Exploring the Rules of Engagement: A New Blog Series

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The Descent and the Rising

The past two weeks have assailed, masticated, consumed, digested, and expelled important parts of my psyche.  A week after basking in peaceful solidarity at the Women’s March, I found myself losing sleep and breaking out—both signs of acute distress.  My mind swam with questions of identity, purpose, and action.  I wrestled with fears around policy, violence, and integrity.  All of a sudden I wasn’t enough, I wasn’t doing enough.  Resist!  Call your representatives now!  Support this march and that protest!  And on the internet, rage escalated everywhere.

I read this article, which I highly recommend, on how to stay engaged and not lose your mind.  The author recommends that we focus our actions on one or two issues, and gives useful self-care tips.  After a few days, I was surprised to find that no particular issue moved me enough to passionate advocacy.  I began questioning my dedication.  But thank God for therapy (which the author also recommends), hallelujah!  I had a breakthrough in session last week, wherein I realized that I am, actually, enough.  And I do actually affirm one key interest: Relationship.

Duh.

For me, it’s less about specific issues than it is about how they’re addressed.  While generally I favor a progressive social agenda, I abhor the entrenched, partisan, winner-takes-all attitude that infects our government operations and civic discourse.  I also deplore the rhetorical, broad brush generalizations that people make about one another, based only on how we voted or an oversimplified position on one issue.  I wrote about this recently, though I buried the thesis in what should have been a separate discussion of healthcare reform.

Looking back, of course, relationship and communication have always been my core concerns—I launched this blog specifically to discuss them, for crying out loud!  Over and again I find myself in the role of mediator—between family members, Chinese and American culture, conventional versus alternative medicine, and between patients, physicians, and the healthcare system.  My whole life I have practiced, sometimes under duress, the art of mutual understanding and negotiation.  Maybe I’ve just been training for this moment in history.

How Talking Politics Is Like Eating Healthy

We could all learn and apply better practices.  We know the theories—more vegetables, less judgment, whole grains instead of processed, less name-calling and more calm, reasoned debate.  But so often the opposite happens:  junk food, sugary sodas,  pointless shouting and blaming—especially on social media.  We feel ashamed and frustrated at the futility of it all.  We figure screw it, I’ll never change (and neither will they), so why bother, it’s too much work, and anyway, it’s not the end of the world.

Never mind that your rising blood pressure and glucose accelerate the formation of atherosclerotic plaque each passing year, and that your risk of dying from a heart attack or stroke escalates exponentially as a result.  Never mind that the less we engage one another in meaningful ways, the farther apart we drift and the more we allow the most extreme factions of our parties to run the show.

The Challenge

In the coming weeks, I will share my own key learnings on healthier engagement practices.  I make no claims to have all the solutions, and I do not mean to be preachy.  These posts will serve mainly as reminders to myself, aspirational pieces to hold my own feet to the fire, marshaling my highest ideals of thought and behavior.  I will try to minimize promoting my own political views, though I suspect they will surface one way or another.  I hope you will follow with an open mind, and a heart that yearns to connect with the best of humanity, especially in those with whom you may disagree.

I’ve said it before and I’ll say it again:  It’s our relationships that save us.  Right now they desperately need repairs.  So let’s get to work.

An Aside

Hello friends.

Though I intend not to make this blog political, it’s more and more clear to me that I cannot exclude my social and political views from this forum.  If I am to be an authentic  writer, I must disclose certain values and beliefs that I hold dear.

My personal and professional missions are to maximize open communication, mutual understanding, shared vision, and collaboration for common good (basically world peace) between all people.  It will take my whole life to find and try different paths to that goal. Today I tried a new one for me.  It felt powerful, and I’ll reflect for a while on the experience.  Below are my initial impressions.

I marched with an estimated 150,000 people in Chicago today, a sister event of the Women’s March on Washington.


* * *

Beautiful day for marching.
The energy was positive, strong, and welcoming. It’s not every day that we get to participate personally in an actual, physical expression of a movement. I’m so glad we went.
I hope this day can be remembered in history like Woodstock–gatherings of people in peace, more to express what we are for than what we are against. Because we marched today FOR inclusion, solidarity, generosity, and the dream of a peaceful life for everybody.

Acts of violence, intolerance, hatred, or contempt by any of us marchers, regardless of the circumstances, would undermine the message and wreck the credibility of the movement.

Onward.

from a friend’s Facebook page…

Inspired

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…by a friend of a friend.

It’s okay to lament the darkness. Grief is normal and healthy.

But then go get a candle and light it.  Then go about lighting other people’s candles with yours.

The best part is, the light just multiplies. Your light shines no less brightly for giving some away.

