From Meaning to Mission:  Finding Your Voice and Speaking Up for Change

Fairmont workshop room

Have you ever felt like you have no voice in your workplace, your community, or the world at large?  When have you felt you do have a voice?  What made the difference?

Two esteemed colleagues, Liz Lawrence and Eileen Barrett at the University of New Mexico, and I presented the above titled workshop at the International Conference on Physician Health on Friday.  The objective was to give participants an opportunity to recognize and rally their strengths, claim their value and agency, and practice the words to advance an idea or project for improving physician health and well-being.

The idea for the workshop came from a conversation Eileen had with a young physician who felt he had no agency to improve his work situation, due to his junior status.  This prompted her to ask, who has agency, and how do they get it?  She concluded that agency is an active skill, not a passive state of being.  Thus it can be learned/acquired, and everybody has/can have it.  Furthermore, we apply it most effectively when we combine it with our strengths, in service of projects that are personally meaningful.

We presented the reciprocal triad of finding meaning in work, feeling empowered, and inspiration and motivation, as the foundation of agency and action.

EB triad

Identifying Strengths

The first exercise had participants pair up and describe their strengths to each other.

What are your strengths?  Imagine describing them to someone, out loud, in person.  How does this feel?  Our attendees reported feeling uncomfortable, not used to it.  They also felt confident, connected, and encouraged speaking to someone they knew was listening supportively.

Defining the Project

Second, we asked participants to think for a few minutes about their own projects.  It could be something they had been working on for a while, a new idea they recently came across, or something from a sample list we provided, related to Culture of Wellness or Efficiency of Practice.  We asked:

  • Is your idea “Big Enough to Matter, Small Enough to Win?” quoting Jonathan Kozol.
  • Is it Specific, Measurable, Achievable, Relevant, and Time-bound (SMART)?
  • How will your strengths apply?
  • What else do you need? Who can help?

Partners met again to share and discuss each other’s ideas.

Afterward they reported elevated inspiration, excitement, and mutual support.  Positive energy in the room rose palpably at this point, with lots of gesturing, smiling, and engagement.

ICPH 2018 workshop

Communication and Relationship

We didn’t call it an elevator pitch, but that’s basically what we asked attendees to attempt.  In 90 seconds, each participant was to distill and express their idea into words that would convey its essence and enroll their partner in its goal.  Having advanced to this segment of the workshop in less than twenty minutes, and now asking them to perform a pitch on the fly, I gave a pep talk (modified here to include some words I wish I had said):

“Now it’s time to PRACTICE.  If we are to make progress in our projects, we must enroll other people.  It’s all about relationships.  Relationships kill us or save us, and they live and die by communication.  A previous presenter said, ‘Language is the vehicle through which all interactions take place—both verbal and nonverbal.’

“You never know when or where you will meet your champion, or who it will be.  The easier and better you can pull your idea out of your back pocket and present it cogently and impromptu, the higher your chances of success.  Know your ask—be as clear as possible.  Know your audience—what about your project is meaningful to them, what will they relate to?  Make them the hero:  Don’t come at them with demands.  Come alongside them with open-ended questions; help them appreciate the power they have to help.

“You will have to be persistent.  Practice will be key.  Our keynote speaker, applying complexity theory to the work of physician well-being, invoked the image of a grain of sand dropping onto a pile.  One grain may stick on impact and nothing happens to the pile.  Another may cause a small section of sand to tumble just a little.  Yet another grain can trigger the avalanche that alters the sand pile landscape entirely—and no one can predict which grain will be which.  I posit that you are not a grain of sand.  You hold an idea—a whole bag of sand—and each time you pitch it, you drop a grain (or a handful) on the pile.  If one grain makes no immediate change, drop another one, and another, and another.  This is the essence of the Growth Mindset—practice.  Practice is Creation.  Practice is Evolution.  Practice is Progress.  Your job now as speaker is to try with abandon.  There is no such thing as a bad try.  Pay attention to how it feels, where you get stuck, and where you shine.  As the listener, your job is to make it safe for your partner to let go of fear and judgment, to lay it all out.  Support, encourage, and critique with love.  What moved you, what did you observe in words and body language that drew you in or put you off?  What did you want more of?

“Make the most of this time.  Dig in the bag and pull out a few grains to drop.  Take advantage of your partner for feedback and support.”

The room was positively buzzing.  And participants’ comments made our day (paraphrased here):

“Sticking with the same partner throughout was helpful; we could really connect each other’s strengths to our respective ideas and help each other develop them.”

“It was fascinating to see the energy change between talking informally about the idea and then having to present it as a pitch.  She was so much smaller and hesitant the second time around.”  (Partner):  “The first time I was just talking to a colleague.  The second time I pictured presenting to my board.”  The experience was enlightening and curiosity-provoking.

“It’s different and easier talking to a supportive stranger, someone with whom you don’t already have relationship baggage.”  How else, then, might we approach our stakeholders—how could we practice awareness of our assumptions and relationship dynamics, and perhaps modify them positively?

“Hearing someone else’s ideas informs my own.  I like how he conveyed something, I saw how I could do the same; it gave me more insight.”  Taking turns both presenting and listening engaged both people in mutual support and encouragement—both roles were helpful.

The Takeaways

Liz, Eileen and I have collaborated on physician wellness since 2015.  We share meaning and mission around inspiring our colleagues to claim their value, recognize and stand both confidently and humbly in their power, and participate in a global movement of positive change.  Our strengths and styles complement one another and the work flows naturally, synergistically.  What a privilege and an honor it was to have this opportunity to present to and commune with our tribe members in physician health.  May the processing and integration of all of our new learnings continue to sustain and connect us for the long road of work ahead.  As Barack Obama says, “Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change we seek.”

