Category Archives: relationship

Gratitude, Generosity and Peace

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How does gratitude serve you? When someone expresses thanks to you, how do you feel? When you feel genuinely grateful to someone, what do you do?

Recently Dan Rockwell posted on his blog, Leadership Freak, on gratitude. He writes:

“Ungratefulness spoils everything it touches.

“Ungratefulness slithers out of a black muck that’s called, ‘don’t like,’ ‘don’t want,’ ‘don’t have,’ and, ‘not enough.’  There is no positive side to the slimy beast of ungratefulness.”

This post reconnected some dots for me between gratitude and generosity.

When I feel grateful, there is enough. I am enough. Even just saying the word, seeing it on the screen, brings me to a more peaceful state of mind and body. It brings to mind the people in my life—my parents, husband, children, friends, colleagues. I recall instances when someone went above and beyond to help me, or when they thought of me and took to the time to call or write. I feel humble. I feel connected.  I want to share what I have with others.

Maybe it was seeing the words of ungratefulness, ‘not enough.’ It reminded me of my favorite book, The Art of Possibility, by Rosamund Stone Zander and Benjamin Zander. The authors make a distinction between scarcity and scarcity thinking. Scarcity is when there actually aren’t enough resources to meet everybody’s needs; scarcity thinking is operating as if this were the case, when it really isn’t. Scarcity thinking at its best may foster healthy competition and innovation, and at worst, aggression, indifference, or even violence. In contrast, the Zanders discuss the notion of abundance. If we lived and operated in a world we assumed to be abundant, or at least enough for our needs, what would that look like?

For example, the woman parked down the street does not have enough coins to feed the meter. She asks me if I have change for a dollar. If money between us were actually scarce, then it would make sense to have an equal transaction—she gives me her dollar bill, I give her four quarters. In a world where we each need to look out for our own, we cannot afford to give anything away for free. But that is scarcity thinking, because I have spare change. Sure, I could spend those quarters to buy a candy bar later; or instead, I could trade them for human connection. If I stop even briefly to think about it, I know which one is the higher value purchase. But it’s not about buying gratitude from someone else.   It’s about the origin of generosity.

That peace that comes with thankfulness is the antithesis of scarcity. When I needed coins for my meter, and a stranger gives me her spare change, it shows me that there is good in the world. I can seek the help of strangers and they will offer it. And if that’s the case, how much more wonderful when I think of my amazing tribe of friends and family who stand ready to hold me up, as I do them? I feel safe. There is enough. So I can give away what I have today, because I know I will get what I need tomorrow, or whenever I need it.

When we practice gratitude, we practice peace. We exude it. It manifests in our expressions and actions. Gratitude makes us creative, by lifting the need to hoard and compete. We come together, collaborate, look for our common passions and visions. We offer more of ourselves to others because we have faith that they will do the same. We know because they did it before—that is why we are grateful.

For a much more eloquent and important view on gratitude, please read David Brooks’s most recent op-ed: http://www.nytimes.com/2015/07/28/opinion/david-brooks-the-structure-of-gratitude.html

Closing the Satisfaction Gap

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Speak the words “patient satisfaction” to any physician these days and stand back.  At best you may get an eye roll and/or an expression of disgruntled resignation;  at worst you may unleash a full-on rant about patient entitlement and how ludicrous it feels to be rated in the same way as servers at a restaurant.  Patient satisfaction survey data drives operational decisions in healthcare organizations across the country, for better or worse.  But what do these surveys mean for the patient-physician relationship?

What goes through your mind when you receive a patient satisfaction survey?

What moves you to fill in the dots, write comments, and then submit it?

What result do you expect from your response?

Do you think of it as communicating with the physician him/herself?

Or are you giving feedback to the organization as a whole?

Would you say to the doctor’s or the staff’s face the things you write in the survey comments?

Do you include your name?

Clearly we doctors feel great when someone writes, “She’s fantastic, I love her!” and “She always makes me feel comfortable and I feel like she really cares.”  Conversely, it’s very upsetting when we get “He’s a terrible doctor,” and “He doesn’t listen and makes me feel bad about myself.”  If someone said the latter about you, what would you think?  One of my first questions would be, ‘What do I do to make you feel that way?’  It’s relevant to both positive and negative feedback.  What do I do that makes you feel comfortable, and communicates caring?  What do I do that causes you to feel shame?  Consider this story:

Dr. Kairselott’s patients consistently wrote on their surveys that they felt rushed when seeing her.  This baffled her, because she prided herself on taking time with patients, looking them in the eye instead of staring at her notes, and making sure she came to each encounter thoughtfully.  Her superiors thought it odd as well, because they knew her to be a compassionate and dedicated physician.  But they felt they had to act on the data, and so admonished her to do better—take more time, don’t just hand the patients a prescription.  Dr. K felt indignant.  Her bosses were not in the room with her, they didn’t see how much she really engaged and attended to her patients’ needs.  She felt attacked, demoralized, and invisible.  She worried that if her patient satisfaction scores remained low, her income and reputation would suffer, and she felt powerless to change it.  What were these patients talking about?  Finally, one of them wrote:

“I really like Dr. Kairselott, but I feel rushed during my visits.  She’s always tapping her fingers on the desk, and it makes me feel like she wants me to talk faster, get to the point.  I end up not saying everything I want to say because I feel like she just wants to get out of the room.”

