Category Archives: physician

A Dawdler’s Triumph

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I am a master procrastinator! It’s starting to show on this blog, but oh well, now you know me better. In high school I always wrote my English papers at the last minute, up late in the basement office, typing furiously, feeling giddily anxious under the pressure. In the end I always knew it could probably be better had I started sooner, but it was always good enough.

This time, though, I surprised and alarmed even myself.

Two weekends ago, while hiking happily through golden aspen groves in Silver Plume, Colorado, I realized my presentation to the American College of Surgeons Annual Clinical Congress was only ten days away. Rather than work on my slides that weekend, though, I spent my waking hours trekking through beautiful trails of my home state, with dear friends and family. I returned to the routine of life in Chicago only to realize that my blog post deadline had snuck up on me, too. I had every intention of writing on the camaraderie of friends, sharing stories, questioning, and challenging, all in loving, mutual respect and curiosity. I spent that weekend steeped in tribal love! No presentation slides materialized.

The trail to Pavilion Point, Silver Plume, Colorado

The trail to Pavilion Point, Silver Plume, Colorado

Last weekend I was scheduled to present a poster on physician wellness at the Society of General Internal Medicine, Mountain West regional meeting in Denver. Darn, I had to go back!  But as if my Unicycling post had foreshadowed, I overslept, missing my 6:00am flight and the poster session. The presentation was flung from my lazy Susan, thudding gracelessly to the ground. I felt terrible, as my colleagues in New Mexico had toiled to get the poster done on time, and because of my mistake, their work could not be presented.

You’d think the guilt from Friday morning would motivate me to get working on the ACS slide deck, but no. I spent that evening and the next day with my parents, seeking yet more autumn aspens among which to commune. This took us to the blue skies, crisp air, and vibrant foliage of Vail, and then back to Silverthorne, where instead of working I then proceeded to make greeting cards and bookmarks with my brilliant new leaf collection. I had come prepared with cardstock and packing tape, and I basked in procrastination heaven.

It wasn’t until 9:30 Saturday night that I finally opened PowerPoint. I chose a design and color scheme. I scoured files and Pub Med for data and citations. I consulted my outline, framed weeks before, and sifted through photos to represent main ideas. As usual, I felt an exhilarating mixture of, “Why do I do this to myself,” and, “Man, this could be really good.” By 4:30am, with eyelids of lead and a fair bit of pride, I could finally go to bed, 35 hours before the scheduled presentation.

Along I-70, Eagle County, Colorado

Along I-70, Eagle County, Colorado

So holy cow, what happened? This was a very big deal, I was going to speak to an entire audience of surgeons, for Chris-sakes, and they are no easy crowd! How could I put off preparing for THIS long? For my last original talk, at the Chicago Medical Society Midwest Clinical Conference in March, I had prepared weeks in advance, even allowing time to practice in front of friends before the big day. That was pretty uncharacteristic, but it was also a very big deal. For the first time in my professional life, I was not only presenting data and evidence, but also my own personal thesis on physician resilience—practices that I myself assert as fundamental to our professional well-being. WHY did I not take the same solemn approach this time?

Here’s the answer: FEAR. While not paralyzed, I certainly felt stymied. In my experience, surgeons tend not to think very highly of internists, as a group. Our training is shorter (think, ‘easier’), our hours often more forgiving, and our acute impact on people’s lives less (concretely) measurable. We are deemed less worthy, or at least that is my perception of surgeons’ perception (based on personal experience). So the idea of talking to this group on the ‘soft stuff’ of self-care and overcoming personal adversity made me feel more than a little vulnerable. On top of that, I lack the credentials we all look for in academic speakers: research publications, professor status, institutional titles. Who was I to speak with any authority to people who literally hold our patients’ lives in their hands every day?

By the time the slides were first done, I had determined that everything would be fine if I could just be myself behind the podium. After all, they invited me for a reason—someone had seen my CMS presentation and thought I was a good speaker. I’d better be, after nearly 30 years of practice! I’m relaxed, passionate, and articulate. So hopefully, the audience would just forget about my thin credentials and simply be awestruck by my superior presentation structure and style. Oh and I thought the content was pretty good, too.

