A Community of Champions

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Spoiler Alert:  Big Bang Theory Series Finale!

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When was the last time you felt totally safe, at work, to address the central relational challenges that hold you and your team back from your best performance?

How often at work can you really assess and evaluate your own interpersonal skills, their impact on those around you, and on the organization as a whole?

How much time and energy do your teams waste being stymied by relational issues, stuck in redundant, dysfunctional power struggles up and down the organizational hierarchy?

How do you feel in your body just reading these questions?  Perhaps tense and frustrated?

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We, the eight participants and two faculty members of Leading Organizations to Health Cohort 11, reported palpable heaviness upon convening for our second training retreat last Tuesday.  Despite the Colorado spring bursting with blooms, wildlife, and vast clear blue skies, dark clouds hung over our collective consciousness, each for our own reasons.  Throughout the week we shared stories of successes, challenges, conflicts, power and powerlessness.  We practiced appreciative inquiry and relational coordination, and explored the insidious impact of unearned privilege.  We spent three days in intense skills training, supporting one another through viscerally gnarly role plays and open, honest feedback about how we impact the group.

In the midst of all this deep work, we also shared meals, walks, a horseback ride, and life stories around a fire pit and drippy s’mores.  As we debriefed around the circle on the last day, something had shifted:  overall we now felt refueled and energized.  The air buzzed with the anticipation of learners on the verge of integrating our emerging skills, excited to bring it all home to practice.  The clouds had parted.  We will keep in touch through peer coaching groups—our newly established, intense-support network.  In my heart, I feel we are really becoming a family.

 

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I headed to the mountains straight from the session, for 24 hours of processing and decompression (and more washi tape card-making).  More and more I marveled at what a rare opportunity I have in LOH, to be led and learn to lead in this relationship-centered way.  For these ten months I am immersed in a professional learning lab, experimenting with different ways of speaking, acting, and being, safe among fellow professionals also grappling with this skill set.  It just does not get any better than this!

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On my way down from the mountains, I listened to an interview with Bonnie St. John on Ozan Varol’s podcast, Famous Failures.  She is the first African-American to win medals in Winter Paralympic competition as a ski racer; she is a lower extremity amputee.  She is also an author, an entrepreneur, and a former member of the Clinton administration.  Her story is inspiring, please take a listen!  At the end of the interview she describes asking a former coach about how he built champions.  He said he never built individual champions; rather, he built communities of champions.  You can only push one person so far, he said; but an allied group of people will hold one another up, push each other harder, make each other better, take one another farther.

That is exactly how I experience LOH—my best self is challenged and called forth in the most loving and professional way.  We hold space for all our struggles, allowing the learnings (epiphanies, in my experience!) to emerge.  It is deeply and literally inspiring.  Though I already do so much of this inner work on my own, there is a profound and unparalleled synergy from learning in this group—we serve as one another’s pit crew for the journey toward our better selves at work and in life.

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Nobody succeeds alone.  In the series finale of The Big Bang Theory (my favorite TV show of all time, which I missed while at LOH!), Sheldon (the obliviously self-centered genius) finally realizes this.  During his Nobel Prize acceptance speech, he acknowledges his sudden and profound appreciation for his family and friends, crediting his success to their unconditional love and support, and recognizing them in front of an international audience.  LOH made this finale even more meaningful to me than it already would have been.

It is always through the struggles that we grow.  When struggle together, any and all successes are amplified exponentially.  My nine new friends will make me immeasurably more successful, both professionally and personally, than I would ever be without them.  God bless them all, and may the work we do together ripple out for the benefit of all whose lives we touch.

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Elephant to Elephant:  How to Change People’s Minds

 

Friends!!  If you read only one thing today, stop here and click on this link to James Clear’s essay on why facts do not change minds.  It’s very similar to Ozan Varol’s post of a similar title from last year.  That piece prompted a prolonged conversation on my Facebook page two months ago, which I described and shared here.

