Category Archives: physician

#AtoZChallenge: More Fun, Less Frazzle

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“Rule #6: Don’t take yourself so Goddamn seriously.” From The Art of Possibility, by Rosamund Stone Zander and Benjamin Zander.

This can be a hard lesson for physicians. We do such serious work, after all. There is always another patient to see, another result to review, another call to answer—now! But I have to pee, when can I pee?

In my first year of practice, I remember a particularly hard day. I was running late (I’m still always running late) and the patients that day were all complicated. No simple UTIs or colds to give me some air. I huffed and grunted my way through the visits, occasionally buzzing by Rose, my medical assistant, to answer messages in between. My bladder felt like it might actually explode, but I could not stop to go to the bathroom—there was no time! I was so afraid to fall even more behind, to fail in some way. Eventually, Rose posted a sign above my workstation: “TAKE A DEEP BREATH.” It was an instant reality check:  I couldn’t go on like this, I’d burn out before my career even started! Immediately I realized how unnecessary, and downright silly, was all the rushing and grimacing—and I laughed out loud. Since then I have never again reached that depth of anxiety and sullenness in a workday. I am forever grateful to Rose for her sign, her loving reminder to slow down and take perspective. God bless her.

If we’re not careful, we physicians could all easily drown in the drama and strain, over and again, every day. And is that really what our patients need from us—to be Frazzled balls of tension and urgency, bouncing haplessly from one task or person to another, barely holding it together (and in)? Is that what we want for our colleagues and staff, to have to put up with our irritable and pressing demands?

It doesn’t have to be that way. In my third year of medical school, on my inpatient internal medicine rotation, Chip Dye was my senior resident. The service was busy; we always had a full census of sick patients. But I never felt harried or anxious because Chip set the tone for the team. Always smiling, always willing to answer any question, and finding any opportunity to laugh, he made it safe to learn. He exuded confidence without arrogance, calm without sloth. After rounds he led the team to attend morning report (daily educational conference and community gathering).  He always made sure we ate.  And there was always time to pee.

It’s not that he underestimated or ignored the work that awaited us. He just knew that we would accomplish it all better in a lighter, happier state of mind. When it came time to buckle down and divide tasks, Chip prioritized them with realistic expectations and we all got to work. No muss, no fuss, no stress. It would all get done because we laid out our plans in advance.  We self-respectfully reserved time and space for meeting basic bodily and communal needs. Thanks to Chip for leading by example.

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From Facebook, I can’t remember where or when!

We can always have some Fun at work, no matter how hard the day gets. Whether it’s telling a silly joke, watching a ridiculous viral baby video, or posting a fun meme on the workroom bulletin board, lightening the mood helps everybody get through a little easier. Laughing relaxes us. Stephen Colbert is quoted as saying, “Do you know what I like about comedy? You can’t laugh and be afraid at the same time—of anything. If you’re laughing, I defy you to be afraid.” And if we can overcome our fears of not getting it all done, of not being enough, we will all be better off—physicians and patients alike.

potheads

Also from Facebook…

 

 

#AtoZChallenge: Drudgery and Discipline

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Well this is scary… It’s only day 4 of the A to Z Challenge and I’m already feeling blocked! ACK! I had what felt like a semi-brilliant idea for ‘D’ –a week ago. I even wrote a short draft. But now I’m embarrassed to continue—it feels redundant and self-indulgent. I’m a little paralyzed by fear. What to do now?

I signed up for this challenge partly to make myself sit down and write every day, or at least attempt it. I’ve kept a running list of my favorite words, declared a theme, committed to a program. I am now accountable. It is up to me to practice the Discipline of daily writing.

I can’t imagine that writing this blog will ever become Drudgery, because if it ever does I can just stop. The blog itself is beholden to no one. But it’s something I created, something that I want to cultivate and develop. Quality of the content is bound to vary; I cannot be the perfect culmination of my best writer self every time! So regardless of how I feel about this post, I have resolved to publish something today, and I will have to find a way to make it good enough. It’s hard work, and it’s what I signed up for.