I finally discovered my core confidence, of course, through writing. On the plane back to Chicago, I took out my freshly crafted aspen leaf notecards to write to my friends. Having just spent such quality time with them, I wanted to stay connected. It’s what I do. They knew about my upcoming talk, and I wanted to thank them for their encouragement and love. I also needed to confess my apprehension—get it out where it was safe. And I found myself writing, “I may not be the one designing the studies, and I may not have the fancy titles. But I’ve dedicated my whole professional life to helping people find their own agency, no matter who they are or what their circumstances. I know this shit; I live it. I’m the perfect person to talk about this, to anybody!”

Aspen leaf notecards and bookmarks, Vail, Colorado, 2015

Aspen leaf notecards and bookmarks, Vail, Colorado, 2015

Thanks to my remarkable tribeswomen, who hold me up even when I’m 37,000 feet in the air, I no longer question my own worthiness among colleagues in the American College of Surgeons, or anywhere. As long as I am my authentic self, and I do my homework, I can speak to anyone. In the hours prior to the talk I did a fair bit of power posing, just to be sure, and everything went swimmingly. I should also mention that three other women spoke at our session. They told personal stories of adversity and how they overcame. It was truly a privilege to be among them.

I sincerely hope that the ACS will invite more speakers from the ‘cognitive’ fields. I encourage the leadership of the American College of Physicians, the internal medicine professional society, to reach out to our surgery colleagues and collaborate on physician wellness initiatives. I read recently, “The only way to survive is by taking care of one another,” attributed to Grace Lee Boggs, 1915-2015.  Just as nobody overcomes personal adversity alone, and no physician can care for patients without an entire team of dedicated staff, no one specialty will hold the patent on physician wellness. Surgeons’ needs differ from internists’, to be sure, but we can all learn from one another, and the sooner we recognize that, the better for us all.

So, I procrastinate. It’s who I am. And I trust myself to get the job done–well, even. I have a chance at redemption for the SGIM blunder. I will represent my UNM colleagues at the podium of another conference in Washington, DC, in 10 days. I have the outline… Planning to create another PowerPoint file in the next day or two…

The Burnout Crucible

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For the past three years, I have had the privilege every month of meeting with a remarkable group of medical students. I precept a group of about ten, discussing topics that range from death and dying to social media. The class meets regularly during the students’ third and fourth years. Through blog posts and discussion, they share stories from their clinical rotations and personal lives, things they witness and how they think and feel on the wards. We talk about culture, technology, and work-life balance, among other things. These students consistently inspire me with their passion, insight, and honesty.

My last group, members of the Class of 2015, set the bar very high for their underclassmen. Over the two years we met monthly, we shared myriad stories and loads of food. They came to my house and knew my children. We slogged through residency applications and interviews, and celebrated engagements, weddings, Match Day and graduation. I loved them. Being with them fed my soul and I could not imagine another group feeling quite the same.

In that time I was also growing my own interest in physician wellness and resilience. In 2014 I had the honor of presenting on physician burnout to the primary care providers at the Cook County Jail, one of the largest correctional facilities in the nation, with an average daily census of 9900 detainees. Can you imagine? I learned infinitely more that day than anyone in my audience—God bless each and every one of them!  Since then I have presented similar talks to members of the Chicago Medical Society, the American College of Physicians, and at the University of New Mexico. I have connected with other physicians similarly interested in helping our profession uphold its principal call to heal, starting with ourselves.

I can joyfully report that I am already in love with my new group of third years. They had me from, “This is why I came to medical school,” when they wrote about their first impressions of clinical rotations.  I could palpate their exhilaration and glee at finally getting to help take care of patients, rather than just reading about it and practicing on actors. In July I found myself practically commanding them to, “Print these essays out and hang them all over your apartment for later, when you hit the inevitable wall!” As if it were a foregone conclusion that the fire of passion in their training would dwindle and burn out.