The Trigger

I’m thinking hard again about facts and changing minds now, as the number of new measles cases skyrockets not just in the US but around the world.  I’m so angry that we have to fight his war again—a war we had won as of 2000.  I’m so frustrated that because of the actions of a relative few, the health and safety of the very many and vulnerable are once again at risk.  I know my colleagues and many in the general public share my sentiments, and we often end up shaming and deriding our ‘anti-vaxxer’ peers.  We hurl facts and statistics at them, incredulous at their intransigence to the truth of science.

In the end everybody digs in, feelings get hurt, relationships suffer, and the outbreaks progress.

There is a better way.

James and Ozan (I imagine them as friends and so refer to them by first name) explain it eloquently in the posts I share here, and I really encourage you to click on those links.

The Metaphor

Personally, I return often to Jonathan Haidt’s analogy of our mind as an elephant (the emotional, limbic brain) and its rider (cognitive, rational brain).  We think, as rational beings, that our riders steer our elephants.  But psychology research and evidence tells us that the elephant goes where it wants; the rider rationalizes the path.  That is why facts do not change people’s minds—they are the rider’s domain.

Chip and Dan Heath, in their book Switch, take Haidt’s idea further in their formula for behavior change:

  1. Direct the rider (provide the facts, rationale, and method),
  2. Motivate the elephant (make the message meaningful on a personal, emotional level), and
  3. Shape the path (shorten the distance, remove obstacles).

It occurred to me recently that when I flood you with facts about measles and vaccines, I speak only through my rider.  You listen (or not) as both rider and elephant.  But as Simon Sinek describes eloquently in Start With Why, the elephant limbic brain has no capacity for language.  And facts, conveyed in words, have no emotional meaning or context.  So unless your rider is somehow really driving in this moment, my rider’s appeal will not move you.  Your elephant does not understand my rider, thus I cannot steer you where I want you to go.

The Approach

So how can I motivate your elephant?  If I’m using words, I can tell a story.  But the words of any story matter far less than the emotions the story evokes.  If I can relate with your own past experience, point you to a loss, a gratitude, or some shared connecting experience between us, then your elephant may hear me.  If I tell my story with honesty, authenticity, and humility, then my rider serves as translator for my elephant, communicating directly with your elephant.

But the most important connection between our elephants, if I really want to change your mind, is my presence.  Researchers agree that a vast majority of communication, up to 90%, occurs non-verbally.  Even if my rider interpreter tells a great story, my attitude carries the real message.  This manifests in my tone of voice, facial expressions, posture, stance, and all kinds of other subtle, nonverbal, subconscious cues—all seen and understood by your elephant, because they emanate from mine.  Even if my story tugs at your heart strings, you will defend your position if you feel me to be righteous, shaming, condescending, etc.  Elephants are smart; they know not to come out if it’s not safe.  And if my elephant is at all on the attack (see anger and frustration above), your elephant knows full well not to show itself.

It’s not the words we say or the things we do—it’s not the method that counts.  It’s how we are, how we make people feel—the approach—that gains us access to people’s consciousness and allows us to influence their thinking (which is really their feeling).

So I calm my rider and elephant first.  Deep breaths.  Then instead of my rider jumping off my elephant and charging at you with a wad of sharp verbal sticks, she sits back in her seat.  My elephant humbly ambles alongside yours on the savannah of community and (humanity), shares some sweet grass, points to the water hole where we both want to go.  I invite your inner pachyderm lovingly on a shared adventure toward optimal health for us all.  Rather than rush, berate, or agitate you, I wait.  I encourage.  I welcome.

James Clear writes, “Facts don’t change minds.  Friendship does,” and “Be kind first, be right later.”

My elephant fully concurs.

 

Some Facts, because I’m a doctor after all:

  • As of last Friday, May 3, 2019, there were 764 known cases of measles in the United States. According to the CDC, “This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000.”
  • About 2/3 of patients are unvaccinated; 1/10 have been vaccinated, and the vaccination status of the rest is unknown.
  • 44% of patients are children under 4 years of age.