Onward, my friends.

EB LL CC ICPH 2018

Moving On From the Last Two Weeks

N 10 Mile Creek Trail Aug

Hello again, friends!  Is this the longest I’ve been away since I started this blog?  Can’t remember, doesn’t matter!  Good to be back!  Hope you all are well. J

I aim to get back in the swing of writing before November’s National Blog Post Month, or NaBloPoMo, as it’s known… I have my list of potential topics all laid out, can’t wait can’t wait!  So here is the first of four weekly posts I hereby commit to attempting in October.

Soooo…  Is anyone else as mentally and emotionally exhausted as I am these past few weeks?  It would take too long to write it all out, and I am really trying hard to get to bed on time these days, so suffice it to say here that it’s been ugly and damanging to many, and we had all better figure out how to move forward lest we eat each other alive.

Throughout the debates on sexual assault, teenage promiscuity, alcohol use, judicial temperament, character, and integrity, I have truly appreciated voices that speak to our higher capacities for connection and understanding.  More specifically, I have sought people on one side of an issue seeking to bridge the gap between theirs and the other.  Now that the deed is done, I look back on the most thoughtful articles, the ones that give me hope for the future of civil discourse.

First, Benjamin Wittes wrote two pieces for The Atlantic.  Initially he laid out how Brett Kavanaugh could present himself such that we Americans could sleep at night with him on the high court.  Despite the impossibility of proving or disproving the allegations against him, Wittes argued, it was his responsibility to convince us that he is truly worthy of the post.  After his rageful and disrespectful performance at the second hearing, Wittes wrote again, expounding on why the judge, despite his legal qualifications, should not be elevated due to his apparent lack of candor and the caveat that would always follow his opinions.  In both pieces, Wittes makes clear that he has no problem with conservatism and Kavanaugh’s jurisprudence.  But as a progressive myself, I felt reassured by Wittes’s words that someone on ‘the other side’ understood my concerns and validated them.

I read a lot of social media posts pointing to the devastating sequelae for men when falsely accused of rape and sexual assault.  I felt gratified to find at least one article reviewing evidence and statistics for this, basically showing that the number is vanishingly low, compared to the incidence of actual sexual assault and violence.  When I post such articles, though, my friends who support Kavanaugh’s nomination are unlikely to read, and more likely to feel I simply ignore their concerns.  So when I found this article, written by Emily Yoffe, a victim of sexual assault herself, advocating due process for the accused, I wanted to share.  I thought that by acknowledging and validating ‘the other side,’ I might open a window for my point of view to enter my “opponents’” minds and prompt consideration.

I admire Senator Murkowski from Alaska, for voting and speaking her mind, pointing us all to the larger picture of the integrity and reputation of our democratic institutions, while also pointing to and maintaining the humanity of all involved.  And then this article by Howard Zinn from 2005 came across my feed this weekend, reminding us citizens of our role in the workings of government and societal progress.

Finally, I was able to unwind with the kids today by watching some Avengers movies.  We like Black Panther in particular, with its epic vistas, futuristic technology, and rich cultural backdrop.  At the end, when King T’Challa addresses the United Nations, his words struck me as exactly what we need across our country and indeed around the world today.  I may print and post them by my bed, to remind myself of how I want to think, speak, and act:

We will work to be an example of how we, as brothers and sisters on this earth, should treat each other. Now, more than ever, the illusions of division threaten our very existence. We all know the truth: more connects us than separates us. But in times of crisis the wise build bridges, while the foolish build barriers. We must find a way to look after one another, as if we were one single tribe.”

Now is the time, more than any in my life so far, when we must call loudly and desperately on the ‘better angels of our nature.’  How can we manifest them the most radiantly?

 

Hold One Another Up

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Hello Friends!

How was your week?  I wrote in my last, very brief post that it had been a hard few weeks, but whoa-Nellie, these past 10 days or so have been a bit unbelievable.  But then again, almost nothing is truly unbelievable anymore.

When the news first came out about families getting separated at the border, I felt profound empathy for the parents, and then the kids, imagining their despair, grief, and lasting trauma.  But the administration is now targeting even naturalized citizens, looking for fraud on applications to deport people.  My parents, my husband, and all of his siblings are all naturalized citizens.  My son is currently abroad and it occurred to me to wonder whether he will be held up in customs and immigration on his return.  At this point I cannot know for sure that my own child, a native-born American citizen, won’t be kept from me, and even though it is unlikely, I now feel it fully in the realm of the possible.  I know I’m not the only one.  That is simply unacceptable.

It also occurred to me that any of my Latinx friends and co-workers could be stopped on the street or approached on a bus or train, and commanded to show proof of citizenship, as so many across the country have experienced, illegal and unconstitutional as it may be.  45 actually autographed photos of people who have been killed by illegal immigrants, while denying that native-born citizens commit proportionally more crime than immigrants, legal or illegal.   Right now, June 2018 in the United States, it feels to me that only straight, white, Christian, cisgender males are safe.  It all makes me want to vomit.

In the past year or so, people who know me call me an ‘activist.’  I take immense pride in this perception, and at the same time feel a little unworthy.  What have I done?  In 2017 I wrote a lot of letters to Members of Congress–even had Healing Through Connection stationery printed to do it.  I called.  I donated.  I marched.  2018 has been slower in action.  I’m still reading, keeping up, donating, and engaging on social media.  But I feel like it’s not enough, that I should be doing more.

Today I am more aware than ever that most of my colleagues and institutional leaders are white.  I am East Asian.  We are not the targeted groups.  However empathetic and outraged we may feel, we are likely only indirectly affected by current events.  So many of our support staff, however, are people of color.  They hold positions in the organization with the least autonomy, authority, and voice.

