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