Category Archives: relationship

Walking the Talk

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The Journey and the Struggle

18 months ago I wrote about my plan for maximizing menopause preparedness.  As with so many missions, this one has experienced both successes and failures.  Since January 2016, I have grooved my exercise routine in the most awesome way.  I am all over the TRX, doing Spiderman push-ups, incline presses, pistols and more.  I get my cardio intervals and I’m foam rolling.  I feel stronger now than at any time since high school, and I’m proud of this accomplishment.

*sigh*

The eating, on the other hand, continues to be a challenge.  Earlier this year a patient looked at me without expression, and stated bluntly that I had gained 8.7 pounds since the last time he saw me.  Right after that’s kind of inappropriate, I thought, well, he’s right, I have been gaining weight.  Last March I wrote about weight loss strategy, thinking mainly about my exercise habit formation.  Sadly, my own weight has gone opposite to the desired direction, despite an honest attempt at adherence to my own advice.  Evidence suggests that weight loss really is about 80% diet and 20% exercise.  But sometimes you can only focus on one thing at a time.

Back in 2008, when I finished nursing, I thought, I can get my body back!  I knew I was not going to exercise, and I had no energy to police my food choices.  But I also knew I was eating too much, so I decided to just cut my portions in half.  It felt easy, decisive, and empowering.  I lost 25 pounds in 9 months, and got down to my wedding weight.  But eventually I acknowledged that though I was thin, I was squishy.  So I connected with my trainer in 2014, the primary goal being to get moving without injuring myself.  Right now I’m up 17# since my nadir in 2009, though I’m much more fit than the last time I lived at this weight.

Talking the Walk

I’ve always had a love-love relationship with food, and it shows in my weight/habitus.  I notice also that my own state of mind and body has influenced the advice I offer to patients.  Before I exercised regularly I spoke to patients a lot more about diet; now it’s more balanced.  One patient brought it up recently.  He asked, “What about the doctors who smoke, or the obese ones, how can they advise anybody about healthy habits?”  I’ve thought a lot about it, so I was ready to answer.  To me, there are three main options, all of which I have tried.

Disclaim.  We doctors can rely on our authority to tell people what to do to get healthier.  They notice our fat rolls, or smell cigarette smoke on us.  They see the dark circles under our eyes and surmise that we don’t sleep enough.  Maybe they can tell we don’t exercise.  But we admonish them to eat less and move more.  We say (subconsciously) to ourselves, “Do what I say, not what I do.”

Avoid.  Rather than give lifestyle advice at all, we can focus on prescriptions and referrals.  We feel we have no place instructing patients to eat more leaves, go to the gym, or quit smoking, when we don’t even do so ourselves.  So we don’t even bother, feeling like hypocrites.

I think both of these responses are rooted in shame and perfectionism.  And I think we should not fault physicians for choosing them—that would be meta-shaming–never helpful.  These are normal, human responses to our professional training and expectations.  Physicians have long held positions of authority and expertise.  Until very recently, our relationships with patients were mostly paternalistic.  But with burgeoning access to information, a culture evolving (rightly) toward patient autonomy, and physicians experiencing historically high levels of burnout and suicide, we cannot afford to burden ourselves with the illusion that we must be perfect in order to be credible.

Connect.  I think the healthiest response, for both patients and physicians, is for us doctors to acknowledge our own struggles; to empathize with the difficulty, the conflict, and the utter disappointment of not being able to control our actions and choices as we would like.  I think patients don’t expect us to be perfect.  But they do want us to be human and relatable.  I often find myself saying, “I know that feeling,” or, “Yep, that’s my weakness, too,” or, “Oh, and what about x-y-z?  That’s my problem!”  Only once has a patient said to me, “Shame on you!”  He was a perfectionist himself; I didn’t take it personally.

I stress eat. I eat when I’m bored.  I eat late at night, and I love sugar, starch, salt, and fat.  The struggle is real, and I know it all too well.  So when I ask you, “What small changes can you commit to in the next month?” believe me, I’m asking myself also.  And if you tell me something that has worked for you, I’ll probably try it.  I still think my ‘4 A’s of goal setting’ apply: Assessable, Actionable, Attainable, and Accountable.  I just haven’t found my 4A formula for eating yet.  But lately I have taken a more lighthearted approach to healthy eating trials.  Nothing is life or death, and I know iterative changes are best.  If one thing doesn’t work, hopefully I can learn something and move on to the next.  No dessert on weekdays.  Vegetarian on days I work.  No eating after 8pm.  No starch at dinner…  Meh, none of it seems to stick yet.  Even my cut-it-in-half strategy doesn’t appeal to me these days.  It’s so frustrating!  And it’s also okay, because I know I’m doing my best, just like my patients are.  We can all just take it a little more lightly, one step at a time.

So by the time menopause actually hits, I’m confident that I will be prepared to meet it, with grace and maybe a little irreverence.  I’m learning to judge myself (and thus others) a little more gently.  I’m learning to love my body, whatever shape it’s in.  After all, it’s the only one I’ll have this time around, and I need to maintain it for the long haul.  Turns out, my patients have been my best companions and consultants on the journey.

