Isolation and Public Scrutiny

What aspects of your work do you share with other professions?

I have presented on health and wellness to members of the judiciary for some years now, and the more I learn about judges’ work, the more I admire. How humbling to be invited to speak to this audience; I think judicial work is severely misunderstood and thus unfairly judged (bad pun) by many. Imagine serving as the sole arbiter in complex cases at the multilane intersections of human behavior, relationship, and the law. Legal rules and regulations constrain process and thus outcomes that you may advance, and hardly anyone outside your profession understands any of it. In your lawyer days you had close colleagues with whom to confer, commiserate, and confide. As a judge it’s just you; your built-in community has suddenly and largely disappeared. On top of that, you are a public figure whose words and decisions are subject to scrutiny by anyone and everyone, who may all feel entitled to opine on your work and even you as a person from any perspective, informed and educated or not. And in this world of echo chambers that so easily incite violence, your and your family’s personal safety are now also potentially threatened.

I have reviewed academic and clinical resources to help judges address these risks to health in their work. That body of knowledge and support has grown significantly of late.
Then it occurred to me recently that my author and voice actor friends may also cope with isolation and public scrutiny, albeit in different ways from judges. So I queried them for reflections, insights, advice, and solidarity.

The response absolutely bowled me over in its immediacy, kindness, thoughtfulness, generosity, and discernment. One artist even offered to Zoom and we talked for 2.5 hours, with a future date to continue the conversation already on the books. Wow.

How wonderful when we can share human experiences across domains? My query post reads: “This feels like a great thing to crowd source! To see and understand similar challenges of divergent professions makes us more open, curious, and empathetic. And that makes the world better, no?” I attempt here to compile and synthesize my friends’ wisdom and add my own reflections. My deepest thanks to all who responded. I have quoted with permission and otherwise paraphrased with care and respect.

I hope this post may serve as documentation, reference, and solace for anyone who feels weighed down by isolation and public scrutiny.
May my friends’ and my words help lighten your load:

Connect Proactively
Physical and social isolation are a fact of life for folks with solitary jobs. You may need to initiate contact more often with both colleagues and friends, as the rest of us take for granted that we see one another in our default environments. Attend conferences, schedule dates, keep up with your hobbies. Set boundaries on time alone and honor them–honor yourself and your needs for connection in this way. And practice self-compassion for your imperfect efforts. If these are new skills, they will take time to establish. How can you recruit help? Connection means not doing things on our own. Even the Lone Ranger had at least one reliable and loyal companion. I ask patients at least every year about their emotional support network. We need that sense of security that when we reach out, whether for a joke, a jog, or acute and serious assistance, someone will reach back without hesitation and sit, stand, walk, and be with us in unflinching solidarity. This kind of deep and steadfast relationship requires active and attentive cultivation, and if it takes overcoming circumstantial isolation to achieve it, then that’s what we must do. The investment yields priceless returns.

Talk Shop, Then Step Away
We all need people who speak our language, with whom connecting is as effortless as it is meaningful. Confidentiality regulations limit judges’ speech more than most professions. And still I have to imagine, as in medicine, we can discuss case scenarios in lieu of specific cases; we can commune with colleagues around the experience of the work, if not the details. The cognitive, emotional, and relational stressors of any case (medical or legal) can weigh heavily because we engage with and affect, sometimes profoundly, the lives of our fellow humans. Folks who live the work first hand don’t need confidential details to relate to our experience. They empathize already. Their immediate presence and understanding soothe us in uniquely needed ways. “I’m having a hard time with…” “I’m feeling the weight of…” When we hear our esteemed colleagues utter these words, we stop what we’re doing, listen, and care.

That said, collective navel gazing has pitfalls. Fresh perspectives from outside our usual circles broaden our minds, challenge our assumptions, and make us deeper, more considerate thinkers and professionals. I asked authors and narrators about their experiences, intending to relate them to that of judges, and found myself relating, too.
The outside perspective can both enliven our work and provide a much needed escape from it. How often do we stumble upon insights and solutions randomly, while engaging with activities and people in completely unrelated contexts? The most innovative, creative, and revered professionals in any domain practice consciously stepping away from the deep work intentionally and regularly, freeing mind and soul to receive the EUREKA– or not. It’s okay and healthy to just hang out and have fun, too.

Discern the Voices That Matter
On the subject of public scrutiny, many thanks to Will Watt, voice over and performance artist, for your wisdom:
“The first thing to acknowledge is that you cannot escape scrutiny. Whether it’s personal or professional, it’s a fact of life. It is not a mark of judgement, although it can feel like it. There will always, always be someone with a dim or contrary view of you or your work, and that’s okay. When it comes to who you are as a person, in a professional environment, it’s important to try to disengage the personal from the professional. It’s easier said than done…
“When it comes to your work itself, scrutiny is important and should be expected. Nobody is ever 100% right 100% of the time. That’s why we have due process and peer review. Again, what’s important is that separation of person and profession. It can feel tedious or disheartening to get professional blowback for something you worked on in earnest, but that blowback should be seen as an opportunity for growth. We learn from mistakes, and we learn from exchange. It’s not a faux pas to get something wrong. It is a faux pas to be surly or bullheaded in the face of getting something wrong. Being proven wrong is like drawing a dead-end on a treasure map. It’s helpful. It gives you – and others – direction and purpose. It helps you for next time.”
“Sublimate,” my friend and writing mentor says. “Try to see whether the criticism has some basis… ignore the often hurtful feelings, and learn from it.”

