Onward, my friends. More to come soon.

*** *** ***

Ever since my presentation to the American College of Surgeons earlier this month on personal resilience in a medical career, I cannot shake the feeling that we need to do more of this work. Physicians from different fields need to talk more to one another, share experiences, and reconnect. We also need to include other members of the care team as equals, and let go the hierarchical thinking that has far outlived its usefulness.

I do not suggest that physicians, nurses, therapists, pharmacists and others should play interchangeable roles in the care of patients. Rather, similar to the central tenet of gender equality, the unique contributions of each team member need to be respected equally for their own merits and importance. As a primary care internist, I must admit that I have seen my professional world through a rather narrow lens until now. I confess that I live at Stage 3, according to David Logan and colleagues’ definition of Tribal Leadership and culture. The mantra for this stage of tribal culture, according to Logan et al, is “I’m great, and you’re not.” Or in my words, “I’m great; you suck.”

“I’m a primary care doctor and I am awesome. I am the true caregiver. I sit with my patients through their hardest life trials, and I know them better than anyone. I am on the front line, I deal with everything! And yet, nobody values me because ‘all’ I do is sit around and think. My work generates only enough money to keep the lights on (what is up with that, anyway?); it’s the surgeons and interventionalists who bring in the big bucks — they are the darlings of the hospital, even though they don’t really know my patients as people…” It’s a bizarre mixture of pride and whining, and any person or group can manifest it.

Earlier this fall, Joy Behar of TV’s “The View” made an offhand comment about Miss Colorado, Kelley Johnson, a nurse, wearing ‘a doctor’s stethoscope,’ during her monologue at the Miss America pageant. We all watched as the media shredded the show and its hosts for apparently degrading nurses. What distressed me most was the nurses vs. doctors war that ensued on social media. Nurses started posting how they, not doctors, are who really care for patients and save lives. Doctors, mostly privately, fumed at the grandiosity and perceived arrogance of these posts. It all boiled down to, “We’re great, they suck. We’re more important, look at us, not them.” The whole situation only served to further fracture an already cracked relationship between doctors and nurses, all because of a few mindless words.

It’s worth considering for a moment, though. Why would nurses get so instantly and violently offended by what was obviously an unscripted, ignorant comment by a daytime talk show host? It cannot be the first time one of them has said something thoughtlessly. What makes any of us react in rage to someone’s unintentional words? It’s usually when the words chafe a raw emotional nerve. “A doctor’s stethoscope.” The implicit accusation here is that nurses are not worthy of using doctors’ instruments. And it triggered such ferocious wrath because so many nurses feel that they are treated this way, that they are seen as inferior, subordinate, unworthy. Internists feel it as compared to surgeons. None would likely ever admit to feeling this way, consciously, at least. But if we are honest with ourselves, we know that we all have that secret gremlin deep inside, who continually questions, no matter how outwardly successful or inwardly confident we may be, whether we are truly worthy to be here. And when someone speaks directly to it, like Joy Behar did, watch out, because that little gremlin will rage, Incredible Hulk-style.

I see so many similarities to the gender debate here. As women, in our conscious minds, we know our worth and our contribution. We know we have an equal right to our roles in civilization. And, at this point in our collective human history, we feel the need to defend those roles, to fight for their visibility and validity. More and more people now recognize that women need men to speak up for gender equality, that it’s not ‘just a women’s issue,’ but rather a human issue, and that all of us will live better, more wholly, when all of us are treated with equal respect and opportunity. The UN’s He for She initiative embodies this ideal.

It’s no different in medicine. At this point in our collective professional history, physician-nurse and other hierarchies still define many of our relationships and operational structures. It’s not all bad, and we have made great progress toward interdisciplinary team care. But the stethoscope firestorm shows that we still have a long way to go. At the CENTILE conference I attended last week, I hate to admit that I was a little surprised and incredulous to see inspiring and groundbreaking research presented by nurses. I have always thought of myself as having the utmost respect for nurses — my mom, my hero, is a nurse. The ICU and inpatient nurses saved me time and again during my intern year, when I had no idea what I was doing. And I depended on them to watch over my patients when I became an attending. But I still harbored an insidious bias that nurses are not scholarly, that they do not (or cannot?) participate in the ‘higher’ academic pursuits of medicine. I stand profoundly humbled, and I am grateful. From now on I will advocate for nurses to participate in academic medicine’s highest activities, seek their contributions in the literature, and voice my support out loud for their important roles in our healthcare system.

We need more conferences like this, more forums in which to share openly all of our strengths and accomplishments. We need to Dream Big Together, to stop comparing and competing, and get in the mud together, to cultivate this vast garden of health and well-being for all. I’ll bring my shovel, you bring your hose, someone else has seeds, another, the soil, and still others, the fertilizer and everything else we will need for the garden to flourish. We all matter, and we all have a unique role to play. Nobody is more important than anyone else, and nobody can do it alone.

We need to take turns leading and following. That is how a cooperative tribe works best. It’s exhausting work, challenging social norms and moving a culture upward. And we simply have to; it’s the right thing to do.

