Category Archives: NaBloPoMo

November 19:  Board Review Makes Me Better, For Sure

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NaBloPoMo 2019

Are you required to do continuing education for your work?

Since 2013, the Illinois Chapter of the American College of Physicians has run a weekly internal medicine board review webinar, MKSAP Live Online Study Hall.  We use questions that ACP publishes through the Medical Knowledge Self-Assessment Program, covering topics in general medicine and its subspecialties, including cardiology, pulmonary, infectious diseases, and rheumatology.  Every Tuesday night at 8pm Central time, two of us moderators and one webinar organizer get online and review about 14 questions, SAT-style.  We interact with audience members through a chat function on GoToWebinar, and we poll some of the questions each session.

I love this program for multiple reasons.

First, I was there when it started.  Gathered around then Governor Dr. Marie Brown’s dining room table, a handful of local ACP members brainstormed and created what is now an international, comprehensive internal medicine board review webinar series.  After some playful, off-topic, post-prandial banter between Dr. Sean Greenhalgh and me, our colleague across the table said wryly, “I’d watch that for an hour.”  Hence the dual-moderator, morning radio DJ style webinar was born.  That was in the fall of 2012, and the Study Hall is now halfway through its third two-year cycle.

Second, I get to hang out with my doctor friends online.  Besides Marie and a couple others, I did not know any of the dozen folks involved in the project before that night at her house.  We did improv workshops at the beginning to form our team and ease our communication skills.  Since then we have all become friends—a clique, even.  We have followed kids’ graduations, births of babies and grandbabies, and some personal challenges as well, all while getting together every few weeks to talk shop for an hour online.  We have even become celebrities of sorts—first at Illinois Chapter meetings and now sometimes at ACP National, people come up to us to say how much they like the program.  We’ve become a fixture in some colleagues’ lives.  We feel pretty proud and special about that.

The best thing about the Study Hall, though, is that just in the space of one hour on a Tuesday night, I am consistently humbled by the sheer volume of knowledge there is to absorb, just in internal medicine.  This is only one specialty of the whole medical profession!  And it’s not just the volume—it’s the complexity, the context, and the ever-evolving research, diagnostic and treatment development, and guidelines.  MKSAP publishes a new set of comprehensive questions every two years, and I do not envy the writers their colossal task of keeping us all up to date.  Without fail, every session I learn something that I will use the following week in clinic.

As this month of daily posts progresses, I feel increasing awe and gratitude for all of the people and opportunities in my life.  Thanks to all my colleagues, leaders, family and friends who make this life so full and loving.

November 18:  Relentless Curiosity Makes Me Better

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NaBloPoMo 2019

“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.”
― Rainer Maria Rilke

Tonight, in the month of gratitude, I feel deeply thankful for Coach Christine.  I might have been a curious person all along, but it was not until I got a life coach that I learned the vast and profound value of curiosity in every realm.  As I wrote earlier this month, standing always in curiosity liberates my mind.  It relieves me of unnecessary urgency for an answer.  I can exercise professional creativity in forming better and better questions, and the answers (often multiple, intertwined, and intriguing) emerge more easily and artfully than if I chase them demandingly.

The business of medicine is to solve problems, to heal, to cure.  So we assume that the faster we get to answers, the better.  And they had better be the right ones, because lives are at stake here!  It’s always interesting to me when patients talk about my work as ‘saving lives.’  I can’t remember a time when I could actually make that claim, at least at all directly.  But to my colleagues—emergency medicine and critical care docs, trauma surgeons, suicide hotline counselors—thank you, you really do save lives every day!

I love primary care because I usually have the luxury of ‘(living) the question.’  When patients present with new problems, as soon as I know they are stable, I get really excited.  I’m liberated to get deeply curious, ask as many questions as they will tolerate, paint the big picture together.  I follow the standard physiologic and diagnostic process initially, which often yields a straight forward answer and plan of care.  But life and work would be pretty boring if that were always the case.  When the usual suspects are all acquitted and the mystery persists, that’s when things get fascinating.  This is when I really get to know a person.  When I ask truly open, honest questions—the questions I don’t know the answers to and that are not meant to lead anywhere—I never know where the conversation will go.  And I always learn something new and relevant, something that helps me connect.  This is the information that makes a person memorable, because it is truly unique to them.

One of my favorite moments in a patient encounter is when I have to pause a few seconds to form a really good question.  What do I really want to know, what am I after, what will really break open this conversation?  It happens regularly, and wow, what a rush.  OH, I just never know what I will learn!  You’d think people would get impatient and grumpy with such prolonged, sometimes meandering interrogation.  But I find that they often lean in, look me in the eye.  They get on the train with me and look as eagerly as I around the next bend.  What will we find?  Let’s explore together!

Relentless Curiosity.  It’s the funnest part of my work.  I love it.  And as we all know, loving our work makes us better.

November 16:  Loving Subversion Makes Me Better

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NaBloPoMo 2019

Friends, do you already follow Seth Godin’s blog?  His post from Thursday stirred something a little irreverent in me.  It was about ‘allies and accomplices’:

To be an ally means that you won’t get in the way, and, if you are able to, you’ll try to help.

To become an accomplice, though, means that you’ve risked something, sacrificed something and put yourself on the hook as well.

We need more allies, in all the work we do. Allies can open doors and help us feel a lot less alone.

But finding an accomplice–that’s an extraordinary leap forward.

I thought immediately about my fellow Better Angels volunteers.  We have all committed time, talent, and treasure to the depolarizing of America.  We do it in public, in front of audiences and cameras, to reporters and members of our communities.  We openly challenge the prevailing culture of ad hominem, oversimplification, and overgeneralization.  We all come to it from our own internal optimism and hope.  But in the face of entrenched polarization and a culture of self-protection above all, we could never make any headway as individuals.  It is only together—as mutual accomplices—that we can truly claim and exercise our collective agency.

I feel even more buoyed by Ozan’s latest post.  He describes a series of well-known studies showing that people will organize themselves into in-groups and out-groups with remarkable loyalty, even around random and arbitrary distinctions like taste in abstract art.  This, of course, carries grave and important implications for prejudice and discrimination.  Ozan then points to two exemplars of the opposite, Dr. Martin Luther King, Jr. and Barack Obama.  In their most famous orations (see links), these remarkable leaders speak directly to what unites us as the foundation for solving our problems, rather than what divides us.

MLK:  The marvelous new militancy which has engulfed the Negro community must not lead us to a distrust of all white people, for many of our white brothers, as evidenced by their presence here today, have come to realize that their destiny is tied up with our destiny. They have come to realize that their freedom is inextricably bound to our freedom. We cannot walk alone.

Obama:  The pundits, the pundits like to slice and dice our country into red states and blue States: red states for Republicans, blue States for Democrats. But I’ve got news for them, too. We worship an awesome God in the blue states, and we don’t like federal agents poking around our libraries in the red states.  We coach little league in the blue states and, yes, we’ve got some gay friends in the red states.

I get goosebumps just reading the words.

It really feels like a loving subversion—of cynicism, scarcity, antagonism, and fear.

Who’s not better for that?