And pretty soon darkness gives way to all of our light.

Peace and hope, friends. 

Inaugural Intentions

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Things are feeling a bit dark again…  Reminds me of October, when I got emotionally hijacked by current events and found myself anxious and angry, but wouldn’t admit it for a while.  On the eve of a new presidential administration taking office, tensions run high once again and I’m challenged to avoid a similar decent into despair.

It really helped to take the Holiday Break and write to my friends.  I did it by hand, with colorful pens, stickers, and rubber stamps (I love rubber stamping).  I intended to connect more personally, and that’s exactly what it felt like.  As I see and hear expressions of fright, dread, sadness, anger, and pessimism among them, I intend to continue corresponding by pen and paper.  There’s just something more tangible about it, more intimate and permanent than email, text, or Facebook.  I have included excerpts below—the ones that felt particularly inspired.  They represent my intentions for managing myself in the coming years, of reinforcing my core values and focusing on my highest aspirations.  As Simon Sinek posted once:  “Fight against something, we focus on what we hate.  Fight for something, we focus on what we love.”

To my friends who have expressed, “get over it,” and “stop whining,” I respectfully request that you try to empathize with those of us who feel despondent.  Nothing will improve if we keep ridiculing and belittling one another.  If you experienced this from ‘us’ before the election, remember how it felt.  Rise above our worst collective behavior and help us overcome our fears and disappointment by showing us that we really do share more love and connection than we might think.

Unity and true indivisibility require all of us to pitch in and reach out.  I hope that by one year from now, we can all look back and feel proud of the connections and relationships we strengthened, from left to right and otherwise.

***

What a crazy year…  All bets are off, no one can possibly predict what will happen now—so much anxious uncertainty surrounds us all over the place!  …And yet I feel hopeful and optimistic.  This is the time for our best selves to truly shine—the perfect opportunity to call on everything we have trained for—all of the grit, the kindness, the curiosity, the openness, the brave vulnerability~~~all of it, in service of connection, mutual understanding, and forging a way forward to a BRIGHTER future!  Because we now know, again, in humanity’s history, what darkness looks and feels like.  We can’t stay here, and we won’t—we can each shine a light.  And if we stand close, the light amplifies exponentially.

So thanks for being a fellow light shiner, (my friend)!  May we keep our connections with each other and our other fellows ever close—we need us—the world needs us—now more than ever!!  Keep it lit, my friend.

***

…Hope this card finds you well and HOPEFUL.

Because I have decided that that is what we all need to practice more now than ever—HOPE.  Those of use who strive for conscious living and more connection than the superficial have TRAINED for this moment in history—to PRACTICE OUT LOUD and IN FRONT of everybody—to lead by example and make the difference we were born to make!  We don’t need to do big things—we just need to keep the faith and stay the course!

’Small things with great love,’ I think Mother Theresa said?

Please know I am here to support your efforts, as I know you are for mine!  Let’s get together and hold each other up again soon!

***

…Because I know so many people whose core values represent the BEST of our shared humanity—equality, compassion, community, connection, love, and forgiveness.  The world needs these qualities and practices by us more now than ever—so if we hold each other up, we’ll all be able to do the work better—TOGETHER!!  So here’s to long friendships and deep love!

***

I received this handwritten response from an old friend today.  It warms my heart and holds up my hope:

“While we may snarl a bit at anticipated political shenanigans, let us remember we have strength in numbers and determination to keep life in this country respectful and fair—simply by the ways we live and interact.”

***

And finally, I’m also encouraged that our international leaders express a similar optimism:

Angela Merkel: “I am very much convinced that we as partners benefit more if we act together than if everyone solves problems for themselves, and that is a constant fundamental attitude on my part.”

Peace to all of you, dear friends.  Let us manifest our best every day.

Getting Past ‘You Suck’ as Dialogue

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Hello again friends, and Happy New Year!  It feels good to be back.  Diving right in with long form again…

This recent article from Wired got me thinking (again), there are so many layers and moving parts to healthcare reform, that no one player stands to lose all or benefit all from any changes.  And yet so much of what we read and hear has an, ‘it’s so simple, they just don’t care about you, but I do’ tone.  The piece describes why insurance companies, who may have advocated most fervently against implementing ACA regulations, actually have a stake in maintaining its current status.  Nothing in our healthcare system is black or white, all good or all bad.

So when I see politicians (and friends) speaking and writing in oversimplified sound bites, and vilifying a whole group (all liberals, all Republicans) over one aspect of their point of view, it really frustrates me. That is exactly the opposite of productive dialogue.  It just makes people stop listening, because they don’t feel heard or understood.  So they have no incentive to hear or understand you.