Only Love Can Win

Posted on August 17, 2017 by Catherine Cheng, MD

Holy hell, what a week. How are you feeling? Most people I know express some combination of shock, resignation, rage, disbelief, hopelessness, gloom, and resentment. I’m trying hard to practice Radical Acceptance. It’s similar to the second arrow principle, in that at the very least, it lessens my own suffering from our collective circumstance. But more than that, it allows me to focus more on what I will do, than seethe around my negative reactions.

I’m thinking of the Twitter account named Yes, You’re Racist. Apparently the owner wants to identify the white supremacists who marched in Charlottesville, to publicly shame them and possibly get them fired from work. At least one person has lost his job based on a photo posted to the account. What do you think about this? I admit, my first reaction was positive. Yes, call them out, make them accountable, I thought. But then I wonder what good will this do? Will the guy who got fired from the hot dog place suddenly think it was morally wrong to attend the march? Or will he interpret his employer’s action as further proof that the liberal left conspires to restrict free speech and assembly, thereby deepening his animosity toward anyone who opposes his views from the left? Will it open any space in his mind to consider why white supremacy is wrong, or help him acquire empathy or compassion toward any marginalized group? Or won’t it just drive his racist expressions underground? Doesn’t public shaming like this run the risk of re-closeting these people, so their grievances foment in the dark, only to be released again under pressure, in some act of overt violence?

I think about the fights between marchers and anti-protestors—between those who wish to incite violence, and those who succumb to the provocation. To be clear, the Neo-Nazi, white supremacist marchers who descended on Charlottesville represent a vile and unacceptable set of ideas. They are the villains. And, fighting violence with violence is never a good solution.

So, we ask, what can we do? How do we respond? Maybe it’s because I’m on vacation this week, communing with nature in the mountains and watching the annual Perseid meteor shower from 10,000 feet, on a clear, literally stellar night, surrounded and awed by our millennia-old universe. It keeps me from stalking Facebook quite so many hours a day, and gives good perspective. I feel somehow more capable of saying, This is how things are. It sucks. It’s wrong. And I can still make a difference.

In the end, I believe Only Love Can Win. Blaming, shaming, belittling, and otherwise demeaning people for certain beliefs, actions, or associations—hating them—does not help. What does help is offering compassion and empathy, and listening to understand. I know I have said and written it many times, and I know many will argue that now is not the time to ‘get soft.’ But believe me, practicing love in the face of hate is anything but soft. Let me share some resources that illustrate this, and that hold me up. This is a very long post, and I hope you will stick with me ‘til the end.

Agape Love

Maria Popova, curator of the illuminating blog Brain Pickings, inspires me with her summary of Dr. Martin Luther King’s 1958 essay “An Experiment in Love.” I refer to this article often since January 20. Dr. King explores six tenets of nonviolent resistance (below). It reminds me that while I vehemently oppose bigotry, racism, sexism, misogyny, xenophobia, and fascism, I can do it with a peaceful heart, full of love for humanity, and with faith that even my small contribution of said love can make a difference. Here are the highlights of her piece, MLK’s words quoted:

Nonviolent resistance is not passive cowardice. “For while the nonviolent resister is passive in the sense that he is not physically aggressive toward his opponent, his mind and his emotions are always active, constantly seeking to persuade his opponent that he is wrong. The method is passive physically but strongly active spiritually. It is not passive non-resistance to evil, it is active nonviolent resistance to evil.”
The goal is connection. “Nonviolence … does not seek to defeat or humiliate the opponent, but to win his friendship and understanding. The nonviolent resister must often express his protest through noncooperation or boycotts, but he realizes that these are not ends themselves; they are merely means to awaken a sense of moral shame in the opponent. The end is redemption and reconciliation. The aftermath of nonviolence is the creation of the beloved community, while the aftermath of violence is tragic bitterness.”
Separate the people from problem (as William Ury et al would say). “The attack is directed against forces of evil rather than against persons who happen to be doing the evil. It is the evil that the nonviolent resister seeks to defeat, not the persons victimized by the evil… [Regarding racial injustice:] We are out to defeat injustice and not white persons who may be unjust.”
Be prepared to pay the cost. “The nonviolent resister is willing to accept violence if necessary, but never to inflict it. He does not seek to dodge jail.”
Manage thyself. Do not allow yourself to descend to the depths of hate while you fight hate itself. Cultivate love instead. “The nonviolent resister not only refuses to shoot his opponent but he also refuses to hate him. At the center of nonviolence stands the principle of love…To retaliate in kind would do nothing but intensify the existence of hate in the universe. Along the way of life, someone must have sense enough and morality enough to cut off the chain of hate. This can only be done by projecting the ethic of love to the center of our lives. This is Agape love… Agape means understanding, redeeming good will for all men. It is an overflowing love which is purely spontaneous, unmotivated, groundless, and creative… Another basic point about agape is that it springs from the need of the other person… The Negro must love the white man, because the white man needs his love to remove his tensions, insecurities, and fears… Agape is not a weak, passive love. It is love in action… Agape is a willingness to go to any length to restore community… It is a willingness to forgive, not seven times, but seventy times seven to restore community.”
Hope. “Nonviolent resistance … is based on the conviction that the universe is on the side of justice. Consequently, the believer in nonviolence has deep faith in the future. This faith is another reason why the nonviolent resister can accept suffering without retaliation. For he knows that in his struggle for justice he has cosmic companionship.”

