Tag Archives: communication

Healing Through Connection

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“How did you get to be so kind, generous, compassionate, empathetic, self-aware, thoughtful, and creative?”

I asked this of someone I admire recently, and then considered all the other people I know and admire to whom I’d ask the same thing. Knowing what I know about their lives, here is my story.

We emit and express these qualities from at least two origins:

First, we have felt them from other people. We were open to and received kindness, compassion, empathy, thoughtfulness–love, basically–from fellow humans. It was role modeled to us. Second, we experienced challenges, struggles, and pain that taught us the value and importance of having this love in our lives. As I think more, these experiences–feeling loved and supported in times of crisis and pain–integrate to make us stronger and more resilient, more grounded in ourselves and open to relationship with others. This is the essence of Healing Through Connection.

Consider the folks you know who exude these qualities. I bet you could easily describe them as Strong and Soft, vulnerable and courageous, with a depth, mass, and volume that can hold space and tolerance for a wide and divergent field of ideas and experiences, even and especially conflicting and paradoxical ones. They are the ones we seek when we long to feel this wideness, this grace.

Then I think about how the opposite happens: When in times of existential crisis and pain we feel isolated, unperceiving of love and support. Just thinking about it evokes a deep sadness, an instant recognition of profound loneliness that seeks immediate relief. What is this dynamic? How does it happen that someone faces pain and struggle truly alone and devoid of kindness, empathy, compassion, and grace–of any connection–shown to them? I know it happens, and I am likely guilty of ignoring or simply being oblivious to other’s struggles as I go about my own busy life.

So when I come across someone who exudes the opposite of kindness, empathy, compassion, generosity, openness, and grace, what story do I tell about that? How does my story, told subconsciously and automatically, then affect and even dictate how I show up to that person? How might I modify and optimize my default story to then raise the likelihood that I will interact with this person in a way that connects and heals?

We’re living in tumultuous and fraught times, friends. The stories we tell about one another, the presence or absence of love in our daily encounters, matter more now than ever. Look around you for the role models. See how they move through life with ease and joy, resilience and hope, optimism despite everything. Observe them, query them, emulate them. Feel the rewards of connection with them, and amplify that.

It’s never too late, and no action is ever too little, to Heal Through Connection.

Tribal Pride and Tribalism

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NaBloPoMo 2017: Field Notes from a Life in Medicine

What tribes do you belong to?  How do they serve you, and you them?  How not?

I think of this today as I have traveled out of state to speak to a Department of Surgery on physician well-being.  I wonder how often they have internists present at their Grand Rounds?  What a tremendous honor, I’m so excited to be here!  I hope my talk will be useful and memorable, as I represent my field and my institution, in addition to myself.  In the talk I describe the central tenets of Tribal Leadership and culture, and how to elevate ours in medicine.

So I’m thinking tonight about tribal pride and tribalism—the benefits and risks of belonging.

We all need our tribes.  Belonging is an essential human need. To fit in, feel understood and accepted, secure—these are necessary for whole person health.  And when our tribes have purpose beyond survival, provide meaning greater than simple self-preservation, our membership feels that much more valuable to us.  But what happens when tribes pit themselves against one another?  How are we all harmed when we veer from “We’re great!” toward “They suck”?

Of course I’m thinking now of intra-professional tribalism:  Surgery vs. Medicine vs. Anesthesia vs. OB/gyne vs. Psychiatry.  Each specialty has its culture and priorities, strengths and focus.  Ask any of us in public and we will extol each other’s virtues and profess how we are all needed and equally valuable.  Behind closed doors, though, internists will call orthopods dumb carpenters; surgeons describe internists’ stethoscopes as flea collars, and the list of pejoratives goes on.  Maybe I’m too cynical?  My interactions with colleagues in other fields are usually very professional and friendly—until they are not.  I have experienced condescension and outright hostility before.  But can I attribute it to tribalism—that general, abstracted “I’m better than you because of what I do” attitude—or to individual assholery?  Or maybe those docs are just burned out?  As with most things, it’s probably a combination.  Based on what my medical students tell me, negative energy between specialties definitely thrives in some corners of our profession.  Third year medical students are like foster children rotating between dysfunctional homes of the same extended family—hearing from each why all the others suck.

So what can we do about this?  Should we actively police people’s thoughts and words in their private moments?  I mean part of feeling “We’re Great!” kind of involves comparing ourselves with others and feeling better than, right?  Isn’t some level of competition good for driving innovation and excellence?  Should we even embrace this aspect of tribal pride?  It certainly does not appear to be diminishing, and I have a feeling it’s just human nature, so probably futile to fight it.

I wonder why we have this need to feel better than.  Is it fear?  A sense of scarcity?  As if there is not enough recognition to go around?  Like the pie of appreciation is finite, and if you get more I necessarily get less?  Intellectually we recognize that we are all needed, we all contribute.  But emotionally somehow we still feel this need to put down, have power over, stand in front.  And it’s not just in medicine.  I see it in men vs. women, doctors vs. nurses, liberals vs. conservatives, and between racial and ethnic groups.  It makes me tired.