See this article in the Washington Post from today for more statistics.

For answers to frequently asked questions about Measles, please refer to the CDC measles FAQ webpage.

Please talk to your doctor if you are unsure about your risk.

 

The Optimist and the Cynic

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Are you an optimist or a cynic?

I consider myself to be, wholly and without question, an Optimist—with a Big O.

In The Art of Possibility, Ben and Roz Zander describe a cynic as a passionate person who doesn’t want to be disappointed again.

By this definition, cynics are not altogether hopeless and negative; they are simply wary and cautious based on past experience.  Still, I judge cynics and find them tiresome.  I reject their gloom and doom outlook.  Sometimes I really just want to throttle them.  In their presence I turn up my outward optimism to happy headbanger volume.  I can tell this makes them a little crazed—they see me as Pollyannish, idealistic, and naïve—and likely wish to strangle me, too.

And here’s the thing:  I also possess a deep cynical streak; one that can really overtake my consciousness sometimes.

Every day I campaign ardently to empower myself and those around me, pointing to all the ways we can claim our agency and effect positive change.  I advocate for using all of our kindness, empathy, compassion, and connecting communication skills, in every situation—take the high road!  Be our Best Selves!  And yet at the same time, a darker part of me, my shadow side, silently tells a contemptuous story of the forces we fight against.  I paint a sinister picture in my mind of impediments made of ‘the other’ people—the small minded, the pessimistic, the underestimating, unbelieving, rigid, unimaginative, distrustful, conventional, supercilious, and condescending themThey are not like usThey are the problem.

Of course this is not true.  It’s just a story I tell—a counterproductive and self-sabotaging story.  How fascinating.

Sometimes I tell this unsympathetic story aloud, out of frustration, impatience, and exasperation.  Sometimes I actually name people and label them all those negative things I listed.  It feels justified and righteous.  But then I feel guilty, as if my worse self kidnapped the better me and held my optimism hostage until I vented against my better judgment.  I wonder when my words will come back and bite me in the butt?  What will I do then?

I suppose I can only claim passion and disappointment.  Sometimes I let the latter get the best of me and allow shadow to overtake the light.  It happens to the best of us; I can own it.  There is no need to disavow the disappointment and disillusionment, the dissatisfaction with what is.  If I didn’t care so much—about patient care, public policy, physician burnout, patient-physician relationship, and relationships in general—I would not suffer such vexations.  And it’s because I care so much that I fight on, to do my part to make it better.  I stay engaged in the important conversations, even if I have to take breaks and change forums at times.

Yes, I, the eternal optimist, harbor an inner, insubordinate cynic.  While most of me exclaims, “Humanity is so full of love and potential!” another part of me mutters subversively, “Also people suck.”  Some days (some weeks) the dark side wins, but it’s always temporary.  The Yin and the Yang, the shadow and the light, the tension of opposite energies—that’s what makes life so interesting, no?  We require both for contrast and context, to orient to what is in order to see what could be. 

The struggle for balance is real and at times exhausting.  And it’s always worth the effort.

Reconnecting to Mission, Patients, and Colleagues

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What’s the most personally fulfilling aspect of your work?  In times of uncertainty, threat, and transition, what holds you up?

This past week, I had the privilege of standing alongside giants in the fight against physician burnout.  In a series of presentations at the annual meeting of the American College of Physicians (ACP), we did our best to acknowledge and validate the current state of physician burnout (about half of all physicians in all specialties report at least one symptom), and then present as many strategies to reduce it as time would allow.  We showed how changes in workflow, task distribution, and technology, such as pre-visit labs and scribes, have been shown to improve physician satisfaction, team morale, and patient experience.  My role was to attempt to inspire my fellow internists to claim their individual agency, model a culture of wellness, and advocate for systems change in their home institutions.

The content felt dense but manageable, and the audience appeared engaged.  Our colleagues from all around the country approached us afterward to clarify studies of efficacy and ask about local representatives for advocacy in the ACP.  In the end, I think we achieved our primary objective of having most attendees leave with just a little more hope for our profession than they came in with.