Many use the car insurance analogy to explain health insurance.  It’s not exactly parallel, but it makes some sense.  The law requires every car to be insured.  (Drivers of) cars that don’t violate traffic law get lower premiums, the longer they stay ‘safe.’  The more traffic law violations, the higher the risk, the higher the premium.  I have an actuary friend, who works for a health insurance company, who advocates, in part, for higher premiums for those who ‘use’ the healthcare system more—like the higher risk cars (drivers).  I understand this logic.  But this idea of making older and sicker people, and women pay more, just because they ‘use’ the system more (and thus financially speaking cost more), does not sit well with me.  People are not cars.  Not everybody maintains their cars well.  But poorly maintained cars do not necessarily lead to increased accidents and traffic law violations.  Poorly maintained health often leads to a human body’s multi-car highway pile-up equivalents.

My friend advocates for insurance coverage for catastrophic care (also aligned with the car insurance model), but not necessarily for preventive or primary care.  There are different ways of ‘using’ the system. If you get preventive care, like recommended cancer screening and annual exams, it may cost more at the time. If you seek help for your back pain early, from your PCP, chiropractor, and physical therapy, that costs money.  But if these early interventions prevent future, more catastrophic and costly outcomes, should we really penalize those who make them?  Illness and infirmity come with age.  So, often, do fixed incomes.  Is it right to make our elderly pay more for their care?

There are costs and benefits to care other than money, which is where health insurance and car insurance diverge sharply, in my view.  I know they are harder to quantify and assign, but they matter.  That secure feeling that I can get care when/if I need it, that my children and I have access to professionals dedicated to my health and well-being, a sense that in our society, I matter just as much as the next person, regardless of my net worth—these things all matter.  Each individual’s health or illness contributes synergistically to the health or illness of a society.  A mother’s depression, untreated and uncontrolled because her health plan does not cover mental health services, can negatively affect every aspect of her and her children’s lives, emotionally, physically, financially, and socially.  We cannot only look at healthcare on dollar spreadsheets of ‘use.’

Maybe it’s about priorities and philosophy—ideology?  Do we feel all people have an equal right to equal care, or do we differentiate what people deserve based on particular group memberships or other characteristics?  Do we feel we should only be responsible for ourselves, or are we called to look out for one another?  I personally believe in equal access to care and ‘look out for others as yourself.’

I also believe that people need to understand–personally and concretely–that everything does cost money, we all pay for one another’s use (and disuse, and misuse) eventually, and more care is not necessarily better.  So I understand and partially agree with my friend’s argument that people need to have ‘skin in the game’ to control overuse of services for no benefit.  One great example is end of life care.  I like this article from Fobres, which describes the conundrum succinctly:

According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life.  I know there are other studies out there that say slightly different things, but the reality is simple: we spend an incredible amount of money on that last year and month.

Dr. Susan Dale Block, Chair and Director of Psychosocial Oncology and Palliative Care at the Dana Farber Cancer Institute and Brigham and Women’s Health Care, recently shared some data with her colleagues.  In the Archives of Internal Medicine, a study asked if a better quality of death takes place when per capital cost rise.  In lay terms … the study found that the less money spent in this time period, the better the death experience is for the patient.

 
Cost, longevity, quality of life, quality of care, value, perceptions, public health—these and other aspects of health and medicine are all inextricably enmeshed, though definitely not integrated.  Any decisions about one must be made in the context of all the others, carefully, transparently, and honestly.  Whenever we hear, ‘if we just do this, everything will be better,’ red flags should fly.

I wrote the first draft of the paragraphs above on my Facebook page.  I ended the post with, “So let’s each educate ourselves on the facts, as well as we can, and try to look at the big picture. It’s so messy.  And it’s what we’ve got, so let’s deal with it–with maturity, patience, professionalism, and equanimity.”

Another friend, a fellow liberal, commented, “This has nothing to do with healthcare. It’s about reducing taxes on the wealthy, reducing benefits for the poor, and denying the democrats credit for anything good. If they actually cared about healthcare, they would fix the obvious problems with the ACA. And because the ACA was the republican plan, they will continue to tie themselves up into pretzels to disown it and put something else in place. That being said, I hope the American people continue to demand access to affordable healthcare for all. It’s a right, not a privilege.”

I had to reply: “(My friend,) I understand your point of view, and I share your passion for equality.  But your statement exemplifies exactly the broad brush, ‘you suck’ attitude that I see holding us all back.  I refuse to believe that all Republicans are only motivated by making the rich richer, and that none of them care anything about the poor, as so many of us on the left say.  We must extricate ourselves from this destructive narrative and learn to hold space for everybody’s complex views and experiences.”