We are all expected come to work every day and do our jobs.  We take care of patients.  We put our personal feelings, stressors, and worries aside and meet our patients where they need us, and nobody knows what we might be dealing with ourselves.  But we do this now during a mind-bending crisis of national conscience.  Now is the time when our emotional and social support networks are called forth and tested.  As a physician, a default leader of the patient care team, how can I not acknowledge this profound disturbance of our collective consciousness?  How can I expect my team to perform optimally in a false vacuum?  The realities of our world are simply inescapable, and they affect us all, like it and accept it or not.

I may not be marching in front of Congress or the DHS.  I may not be writing legislators or calling them every day.  I am not a designated leader of my professional society, publishing op-eds on the long term health and societal consequences of our government’s actions.  But I can absolutely stand up in solidarity with and for the people closest to me.

So this week I expressed to my teams in no uncertain terms that whatever anyone is feeling or going through right now, they should know that their physician leaders support them, and we will be here for them however they need us, just like we are all here for our patients.  I made no overt political commentary.  I simply acknowledged the moral morass I see in our country and tried my best to make it safe for us all to experience it together, out loud and in person, and to help one another through it.

If there were ever a time for physicians to walk the talk as leaders, as caregivers for the caregivers, it is now.  I know now that I don’t have to be the loudest or most visible ‘activist.’  I just have to act in accordance with my core values.  And it starts with holding up the people right next to me every day.

Relationship Revolution

 

“In my lifetime I want to see the culture of medicine driven more by relationship than by revenue.”

–me

 

Nice to be back, friends!

This post is a bit different from my usual format and style.  It’s maybe more raw and blunt.

Please bear with me and keep an open mind?

I know posting this may be risky.  It started out as just jotting down ideas for a longer, more detailed future post.  I had to get the ideas and thoughts out so I could focus on work.  And then the ‘jotting’ somehow evolved into what I imagine a poetry slam might look like.  So I decided to post as is.

My long term objective is to stimulate generous thought and respectful discussion between patients and physicians.  I wish to prod us out of our default complaint modes and reorient all of us to the idea that we are all on the same team, but our connections are under siege by outside forces.  The system harms and oppresses us, physicians and patients, the end users, and the ones with the real power.  Together, we are the sleeping (sedated?) giant that must rise up and reclaim the system for ourselves.  This post is an attempt to spark the flame that draws us together, by pointing directly to the spikes that drive us apart.

Disclaimer: What follows is my own expression and does not represent or reflect the opinion or position of any colleague, institution, or professional society with whom I associate or to which I belong.

ice castle spider legs

I hear my colleagues say: Get rid of the patient portal!

It’s too much!

Limiting characters does not work, they just send multiple messages

Charging for messages just makes more work

“They abuse the system”

“We give an inch, they take a mile”

Keep them away!

Us vs. Them mentality.

Antithetical to mission of medicine: To meet patients where they need us, and help them.

WHY?

Because we are too busy.

DOING WHAT?

Every. F*ing. Thing.

Rx prior authorizations

Endless documentation, infinite clicks

Rx refills with no information on follow up or patient status

Filling slots to meet RVU goals

Prescribing more meds to meet “quality” goals

Keeping up with the latest evidence for every disease, test, treatment, guideline, diet fad

Rushing to the next patient so that the patient we’re with does not have time to even think of their questions, must less ask them

Patients walk away from visits with their true needs unmet.

So they use the resources available to them to ask for what they need.

And this ‘adds’ to our work

And we feel busier and more frustrated, exhausted, frayed, irritable

We feel Overwhelmed.

 

Patients also feel it

They feel unseen, unheard, dismissed, discarded

And they don’t understand or relate to where it comes from

They get angry

So they send more messages: to us, about us; criticizing us, lashing out

Making us feel bad about ourselves

Which manifests as defensiveness first, then even more frustration, exhaustion, irritability

But we don’t disengage.

We remember our calling.

We forge on in smoldering resentment, pride, bitterness, duty, guilt, shame, and occasional fulfillment

 

And then abstractions to reconcile the cognitive dissonance

 

Patients suck

All they do is take take take

They don’t understand that I’m Doing My Best to help them

Why don’t they appreciate me

They are so entitled these days

They want everything now now now

They think I’m at their beck and call

Like I’m not working every minute of every day

Like I don’t have a family and a life also

Like I live only to serve them

Patients are the enemy

Really?

 

Oh and it happens on both sides

 

Doctors suck

All they do is type away at that blasted computer

They don’t even look up, see me, or hear me

They don’t understand what I need

They just want to see more patients

Make more money

I’m just a number to them

A cog on a conveyor belt

They’re all in the pockets of Big Pharma and Insurance

They withhold the help I need

They hoard it

They don’t care about me

They Don’t Care About Patients

All they care about is making the next buck

Doctors are the enemy

Really?

ice castle doorway

There is no substitute for the Time and Energy

Required to cultivate Healthy, mutually Respectful, mutually Fulfilling, mutually Beneficial relationships

It is always a two-way street

Our relationships kill us or save us.  Always.

snake river keystone

Doctors and patients must find ways to reconnect

Find one another through the thick morass

And Hold Tight

In Solidarity

Learn, Train and Practice Together

Our Communication, Empathy, Compassion, and Collaboration skills

Defend against the forces that drive us apart

Advocate for one another and for our Sacred Contract

So we may once again

Heal Through Connection

 

The Only Diet That Works

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Hello Friends!!  Oh my gosh, it feels so good to be writing again, like sinking into my favorite squishy armchair, at the campus coffeehouse where I have met my friends since college, to sip, gab, bond, and plot to save the world.

