Category Archives: mindfulness

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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All Hail Your Dark Side

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What triggers you?

I don’t mean your pet peeves (please, stop using “there’s” when speaking about anything in the plural).  I mean what gets under your skin and affects you viscerally, really hijacks you?  I’m talking about the thing that escalates you so fast or intensely it’s like an out of body experience—you know you’re overreacting, you know it’s irrational, and yet all you can do is sit by and watch it unfold, powerless to control or direct it.

I had the pleasure of self-witnessing two such episodes recently, and it’s all so fascinating I had to write about them!

Bad Mom

A leader whom I deeply respect has asked me twice, in separate conversations, with slightly different words, how I manage my time.  The second time his words were, “How do you prioritize?”  Interestingly, I immediately altered his question in my mind to What do I prioritize?  I answered easily both times about strategies for handling emails, task lists, time with family, workouts, etc.  But after the second time I started to worry.  What’s behind this questioning?  Is he worried for me about something here?  Does he think I’m neglecting my family for work, and/or my clinical duties for all the extracurricular stuff?  Does he think I can’t handle it?

Over the next several days I had to chuckle with that sly, knowing expression when I realized it didn’t really matter what he was thinking.  The question, repeated, was a stealth trigger for my Bad Mom fear.  It wasn’t that I worried about his concern for my work life balance.  It’s that I was worried for it, and that I secretly question, more than I like to admit, whether my kids really feel loved enough by me.  This despite my previous blog post claiming that I actually don’t question it!  Blaaaaahahaha, how cosmically ironic!  Looking back, the article that incited that post touched pretty much the same trigger, and it has taken me this long to see it (better late than never).  How fascinating!

In my defense, I really do think I’m a good mom—mostly.  But like being a good leader, it’s definitely not always easy, and that I question my competence/proficiency/mastery does not necessarily detract from my real, ever developing, occasionally flourishing skill set.  Thanks to this new awareness of the Bad Mom Trigger, I have adjusted my strategies and tools, and rebalanced, for now, time and energy between work and home.  I look forward to receiving more gracefully the signals for future opportunities to readjust.

Canned and Rote

Last year I was leaving an evening work gathering.  A nice man saw me departing, got out of his seat, and approached me, apparently to introduce himself.  He said he had heard my ‘shtick’ something something something—I did not really hear anything else, as my abhorrence of that word had made me stop listening.  I think I was polite, and I exited with as few words exchanged as possible.

Readers of this blog know how much I admire Brené Brown.  Followers of Brené also know that her work is always evolving, new theories testing, refining, and building on prior ones, always with deeper and more meaningful understanding and application in relationships.  So I was deeply offended when I recently heard someone refer to her presentations as ‘shtick’ and ‘spiel.’  These words feel dismissive, mocking, and pejorative to me.  I have only heard them used in a disrespectful way about a speaker or their speech.  But why should I be so offended on Brené’s behalf?  She knows the value of her work; she does not need me to defend her.

Of course, as usual, it hit me later:  I identify with Sister Brené, so I took these words personally.  To me, shtick and spiel are how we describe presentations, and thus people, who stopped learning and growing long ago.  We utter these words and roll our eyes at having heard it all before—nothing new here, folks.  David Litt has said that when preparing a presentation ask yourself, what is the one thing you want someone in your audience to tell their friend about your speech the next day?  If the words ‘shtick’ or ‘spiel’ appeared within a hundred yards of someone describing my work—if someone thought I had not prepared but just shown up with canned, stagnant drivel—I would be mortified.  I pride myself on constant learning, self-awareness, and self-improvement.  I want every audience to feel that my presentation was uniquely relevant to them, that I worked hard to meet them exactly where they needed me.

I understand that everybody may not see or hear these words the way I do.  I can respect that and monitor/manage my reactions from now on.  But wanna trigger me?  Tell me you heard my spiel.  Go ahead, I dare you.

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Debbie Ford and Your Dark Side

OH it’s all so funny, the things that trigger us.  Because if we don’t laugh we will absolutely cry.  Or pick fights with our spouses that last weeks on end.  That’s what happened to me when I read The Dark Side of the Light Chasers about 10 years ago.  I was young yet in my adult development journey, and I had a few (just a few) more emotional hang ups than I have now.  On page 69 of the paperback edition she lists negative words like greedy, liar, sleazy and freak, and suggests an exercise:

Take a few minutes and identify any words that have an emotional charge for you.  Say out loud, “I am _____.”  If you can say it without any emotional charge, then move to the next word.  Write down the words that you dislike or react to.  If you are not sure that the word has any charge for you, close your eyes for a minute and meditate on the word.  Repeat it to yourself a few times out loud and ask yourself how you’d really feel if someone you respected called you this word.  If you’d be angry or upset, write it down.  Also spend some time thinking about words that are not on this list that run your life or cause you pain.

I didn’t get through the whole book back then, so I don’t know what she wrote about ‘embracing your dark side,’ ‘reinterpreting yourself,’ and ‘letting your own light shine.’  But I think I have figured it out for myself, at least a little bit.  It’s about self-compassion, acceptance, growth mindset, forgiveness, connection, learning, and joy.

Every light casts a shadow, and we need both light and dark for balance in life.  I’m learning to hold it all a little more lightly (ha! Pun!).  Debbie Ford felt too heavy for me ten years ago.  I’m looking for a new book this week.  Maybe I’ll pick hers up again and see how it feels.  …Makes me a little nervous, actually.  I wonder what I’ll find this time?