But maybe we can manage it better.  Maybe we can be more open and honest about our tribal tensions, bring them into the light.  Yes, I think surgeons can be arrogant.  And that’s okay to a certain extent—it takes a certain level of egotism to cut into people, and when things start going wrong in the OR, I think that trait can help make surgeons decisive and appropriately commanding when necessary.  I imagine surgeons get impatient with all the talking we internists engage in.  So many words, so little action, they might think.  And yet they understand that words are how we communicate with patients, how we foster understanding and trust.  Maybe we can all do a better job of acknowledging one another’s strengths and contributions out loud and in front of our peers (and learners).  The more we say and hear such things, the more we internalize the ideals.

Tomorrow I get to spend a morning with surgical attendings and residents.  I hope to contribute to their learning during my hour long presentation, but I really look forward to my own learning, to expanding my understanding and exposure to parts of my profession that I don’t normally see.  I’m humbled at the opportunity, and I will look for more chances to bring together colleagues from divergent fields.  If we commit, we can connect our tribes and form a more cohesive profession.  That is my dream for future generations of doctors—to be freed from infighting and empowered to collaborate at the highest levels, for the benefit of us all.

 

I’m the Doctor, You’re the Doctor

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NaBloPoMo 2017: Field Notes from a Life in Medicine

“I’m the doctor, just do what I say.”  I don’t think doctors actually say this anymore, but I wonder how many of us think it?  It’s probably not even a conscious thought, but rather an attitude—paternalistic and directive, a relic from the old days when patients had no power or voice in the relationship because the doctor held all the information and all the expertise.  Today patients are empowered by culture and the internet to participate in shared decision making , and it’s a good thing.

The problem with the “I’m the doctor” attitude is that it inhibits the patient from owning their own healthcare choices.  Then if and when the care plan goes badly, they feel rightly justified blaming the doctor, because they were just following orders.  Sometimes it’s necessary, like in the case of trauma or serious surgery, where the doctor is truly in charge and must make life or death decisions according to their expertise and judgment.  Thankfully this is not my work.

In primary care, if I take this attitude, I miss an opportunity to forge a collaborative and rewarding relationship with my patients.  If I simply issue orders, people don’t feel seen or heard, and they may withhold important information that would help me make a better, more relevant diagnostic and treatment plan.  And if they defy my advice (edict), as they are more likely to do when our relationship is transactional and cookbook, and things go well, then I lose credibility and they are even less likely to follow my advice in the future.

“You’re the doctor,” on the other hand, is something I hear often.  It usually comes up when patients (and I) are faced with decisions involving competing interests or vague risks and benefits.  An example is prostate cancer screening.  Guidelines over the years have ranged from screening every man, every year, starting at age 50, for life, to don’t screen anyone ever.  Most physicians and professional societies agree currently that the best approach is to discuss risks of screening (over-diagnosis, harm from testing in patients without disease) and not screening (missing early cancer, delayed diagnosis, possibly leading to preventable negative outcome), and make decisions based on patients’ individual values and goals.

When a patient in this or a similar situation says to me, “You’re the doctor, just tell me what to do” alarms ring my mind.  What I intend to be a shared decision suddenly falls to me to make unilaterally.  In this scenario, the patient essentially cedes responsibility for the treatment plan, and if it goes badly then it’s my fault “because you told me to.”  Or the patient may choose to ignore my directive and also blame me because “you told me to but I disagreed.”  Either way a patient may then feel justified to blame me for any negative outcome, even though I gave them what they said they wanted.  I understand that this is not how the scenario necessarily plays out, but somehow I’m wary of it.

I had my teeth cleaned today.  The dentist recommends x-rays every year; I politely decline most of the time.  I just don’t understand (or accept?) the rationale and benefits of annual radiation to my face, and I’m cynical about the fee-for-service structure in which providers make more money for ordering more tests (which is a legitimate concern in medicine, also).  Without explaining why it’s recommended for me particularly (it was explained later), I heard, “Well, it’s okay if you don’t do it today, but you have to do it next time.”  [Expletive, not stated out loud.] I am emotionally triggered when people try to tell me what to do without asking me what I think about it first (see my post from 2 days ago).  So I bristle when I witness colleagues doing it, or when my patients demand it from me.

I don’t see my job as telling people what to do—I am not a surrogate.  Rather, I think of myself as consultant and guide, expert, counsel.  It’s my job to discuss, explore, explain, review, consider, negotiate, compare, assess, debate, explain and discuss again, and then make a shared decision.  This includes follow-up and contingency planning, setting expectations, and reassurance about my commitment to the person, regardless of the problem.  I’m the doctor, you’re the patient, we are a team.  We are in this together.