Since the summer I have wondered, is it necessarily better to enjoy an ever-roaring fire? Or could there be greater value in the flagging smolder, and the attention and work required to re-ignite the flame? As the students progress in their training, we talk about behaviors that they witness—many inspiring, some not so much. We examine the potential origins of the latter. I ask them to assume that all of us, physicians, nurses, therapists, and other clinical staff, come to medicine to help people, and that we are all kind and compassionate people at heart.

What then, drives people like us to behave in such unloving, unkind, dismissive, and undermining ways? Emergency room doctors and nurses crack jokes and exchange snarky remarks about trauma patients, teams rounding on wards refer to patients by their diagnoses rather than their names. The students know the causes—they are the defining markers of burnout: emotional exhaustion, depersonalization, and low sense of accomplishment. It’s not intentional, it’s insidious. It’s toxic, and the medical community is waking up to the costs, both personal and institutional, of burned out physicians. It resembles a plague, infectious and potentially life-threatening, with few reliable treatments.

While I would never wish burnout on anyone, I also think that the process of rising from its depths to a new mesa of joy in medicine can be a good thing. For my students who articulate so clearly their Why for being here, maybe all it will take is reading their class blogs or med school application essays over again. Or maybe it will take deeper soul searching and acquisition of new skills, in mindfulness and stress management, prioritization and boundary-setting, to get them out of a burnout funk. Will those surviving this crucible be better physicians, better people, than those for whom the fire never dwindles? I don’t know.

I’m reminded of a TED talk by Ester Perel on infidelity. As a researcher, she’s often asked if she recommends that people have affairs, because she studies the personal growth that can result from the experience. She says she would no more recommend having an affair than having cancer. And, that cancer survivors will often tell you that they now live more fully and authentically because of their illness. Maybe burnout is the same? We don’t want it, it’s painful and destructive, but if we can come through it, we may be better for it.

Maybe it’s a moot point, whether it’s better to never burn out or to burn out and relight. We’re all here doing our best every day. Maybe it’s more important to just cut ourselves and one another a little slack sometimes, have compassion for aggressors while calling out their unjust behaviors, and offer everybody the benefit of the doubt, especially when we’re all stressed out. In my last session with the students, we ended by asking ourselves:

  1. What do I need (to take care of myself)?
  2. How will I get it (without harming someone else)?
  3. How will I be a contribution?

Maybe this is a good place to start.

Legacy of the Rental Crisis

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Many thanks to all who expressed support and encouragement after my last post—this community continues to amaze me with its welcoming and generous spirit! Now that I’ve had time to reflect some more on the events of last week, I have clarity that I lacked before. Funny how crises lead to growth.

First, I regret that I resorted to name-calling when describing the previous tenant. ‘Renter from Hell’ and ‘Lucifer’ certainly represent how I felt about him, and still feel, from my judging self. But really, I don’t know him. I can’t say that he is truly evil. I can judge his actions as rude and inconsiderate, to say the least, but making sweeping claims about his character and shaming him publicly, even if anonymously, does not reflect my highest values. It would be fair to say that I was emotionally hijacked for a few days, fuming over how he desecrated my home. And we all know that we should not hit ‘Send,’ or ‘Publish,’ in that state of mind. Lesson learned.

If you have not watched Simon Sinek’s TED talks on leadership, or read his books, Start With Why and Leaders Eat Last, I highly recommend them. He is my new author-hero, sharing the golden bookshelf with Benjamin Zander and Rosamund Stone Zander, authors of my first favorite book, The Art of Possibility. Briefly, Sinek posits that leaders attract followers, and companies attract customers, when they are clear about their ‘why.’ In other words, they discern and exude their central purpose, their raison d’etre. When this is the case, the things they do, their whats, extend directly from the center where their core values live, and serve as tangible evidence for their why. He uses Apple as an example. We may think of Apple as a computer company, but Sinek asserts Apple’s why as ‘challenging the status quo.’ They revolutionized the computer industry with the graphic user interface, the music industry with ‘1000 songs in your pocket’ on your iPod, and the phone industry by dictating to the mobile phone carriers what the iPhone could do, rather than accepting the conventional, opposite practice. Computers, music devices, and phones, Sinek says, are Apple’s whats. They are the outputs of their why, and though disparate products, all align with Apple’s core values. Making great computers and phones is not an inspiring why. Challenging the status quo is. And people for whom that message resonates are the ones who will camp out overnight to be the first to get the next Apple product. They feel connected to the company and show loyalty.