New phase of life, woo hooooooo!  And eekgadds.  I have long thought of balance as a dynamic state, like that octopus ride at the amusement park.  I am the ride, spinning around, raising and lowering each aspect of life in controlled coordination, attending to each car so nobody flies out and gets hurt.  With the added responsibility I have taken on at work this year, it feels like I have just agreed to accept a massively overweight rider in that car, and my whole frame now strains to keep everything moving smoothly.  At first everything looks normal.  But the continuous strain of gravity, mass, and cumulative sheer forces create microfractures in my arms over time.  And suddenly one day, something (or everything) may come crashing to the ground.  People get hurt.  The ride is broken, in need of major repairs, possibly never the same again.

 

So better to slow the RPMs now, decrease the amplitude of vertical oscillations.  And, increase frequency and intensity of maintenance: inspection, lubrication, computer upgrade, parts replacement.  All of this is to say that 2018 is my year of graduate study in life-octopus ride maintenance.  Curriculum so far includes a lot of Thomas Rhett songs (“Drink a Little Beer”), communion with close friends, and a resurrection of my spiritual life.  I’ got this. [fist bump emoji]

***

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Okay so, this is a post I have thought about for weeks and I can finally sit down to write it today/tonight.

Since December, two people have told me, essentially, “Medicine has failed at nutrition.”  One person was a good friend, the other a new acquaintance.  Both were athletes, well-educated professionals, and thoughtful men.  I respect both of them and was intrigued by their assertions (and, honestly, just a little defensive).  They pointed to the myriad books, fads, products, news articles, and programs around the country in the last decade or so, all claiming to have the one method for lifelong healthy eating.

Their expressions went something like this:  “What’s the deal with gluten?  I’ve read Wheat Belly and Grain Brain and now I feel conflicted every time I want to have some bread, even though I feel fine, and I like bread.  …Is saturated fat bad or good?  On Atkins I can have as much steak and liver as I want, and my cholesterol is supposed to get better.  And Bulletproof says I should be drinking butter and coconut oil in my coffee.  But my doctors all tell me to minimize red meat and oil in general.  …The Inuit people live off of whale blubber, and they have a fraction of the heart disease we have.  I used to think I knew how to eat healthy and now I’m not so sure.  I’m so confused.”

I was taken aback somewhat by both of these conversations, as I don’t feel confused at all about nutrition and eating.  I feel personally tempted, frustrated, vacillating, under-motivated, and/or fat, depending on the day.  But professionally I feel informed, confident, and reassured that I can counsel my patients solidly toward optimal health.  So wherein lies the disconnect?

In my practice, our approach to nutrition starts with the patient interview.  What is your current eating pattern?  How does weekend or travel eating differ from regular workdays?  How does this pattern either promote or hinder your health and well-being?  What are you doing that’s already healthy and where is there room for improvement?  What needs to happen in order for you to make small, sustainable behavior changes for optimal health?  How important is it to you to do so?  The conversations focus on my patients’ own physical, mental, and emotional experiences around food.  They have a chance to relate their eating habits to personal and professional goals, and a vision for their best selves.

I have learned that my advice needs to be concrete, specific, and relevant at a granular level.  I can roll with Paleo, Atkins, Whole 30, gluten-free, vegetarian, ovo-lacto, oil-less vegan, pescatarian, Mediterranean*, or other diets.  There is some good evidence for all of them.  But is any one of them the sole antidote to all of our eating poisons?  My left brow rises every time I hear someone make this claim.  Here’s the key:  None of these diets tell us to eat pizza, burgers, chips, cheesy fries, dinner rolls, diet soda, craft beer, loaded nachos, fettucine alfredo, cookies, cake, ice cream, and candy the way most of us do.  So what are the underlying origins of my night-time corn chip-cream cheese binges?  What strategies can we brainstorm to cut back on my birthday cake consumption between birthdays?  Questions like these and the conversations that follow serve my patients far better than my recommending the blood type diet (which I do not).

Furthermore, leading proponents of each of these diets also emphasize the importance of concurrent self-care in the other realms of health: Exercise, Sleep, Stress Management, and Relationships.  Diet and nutrition are vitally important for health, but they do not occur in a vacuum.  All of our health behaviors need to be assessed in their combined context, and recommendations are best made with circumstances, preferences, logistics, and access in mind.

If you’re an elite athlete whose diet is already 99% cleaner than the rest of us, yes, maybe there is a subtle difference between medical diets that will affect your performance and sports longevity.  Then again, maybe not.  And you are also likely attending to your needs for training, rest, recovery, and stress management.  So you’re probably good either way.

For us regular people, the only diet that works is the one we can stick to, that doesn’t cost us inordinate amounts of psychic energy to maintain, and that actually makes us healthier.  How can we tell we’re healthier?  We may feel: lighter on our feet, increased energy, more regular bowel movements, clearer skin.  When we see our doctors (as we all should, ahem) they may find we have lower blood pressure, lower body fat, smaller waist circumference, lower fasting and overall glucose, lower LDL and triglycerides, and an overall brighter aura and vibe.

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So maybe keep Michael Pollan’s words in mind as a general guideline: “Eat food.  Not too much.  Mostly plants.”  I would add:  Eat foods as close to how they occur in nature as possible.  If you can tell what leaf/seed/grain it is by looking at it, it’s probably better than if you cannot.  Harvest/kill it, cook it (or not), eat it.  The fewer steps the better.  Eat often and slowly with people you love.  Help each other moderate the junk.  Enjoy your food.  Life is short.  Strive for an eating life that adds joy and delight to your whole being, both immediately and in the long term.

Onward, my friends.