Here again, context and perspective count. Whose scrutiny and criticism actually matters? I see an important paradox here. Every voice matters to some degree, and even the most innane or ignorant expression may yield important insight, however inadvertently. Most opinions also carry some degree of projection and bias, which needs parsing–it’s often not about us at all. Multiple writers and actors impressed upon me the importance of not taking things personally, even (especially) the ad hominem attacks. “Check the facts,” as the dialectical behavior therapists say. If someone’s opinion–positive or negative–affects me disporportionately, what is that about? Understanding our own patterns of reaction to scrutiny is half the battle of navigating it more easily.

In the end, we all must decide which voices deserve space in our consciousness. Authors and actors, and even physicians don’t read or internalize every consumer and patient review. Every opinion is not equally valid, relevant, or useful.

Practice Integrity, Accountability, and Humility
Does the work you do–your output–align with your Why for doing it? Is it consistent with your professional oath and ethos? Can you stand behind it with your head high, shoulders back, and defend it with integrity? If so, how do you know?

Those close colleagues can tell you. If you’re connected well enough, they see you, know you. And if you care about one another, they will tell you honestly (and hopefully kindly) when you need to reset perspective, stop deluding yourself, or get a grip. What Will said about separating the personal from the professional is important. I would also suggest that it cannot be a complete and total separation. We are who we are in both our personal and professional–in all aspects of our lives. The most meaningful work, I believe, is an expression of ourselves, no matter the domain. So assessing the relevant scrutiny, acknowledging mistakes and missteps, learning from them, and maintaining a growth mindset are all part of living an accountable life, professional and otherwise. This robust root system of integrity and accountability, in turn, makes the isolation and public scrutiny more tolerable.

So often my writings return to the same ideas. Here I land on confident humility. Whether we are doctors, lawyers, judges, writers, or actors, we have trained. We are experts in our fields of study and work. And yet none of us knows it all. There will always be more to learn. However we are right, it’s always only partially. Humility, in addition to integrity and accountability, liberate us. They keep our minds and hearts open to what we don’t yet see, know, or understand. They keep us connected to our fellow humans, no matter where we’ve been or what we do.

The other recurring idea in recent years is goals and trade-offs. Whatever line of work we choose, assuming we choose it, we must decide for ourselves what we want out of it. Then, what are we willing and not willing to do, to sacrifice, to get it? I think this assessment should be made regularly and frequently. Goals and trade-offs can change over time; we learn, grow, and evolve over a life. If we feel isolated, and/or if public scrutiny feels heavy and restrictive or threatening, we can ask first, are we okay with it the way it is? Are the rewards worth the risks and costs, to us and our loved ones? If not, then what needs to change, and how? That question feels like an invitation to me, an expression of possibility.

If we can move our focus from isolation and public srutiny to community and relevant appraisal, then I believe we will suffer less and live more joyfully in our lives, both professionally and personally.

Chengerisms and NaBloPoMo 2024

“Hey friend, favor?
“When you think of me, what things do you hear me say all the time that signify to you who I am and what I’m about? 🤔
“…Collecting ‘Chengerisms’”

The compulsion overtook me Thursday evening, when I should have been finishing clinic notes and packing for LA. I texted a slew of people in a flurry with the question above, intending to assemble their answers into backbone for National Blog Posting Month in November. For those who don’t know, NaBloPoMo challenges bloggers to publish 30 posts in 30 days, all written in real time. It coincides with NaNoWriMo, National Novel Writing Month, a sprint to write a 50K word manuscript in the same time.

This will be my tenth consecutive NaBloPoMo challenge–BRING IT, I say!

My “Chengerisms” query, I see now, was actually me gathering validation and support for showing up all me, all in, BOOBS OUT at the Writers Rising retreat this weekend. My subconscious intuition knows what I need; I sense, trust, and follow better with age. Replies rolled in with speed, earnestness, and so much love it positively bowled me over. Highly recommend!

The strongest messages I perceived throughout the conference reinforced all of my highest writing and living values:
Let loose your curiosity
Take risks
Tell the truth
Honor your Central Self
Own Your Shit
You are enough
Assemble your pit crew
Connect, connect, connect!

How tightly these correlated with the Chengerisms my friends mirrored to me:
What is that about?
How fascinating!
Tell me more…
Hey friend
How did that feel?
Love you love you
Yaaaay!
One breath
Walk the talk
BOOBS OUT (apparently catching on in my small circles–yaaaayy!)
Tribe
Sooo human.

