Category Archives: relationship

November 5:  Peer Coaches Make Me Better

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NaBloPoMo 2019

When you’re working through a challenge, who helps you?  What is it about them, how are they most helpful?  How not?

Through the years I have learned what I can get from certain people.  I know to call this person when I need validation, that person when I need a devil’s advocate.  I also know which people to avoid altogether—those who cannot be trusted with my vulnerability or confidence.

But when I need to hold space and tension with an issue, to patiently look at it from different angles and process the perspectives, I look to my peer coaches.  I feel gratitude and gladness for these friends today, after my LOH group had our monthly peer coaching call.  As we progress through our 10 month leadership training, we take tenets and skills home from each retreat to practice.  Monthly Zoom calls have no agenda, other than to reconvene, share, and mutually support.  Every time I come away appreciating just a little more how nothing in life—work, personal things, social context—can really be separated from anything else.

These friends are not my first or only coaches, however.  In 2005 I started working with Christine, my life coach.  Every session, 14 years later, is still transformative.  How is this possible?  Curiosity.  Christine coaches every call squarely and unwaveringly from this perspective.  It was not long before I realized how powerfully this method could alter my own encounters with patients.

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The best coaches have no preformed or decisive answers.  They have the uncanny ability to ask the best questions–Open, Honest Questions (OHQs)–which then lead clients to their own best answers.  They help frame and reframe problems.  They point us to alternate perspectives and help us open our minds to narratives other than the ones we too often grip so desperately.  It was my second year in practice when I started asking coaching questions to patients, and I have never since feared any symptom, syndrome, or answer.  When there is no clear diagnosis or answer for someone’s distress, I can just keep asking until something helpful emerges.  Most often it’s not a single piece of information that gives clarity; rather, it’s the story that materializes.  Coaching skills help me help my patients find and tell their stories of health and wellness, illness and pain, agency and action.

Here are the tenets of true Open, Honest Questions, from the LOH syllabus:

  • The best single mark of an honest, open question is that the questioner does not know the answer and is not leading toward a particular answer.
  • Ask questions aimed at helping the other person come to a deeper understanding (help them access their own inner teacher).
  • Ask questions that are brief and to the point without adding background considerations and rationale—which make a question into a speech.
  • Ask questions that go to the person as well as the problem or story—for example, questions about feelings as well as about facts.
  • Trust your intuition in asking questions. Inviting metaphors or images can open feelings, new lines of thinking, and unexpected possibilities.
  • Try to avoid questions with yes-no, right-wrong answers.
  • Avoid advice disguised as questions.

My best friends are my peer coaches.  And now I have my LOH cohort-mates.  We make no judgments about one another’s circumstances, feelings, or experiences.  We make the most generous assumptions about our motives.  Our role in each other’s lives is almost never to give advice; rather it is to hold space, listen reflectively, offer moral support, hold up core values, and help one another query thoughtfully and honestly.

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Questions asked and reflective statements made on the call today:

  • If you left work tomorrow with enough money to be unemployed for 6 months, what would you do?
  • How does it feel to speak (your issue) out loud?
  • When you think about current state compared to past, how does it feel physically in your body?
  • Sounds like you’re working on a core tension.
  • What do I/you want now?
  • What’s roiling around in you?
  • Who around you can get creative with you?

We each bring diverse questions and challenges to each call.  But somehow we always relate deeply, and listening/querying helps us each learn from every other.  Today I saw central themes emerge around identity, contribution, voice, and meaning.

In the end, I think there are few things more important in life than meaning and connection.  These are the gifts from my peer coaches, and they always make me better, no question.

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November 2: Reading Makes Me Better

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NaBloPoMo 2019

Today I share a Facebook comment series I wrote in response to a prompt from a progressive friend, in its original form.  His post made me look up and read 7 additional articles, all of which I linked in my comments.  In the end I became more aware of my own biases, and recommitted to finding common ground with people who think differently from me.  So I think reading makes me better.  What think you?

wsj divided nation 2019

Friend’s post:  (Cathy):  I’d be interested in your perspective on this article in terms of your work to bridge divides and create civil conversations.   [Wall Street Journal slide deck describing the economic basis of party divisions in the US—it’s a fast click through which I recommend.]