Over the four day conference, however, what consistently grounded me in professional mission and meaning, not only in our own presentation but in others, were the personal stories.  That is how we humans relate to one another, after all—through narratives.  And connecting to mission and colleagues is key to maintaining a healthy and productive workforce, physician or otherwise.

Our attendees participated in two practices that I’ll share here.  Both were “Pair and Share” activities, meant to stimulate reflection both internally and externally.

Who In Your Life Really Changed You?

First we asked our colleagues to think of a patient who changed them, how, and to what end.  I know there have been many patients who changed me, but I always think of one particular woman.  She was middle aged, obese, diabetic, depressed, and severely disabled from osteoarthritis.  She lived alone and had a sparse social network, and her life partner had died unexpectedly a few years before I met her.  At every visit we struggled through the same fundamental challenges of weight loss, glucose control, and pain management.  How could she take her diabetes medications more regularly?  How could we control her pain without having to take opioids every day?  How else could we manage her depression, as some of the medications were raising her blood sugar?  She may have cried at almost every visit; wailing was not uncommon, and once she even vomited from cumulative distress.  Our relationship was good overall.  I overcame my impatience with her non-adherence to the treatment plan as I understood her life situation better.  But for four of the five years we knew each other, I saw few if any indicators that her thought, emotional, and behavior patterns would change.

Then things started to turn around.  She started coming consistently to appointments, no more no-shows.  She got online and found a community center that was accessible by bus.  She connected with a knitting group and started going to art fairs to sell her creations.  She started taking her medications more regularly, and lost enough weight to have her knee replaced.  By the time we parted ways, she had transformed from a weeping victim of circumstance to a woman with agency, self-efficacy, and goals, dammit!  And most of this had nothing to do with me.  I simply had the privilege to witness and support her intrinsic revolution.  From her I learned what perseverance looks like; I learned about hope and self-redemption; I learned that I should never make assumptions about anybody’s future.

Who Supported You in a Time of Vulnerability?

They said do the hardest thing that you know you don’t want to do for a living as your first rotation.  So I chose surgery.  In July of my third year of medical school, my days started around 5:30am and could end the next night at 10pm if my team was busy post call.  Most faculty physicians were kind and wise, or at least non-abusive.  Some, however, not so much.  What buoyed me most through that rotation was always the support and protection of the residents on my team.  I would watch them get abused by our attendings, but that sh*t never rolled downhill when the boss left the room.  I did not fully realize until years later what a gift that was and how much it spoke to the character of these men (they were all men).  This was in the 1990s; verbal abuse of medical students and snide comments about one’s appearance, gender, and just about everything else were simply to be expected.  But my favorite residents always pulled me aside and asked how I was.  They always made sure I felt confident about my role on the team, and they taught me basic skills with conviction and encouragement.  As I was about to insert a patient’s bladder catheter in the operating room, my elder brother in training told me firmly, like he really believed I could do it, “Don’t be afraid, hold it (the penis) like a hose.”

As we did this reflection exercise at the meeting last Wednesday along with our audience, I was so moved by these memories that I looked up one of my old residents that night and sent him a thank you card.  I bet he won’t remember at all who I am, but he will hopefully feel validated that he is in exactly the right position now as program director of a surgery residency.

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Recalling stories like these, and then sharing them with a person who truly listens, receives them generously, and simply helps you hold them (that was the instruction to the group—when it’s your turn to listen just do that, no interruptions, no jumping in), reconnects us to our calling in medicine.  It’s not just about the patients or the science.  It’s about all of the relationships and how we tend them.

We will not solve the immensely complex problem of physician burnout overnight.  It will take a concerted effort at all levels of healthcare, and physicians cannot and will not do it alone.  And it’s not that we are stoic, arrogant, and somehow intrinsically flawed, and thus dissatisfied with our work and leaving the profession in record numbers.  It is a systems problem, no question.  And, while we call our congressional leaders and professional advocacy groups to change policy, while we lobby our hospital administration to hire more support staff and move the printers closer to where we do our work, we can all take a few minutes each day and reconnect to the core meaning and purpose in that work.  Let us all remember a cool story and share it today.