This spontaneous, subconscious-driven exercise shows me the profound importance of good, loving feedback and the absolute value of meaningful relationship. My response to almost every reply was a sincere and heartfelt, “I feel seen!”

While I continually noodle on content and structure of Book (I’m getting closer, really!), I feel a limbic and visceral certainty about how I want readers to feel throughout and especially at the end–seen, validated, inspired, empowered, and convicted. This NaBloPoMo, I aim to color in and sharpen that vision, saturate my thinking and writing brain with it.

At the end of an executive physical, I want my patient to feel thoroughly understood. I show that I know them, even if I only see them once a year, by reflecting their stories back to them, interpolating and extrapolating what’s not said, checking in, and providing what I know patients need from their doctors: personal connection in service of self-efficacy for health. So this year for NaBloPoMo, I commit to the theme:

What I Wish For You

Thirty things I want patients, readers, or anyone, really, to experience after encountering me in person or in print. Chengerisms in action. I will resist wallowing in guilt and shame when I notice how often I fall short of these aspirations. When I see perfectionist self-loathing approach I will divert it to the nearest off-ramp. All part of the process.

This could be both fun and enlightening! Let’s see what happens, eh? Ready, set, let’s go.


I Just Want to Talk to People and Write About It

WAIT—I already do this! 

All day, every day at work I talk to people.  I query their perceptions about their health, their habits, relationships, and leadership.  I ask about their families, challenges, and struggles.  We get as personal as they are willing, and it is always a privilege and honor to be allowed into people’s lives like I am.  Between the pre-call, the morning interview, and the debrief, I spend about two hours with each patient during their annual exam, reviewing the year past and anticipating the year ahead.  The best days end with me feeling joyously spent, having attuned and attended to each patient intently while mining all my cumulative expertise, both personal and professional, to compile the most collaborative, relevant, and holistic action plan I can muster.

I have saved face sheets from these annual exams for the past year, all the encounters that felt meaningful to me.  Each paper bears my notes from the interview, essentially a list of ideas/concepts, resources, and recommendations to include on the action plan.  It’s a set of organic notes for myself, a record of how I know each person, what stands out about their life today, the most salient aspects of health and relationships this year.

Internal Medicine is a ‘cognitive’ field—we don’t do procedures.  “I think, therefore I.M.” my American College of Physicians mug says.  I literally talk to people for a living.  And then I write about it.  Each clinic note reports my patient’s state of being, in the context of their life at the time.  Every year I add on to the cumulative ‘social history’—work, eating and exercise patterns, sleep, stress, and relationships.  Reading through that section of the note, I can see how many years I have known the patient, and how each of these aspects of their health has evolved over time.  They rise in the ranks of work, change jobs.  Weight fluctuates.  Kids grow up, graduate, leave home and go to college, get married.  Grandchildren accumulate.  My annual exam note is the record of a person’s life as I hear it.

Each encounter note’s ‘Assessment and Plan’ is essentially a problem list with my description of each active medical issue, interpretation of potential causes and implications, and plan of care.  It serves to guide anyone who cares for the patient in the future (myself included) and to inform patients themselves, so they may know the rationale behind my recommendations.

This past week, I started a new journal to document each encounter for my own benefit—to recall and reflect on each interaction and log my own perceptions (intellectual, relational, visceral, and otherwise) and insights.  Each entry ends with the heading “FEELING”—my attempt to articulate how the encounter affected me personally, what meaning I derived from it.  I LOVE this new practice.

Similarly, I have often journaled feverishly after conversations with my best friends—the deep, philosophical, and bonding ones wherein I grab my journal in real time to jot ideas, insights, and epiphanies.  My days off fill up with calls and coffee dates well in advance, and I now set aside time after each of these encounters to make similar recordings to those after my patients’ annual exams.  Between friends who have known me decades (‘stem cell friends’, as I have named them this week) to lovely new ones who may be decades younger or made in specific contexts (‘tissue friends’), the connections made of late flourish as if doused in Miracle Gro concentrate.  And I’m writing it all down!

This blog will be ten years old in April.  This is the 630th post.  It all started because I wanted to write a book on physician-patient relationship and how to save it.  And yet the focus, content, and organization of Book has eluded me all this time.  But it’s okay; I’m having so much fun with the process, feeling my way through, attending to and reveling in each twist and turn of the journey.  I’m getting closer.  I have no deadline or expectation, no goal other than fostering and honoring what emerges from the most organic and authentic places within me, for no other reason than to connect with people for whom it will be meaningful.

I talk to people.  I listen.  I connect.  I write about it for all our benefit, so our bonds may hold strong long after each encounter, cumulatively, in the most intersecting and inclusive ways.  I do it for a living—not just for an income, but for my very livelihood—I traffic in the spoken and written word to make the highest, deepest connections and meaning in life.  Wow, what a duh-HA! revelation.  And how lucky that my life calling and profession should align so perfectly? 
Book will come eventually, I am confident.  I can feel it. 
Onward.