For years now, I have used the phrase, “Live your best life every day” as a mantra in my work. This is what I aim to help people do, however they define it, and however they can achieve it. It’s my job to support them in their personal journeys. I try hard to apply it to myself, as well—what does my best life look like today? Best workdays in Chicago look very different from best vacation days in Colorado, and each day can be affected by myriad external and internal variables. But I find that when I can approach life in this way, newly open to possibility each morning, I feel liberated. I am free to redefine my best self, best day, best life, over and again. [You should know, however, that it is a constant struggle and I fall miserably short of this potential most days. But it’s a good practice to continue, and I think I’m getting better over time.] I started my career in a conventional primary care office. I spent five years in an integrative medicine practice, and now I do executive physicals and some concierge medicine. For a while I had a hard time reconciling this last step—it feels a little elitist and contrary to my usual liberal sensibilities. After digesting the Start With Why philosophy, though, I can confidently say that what I do now is entirely consistent with my core values.

Today I stand decisively at the intersection of Leadership and Health. My patients are leaders of their organizations, and it is my job to help them take care of themselves. Why? So they can better care for those they lead. By helping them live their best lives every day, they will role model this to their colleagues and staff, and empower those around them to do the same. How do I do this? By taking the time to know each patient as an individual, understanding their personal goals and aspirations. I collect objective data about their health and offer personalized recommendations, based on what I know aligns with their values. Today I happen to do it through executive physicals, but it’s what I have always done. I give presentations to colleagues on physician resilience, and I lead educational initiatives aimed at advancing professionalism and collaboration. This is my why—live my best life every day, and help others do the same, through our relationships.

Now I know how I must approach my rental property. It cannot be just another way to make money. It must be another what to my why. My reasons for keeping it must be consistent with my values and goals as a person, which must be the same as my goals as a physician, friend, spouse, parent, and landlord. Renting my home to a tenant is my contribution to their journey of self-actualization! Go ahead, laugh–it sounds completely whacky! And yet, approaching it this way clarifies all of my decisions and actions. As a landlord with the tenants’ best interests at heart, rather than simply calculating costs versus income, I will move swiftly and easily to repair or replace degenerating appliances and fixtures. I will take an interest in the tenants’ lives and check in with them frequently. I will monitor the upkeep of my property not just for myself, but for them. I will build the kind of trusting relationship that fulfills me in every other aspect of my life. The yield, I hope, will come in the form of respect and appreciation from the tenants, expressed in loving care of my home. You could see it as a manipulation, guilting them into cleaning up after themselves, I suppose. But it doesn’t feel like that. I know now that I want honestly to connect with my renters, to feel good about our relationship. Actions taken out of true caring are very different from mere transactions, and everybody feels it.

Before this last tenant, I never experienced this kind of drama and anguish over the apartment. But looking back, something about my relationships with renters felt distant and awkward, not like my other relationships. Now I know why, and it has to change. I have to be me in everything I do, including this. Some people will not want it. They will feel uncomfortable and see me as nosy and prying. Some patients don’t want a personal relationship with their doctor, either—they just want to have their cholesterol tested and their medications prescribed on time. I would not be a good fit for either of these groups, and the good news is they are free to not rent my home or choose me as their doctor. “People don’t buy what you do, they buy why you do it,” Simon Sinek says over and over. “The goal is to do business with the people who believe what you believe, not just the people who need what you have.” This sounds familiar: Seek the fellow lone nuts, the early adopters, the ones with whom my why resonates. If I can do that, no matter what happens, I can make a positive difference in the world, and attain peace for myself.