 

 

 

 

“Friendversary”

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It’s all worth it, hallelujah!

Those of you who read this blog regularly know that I spend inordinate amounts of time on Facebook.  I struggle with the balance–hours spent face to phone reading articles, engaging with friends over politics, healthcare, and nature photos, and also work, chores, and quality time with the family.  One of the people I interact with most meaningfully online is a high school classmate.  He and I were friendly acquaintances back then, and I assumed at graduation that I would never see him and most of my classmates again.  I will call him Al.

A while ago, through a mutual Facebook friend, I saw a post by Al saying that he wished to have civil conversations on politics with people who did not share his views.  I immediately sent a friend request, which he promptly accepted.  My rule is that I will be friends with people on FB who are already my friends, or with whom I want to actively cultivate friendships.  Al was definitely the latter, based solely on his proclaimed desire for civil discourse.  This week was our two year Facebook Friendversary.  I know because he shared the notification, which I had not received.

In the first year our exchanges could be awkward, and sometimes felt tense (on my end).  I noticed that while I often asked him to elaborate on his thoughts and positions, he rarely asked me.  I often felt unheard and lectured to.  I considered giving up on the relationship.  Why bother, I thought, we live in separate states, we disagree on everything, and it’s just too stressful—I’m not even sure he cares what I think.  A year ago I posted about a conversation we had about white male privilege.  I decided to maintain our online friendship because despite the tension and discomfort, the exchange had given me new insights into managing the tension and discomfort.

These two years we have discussed transgender bathroom legislation, affirmative action, unconscious gender bias, racism, and climate change, among other things.  We have always been civil, and conversations feel more relaxed and congenial these days.  Al types more words now than he used to, he asks me what I think about things, and has expressed more consideration for my point of view in this second year.  It moved me when he wrote that when his coworker came to work distraught and crying over the presidential election, he hugged her.  [For the record, my friend is a Republican and not necessarily a Trump supporter.]  Throughout our intereactions, I have always remembered my fundamental assumptions of this man, whom I don’t actually know that well: That he is a kind and honest person, that he wants all people to enjoy happy, healthy lives, that he has natural unconscious biases as I do (and these do not make us bad people), and that he is sincerely interested in my point of view.

Our most recent exchange almost brought me to tears because I finally felt fully seen, heard, and understood by this person who barely knew me 25 years ago, lives 800 miles away, and whose life experiences lie surely on the other end of any spectrum from mine.  I share the thread below.

So many people decry social media, and rightfully so.  It’s too easy to descend into mindless flaming and impulsive ad hominem attacks from the safety of a screen and keyboard.  And I still struggle with the time sink and distraction.  But today I feel good about my SoMe usage.  To me, this two year, ‘virtual’ friendship I have cultivated feels as real as any other.  I hope Al feels similarly.  I look forward to the next two years and beyond on Facebook, and perhaps an in-person encounter in the foreseeable future.

***

On Being Wrong

CC:  OH MY GOD YEESSS!!
If you are serious about or remotely interested in self-awareness and connecting better with your fellow humans, understanding this idea, even if only intuitively, is a fundamental requirement.

https://wwwted.com/talks/julia_galef_why_you_think_you_re_right_even_if_you_re_wrong

[Julia Galef’s TED talk on soldier vs. scout mindset, and how holding either influences how and whether we examine our beliefs]

 

AL:  Have you seen this?

https://www.ted.com/talks/kathryn_schulz_on_being_wrong

[Kathryn Schultz’s TED talk on embracing our fallibility]

 

CC:  I have not!  Will view soon!

AL:  I eagerly await your thoughts on it. It’s dang near life changing.

CC:  I watched it! And I will happily tell you my thoughts, but since you posted it and made the ‘damn near life changing’ claim, I request that you go first. And if you could also comment on the talk from the original post–feel free to go all expository–that would be great, also! I promise to reply in kind!

AL:  It was the line that feeling wrong is the same a feeling right. And the idea at how unreliable your feelings are. But I really like questioning one’s sense of rightness.

CC:  Follow up question: how has this talk changed your own approach to ‘feeling right,” or how you engage with people with whom you disagree?

AL:  I can’t say I’ve completely abandoned my feeling of rightness. It’s just so nice to feel right. But I try to loosen my grip on the feeling of rightness and make fewer assumptions.

CC:  Thank you. I hear you, it is so delicious to feel right–to feel *righteous*… And I like this, “loosen my grip on the feeling of rightness” (and righteousness?). What assumptions are you making less, may I ask?

AL:  I can’t think of general areas right off the top of my head. But more often than before I try to remind myself I don’t have all the facts and there could be something I don’t know. This has to do more with interpersonal interactions. Like I try not to act on my initial assumption of someone else’s motivations.

