Here’s How We Can All Help

How do we stick with something when it’s hard? 

I queried my Facebook friends this weekend.  My favorite answers:

“Doing it with friends/family.  People you like spending time with.”

“The alternative of not doing it is worse… and how it helps in the long run.  Knowing it helps me feel better about my life.  …Also, hope matters a lot.  Gotta have hope or else it’s hell.  Finally, helps a lot if you love the subject matter or the work, even if it’s hard.  Or you care about the person for whom you’re doing it, if it’s not for you.”

Most people thought about exercise and other personal habits.  But I’m thinking about those hard conversations about racism, bias, and prejudice.  It’s a whole other ball game, and yet similar principles of practice, persistence, and resilience apply.

This week I had a heartfelt and enlightening conversation with fellow physician leaders about addressing racism and bias at work.  It was the first prolonged, frank conversation most of us had had on the topic with colleagues.  I came away feeling connected and also frustrated, with three conclusions:  1) We all see the problem and we all care; 2) Too often we don’t know what to do or how to help; we feel like deer in headlights—because it’s hard—so we stay silent; and 3) What I want most is for us all to keep trying anyway, even though it’s hard and we don’t feel totally competent—yet.

I see parallels to counseling I do for patients about lifestyle habits.  So many people tell me that they don’t bother trying small habit changes because they never stick.  They believe they are ‘all or nothing’ folks—full on angels or devils of habit—no incremental change possible.  Psychology research tells us that this is not an intrinsic or immutable trait; we can overcome it.  But it’s hard.  We forget that learning, competence, and mastery take practice, time, and persistence.  Sounds a lot like communication skills, no?  In lifestyle counseling, we take a very concrete approach to habit change.  After work, I often overeat in a fit of stress and desire for reward/relief.  I always regret it.  I can delay and diminish my mindless vacuum eating, however, by changing small things in my home arrival routine, like bypassing the kitchen and going upstairs, drinking some water, and breathing deeply, to re-center for a mindful dinner.  I can take small steps—not all or nothing, rather all or something

Obviously, addressing bias and racism at work is different from managing eating habits. But we can still take small steps to build confidence and competence. A lot depends on the culture at work—are hard conversations even safe to have? We must also consider relationships and context—sometimes it’s better one on one, other times you can talk about it as a group. There is no substitute for active awareness practice—attunement to self, others, and environment. Moments of potential connection and understanding can be fleeting. How can we develop an effective skillset, one that builds confidence and agility so we may recognize, seize, and capitalize on those moments? Repetition is key for entraining any skill, and it’s our small daily practices that can cumulatively improve the psychological safety of our work cultures, and make the hard conversations easier. Below is a list of small steps we can all take. With regular exercise and training, we can strengthen our upstander and allyship muscles. If we find workout buddies (like my physician leader forum group) and support one another by sharing challenges and iterative victories, just like at the gym, it’s easier and more successful for us all.

How are you already holding up marginalized people in your world?  How do you stick with it when it’s hard?  What and who holds you up?

* * * * *

Learn and Use People’s Correct Names

My first name is spelled with a C, and my last name has an E and ends with a G.  It matters to me.  Allison goes by Ally.  ‘Chien’ could be pronounced with a ‘ch’ sound or a ‘j’ sound at the beginning, depending on where someone is from.  It’s okay to ask someone how to pronounce their name.  It shows that we care to connect and acknowledge their identity and whole personhood.  Hear or read this short article on how this simple practice can make a world of difference in how we include one another in the workplace, and for tips on how to do it effectively and easily. 

Don’t Laugh at Racist (or Sexist, or Any ‘Othering’) Jokes

And for sure don’t make them.  Psychologists call this disparagement humor:  “any attempt to amuse through the denigration of a social group or its representatives… (It is) paradoxical:  It simultaneously communicates two conflicting messages.  One is an explicit hostile or prejudiced message.  But delivered alongside is a second implicit message that ‘it doesn’t count as hostility or prejudice because I didn’t mean it—it’s just a joke.’”  Such expressions perpetuate a social norm that marginalized people and groups should ‘just lighten up’ as others devalue and dehumanize them.  Read how it affected one East Asian woman when she internalized her own white friends’ ridicule, and how she overcame it.  If you see a marginalized person participate in denigration of their own group, ask yourself how that came to be; then recognize and consider the complexities of assimilation and survival.

https://www.diversitybestpractices.com/sites/diversitybestpractices.com/files/attachments/2020/06/upstanding_against_racism_-_a_practical_guide_final.pdf

Upstand When You Witness Aggression of Any Kind

What will you do the next time someone makes a racist, sexist, or otherwise denigrating joke or comment?  Or when someone starts abusing another person on the bus?  How can you help?  You don’t have to be a hero or put yourself in harm’s way.  And you can still respectfully and firmly disrupt aggression, and signal your support to a targeted person.