So this gets me thinking… How many physicians think of their work as drudgery? Sadly, the answer is more than we’d like to admit. Statistics abound on the alarming increase in burnout among physicians, physician suicide, and the associated decline in patient satisfaction and health outcomes. The defining features of burnout in any field are depersonalization, emotional exhaustion, and low sense of personal accomplishment. That’s as good a description of drudgery as I’ve ever seen.

Most of us experience some symptoms of burnout at one time or another. How do we get through it? Many of my colleagues rightfully look to operations—promoting streamlined workflows, simplifying documentation and coding, and standardizing protocols. But these changes come slowly, and we must function in the existing, cumbersome and inefficient systems while we advocate for the changes we want. So in the meantime, we forge ahead with gritty discipline.

Medical training remains rigorous, though in recent decades we have made it more merciful. From the premedical curriculum, to clinical rotations, to on-call responsibilities as attending physicians, our professional lives require us to be there for our patients when we’d rather be communing with friends, attending our children’s school plays, or just sleeping. We made a commitment, took an oath. And for the most part, our work rewards us with rich opportunities for lifelong learning, hearty fellowship, and the privilege of caring for humanity in the most intimate ways. The discipline—the commitment to the work—pays off in spades.

In my reflections on physician health and well-being, however, I always come back to another domain of discipline—that of self-care. Medicine attracts caregivers. Sometimes we are also control freaks, and exhibit somewhat masochistic tendencies. When we let these traits take over, they upset the balance needed to thrive in the complex medical milieu. We need to maintain objectivity with compassion and sensitivity, calm and clarity with intuition and judgment. We cannot do this effectively if we constantly run on empty. When we neglect our body/mind/spirit, we get irritable, and our work and relationships suffer. Ever seen a toddler clunk her head on some furniture while walking? If she’s well-fed and well-rested, she’s likely to keep moving, intent on getting to her favorite toy on the other side of the room. If she is tired and hungry, however, the same innocuous thump may trigger a full-scale meltdown of epic proportions. It’s no different for adults. We need regular feedings, rest, and playtime just as much as our children do. For my part, when I speak to colleagues on burnout and resilience, I focus on the discipline of self-care. It’s what we can control now, while we continue the necessary work of systems change.

Fortunately, I have chosen a profession that feeds my soul. It is a calling, a vocation. I have also chosen to indulge in a hobby, writing, that fulfills me similarly. Both require commitment, discipline, and practice to be done well. Both run the risk of becoming drudgery, under certain circumstances.

This post has been an exercise in Disciplined Writing. I wanted to write while inspired, and it just was not happening. So I had to simply sit down and get to work. But as Liz Gilbert discusses in her brilliant new book, Big Magic, inspiration did visit me, however briefly, in the process.  That will keep me coming back to practice. I will continue this exercise all month—thank you for bearing with me!

#AtoZChallenge: Assumptions and Appreciation

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Welcome to my first attempt at the Blogging A to Z Challenge!  26 posts in April, one for each letter of the alphabet (I get one day off per week).  I will explore meaningful words to apply to perceptions, attitudes, behaviors, and relationships. It’s a personal journey, part of my mission of self-assessment and development through writing.  Thank you for stopping by, and please feel free to comment! 🙂

 

Yoga instructors. Football players.  ER nurses.  Asian college students.  Old white men.

Hold these likenesses in your mind’s eye for a moment. Who do you see?

Was the yoga instructor a man or woman? The football player?  It’s impossible not to make assumptions, to apply stereotypes.  Such constructions help us make sense of the world.  They allow us to move through countless human encounters quickly and automatically.  And, they can limit us far more than we realize.

One spring day my kids and I sat in the car, waiting to exit the parking lot after church. Three men, Caucasian, in their 60s, crossed in front of us.  They were well-groomed and overweight—grandpas, likely.  Their expressions were neutral, absorbed in conversation.  One of them looked a little winded from walking.  They were perfectly unremarkable, and they did not notice us.