[I ‘loved’ this reply]

 

CC:  I am not sure you could ever know how happy it makes me to read this. This is all I ever want from people–to just slow down, withhold judgment *a little*, especially about one other’s motivations. It has taken me too long to learn that everybody has a unique and VALID personal story, and that elements of that story always influence how we approach any problem or circumstance, for better or worse. The more open we can be to one another in this way, the fewer and less contentious our conflicts will be, I am CONVINCED. And, it’s sooooo much easier said than done. And, the first step is an awareness of its importance. The second step is an intention and commitment to practice, no matter how many times we fail, and/or others fail. I have to go see a patient now… Maybe I’ll write more. But really, I’m almost in tears right now. I feel vindicated, in a way. Thank you.

[Al ‘loved this reply.]

Everyday Power and Influence

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If you wonder how physicians think and feel, about anything and everything related to medicine, healthcare, economics, parenting, relationships, and life in general, check out KevinMD, an expertly curated blog by physicians all around the world.  I recently read a heartening and important piece on gender equality in medicine.  A pediatrician husband wrote about the stark differences in assumptions about work-life balance for men and women, in “What Does Your Husband Think of You Being a Surgeon?”  Then I came across another article by a male cardiologist, whose wife is also a physician, entitled, “The Gender Gap in Cardiology Is Embarrassing.”  Both men’s wives delayed their medical training, and these husbands bore witness to our culture’s implicit gender bias against their life partners.  I strongly encourage you to read both pieces; they are short and poignant.

—- Please click on the links and at least skim the articles, before continuing here. —-

Now, consider how much more weight and influence these pieces carry, simply because they are written by men.  If you find this difficult, imagine your internal response if they had been written from the women’s perspectives.  Which position is more likely to evoke, “Hmm, interesting,” as opposed to, “What are these women whining about?”

When we consider advocacy, it’s fair think of it as those with more power and influence using these advantages to champion those who have less.  Sure, the less powerful and influential can and do advocate for themselves, but without allies among the advantaged, the message and movement stall and stutter.  Consider slavery and the Civil Rights Movement.  If it were only ever black people advocating for themselves, what would the American racial landscape would look like today?  Think about women’s rights.  There is a reason the United Nations launched the HeforShe campaign.  Self-advocacy is required, but sorely inadequate, to lift people out of oppression.  And let’s be clear: oppression takes many forms, which we often fail recognize or acknowledge.

I have a fantasy about patients advocating for physicians.

I imagine Sally and John*, two friends communing at their favorite coffee shop, one of their regular meetings of mind and soul.  The conversation veers toward healthcare, and Sally starts ranting about how physicians don’t care about patients anymore.  They’re only in it for the money, having sold out to pharma and industry, and they think of themselves as second only to God him(her)self, exercising control over patients’ lives with little regard or actual caring.  In this coffee shop scenario, I as physician have no power or influence.  If I sat there with them, trying to explain how ‘the system’ drives wedges between us doctors and our patients, about how on average doctors spend twice as much time on administrative activities as patient care activities, how 50% of us report burnout, and how our suicide rate is up to 4 times that of the general public, I estimate that I’d likely be seen as whining and making excuses.  In this scenario, facing a (rightfully) prejudiced audience, my voice counts for very little.

Although physicians still enjoy a fair amount of respect and deference in society, our struggles, personal and professional, are still poorly understood by the general public.  I think people are even less cognizant of the insidious and profound detriment that physician burnout and depression have on patient care and the economy at large.  But when doctors describe our adversities to patients, I think we still come across as whining.  Knowing that I write this as a physician, what is your reaction?  Is it closer to, “You live at the top of the food chain, what are you complaining about?” Or rather, “Wow, what’s going on that so many doctors feel so badly, and how could we all help one another?”

Lucky for doctors everywhere, John is my patient and we have a longstanding, collaborative relationship.  He empathizes with Sally’s perspective, as he knows what she has been through medically.  He has also inquired about my work, and understands the systemic frustrations that physicians face in all fields.  Because they are such good friends, John feels comfortable challenging Sally’s skewed assertions.  He describes what he has learned from me, and explains earnestly that all doctors are not, in fact, swine.  Because he is her trusted confidant, she believes him.  Her attitude opens ever so slightly, and she is more likely to acknowledge how physicians and patients alike suffer from our overall healthcare structure.  John is, in this case, the strongest advocate for me and my ilk.

Whenever one of us stands up as a member of a group, and speaks up to our peers on behalf of another group—white people for black people, men for women, Christians, Jews, and Muslims for Muslims, Christians, and Jews, liberals for conservatives, physicians for patients, and vice versa in each case—we are all elevated.  Our mutual compassion and humanity are called forth to heal our divisions.  This is how personal advocacy, how everyday power and influence, works.

As a patient, you have more power than you may realize.  I bet most people don’t necessarily feel adversarial toward doctors.  But they probably don’t necessarily feel allied, either.  What can you, as a patient, do to bridge this gap?  How else could we all, physicians and patients alike, create that essentially healing inter-tribal connection?

*Hypothetical friends