Category Archives: physician

What Does Meaning Feel Like In Your Body?

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I recently had the privilege again to meet with a group of bright, hard-working medical students.  Their college mentor, my friend and colleague, invited me to lead a discussion on meaning and stress.  She saw them, only starting their second year, already losing sleep and well-being over choosing a subspecialty (they do not have to declare until 2 years from now).  I recognize a similar anxious urgency in my own son, who applies to college this fall.  My friend and I wish for all of these young people to suffer less and really enjoy the journey of learning and integration, so we sat them down for a chat.  As usual, I learned at least as much from our conversation as the students did.

We discussed the Meaning to Stress Ratio, a framework I started using with patients years ago.  In essence, I posit that if your experience of meaning/personal fulfillment at work outweighs your experience of stress, then it is likely a sustainable situation.  We can afford to pay high amounts of stress if the work has enough intrinsic value to us.  Many students seem hesitant to choose certain specialties for fear of stress (hours, responsibility, risk), among other things.  Some are even prepared to forgo their true interests and passions, and commit to fields with better, lower stress ‘lifestyle’. 

My friend and I, sitting in the circle of students like a couple of Cub Scout den mothers, tried our best to reassure and encourage her students that they, like we who went before them, would figure out their true places in good time.  Our goal was to give them both moral support and some concrete tools to navigate the journey more lightly.

“What does meaning feel like in your body?” This question occurred to me while preparing for the session. I had never thought to ask it, to anyone, before now. For years I have asked patients where/how they feel stress in their bodies. The intent is to strengthen self-awareness and identify smoke alarms of sorts, so people can take steps to head off unhealthy consequences of excess stress and rebalance self-care practices. And though I ask patients about sources of meaning and personal fulfillment in work, I never wondered what meaning actually feels like, physically. How fascinating!

I thought to ask now because these students are still searching for meaning in their work (lives), while many of my patients have long since identified and pursued it.  If body signs of stress are smoke alarms, perhaps body signs of meaning are smoke signals.  They draw us in the direction of what needs us, and what we need.  Students reported sensations like ‘energized,’ ‘light,’ and ‘revved,’ and feelings of satisfaction, contentment, peace, and inspiration. They described being in flow.

In the end, we agreed on three practices for my future colleagues to develop as they find their rightful place in our profession.  I write this as a message to those students—Onward in solidarity:

Know your body signs.  Check in with yourself physically on a regular basis.  What body systems agitate and/or crash under stress?  How does this manifest in your behaviors and performance?  Your relationships?  When do you notice the opposite happening, what does that feel like, and could this be a sign of meaning?  Once you know your signs, what will you do when you notice them emerging?  How can you set your personal marathon course with pee stops and goo stations where you need them?  How do you feel at your highest and best, and what helps you get there?  How can you get more of that?

Maintain strong boundaries and observe.  There will never be a shortage of people, mostly older doctors, telling you why you should or should not choose this field or another.  They will project their own biases, disappointments, pride, and traumas onto you, ostensibly to help you, but I suspect it’s a version of self-soothing for them.  Do not let them enter your psyche; they may not have your best interests at heart.  Rather, look around for the people who exude joy at work.  Find the ones with whom everybody loves to work, the intense yet relaxed, the energized, light, satisfied, and peaceful ones.  Interrogate them about what makes them click at work, and see if it resonates with you.  Observe yourself in their presence—do you vibrate at the same frequency?  What does that tell you?

Cultivate relationships with those who/m: 1) you admire, 2) seem to balance meaning and stress well (then probe their practices), 3) sincerely care about you and your well-being, 4) will give you honest and loving feedback/reflections/observations about you/r attitude and impact, and 5) will stick with you through the hard times and hold you up—and whom you would support in kind.  These are the people who earnestly call you out and forth, who help your best self shine, sometimes through your own BS.