My point here is that nothing is as simple as we’d like.  It’s so much easier to blame those who disagree with us for being stubborn, selfish, or evil, than to cope with the discomfort that our system is deeply flawed, there are no easy answers, and our fundamental philosophical differences make it that much harder to agree on the best way forward.  And yet, this is what we are called to do.  It’s up to each and every one of us to change our language.  Each of us has, I believe, the opportunity and the responsibility to create an environment in which open, respectful discussion and debate are the norm, rather than echo chambers and verbal warring.

I am only one person.  I have no designated leadership titles or widely visible platform.  But my words have power.  So do yours.  Please use them wisely.

 

A Holiday Break

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Happy Holidays, friends!

December flies, does it not??  What is it today, the 18th?  Holy cow!  The kids are off for winter break, holiday greetings have overtaken snail mail (Yippeeeee!!), and now that NaBloPoMo has concluded, I am back to scrounging for blog post topics again.  How fascinating…

2016, what a long, strange, CRAZY trip!  The moments (periods?) of shock and disdain stand out, but there were also times of profound inspiration, learning, and connection.  2015 did not see any holiday greetings from us, a lapse after at least 15 consecutive years of not only composed letters with photos and personal notes on every one, but also often a craft of some sort.  I was just overwhelmed with other stuff to do, though now I can’t recall what all that stuff was.  This year I contemplated the annual year-in-review letter.  I have also proofed a bookmark on vistaprint.com.  But the mass-produced, conveyor belt greeting feels unsatisfying right now.

We have all witnessed the escalating anger, division, and destruction of relationships, both individual and between groups, these last 12 months (really, much longer?).  The emotional hijacking took me over for a while, too.  After all we’ve been through, I feel an urgent need to connect with friends and loved ones more intentionally, personally, and directly.  Many on my ‘list’ have known me most of my life, and I want to take time to write to them.  I used to write them all the time–I went to college with 100 postage stamps freshman year, and used them all.  I feel a need to tell people one by one this year how much they mean to me, how they have shaped the person I am today, what I admire about them, how I see them contributing to our world.  I want to encourage them, hold up their optimism and hope.  Most of all, I mean to reinforce my connections with them, so we may all help one another soldier forth in a world of increasing uncertainty.

We cannot control what others say or do.  But we can call out the hatred, illuminate and inform the ignorance, and stand up for core values of love, connection, inclusion, equality, compassion, and justice.  We can do this all the better if we support one another in action.  That support must be cultivated, tended, and protected.

So I’ll take a break from regular blogging for a while, to write by hand (with fun-colored gel pens on cute cards, and lots of stickers).  We’ll see if I break my tardy record for holiday greetings, St. Patrick’s Day…  I think it’s okay–never too late to make a meaningful connection.

Please share your intentions for the new year here, if you like–the community I have found here lifts me every time I open the window or the app.  Thank you for your engagement and encouragement, and Best Wishes to you all this season!

 

 

On Journeying Together

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NaBloPoMo 2016, Letters to Patients, Day 30

To Patients Who Journey With Me:

It is my privilege and my honor.

Well here we are, my friends, we made it!  30 posts in 30 days, woooo hoooooooooo!!

I had 30 topics all lined up on Halloween, and I think I used 6 of them.  How fascinating!  Looking back, I’m pretty proud of the content this month.  It all came from places of true feeling and contemplation, and I tried my best to make it relevant to the physician-patient relationship.  I meant to write more cogently about policy and operations, maybe illuminate more of the physician’s experience, to help patients understand our perspectives.  I wonder if that is more appropriate for long form writing, or even not writing at all, more like panel discussion or podcast?

Some of you have followed, liked, and commented all the way through—thank you so much.  After all, what is a blog if nobody reads it?  The feedback has held me up and kept me going.  It’s not so different from my relationships with actual patients.  Some are superficial and short-lived.  But most have a true human connection, and potential for integrative growth over time.  My heart is warmed whenever you inquire about my children with genuine caring.  When you remember my extracurricular projects and congratulate my successes, I feel respected.  Heck when you just notice that my hair is longer, I know you see me!

Believe me, I’m not in this just for the science, or the money, or the prestige, or the teaching.  I’m in this to know you, my patient—and for you to know me.  I know there are some who see me as expendable, exchangeable.  Their interactions with me feel purely transactional.  And that’s okay; everybody needs something different.  But I could not long survive a practice of only such relationships.  No, that would kill my soul for sure.  I live for the connections, I say.  I learn from every one of you, and you make me better.

So thank you for journeying with me.  It’s a long, strange trip, eh?  The path winds, the weather shifts, and times change.  But as long as we go together, I’m all in.