Pain and Desperation

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When was the last time you used any narcotics?  I think I took some of my mom’s cough syrup with codeine over a decade ago, when I felt like I might actually cough up a lung.  Before that it was one dose of Darvocet after having four impacted wisdom teeth extracted at age 18.  I don’t really remember much after swallowing the pill and lying down on the sofa.  I was given multiple opioids during knee surgery last year, but needed only Tylenol and Advil afterward.  Looking back on the post I wrote about that experience, I realize even more how I was influenced by this piece in the New York Times just a month before my surgery.  In it the author is reminded that pain serves an essential purpose, and it’s better that we not necessarily seek to obliterate it at every turn.

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Four or five times in the last two weeks, I have received calls from local pharmacies to confirm opioid prescriptions that I did not write.  They were all paper prescriptions for patients I have never met, caught by astute pharmacists who suspected fraudulent activity.  This is the first time it has happened to me, and I know many of my colleagues have experienced the same.  Pharmacies in the area have now flagged my name and license number, and they know not to fill any controlled substances without direct confirmation from me.

What a morass.  How did we get here?  It’s a rhetorical question, really, but not a simple one by a light year.  When I started my training, we were taught to consider pain the ‘5th vital sign.’  Every patient assessment included the cartoon face pain scale.  Anesthesiologists’ prioritized rubrick for pain control started with long acting opioids around the clock, then regular anti-inflammatories if no contraindications, then short acting opioids as needed for breakthrough pain.  In the hospital I never questioned this method, especially since I almost never interacted with these patients after discharge and was oblivious to follow up issues.

It was not until I started in practice that I experienced the multidimensional challenge that is pain control and opioid prescribing.  After 15 years I am still learning the layers of complexity, unique for every patient, and I see that even if we understand it (which I think we do not), most of us feel helpless to address it.

The pharmacist I spoke to today told me that his store’s standard procedure is to inform the patient that the prescription was proven to be fake, advise the patient not to attempt such an act again, and let them know that the prescriber is aware and the police will be contacted.  It was that last part that made me pause.  Because even as I intend to file a police report (as advised by my institution), the answer to the problem is not, in my opinion, rounding up patients with chronic pain and throwing them in jail.  In order of importance, I think the opioid crisis is first a social, then a medical, and only then, a criminal problem.

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Increasingly, we have become a society of immediate gratification and entitlement.  We want and expect a magic pill for and complete relief from whatever ails us—because it’s the twenty-first century for crying out loud, how could we not have that already?  Also, medicine has become increasingly transactional.  We, patients and physicians alike, experience ‘care’ in predetermined packets of protocol and procedure, and spend considerably less time in conversation, education, expectation setting, and actual caring.  The advent of the internet has accelerated this immediate gratification expectation.  It also gives many of us an illusion of connection through social media, when in reality, we are actually less and less connected to one another.

Pain results from myriad causes.  We all have varying thresholds for feeling and tolerating pain, which vary themselves depending on circumstances, mindset, expectation, and meaning making (think childbirth versus bike accident).  There are so many factors that impact our pain experience, including dehydration, sleep deprivation, low mood, and emotional and/or mental stress.  Loneliness, depression, anxiety, sleep disruption, suicidality, and substance abuse are all on the rise.  And all of these conditions lower our thresholds for pain and the harm it does to us.

For many, opioids are indeed the immediately gratifying magic pills.  But the magic wears off faster and faster, and both pain and the desperation for relief accelerate in the wake of short and long term withdrawl.  As physicians, we feel an intense desire to alleviate suffering.  Once a patient has experienced the profound relief (both physical and psychological) from opioids, it feels cruel for us to withhold them, even when we understand fully their risks and the long term harm they cause.  And we have less and less time to explore with and educate patients about adjunct pain management practices, such as mindfulness, biofeedback, and movement.  Everybody feels despairing and impotent, and this drives people to do things they might not otherwise do, like make a fake prescription for hydrocodone and try to get it filled.