My comments:

Thanks for sharing, (Friend)! Okay, I will take the time to make a long comment thread, as this is really interesting to me. Thank you for asking the question you did–I’ll get to it eventually! First: The information presented in this slide show is consistent with what I have read before. The facts presented are real. And they are incomplete. It looks at differences between districts, which is the best way to highlight division. I think this is a direct consequence of gerrymandering, which is designed exactly to create districts that will reliably vote one way or another. And we have all seen the US map showing blue clustered around big cities and red everywhere else. AND, this report ignores the glaring truth that despite the economic divisions by district and income, a much larger proportion of the top 1% is either declared or leans Republican than Democrat (though not necessarily more conservative):  https://news.gallup.com/poll/151310/u.s.-republican-not-conservative.aspx

Gallup 1% 2011

Second: The suburbs are where Reds/Blues live amongst one another, and this report ignores them, pretty much. That said, even without gerrymandering, we Americans have sorted ourselves ideologically. Bill Bishop wrote a fascinating book that details the economic and social evolution, _The Big Sort_ (listened to the whole book a year ago, I highly recommend it): http://www.thebigsort.com/home.php

I think suburbs are where work like Better Angels has the most potential to spark civil discourse, except that people are hesitant to engage, for fear of upsetting the tenuous and silent politeness that constrains their ability to talk openly about politics. That cultural noose is hard to untie.

Dem demographic 2019

[Below are a] couple of other links that have additional demographic information that gives context and texture to the WSJ slide deck. The point of all of this is that when we I read articles that start out with nihilistic, Vader-like proclamations of “America’s political polarization is almost complete,” I see an implicit agenda to actively contribute to that polarization for the good of the publisher. Brené Brown reminds us to beware of those who tell us things are absolute, either/or. Reality is almost never this dichotomous, and whenever we hear it is, we should look for who benefits from us thinking it is. Economic demographics of Democrats: https://www.debt.org/…/economic-demographics-democrats/

Economic demographics of Republicans: https://www.debt.org/…/economic-demographics-democrats/

Okay finally, to answer your question, on my “perspective on this article in terms of (my) work to bridge divides and create civil conversations”: My favorite visual is this table from the first article I linked to. In some ways we are ‘almost completely’ divided, as the Vader article posits. In other ways, we are not. I think of the surveys showing a majority of Americans being in favor of background checks for gun ownership, in agreement that abortion is generally not something we want happening all the time. I think of all of the conversations I have with pretty much any other human, and how we are all 90% more alike than different. But this article and 90% of the articles we see highlight the other 10% of differences, and worse, the most vehement and violent expressions of those differences. So my perspective on this article is that it contributes significantly, if not blatantly, to the division it reports. And it does not serve us in any way. And, I hope I would have the same response if it were published by the New York Times. 😉

top 1% demographics 2011

HANG ON. I just saw that this favorite article I cited is from 2011. I have found a couple of more recent ones; will review and continue the thread….

vox welthy dems 2016

Okay, here is an article from 2016 by a poli-sci expert who, [Bill Bishop-style], explains well the progressive evolution of the top 4%. Very interesting:  https://www.vox.com/…/6/3/11843780/democrats-wealthy-party

And hey, here is one from Forbes this year, which quotes the author of the Vox article, highlighting how a sizable number of Republicans actually align ideologically with Democratic policies:

“The fact that lower-income Republicans, largely known as the ‘basket of deplorables,’ support more social spending and taxing the rich was a key takeaway from this year’s report, says Lee Drutman, senior fellow on the political reform program at New America, a Washington D.C.-based think tank… ‘It is pretty striking that about a fifth of Republicans had views closer to the median Democrat than their own party,’ he says. ‘A lot of them actually want a sizeable social welfare state. It’s a little bit of a puzzle why they don’t vote for the Democratic Party, other than long-standing cultural ties maybe and other ballot issues. What we have here is just one of the two parties stands out to have a bunch of its supporters in opposition to some of the party’s economic platforms but still gives them their vote.’” https://www.forbes.com/sites/kenrapoza/2019/06/24/how-democrats-and-republicans-differ-on-matters-of-wealth–equality/#13e06ab8702f

More from the Forbes article:

“But when looked at closer, a plurality of voters (72%) across the spectrum said the government should provide tax credits for low-income workers. Some 60% are in favor of raising the minimum wage, and 58% were in favor of raising taxes for those families earning over $200,000 a year.

“Across party lines, Democrats were the ones who were most interested in a higher tax burden for the wealthy, though it is unclear if they considered themselves to be part of the income group that would be hit with higher taxation in a more progressive tax structure.

“An overwhelming majority (79%) of Democrats earning under $40,000 a year wanted to tax the rich more. Democratic Party voters earning over $80,000 were 83% on board with taxing higher incomes at higher rates. For Republicans earning under $40,000, 45% were in favor of taxing the rich. Republicans who earned over $80,000 didn’t like the idea. Only 23% were in favor.”

[In conclusion:]  Complexity does not make for headlines, sadly, and we should take this into account when we read and share. Thanks for posting on my page and asking the question, [Friend], you have made me think and thus made me better! 😀

NaBloPoMo 2019:  What Makes Me Better

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My friends, it starts again woohoooooo!