 

*I have no financial, philosophical, or other interests in any of these or other diet programs, products, centers, providers, etc.

200th Post: The Best of Healing Through Connection

Harper Columbine 5-31-14

Happy New Year, my friends!  May 2018 bring us all health, joy, connection, and learning!  And may we all look back one year from now feeling more empathy and compassion, and enjoying better relationships than ever before.

If you are new to this blog, welcome!  I hope you find something that resonates.  If you are an old friend, thank you for your support, feedback, and encouragement the last 32 months.  As I reread the last 199 posts this past week, my favorite parts were the thoughtful and enlightening comments.  I never imagined I could make friends writing a blog and yet here we are, connected, engaged, and holding one another up.

What have you discovered about your own writing when you go back and read?  Turns out I have a pretty consistent theme—it’s all about relationships.  Relationships require awareness, insight, active engagement, negotiation, and adaptation.  This is no less true in our relationships with ourselves than with others.  I have divided my favorite posts below into three categories: Health & Self-Care, Physician-Patient Relationship, and Relationships and Communication in general.  Though I have written pieces on politics and healthcare, I realize that these are critical arenas in which to explore relationships, and not my primary areas of focus in and of themselves.

2018 brings big new projects and responsibilities, yay!  So of course there will be big new challenges, also yay!  Looking ahead, I commit to my self-care practices with renewed motivation:

  1. Get to bed by 11:30 every night—Coach Christine has permission to call me out if I’m caught Facebooking past this time.
  2. Maintain 4+ workouts per week. An aging body needs regular vigorous movement!
  3. Keep up with therapy and resume regular coaching calls—reflect internally and project my best self outwardly.
  4. Maximize intake of stems, stalks, leaves, and fruit; minimize refined sugars.
  5. Nurture my ties to my tribes. They hold me up so I can do my best for those whom I lead.

The coming year will also require pulling back on certain things in order to maintain sanity.  While I refuse to renounce my Facebook use altogether, I have already decreased daily hours spent.  And though I still strive to maintain social/political awareness and activism, I will engage less with opposing voices on social media.  The costs, I have learned, far outweigh the benefits.  I would much rather take a politically oppositional friend out to lunch, or even fly to meet them, and have far more meaningful conversations in person.

For now, I plan also to scale back on the blog.  I’ll continue to write, of course, but likely more in the form of stream-of-consciousness journaling, brain-dumping, and snail mail letters to friends.  I expect that once in a while one of these activities will yield a post or two, and I hope to catch them by the tail and publish them before they escape the moment.  I leave here the list of my favorite posts to date.  Please feel free to dip in and out, leave new comments, and share links.  I suspect I will be drawn back to the page before long, as I already have a list of ideas for future posts.  But in case it’s longer than I anticipate, please know that I appreciate every view, every like, every comment, and every connection.

Thank you for stopping by and taking the time to read.  And may you take something away that makes you glad you came.

Sincerely,

Cathy Cheng


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Health and Self-Care

The Sh*tpile  /May 2015

https://catherinechengmd.com/2015/05/01/the-shtpile/

Everybody has one.  We inherit large parts of it from our parents, whose parents passed theirs down, etc.  Life experiences add mass and odor as we grow up.  It sits squarely in the middle of the house of our existence.  For the most part, we simply live our lives around it, walking past every day, careful not to knock any pieces off.  The surface gets dry and crusty; we grow accustomed to the smell.

 

How Health Begets Health  /November 2015

https://catherinechengmd.com/2015/11/07/how-health-begets-health/

As the kids and I sat waiting to get their flu vaccines this morning, I heard someone blow their nose. It was that thick mucus blowing that feels, at the same time, both gross and gratifying. I took a deep breath through my unobstructed nostrils and looked happily at my uninfected children.

 

Setting Intensions for 2016  /January 2016

https://catherinechengmd.com/2016/01/01/setting-intentions-for-2016/

This year I realized my body’s inevitable march toward menopause, a stark and sudden awareness. It came to me sometime in the spring, and I felt a keen jolt of motivation to prepare.   After 13 years of practice, I recognize two characteristics of women who suffer the least through this dramatic hormonal transition.

 

So You Want to Lose Weight  /March 2016

https://catherinechengmd.com/2016/03/12/so-you-want-to-lose-weight-the-four-as-of-goal-setting/

We set weight loss goals all the time, all of us—physicians included. We choose a number on the scale—an outcome—that represents our better selves, however we see it.  I suggest today that behavior-oriented goals, rather than outcomes-oriented ones, lead to far greater and more meaningful success.  How much are we really in control of what we weigh, day to day?

 

Never and Now  /April 2016

https://catherinechengmd.com/2016/04/17/atozchallenge-never-and-now/

And, there is another important practice to overcoming the Nevers: Mindfulness, the practice of the Now.  Never is about the future or the past.  Often it’s a shadowy, catastrophizing perspective of things.  But we cannot predict the future, despite our arrogant human certainty.  And we cannot live every day to come based solely on what has already happened or not happened.  Circumstances and attitudes change.  Landscapes change—at times literally, and in an instant.  We evolve, we learn, we grow.  How can we be so sure that Never is real?

 

Yes, And!  /April 2016

https://catherinechengmd.com/2016/04/30/atozchallenge-yes-and/

The goal is to open our minds, allow possibilities, expand our boundaries, and encourage creativity. I can still see her smile, the gleaming light of engagement and anticipation in her eyes.  I also remember my own hesitation and self-consciousness.  What do you mean, pimple on my forehead?  Is it really about to burst?

 

On the Critical Importance of Self-Care  /November 2016

https://catherinechengmd.com/2016/11/06/1638/

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… 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.