I felt an acute flash of fear.  It was visceral, as if, at any moment, they could decide that my kids and I were not worthy of being at that intersection, and that they somehow had the power to impact my life in ways that I could not control or influence.  Three apparently unassuming white men.   Fascinating.

I remembered this story when a friend and colleague recently shared this blog post on our assumptions about surgeons.  I realized that despite being married to a surgeon, having multiple surgeon friends, and trying every day to live with an open mind, I still ascribe to the stereotype of the mean surgeon.  It comes out when I hang up the phone after a pleasant conversation with an ENT fellow.  “Wow, he was so nice,” I think, surprised.  Or when I feel righteously annoyed after a terse and condescending interaction with his attending.  “What do you expect,” I say to myself, “he’s a(n old, white, male) surgeon.”  Nobody would ever say that about a pediatrician.

I don’t shame myself for harboring the mean surgeon and old white men stereotypes. They were born of a certain reality and make me appropriately cautious in new situations.  I don’t think I behave badly because of them, and I readily acknowledge when the stereotypes are broken.  But the realization that I hold these assumptions so deeply—subconsciously—gives me pause.  What other assumptions do I carry, and how do they limit my relationships?  I think it’s fair to say that we all carry shards of racism, classism, and other forms of blatant prejudice.  Here’s what I also think:  It’s okay.  We can’t help it, that’s just how it is.  Denying it just makes it that much more insidious, subversive, and toxic.  I’m prejudiced, you’re prejudiced, we’re all prejudiced.  The more we say it, the less scary it gets.  The first step is acknowledgement without shame.

But we cannot, and must not, stop there. We can’t only say, “We can’t help it, that’s just how it is.”  We must take the next step, which is to manage it better.

I think an excellent antidote to toxic assumptions is appreciation.

Dictionary.com includes the following definitions of appreciate:

  1. To regard highly; place high estimate on: to appreciate good wine.
  2. To be fully conscious of; be aware of/ detect: to appreciate the dangers of the situation.

Let us first fully appreciate (be aware of/detect) the scope of our prejudices: Their cultural, familial, or experiential origins, their subtle influence on our perceptions, and the covert ways they manipulate our thoughts, words, and actions toward others.  Awareness is key.  It is also hard.  It’s hard because we know we shouldn’t be prejudiced, it’s bad.  Prejudiced people are bad, they do bad things, we don’t want to be like them; if we admit our prejudices then that means we are bad, that we are not worthy.  STOP.  The only way to keep from acting on our negative stereotypes and perpetuating racism and xenophobia is to fully acknowledge their existence and confront them, head on.  They do not define us.  They are not all of who we are and what we stand for.  Their presence does not negate all that is good, generous, and inclusive about us.  AND, they are part of us.  We cannot escape them by way of denial.  If we can call ourselves out honestly, lovingly, and with forgiveness, we can then integrate our prejudices, and put them in their place.  Appreciation does not mean approval of, or abject subjugation by, our biases.  It is simply the first step to living wholly, to knowing and owning all of ourselves, and moving with intention and mindfulness.

Then, let us apply the other definition of appreciation to others. Let us regard more highly those whom we may automatically, however subtly, belittle in our subconscious.  How might we do this?  Look for that which we share.  She is a mom.  She must love her kids as much as I love mine.  What are their circumstances, what lessons is she trying to teach them, and what would I do in her place?  Why did he become a doctor?  He must want to help people like I do.  I could never do what he does, so high risk, so much responsibility.  God bless him, we need people like him.

Let us then solidify the process with words, out loud. “I can tell you really love your son.”  “Thank you for caring so much about our patient.”  It may sound trite, even silly, at first.  But we can never underestimate the impact of a few kind words, not just on others, but on ourselves.  When I acknowledge myself in you, I make a connection.  I see you, I recognize you, I appreciate you, as I do myself.  Prejudice thrives in silence and denial.  It cannot long survive being spoken out loud and it certainly withers in the presence of true connection.

We will always make assumptions.  Tempered with some well-placed appreciation, though, perhaps we can get through life with a little more love and a little less suffering.