This patient gave Dr. K the best possible feedback: An objective observation about a behavior, her subjective interpretation of it, and its consequence for their relationship.  This is how we communicate evaluations to medical students on their performance in clinical rotations.  There is no reason why it should stop at the end of training; it’s just that the evaluators have changed.

Dr. K knew about her finger tapping habit, but had no idea of its effect on her patients.  It made sense, and she felt validated—she was, in fact, doing things right, and after gaining this new insight, she could take action to improve her patients’ experiences, and thereby her relationships with them.

Feedback can go both ways, too.  If I sense a patient disengaging, I can point out that his posture is turned away from me, he is not looking into my eyes, and his brow is furrowed.  I can tell him that I feel he does not trust me.  I can invite him to tell me what he’s thinking in the moment, and open the door to clearer communication.  Sometimes he will accept the invitation, other times not, and our relationship will proceed according to the path we choose to take together.

Medicine is more than a business; physicians are more than shop owners who want return customers.  When patients and physicians alike can approach patient satisfaction surveys as an opportunity to improve our relationships, rather than a forum to simply compliment or complain, then the surveys will truly fulfill their highest purpose.

The Best of Both Worlds

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I met my husband my second day on campus at Northwestern University, 1991. He started one year ahead of me; I met him in the bookstore. He was an established  molecular biology major, having years of laboratory research experience behind him already. I, too, decided to major in biology, but with a concentration in physiology. The micro and the macro–that may describe us in a nutshell: Both awed by the mysterious and yet completely logical ways of the body—the ultimate integrated system—but from opposite ends of the spectrum. We trained at the University of Chicago, that mecca of hard core basic science. Research and discovery of the fundamental mechanisms of disease—much of it at the molecular level—still thrills him, and leaves me positively lethargic. Show me how people transform health through relationships and beliefs, how the mind and body are connected in ways we cannot measure—that seizes my attention.

Today my husband specializes in orthopaedic tumors and joint replacement, and I do primary care. Much of his professional world consists of binary decision making: operate or not, the experiment proved the hypothesis or not. I like exploring multiple solutions for a particular problem, withholding judgment, and trying one approach at a time. Personally, he likes to be alone; I love people, the more the better! He makes decisions based largely on data and devoid of emotions, whereas I root my decision trees firmly in how I feel about the issue at hand. I seek color, texture, and meaning in everything around me; his needs are pragmatic, functional, and stoic.

And yet, what seems contrasting and opposed turns out to be, in every sense of the word, complementary. For the most part, we both balance objective and empathic information when making decisions. But when my emotions run high and objective data look fuzzy, he points out the practical implications of my choices. When he faces decisions that impact relationships, I help him identify core values that lead him to settle on one side of an issue with confidence. When both people in a relationship are free to be fully themselves, without fear of judgment or ridicule, their differences, and respective strengths, hold each other up.

The most interesting conversations we have about work revolve around teaching.  As a surgeon, his primary charge is to prepare his trainees to be technically excellent in the operating room, to carry out patient care decisions with confidence and resolve. Nobody wants a wishy-washy surgeon. My teaching focuses on fostering empathy, role modeling excellent listening skills, and showing students that no matter what specialty they choose, their patients will always need to feel seen, heard, understood, and cared for. In primary care, the old saying, “They won’t care how much you know until they know how much you care,” has explicit meaning. I like to think that because of me, my husband models more mindful interpersonal skills for his residents and students. And because of him, I try always to incorporate evidence and concrete, goal-oriented rationale in my decision making. We influence each other for the better.

The long-standing tension between surgeons and non-surgeons remains a fact of life in medicine today.  Stereotypes peg internists as ruminating and indecisive, and orthopaedists as dull-witted, mallet-wielding carpenters. This territorial, oppositional culture can be insidious and damaging.  How can we do best by our patients if we cannot get along ourselves?  In our ‘mixed’ marriage, I see us bridging this gap.  I hope it translates to better patient care. For ourselves, at least, it makes for interesting dinner conversation and a shared love for our work. And we would not have it any other way. Footnote: I first published this post on the American Holistic Medical Association blog in 2012.