 

On the Second Arrow  /November 2016

https://catherinechengmd.com/2016/11/11/on-the-second-arrow/

Eventually, breathing, we can let go the negativity, pull the arrow out.  Breathe.  When assailed by another first arrow, see the second arrow coming and sidestep.  Breathe.  Keep breathing.  Practice self-compassion and forgiveness.

 

On Readiness  /November 2016

https://catherinechengmd.com/2016/11/16/on-readiness/

I confess I am guilty of impatience and judgment.  When I see your uncontrolled, lifestyle-related medical problems, and you resist behavior change, I feel frustrated.  I know you feel it, too.  But know that I don’t blame you. The point is: we don’t make changes until we are ready.

 

Walking the Talk  /July 2017

https://catherinechengmd.com/2017/07/09/walking-the-talk/

18 months ago I wrote about my plan for maximizing menopause preparedness.  As with so many missions, this one has experienced both successes and failures.

 

Just Do It My Butt  /November 2017

https://catherinechengmd.com/2017/11/06/just-do-it-my-butt/

Medical systems which include dieticians, exercise physiologists, and health psychologists can deploy these team members to support patients in their health journeys.  But does your doctor’s office have this kind of set up?  Does your insurance pay for these services?

 

Citius, Altius, Fortius!  /November 2015

https://catherinechengmd.com/2015/11/09/citius-altius-fortius/

Every day I live in awe of the astounding miracle that is the human body. It is the quintessential integrated machine.   Almost every part serves a unique and essential purpose in normal daily function, and the parameters for such function are incredibly narrow.  But take something out, wound something else, or trash multiple systems at once, and the whole assembly adapts around the insults, automatically, without any action or awareness on our part.  The body’s compensatory mechanisms exemplify the resilience and tenacity of nature, no doubt about it.

 

Dance For Your Health  /November 2017

https://catherinechengmd.com/2017/11/16/dance-for-your-health/

So basically, dancing activates key areas of the brain and body in an orchestrated fashion, igniting motion, joy, connection, exhilaration, sensory integration, creativity, passion, cardiovascular elasticity, and fun.  How could this not make us all younger?


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Physician-Patient Relationship

The Premise  /April 2015

https://catherinechengmd.com/2015/04/14/hello-world/

Patients and physicians have control over one thing above all else: our relationship with each other.  Relationships live and die by communication.  Barriers on the obstacle course of patient-physician communication loom large and formidable. Our system fails us over and again. And it falls to each of us, not the system, to find our way to connection and healing relationships.

 

What Are You Looking For?  /April 2015

https://catherinechengmd.com/2015/04/22/what-are-you-looking-for/

My mind’s eye saw hers widen with disappointment, then anger, her posture turn aggressive.  My inner conflict escalated quickly:  Sacrifice the rapport I had just established in the name of antibiotic stewardship, or give in to the misguided pleas of a wrung out fellow working mom, and contribute personally to the scourge of antibiotic overuse and resistance?

 

More Than Enough Love  /June 2015

https://catherinechengmd.com/2015/06/20/more-than-enough-love/

Like parenting, the path of medical practice is not paved with lollipops and ice cream.  It’s more like an uphill dirt road with pits and grooves, erratic weather, and hairpin turns that make you dizzy and nauseated.  It can also offer astoundingly beautiful scenery along the way—like parenting.

 

Help Me Help You  /July 2015

https://catherinechengmd.com/2015/07/10/help-me-help-you/

When you feel that disconnect, like I have left Best Me somewhere else and you’re not getting what you need, what will you do?  Will you yell and storm away? Smile to my face and then write a scathing, anonymous Yelp review? What would you do if I were your spouse, colleague, friend, or child? You and I are in a relationship, not unlike these.

 

Closing the Satisfaction Gap  /July 2015

https://catherinechengmd.com/2015/07/20/the-thorn-in-our-collective-side/

This patient gave Dr. K the best possible feedback: An objective observation about a behavior, her subjective interpretation of it, and its consequence for their relationship.  This is how we communicate evaluations to medical students on their performance in clinical rotations.  There is no reason why it should stop at the end of training; it’s just that the evaluators have changed.

 

The Burnout Crucible  /September 2015

https://catherinechengmd.com/2015/09/20/the-burnout-crucible/

Maybe it’s a moot point, whether it’s better to never burn out or to burn out and relight. We’re all here doing our best every day. Maybe it’s more important to just cut ourselves and one another a little slack sometimes, have compassion for aggressors while calling out their unjust behaviors, and offer everybody the benefit of the doubt, especially when we’re all stressed out.

 

What Makes You Think You Can Trust Me?  /February 2016

https://catherinechengmd.com/2016/02/01/what-makes-you-think-you-can-trust-me/

Trust is the cornerstone of any meaningful relationship. The patient-physician relationship is no exception. It takes time and presence to cultivate. These are big investments, and if we are willing to make them, the returns can literally save us.

 

 

I am Edna Mode  /February 2016

https://catherinechengmd.com/2016/02/20/i-am-edna-mode/

Clearly, Edna trained in the School of Tough Love.  Fortunately for you, I have also studied empathy, compassion, and motivational interviewing.  I can help you persist.  I have patience for your journey.  I can be your pillar of consistency.  Edna is nothing if not consistent!

 

Humbling and Honoring  /April 2016

https://catherinechengmd.com/2016/04/09/humbling-and-honoring/

I get to choose when I am willing to donate my time and energy to the free clinic—everything I do there is on my own terms.  The patients there have no such choices.  If they want care, they have to show up—early—on the day the clinic is open, regardless of what else is going on in their lives.  There are no appointments, and almost no continuity with providers.  It’s a completely different world from where I make my living, on the Gold Coast of Chicago.