I know there are real criminals out there, people not really in pain, who do this to make money—to take advantage of people in real pain.  I don’t know who’s who.  But the story I tell myself is that this is not most people.  What we need is a stronger infrastructure to address chronic pain at multiple levels—individually, in community, with policy, and culturally.  As I write this, even as a physician with a leadership title, I feel powerless and a little hopeless.

But maybe a good start, at the individual level, that we can each do the next time we look ourselves in the mirror or meet another human being on the street, is to just exercise a little compassion and generosity.  I assume that those patients presenting the fake prescriptions, if they are real patients, are not criminals at their core.  Pain makes us do unthinkable and unbelievable things.  I hope we can all help one another find better sources of relief and support.

Theory and Practice

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Does anyone become a great skier or volleyball player by just reading books and watching videos of other people doing it?  Of course, not.  And even if you have the best coach, with the most knowledge and expertise, you still have to get out on the trail or the court and do it yourself, find your own groove, create your own style and habits that work for you and your team.

I realized this over the past week, as once again I found myself calling forth everything I have learned about leadership from books and observations of other leaders.  Leading people is hard, and I often feel at the same time that I do it well and that I totally suck at it.  I worry that because it feels mentally and emotionally exhausting, I must be doing it wrong—like if I really knew what I was doing it would just be easy.  But that is perfectionism and fixed mindset talking, I’m pretty sure.

Knowing theory is key, no question.  If you don’t understand in advance what it will be like to stand up on skis (they don’t stop themselves and if the tips are pointed downhill that is exactly where you will slide), you will fall and risk injury to self and others a lot more than if you are prepared with a few pointers in advance.  It’s the same with leadership.  Remembering how it feels to be led well, versus poorly, allows me to have empathy for those I lead.  Mastery of, or at least proficiency in, some key communication tools such as reflective listening, nonjudgmental questioning, and objective feedback, makes the skills easier to access under stress and pressure.  Holding core values and principles in front, and exemplifying them, rather than just professing them, earns trust and credibility.

I wrote to a mentor recently, “I find myself repeating language from the books, inventing analogies and using examples from the team’s lived experience to show how the theories apply.  Words like empathy, curiosity, generosity, non-judgment, deep breathing, and ‘How fascinating!’ exit my mouth a lot, as well as, ‘It’s all about relationships!’ People must see me as a broken record…”  He reminded me that we need these mantras to keep ourselves focused and also to repeat out loud and invite accountability in our actions.  I wholeheartedly agree.  Maybe I will take a misstep here or there (no maybe—it will happen!).  It won’t be because I’m not trying or I don’t care—it will be because I’m human and we all make mistakes.  It’s because I’m out there practicing.

When I think back to high school volleyball practice, residency, personal training, and the early days of parenting (hell, every day of parenting), it’s not the easy days that stand out in memory.  It’s the hard days, the days when I really struggled, but came out having grown, even in a little, in my learning.  It’s the days when I can say, hey, I know better now, and I will do better next time—bring it.

So yes, leading well is hard.  It’s exhausting.  It costs inordinate amounts of energy, self-awareness, -monitoring, and -control.  It makes me hypervigilant of my words, posture, and actions.  Theory and practice go hand in hand; they are the twin pillars of learning, application, and success in all realms.  I will keep reading for theory (I highly recommend Legacy by James Kerr and Big Potential by Shawn Achor).  I will keep showing up every day ready to do my best in practice.  I feel confident in the trust and credibility I have already earned, and that people can see that I’m honestly doing my best, for all of us.

 

Synthesis and Integration: Self and Other Focus

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Hey friends, how was your week?  Learn anything new and interesting?  Anneal any new ideas to existing frameworks in your already complex world view?  I did!  And it came in another big wave after my presentation on Friday.