Learn and Share—Find and Be Peer Support

I’m so grateful for friends and colleagues who have committed to this work.  We validate one another’s experiences, fears, triumphs, and learnings.  We exchange resources like everything linked in this post.  I keep articles in my Pocket app, so I may share them readily and widely.  We acknowledge that the work will not finish in our lifetimes.  And yet we persist, because we believe we can contribute.  We work to leave the world better for our children, and to lead them by example so they may carry the torches after us.  We hold one another up in hope.  Please, join us.

How to Support Your Asian Colleagues at Work Right Now:  1. Reach out in support if it’s appropriate to your relationship.  2. Consider your intent—is it really to help them, or are you just making yourself feel better?  3. Don’t invalidate or diminish their feelings.  4. Listen to understand, not to fix.  5.  Just don’t stay silent.

InclusionLabs Fellowship Program:  For a deep dive of inner work in service of effective action, check out this program to connect to others who have also made the commitment. 

The Value of Comradery

I’m having a party!

Well, not really.  I’m inviting colleagues to convene on video in the name of professional community and connection, so it’s almost a party.  It’s also my homework!

These six weeks I get to take Stanford’s inaugural online Physician Well-Being Director Course, along with over a hundred other physician leaders.  What a privilege and pleasure!  I’ve already learned so much, and we’re only one third of the way through.  I may have made a new friend—we bonded over our shared tendency to stress eat, and that we are both using the Noom app to overcome it.  It happened during a breakout session to sample a Comradery Group.

Turns out there is clear evidence that community building, done intentionally and purposefully, promotes clinicians’ overall well-being.  “Well, duh,” you might say (I have).  Why did this have to be studied formally?  But I get it now.  When there is objective evidence for direct benefit and a positive cascade (well physicians tend to have higher engagement, higher patient satisfaction, happier teams, and systems that thrive—relationally as well as financially), healthcare organizations are more likely to invest resources to execute the well-being programs shown to work. 

In a Comradery Group, the objective is more than just venting.  It’s about finding meaning, fostering growth, and supporting one another through empathy, querying, and sometimes even challenging—all in a psychologically safe environment.  Groups meet to discuss particular topics and are admonished to stay on task.  There is usually a facilitator.

I have always found communing with colleagues nourishing—particularly across specialties.  More and more, we toil in silos.  Advancing technology accelerates complexity of both diagnostics and therapeutics at breakneck speed in almost every field.  Everybody can barely keep up with their own work, let alone understand what’s happening in anyone else’s.  And with in-person conferences and other professional gatherings banned for the past year, our sense of community wanes further and faster.  Our disconnection propagates insidiously, and we will all pay in the end, physicians and patients alike.

So what better moment to tend and strengthen our connections?

I have a few colleagues from internal medicine, OB/gyne, ophthalmology, and orthopaedics ready to gather in meaning on Microsoft Teams.  Can’t wait can’t wait!  The first rule of Comradery Group is that what’s said here stays here; holding confidence is key to connection and trust.  We can set other rules at our (first) session.  The homework assignment is only to experience a group once, but my secret hope is that my colleagues will get enough from this meeting to consider doing it again (and again!). 

I’ve proposed some sample topics below.  I’d love to discuss any of them, and I’m sure my friends will suggest others.  Take a look—how could you adapt these questions to your own profession?  How are you and your colleagues at risk for burnout, and how do you imagine Comradery Groups could help?

Here’s something new for the blog:  If you answer one of the questions in the comments, I’ll share my own answer to the same in reply (or a separate post!).  Please also feel free to offer a different question, one that holds meaning and importance to you.

Times are hard and complicated.  We humans are social creatures.  The better we can maintain and strengthen our ties to one another, the less we will suffer—no—the more we will flourish

Onward, friends.  We are all we have.

  1. How has doctoring the past year through a global pandemic impacted your professional and personal outlooks?
  2. What lasting lessons from the past year do you want to keep front and center?
  3. What do you want most from your colleagues in other specialties?
  4. How would you change medical education?  Why?
  5. How have you seen medical culture evolve over your career, for better and/or worse?  How has this impacted your personal experience of your work?
  6. What concrete changes have you made to the way you do things, over the years and the past year?  What do you miss and not, about the way things used to be?
  7. What makes a hard day at work?  An easy day?  A good day?  A bad day?
  8. What is your preferred leadership style, as both a leader and one who is led?
  9. What is the value of DEI initiatives at work?  What are the barriers?  Pitfalls?
  10. What’s foremost on your mind right now for your own well-being?  How are you upholding it?