I’ll find a way to translate these principles for Son, as he writes his college essays. If only I could breathe peace and excitement into his lungs, and suck out the anxiety and pressure. For now I can at least be one of those loving mentors, standing by with Gatorade and cool towels when he swings by me this lap and the next, and the next.

Deep breaths, my friends.  Find your pit crew and trust the process.  You’ got this.

Sometimes Just Being With Each Other Is Enough

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When my friend Dawn lost her daughter in a school shooting, our friend Lisa showed up on her doorstep unannounced.  She came in and just sat with Dawn.  No food, no words, just presence, which is what Dawn needed.

When else is simple, resonant presence enough?

My experimental physician comradery group met for the third time this week.  I am positively beside myself giddy that my MD friends are so willing to give up an hour in the evening to spend on yet another video call.  Research has shown that formal, facilitated physician forums increase our well-being in multiple domains.  Seeing as our group is informal, I have hesitated to impose an agenda.  But being docs whose nature is to ask, “What is the goal of this meeting?” I felt obligated to query us about our objectives.  What is the purpose of these sessions, how will they best serve us all?  Some awkward seconds of silence ensued, heads cocked, brows slightly furrowed.  Then, quite easily, we agreed that just being together, in professional and personal communion, was enough.  Wow, that’s it?  We just want to be in one another’s company?  I felt relieved, and also sad that this is how starved we are for connection.

I confessed my ulterior motive for forming the group:  to begin construction on wide bridges between departmental silos.  I dream that we can not only form thick personal connections, but also make our operations decisions with those connections in mind.  Scheduling protocols in your department impact workflow in mine.  Optimization for me may detract from your efficiency.  In many cases, patients are also negatively affected.  Can we find the win-win more often and easily?  I think so, and like so many things, it takes time and effort to cultivate the necessary relationships.  Maybe it can start with a few of us early adopters, choosing each other’s company once a month.

Yesterday I completed the Aspen Institute First Step Seminar: Transcendent Dialogue in a Polarized World, a three-session workshop on engaging with difference.  Once again I got to participate in a transformative pilot, and OMG it was amazing!!  Check out the workbook that guides one through assessing, constructing, and articulating their Worldview (attendees have permission to share)—phenomenal!   Session titles:

1. Understanding and Articulating Worldview

2. Pushing and Challenging Your Own Worldview

3. Making Commitments

Immediately I found myself surrounded by people from across the country and myriad fields of study and work, all convened in a wholehearted spirit of curiosity, learning, and connection—my tribe!  But by the end of Session 2, I found myself impatient, wishing for more concrete skills acquisition and training.  What method or mantra could I learn, that I could then take and apply to my next encounter with a Trump supporter?  I wanted to role play, OMG!  After sitting with this disquiet, and then discussing with the group, I realized again that simply being with these amazing people could be enough.  We read and interpreted poetry, discussed worldviews and core values.   We defined, debated, and redefined terms that appear benign and banal at first, but can be fundamentally divisive (eg “safety” and “common good”).  We sat together in mutual discerning presence, with respect and openness.  Hearing eight other people’s reflections on “Salmon Courage” by M. NourbeSe Philip flung my mind open in the most exciting way!  I cannot remember the last time I encountered so many diverse perspectives so collegially and lovingly, and I could not get enough. 

Turns out I learn, indirectly perhaps, a ton of applicable skills from these communal encounters, formal and informal alike.  I’ll continue to dissect for myself the aspects of these groups that make them so effective, such as explicit and implicit agreements around conduct and relationship.  I always seek connection when I’m with people, no matter the size of the group.  But maybe I’ve too often thought of it as gravy more than meat and potatoes?  When I approach a structured meeting, I want to take away something tangible to report on—something useful to share, that the non-attendee can also practice.  But maybe I can loosen my grip on that need.  Maybe it’s okay to say, “You just had to be there,” and then invite my friend to come with me next time. 

That is how we grow strong, loving, and productive communities anyway, right?

**Sorry for the weird formatting, friends–I don’t know how to fix it! ;P**

Here’s How We Can All Help

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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.