I wrote last week about how I put together a new presentation.  For the first time, I added the idea of medicine as a complex adaptive system to a talk I gave to physicians at various levels of training and practice.  The objective of the presentation was for people to understand the scope of physician burnout, and leave with some ideas of how they could not only cope better themselves today, but also influence the system and move it toward a healthier, more compassionate state in the future.

As usual for my talks, I focused first on personal resilience.  Many physicians push back at this idea, and rightly so, as many medical organizations have instituted physician wellness programs aimed mainly at ‘fixing’ the doctors with yoga and meditation classes, while allowing the system that burns them out to continue its toxic trends toward over-regulation, loss of physician autonomy, and driving metrics that lie outside of, or even counter to, our core values.  I worried that my talk would be taken as just another attempt to tell physicians we aren’t good enough at self-care.

Thankfully, the feedback so far has been positive and I have not heard anyone say they felt berated or shamed.  I hope it’s because in addition to tips for self-care (eg 7 minute workout, picnic plate method of eating), I talked about how each of us can actually help change the system.  In a complex system, each individual (a ‘node’) is connected to each other individual, directly or indirectly.  So, difficult as it may be to see in medicine, everything I do affects all others, and everything each other does affects me.  This means I can be a victim and an agent at the same time, and the more I choose one or the other (when I am able to choose), I actively, if unintentionally, contribute to the self-organizing system moving in one direction or another [URL credit for image below pending].

Nodes in Complex System

My primary objective in every presentation is to inspire each member of my audience to claim their agency.  Before that can happen we must recognize that we have any agency to begin with, then shore up our resources to exercise it (self-care and relationships), and then decide where, when, and how that agency is best directed.

 

In 5 years of PowerPoint iterations, including and excluding certain concepts, I have always incorporated David Logan’s framework of stages of tribal culture.  Basically there are 5 stages, 1-3 being low functioning, and 4-5 high functioning.  The tribal mantras for the first three stages are, respectively, “Live sucks,” “My life sucks,” and “I’m great”.  Stage four tribes say, “We’re great” and in stage 5 we say, “Life’s great.”  The gap between stages 3 and 4 is wide, as evidenced by the traffic jam of people and tribes at the third stage.  In my view, the difference is mindset.  In the first three stages, most individuals’ implicit focus is on self, and subconscious mindset centers around scarcity and competition.  Victims abound in these cultures, as we focus on recognition, advancement, and getting ours.  We cross the chasm when we are able to step back and recognize how our mutual connections and how we cultivate them make us better—together—we see the network surrounding and tied to our lone-node-selves.

This week I realized that crossing the stage 3-to-4 chasm relates to two frameworks I learned recently:

The way I see it, in Logan’s tribal culture structure, one initially works toward self-actualization, essentially achieving it when fully inhabiting stage 3, “I’m great.”  But crossing to stage 4 requires self-transcendence, as described by Abraham Maslow, by recognizing a greater purpose for one’s existence than simply advancing self-interest.  In the same way, through stage 3 we live in what the Arbinger Institute describes as an ‘inward mindset,’ and we cross to stage 4 when we acquire an ‘outward mindset’, which is pretty much what it sounds like.  Essentially in stage 3 we mostly say, “I’m great, and I’m surrounded by idiots,” and in stages 4 and 5 the prevailing sentiment resembles, “We’re great, life’s great, and I’m so happy to be here, grateful for the opportunity to contribute.”

An astute colleague pointed out during my talk on Friday that we do not live strictly in one stage or mindset in serial fashion.  Depending on circumstances, context, and yes, state of mind and body (hence the importance of self-care!), we move freely and maybe often between stages, sometimes in the very same conversation!  The goals are to 1) look for role models to lead us to higher functioning stages more of the time, and 2) model for others around us to climb the tribal culture mountain with us, spending more and more mindset and energy at higher and higher stages.

The problem is the system, and we are the system.  So, onward.  Progress moves slowly and inevitably.  It will take time, energy, and collective effort.

We’ got this.