10 Ways to Fight Hate

One of the first pieces I read after the events on Saturday was this article from the Southern Poverty Law Center, listing ten ways to fight hate. So while I carry that peaceful heart full of Agape love, these are the concrete things I can do right now (highlights quoted):

“The good news is, all over the country people are fighting hate, standing up to promote tolerance and inclusion. More often than not, when hate flares up, good people rise up against it — often in greater numbers and with stronger voices.”

“Do not debate hate group members in conflict-driven forums. Instead, speak up in ways that draw attention away from hate, toward unity.

“Goodness has a First Amendment right, too. We urge you to denounce hate groups and hate crimes and to spread the truth about hate’s threat to a pluralistic society. An informed and unified community is the best defense against hate.

“You can spread tolerance through social media and websites, church bulletins, door-to-door fliers, letters to the editor, and print advertisements. Hate shrivels under strong light. Beneath their neo-Nazi exteriors, hatemongers are cowards and are surprisingly subject to public pressure and ostracism.

Educate Yourself

“Most hate crimes…are not committed by members of hate groups; the Southern Poverty Law Center estimates fewer than 5 percent. Many hate crimes are committed by young males acting alone or in small groups, often for thrills. While these perpetrators may act independently, they are sometimes influenced by the dehumanizing rhetoric and propaganda of hate groups.”

Create An Alternative

“Do not attend a hate rally. As much as you might like to physically show your opposition to hate, confrontations serve only the perpetrators. They also burden law enforcement with protecting hatemongers from otherwise law-abiding citizens. If an event featuring a hate group, avowed separatist or extremist is coming to your college campus, hold a unity rally on a different part of campus. Invite campus clubs, sororities, fraternities and athletic organizations to support your efforts.

“Every act of hatred should be met with an act of love and unity. Many communities facing a hate group rally have held alternative events at the same hour, some distance away, emphasizing strength in community and diversity. They have included forums, parades, and unity fairs featuring speakers, food, music, exhibits, and entertainment. These events give people a safe outlet for the frustration and anger they want to vent. As a woman at a Spokane, Washington, human rights rally put it, “Being passive is something I don’t want to do. I need to make some kind of commitment to human rights.”

Pressure Leaders

Form relationships with community leaders before a hate incident occurs.

Encourage leaders to name the problem.

Push leaders when they show bias or fail to act. [And do it respectfully—ad hominem never helps.]

“Bias is learned in childhood. By age 3, children can be aware of racial differences and may have the perception that ‘white’ is desirable. By age 12, they can hold stereotypes about ethnic, racial, and religious groups, or LGBT people. Because stereotypes underlie hate, and because almost half of all hate crimes are committed by young men under 20, tolerance education is critical.”

Dig Deeper

“Look inside yourself for biases and stereotypes.

“We all grow up with prejudices. Acknowledging them — and working through them — can be a scary and difficult process. It’s also one of the most important steps toward breaking down the walls of silence that allow intolerance to grow. Luckily, we all possess the power to overcome our ignorance and fear, and to influence our children, peers, and communities.”

Breathe Deep, Stay on the Path, and Engage

How would you confront a white supremacist in person, face to face? Would you share a meal with him/her? I saw this video clip on Facebook, of a young Chinese-American man, Eddie Huang, sitting down to dinner with Jared Taylor, an older, white nationalist man, and founder of American Renaissance, to discuss Taylor’s perspective. The American Renaissance site espouses genetic differences in intelligence and the propensity to commit crimes between races, among other things. Taylor states that historically, Europeans have “killed more people per capita” than any other group, and attributes this to them being “more technologically advanced.” He voted for 45 because his policies would “slow the dispossession of whites in America.” He says he wants to keep whites a majority in the United States, or else they “no longer control our own destiny.”

I imagined myself in Eddie’s shoes, and I could not fathom how I could stomach this conversation while eating. Actually I think he stops, while Taylor continues to eat—Chinese food. I don’t know anything about Eddie Huang other than what I see in this video, and I admire him. He sits down and engages respectfully, thoughtfully, and firmly, with a person who basically thinks he does not deserve to be an American. Could you do that? I’m not sure I could. And what would the world be like if we all trained to do exactly this?

Thank you for reading to the end. My point here is that we can oppose and resist more effectively than with rage, shame, and violence. I know I won’t make everybody put down their clubs and fists with my small words, but this is where I stand, and I commit to speaking my stance as much and as loudly as possible. I pledge to do my best always to profess what I am for, more than what I am against. I commit to a practice of Agape love, Radical Acceptance, Mindfulness, and Peaceful, Respectful Activism. I would love your company on this journey.

Healing Through Connection

The Inner Work of Physician-Patient Relationship…And Other Things

Category Archives: leadership

Hopey, Changey Hero Making

Whole Physician Health: Standing at the Precipice

Only Love Can Win