National Blog Posting Month occurs every November, a 30 day daily blogging challenge apparently founded in 2006, inspired by National Novel Writing Month, or NaNoWriMo.  I think this will be my fourth attempt, and it gets easier and more fun every year!

This year’s theme originates from a sense of both gratitude and anticipation.  Increasingly I feel compelled to do more, contribute more, help more.  When I look around I am consistently humbled by those who go before me, on whose broad and strong shoulders I stand.  So I dedicate this month to all of you.

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November 1:  Role Play Makes Me Better.

I was converted to the Church of the Necessity of Role Play in 2003.  I had previously belonged to Tribe of Full-Socket Eye Roll at Role Play.  That year I had the privilege of attending a Stanford Faculty Development Program series.  It was a 7 week clinical teaching program for physicians.  Every week we practiced a specific teaching skill, on camera, then had to watch ourselves and critique our own and one another’s performance.  Even though each ‘encounter’ was only a few minutes, and we were all pretending, it felt real enough to translate into concrete behavior changes in real life—for all of us.

Since then I have always employed role play when teaching motivational interviewing (MI) to medical students.  At first I played the noncompliant or resistant patient, and had students take turns trying MI skils on me.  When I noticed myself feeling defensive and belittled in that role, I realized what the students were missing, and how it could enhance their empathy.  So I started having them take turns playing both patient and physician.  That was an epiphany for us all.  When I attended the Harvard Lifestyle Medicine Conference MI session in 2015, I experienced yet another layer of important experiential learning.  In dyads, we not only took turns playing patient and physician, but we practiced both directive and MI styles of counseling.  The contrast on both sides of each of those interactions solidified in both my cognitive and limbic brains why MI is a superior counseling method for behavior change.

This week at ICCH I innocently volunteered to play the physician in yet another role play.  Little did I know what I was in for.  I should have seen it coming, as the workshop title was “Teaching Medical Students How to Deal with Challenging Patient-Physician Encounters.”  I, unknowingly, stepped into a scenario of recurrent asthma exacerbation brought on by stress, due to domestic violence.  I felt anxious with a circle of international colleagues watching, and also confident that I could enter the play encounter the same as I aspire to enter a real one—present, open, grounded, kind, loving, and smart.  The physician teacher who played my patient stayed solidly in character and immediately drew me in with her slumped posture, dejected facial expression, and barely perceptible voice.  And she, like so many victims of violence, was not giving it up easily.

I had to conduct a medical interview as well as a psychological one, at times alternating between them.  I wanted to get at what I suspected (first generalized stress, and then clearly violence at home), but we had just met, and she really wanted to get out of the hospital.  Her fear was obvious; but she held its cause close to her chest, like the rest of her, until she could trust me.  I approached with general words at first, “Anything else going on lately?”  I kept my questioning as open ended as possible, and tried to leave space for her to answer.  Nothing.  Then I confessed my own inner dissonance:  “I feel like there’s something else…”  When that didn’t work, I continued with the general history.  No other chronic medical problems, no surgeries; allergies that can trigger her asthma, but no recent exposures.  You have 4 young kids, a full time job, a house to take care of.  Are you partnered?  Yes, married, to Bob.  Pause; a breath.  Then, “How does Bob treat you?”  Pause.  Why do you ask me that?  “I’m asking about abuse.”  And then it opened.  How did you know?  “I’ve been doing this a long time…  And someone close to me was abused.”  Do I look like her?  “You remind me of her.”

She was mortified that I would tell anyone.  How could I possibly help, then?  There were longer silences as I, frantic on the inside and slow breathing on the outside, racked my brain for solutions.  The harsh reality eventually settled on us both:  Neither of us could do much about her situation in that moment, her asthma attack was resolved, and the longer I kept her away from her family the worse I might make everything for her in the near term.  We agreed that I would look for ‘stress management’ resources, and I would give her my phone number.  And I would discharge her later that day, back to her violent husband, who had promised he would never hit her again.

It was so real.  I was almost able to forget about the audience.  I was personally invested in the health and well-being of this one person in front of me.  I imagined if she were a real patient.  Would I actually give her my phone number in this moment?  Absolutely I would.  We had to start somewhere, and I was the only person who knew, who could connect her to resources for help.

After it ended, I felt pretty drained.  We had both been tearful at times.  I also felt proud to have gotten through—both the exercise and to my patient.  I connected.  And even though I had no immediate solutions, I had established a relationship that had hope for helping a person who really needed it.

I have not encountered this scenario in real life in a while—that I know of.

I hope I’m not missing something, somewhere, for somebody who needs me.  Yikes.

Role play makes me better.  It reminds me to always beware my blind spots, to keep practicing, and to remember the deep humanity of every person I meet.