 

On Mutual Respect  /November 2016

https://catherinechengmd.com/2016/11/05/on-mutual-respect/

To Patients Who Abuse Medical Staff: Let me be clear: That is not okay.

 

No Substitute for Time  /November 2017

https://catherinechengmd.com/2017/11/03/no-substitute-for-time/

“More information about the value of a physician-patient encounter will always be found in the content of their communication than in what they ultimately do. The difference in… physicians’ behaviors will not be found in any database, electronic medical record, or machine-learning algorithm. I have yet to see data on the contextual information from a history of the present illness in any data set or quality improvement initiative.”

 

Dr. Jerkface In Context: Healing the physician-patient relationship  /November 2017

https://catherinechengmd.com/2017/11/25/dr-jerkface-in-context-healing-the-patient-physician-relationship/

Do patients care about doctors’ suffering?  If they knew how the system harms physicians, would they have compassion for us?  What about if they knew how physician burnout and dissatisfaction directly affects their quality of care, all of it negatively?  What would move patients to stand up with and for doctors?  This is my goal for the indefinite future: to help us, patients and physicians, the end users of our medical system, stand up with and for one another, for positive systems change.


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Relationships and Communication

Gratitude, Generosity, and Peace  /July 2015

https://catherinechengmd.com/2015/07/30/gratitude-and-generosity/

When I feel grateful, there is enough. I am enough. Even just saying the word, seeing it on the screen, brings me to a more peaceful state of mind and body.

 

Warrior Pride and a Plea for Kindness  /December 2015

https://catherinechengmd.com/2015/12/13/warrior-pride-and-a-plea-for-kindness/

There is no substitute for a face-to-face conversation, and the time and energy it takes to have one. It requires a certain degree of tolerance, and an unspoken contract of civility and courtesy.  We must choose carefully with whom we are willing to undertake such a venture.  And perhaps most importantly, we must be clear about our objective(s).  Do we really expect to change someone’s fundamentally held political or religious beliefs?  How realistic is that?  What other purpose, what other good, could possibly come from such conversations?

 

On Belay  /April 2016

https://catherinechengmd.com/2016/04/02/on-belay/

The interview starts with the two men talking about Hank Williams’ troubled life, his ‘formidable demons,’ as Hiddleston puts it. He expresses compassion for this, as I have seen him do in previous interviews about other characters he has portrayed.  He describes how Williams rose to stardom quickly, but ‘with no real support, no one to anchor him.’  Funny how he uses that word, anchor—like belayer.

 

Opposition and Openness  /April 2016

https://catherinechengmd.com/2016/04/20/atozchallenge-opposition-and-openness/

When I look at the list of definitions of oppose, I feel tired.  When I think of the energy it takes to constantly stand against something, I feel listless and drained.  Fighting, resisting, combatting, Obstructing, standing in the way, hindering, disputing, dissenting, contradicting—it’s exhausting.  I think of times when I meet someone new and all they talk about are the things they hate, that they can’t stand, that they want changed.  I cannot wait to get away and find levity.

 

Every Day a Revolution  /April 2016

https://catherinechengmd.com/2016/04/22/atozchallenge-every-day-a-revolution/

Like the turning of an incandescent light bulb, gently, patiently, and consistently in one direction, the steady work of activists eventually leads to sudden and intense illumination.  Darkness becomes light, cold spaces are warmed.

 

Withhold Judgment  /April 2016

https://catherinechengmd.com/2016/04/29/atozchallenge-withhold-judgment/

After all of this exploration, conversation, debate, research, and observation, once again I conclude that one of the most important practices for inner peace is to Withhold Judgment. Not all judgment, and not indefinitely, but much and for a while.

 

Playing My Part  /May 2016

https://catherinechengmd.com/2016/05/22/playing-my-part/

Given the awesome support network with which I am blessed, I feel an impulse to do something more with my writing—to amplify and project all this love and connection back out onto the world for some positive purpose.  But how can my words possibly make a difference?

 

Holding the Space for Personal Acts of Peace—On Listening  /July 2016

https://catherinechengmd.com/2016/07/11/holding-the-space-for-personal-acts-of-peace-listening/

I know I will not do justice to all the complexities of our issues in one blog post, but I ask your forbearance for my interpretation, as it has led me to greater conviction for what I can do, I, one person.

 

Holding the Space for Our Suffering to Heal Us  /September 2016

https://catherinechengmd.com/2016/09/22/holding-the-space-for-our-suffering-to-heal-us/

For a moment we felt stuck, we connection seekers.  I looked at our leader.  His expression conveyed nothing but humility and empathy.  His posture conveyed resolution.  Despite our deep longing, he refused to lead us into treacherously thorny fields, because he knew he did not have the time to bring us safely through to the other side.  But he also allowed us to process, invited us to consider how else we could collectively resolve our unease.

 

On the Golden Positivity Ratio  /November 2016

https://catherinechengmd.com/2016/11/25/on-the-golden-positivity-ratio/

I remembered something about healthy relationships maintaining a 3:1 ratio of positive to negative interactions.  Turns out it’s actually 5:1, widely attributed to observations by Dr. John Gottman, renowned marriage and relationship psychologist.  I think the same thing applies in other realms, too, such as self-talk—a reflection of our relationships with ourselves.  It’s not a far leap to see how this idea pertains to news, social media, and any other human interactions.

 

Train to Withstand the Discomfort  /February 2017

https://catherinechengmd.com/2017/02/20/train-to-withstand-the-discomfort/

We all know the satisfaction and comfort of echo chambers.  Seeing, hearing, and reading that which validates our existing positions feels so good.  But the farther we regress here, the harder it becomes to tolerate a dissenting view.  We must resist this temptation; we are called to be more disciplined than this.

