Category Archives: medicine

On Setting Intentions

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NaBloPoMo 2016, Letters to Patients, Day 9

To Patients Seeking Bearing and Beacons

Set your intentions for the day.

In the aftermath of the election…  I feel an intense need to self-soothe and focus.

A wise friend recently introduced me to a morning practice that has impacted my days in wonderfully tangible ways.  He describes a 5×5 grid which he pencils in his journal each morning.  He fills each box with a word that he wants to hold in intention for the day.  For each word, he meditates on its meaning, then what it would feel like.  Then he meditates to feel it and live it already.  Throughout the day he then recalls the words and their sensations.  He started with a 2×2 grid (four words), then gradually increased it to 5×5.

I have had 9 (now 10) presentations to prepare between mid-August and the end of this month.  My practice continues to grow.  The kids’ schedules and activities multiply proportional to their heights.  Learning this anchoring method from him has been a Godsend for focus and grounding, and I am so grateful.

I started with 3 words, and have practiced inconsistently (this appears to be a pattern for me).  But each day that I take time to determine the words and sit with them a while, I notice a remarkable steadiness throughout the day.

Patience.  Compassion.  Focus.  Love.  Empathy.  Ease.  Generosity.  Equanimity.  Joy.  Fun.  Peace.  Forgiveness.  More Love.  Connected.  Center.  Openness.  Curiosity.  Engage.  Movement.  Lightness.  Ground.  Calm.  Acceptance.  Non-judgment.  Happy.

It’s really amazing:  Just a few minutes in the morning are all it takes to frame my mind and resolve my heart.  I feel steadfast as I walk out the door.  I go about my day and forget.  Then, in those unfocused moments, the words rise to conscious awareness and I remember, reset, and re-center.

Maybe you’re feeling a little unsteady now, also?  Give the Word Intention practice a try.  It can’t hurt.  It costs a few minutes of time.  You can start with one word.  You can write it on your hand.  There is no such thing as cheating, only seeking and centering.

Best wishes and peace to you.

On Finding Meaning

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NaBloPoMo 2016, Letters to Patients, Day 8

To Patients Seeking Meaning:

Try the Three Question Journal.

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

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

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

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

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

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

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

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

 

On the Critical Importance of Self-Care

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NaBloPoMo 2016, Letters to Patients, Day 6

To Patients Who Feel Overwhelmed:

Put your own mask on first!

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

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

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

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

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

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