No Wonder I’m Burned Out!

Once again, I ask my friends:  How are you? 

I am not great!!  Neck, back and head pain, insomnia, low mood, and the worst case of stress eating in a couple years—GRRRRRRRR!  *deep breath*  …So, like a good primary care doctor (she says with tongue in cheek), I evaluate and treat myself.

I ask patients to rate the stress and meaning of their work and then compare:  Is work overall more stressful than meaningful, or the other way around?  It helps me assess the sustainability of their work life, and gives me insight into their values and priorities.  In recent years when I’ve asked myself, the answer is consistent: moderate stress, HIGH meaning.  Today it’s high stress, less high meaning.  For the first time in a long while, work is not necessarily more meaningful than stressful.  Yikes.

Stress:  It’s COVID. 

Meaning:  I ask patients how they derive personal fulfillment and meaning from work.   I recently asked myself again.  It’s twofold:   Relationships and Efficacy.

Relationships: I am your primary care doctor. Sometimes I’m your therapist, your cheerleader, your drill sergeant, and your accountability buddy. I have always loved this, even on the hardest days. But this year, I am also a resolute public health advocate. Sometimes that rubs you the wrong way, because I tell you things you don’t like. I recommend against flying. Don’t eat at restaurants. Don’t gather with your family for the holidays. Don’t go to church. Stay home for 14 days after an exposure. I interrogate your COVID precaution practices. Then I dissect and judge them (not you), thank you on behalf of humanity, and admonish you to persist, longer and longer, for all our sakes. It kinda puts a damper on our relationship.

Efficacy:  I. Help. People.  It’s my calling!  Hemorrhoids?  No problem.  Back pain?  I’ got this (yer back, that is).  Viral gastro?  Migraine? Core instability, palpitations, paresthesia, GERD, thyroid nodule—even  depression and anxiety—I can make a good plan for all of these things.  I can walk you through it, reassure you, and help you feel better, even when I can’t fix the problem. 

Not so with COVID.  How did you get it, when you were so careful?  If the test is negative there’s still a 20-30% chance you’re infected if the scenario is high risk, but I can’t say for sure.  If you’re sick, how long will it last?  Will it get worse before it gets better?  How much worse?  Will you have lasting symptoms or long term health problems?  How long does immunity from illness or vaccine last?  I cannot lie:  I. Don’t. Know.  I will stay with you through it, but I can’t even satisfy your most basic questions, while you sit alone at home coughing, short of breath, unable to see or touch your loved ones, sipping ginger ale because you throw up anything else.  I can’t help.  And it kills me.

On top of that, I’m not doing any good as a public health champion, either!  Have I changed any of your behaviors?  Have I made even an iota of difference in my community to stop the spread?  All signs say NO.  I’m failing left and right.  No wonder I’m eating so much.

Burnout

Burnout is widely understood to have three key components: 1. Emotional Exhaustion, 2. Cynicism/Depersonalization, and 3. Reduced Personal Efficacy. Studies of physicians generally show that while we often score high on the first two, we do better with the third. I think not anymore. Burnout affected about half of all physicians in all specialties a few years ago, but had improved due to widespread research, awareness, and advocacy for systemic change led by professional societies such as the American College of Physicians and the American Academy of Family Practice. But think about 2020: Whatever emotional exhaustion my emergency medicine and critical care colleagues felt before, caring for the sickest of the sick, likely pales in comparison to the horrors of this pandemic. When their health systems ignored their pleas for PPE and then laid them off, making remaining docs work that much harder, and when they saw people partying and spreading virus all over the place, could you blame them for getting cynical? And though we’ve learned so much and fatality rates are lower now than in March, imagine going to work every day to watch patient after patient suffer and die alone, despite your and your team’s best efforts. We can no longer count on efficacy to save our morale.

Re-ignition

So how do we hold it together? Well DUH, it’s about connection! I had not felt this bad in a long time, but I’m better now, thanks to my peeps. They’re everywhere, and we hold each other up. Texting a meme here, venting (a lot) over there, and generally being present for one another, sharing, even embracing, the deep suck of the morass. Because this too shall pass… Like a kidney stone, as they say.

The only way out is through.  The best way through is together. 

I haven’t thought, said, or written that in a while.  It’s not that I forgot.  I got overwhelmed.  Happens to the best of us.