 

To Train or Not to Train  /May 2017

https://catherinechengmd.com/2017/05/08/to-train-or-not-to-train/

…even if we don’t all talk politics, we all need effective communication skills, especially in the arenas of conflict resolution, negotiation, parenting (which encompasses them all), and the like.  We are social beings—we only survive by cooperating and living well within our tribes, and by tribes living well among one another.  That can only happen if we practice getting along.

 

Tribal Pride and Tribalism  /November 2017

https://catherinechengmd.com/2017/11/29/tribal-pride-and-tribalism/

We all need our tribes.  Belonging is an essential human need. To fit in, feel understood and accepted, secure—these are necessary for whole person health.  And when our tribes have purpose beyond survival, provide meaning greater than simple self-preservation, our membership feels that much more valuable to us.  But what happens when tribes pit themselves against one another?  How are we all harmed when we veer from “We’re great!” toward “They suck”?

 

 

 

An Early Resolution

IMG_6536

NaBloPoMo 2017: Field Notes from a Life in Medicine—Last Post

It’s December 1 here in Chicago, but I have almost 2 hours before midnight in California, and 5 hours in Hawaii, so I’m still counting this post as on time.  Meh whatever, it’s my blog and I can do what I want—last post for NaBloPoMo 2017, woo hoooooooooo!!

Okay so, when was the last time you gave another driver the finger?  I can’t even remember myself, maybe high school?  Definitely by the end of college I had stopped, and I can honestly say I probably only ever did it a handful of times.  In college I was in a car with friends and the driver cheerily wagged his finger at another car that had cut us off.  He didn’t get angry, but rather acknowledged the rudeness with humor.  At least I thought it was humorous.  So I’ve been doing it ever since—but with varying degrees of good humor.

Last week I was driving to work (you know what’s coming).  As I approached an intersection about 1.5 car lengths behind the sedan in front of me, where we had no stop sign but the cross street did, I could see a car inching out at the corner.  I anticipated that it would try to make a turn after the car in front of me passed, thereby causing me to have to slow down.  Sure enough that’s what happened, and I wagged my finger.  I suppose my intent was to shame, I’m embarrassed to write.  If I were that driver, I might have felt ashamed, and also annoyed at the gesture.  He, in turn, showed me a stiff, straight middle finger, accompanied by an unmistakable expression of the very same message—eye contact and all.

That hurt my feelings, I’m also embarrassed to report.  Not quite sure why I’m embarrassed—because I kind of deserved it, or because we’re not supposed to let stuff like this get to us?  Whatever, it felt bad and I didn’t like it.  After reflecting over the next mile or so, I decided that from now on I will simply treat other drivers with kindness first, regardless of the crazy antics they perpetrate on the roads (and let me tell you, in Chicago it can get pretty crazy).  That is the resolution that makes me feel the best.  And now I’m even more embarrassed and ashamed because this is pretty much how my mom treats all drivers (all people, really) since I can remember.  Well, better late than never.

I’m trying to remember how I came to this conclusion, because it took like quick-drying super glue, and I have abided by it firmly ever since.  I tried to imagine myself in that driver’s place.  What would make me in such a hurry that I would intentionally inconvenience another driver, who has the right of way, to get going just a few seconds sooner?  Was he really late for work, or to see a sick relative in the hospital?  Was he just an impatient driver in general?  Regardless, was my finger wagging helpful to either of us?  Would it make him less likely to do the same thing again?  Maybe it would have been better if I had waved, offered some grace and generosity of spirit?  If I were him, I would certainly appreciate that more than a pompous finger wagging.

Exercising patience and generosity on the roads is easier said than done, though, am I right?  Surely I cannot be the only one challenged by this?  Now that I think more about it, maybe my embarrassment at feeling hurt by his gesture relates to the fact that society tells us in a lot of ways that we’re not supposed to treat other drivers as human—and thus not be affected by them.  Jockey for position, don’t let ‘em in, fuck ‘em.  Stupid gestures should mean nothing, because we’re simply expected to treat one another like garbage.  It feels like this when I let someone in my lane and they don’t wave.  No acknowledgement, no appreciation.  That doesn’t feel good, and it’s not who I am.

Long ago I realized that I almost never need to get anywhere so urgently that I need to cut people off or risk my safety, or that of my passengers, in the car.  Whenever I see someone signaling to get in my lane, I almost always make space for them.  I try to avoid entering intersections I cannot clear, because I hate when cars do that and cause gridlock, especially at rush hour.  But somehow I didn’t see the finger wag as contrary to these other acts of driving courtesy—in this respect I guess I was stuck in the ‘fuck ‘em’ mentality.  So it makes sense that after experiencing the other side, and so emphatically, I realized that the only thing to do for my integrity is to reject that behavior altogether.

So, no more finger wagging.  Maybe I’ll take a deep breath and find some other, more neutral expression?  It feels necessary to acknowledge my own frustration, but not necessarily to project it on the other person.  Maybe I need a mantra.  *Deep breath* “You be safe now.”  *Deep breath* “You do you, I’ll do me.”  *Deep breath* “Thank you for not hitting me.”  *Deep breath* “I remind myself that you are a fellow human being, and we are all here doing the best we can.”  Maybe a more succinct version of that last one.  I’ll work on it.  I’m sure I’ll be working on it for a long time yet.

_ _ _

Thanks to all who have read along this month, it’s been fun!  Now onto holiday cards, each of which I will once again attempt to write by hand this year.  It just feels like the right thing to do, and I get to break out my fun colored pens.  In case I don’t make it back in time, Happy Holidays to all, and best wishes in 2018 and beyond!