Love Letter to My Superstar Friends

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Dear Paul & Joanne*,

I cannot tell you how grateful I am to you both for taking the time to meet me last week.  You came out in the pouring rain, not for a lighthearted night of drinks and karaoke, but to talk charged politics with your tortured, melancholic, liberal friend.  I hope it did not feel too burdensome, and that you would do it again.

It was quite the emotional evening for me, unsettling, sometimes uncomfortable, and also dominated by love.  Joanne, we have known each other about 15 years, and I know you are not a fan of politics in general.  Paul, I know you mostly through your witty holiday cards, and your occasional Facebook posts that often touch on politics.  You lean right, it seems, about as much as I lean left.  You gently called me out when I shared a Trump supporter-shaming video, reminding me to hold myself to a higher standard of discourse on all platforms.  That is why I sought you out.  When you engage, you exemplify the attitude toward political discourse that I aspire to.

I described to Joanne over the phone how distraught I had been since November, something akin to “watching the fabric of my generation’s social progress torn to shreds by a maniacally fomenting, double-machete-wielding narcissist.”  You seemed genuinely surprised and curious—why did this election have such a profoundly tormenting effect on me?  What made millions of people pour into the streets around the world in protest?  I was incredulous at your incredulity, and yet I felt a mutual, loving acceptance between friends who only want each other to be happy and feel secure.

At dinner, I could tell that you both cared acutely about my distress, and wanted to help alleviate it.  You reassured me that the worst case scenarios are highly unlikely to actually happen.  You reminded me that hyperventilation and arm flapping are not productive energy expenditures.  You gently encouraged me about the long, jagged, often meandering, and also inevitable path of social progress, and the importance of taking the long view.

I admit that I felt a little defensive at times, as if anything I said about the origins of my distress would be met with, “You’re overreacting,” and “You’re worried about nothing, please…”  We later agreed that it is never helpful to invalidate someone’s emotional response to a stressor, regardless of whether or not we can relate.  Paul, you are so well-read and convicted about your opinions.  I did not see a point in arguing, as you did not seem interested in debate, and I left feeling disappointed that I had not presented a stronger defense of my liberal ideals.  The whole exchange felt lopsided in favor of your position.  But I did learn from your point of view, which was one of my primary objectives.

Most importantly, our conversation revived my mindfulness practice.  You’re right—energy spent catastrophizing about a hell-on-earth future is energy wasted.  As Michael J. Fox says (I paraphrase), “Don’t spend your time worrying, because if what you’re worried about actually happens, now you’ve lived it twice.”  My energy is better spent in the present, attending to what is, rather than what I fear might be.  And I feel justified in my shock and dismay at what is.  In my opinion, Donald Trump has defiled the presidency and brought our politics to a new moral low that I could never have predicted.  I don’t need to ‘go apeshit’ over the future, as there is plenty of wreckage to confront right now, not the least of which is our collective refusal to engage one another in civil discourse.  I can center, ground, and focus, breathe deeply and engage, one step, one person, or one loving couple, at a time.

Last week Dan Rather wrote my heart on his Facebook page:

The threats, the lies, the willful disregard for the rule of law should be limited to the world of Hollywood caricature. To see this played out each night on the news, to read about ramblings and inconsistencies in justifications for actions that should never have been taken, is to see a moment of great peril for our nation.

I remain, however, an optimist. I see the swellings of civic engagement and action. I hear the voices of those who demand that this subversion of our national ideals shall not stand. I have covered social movements of the past, and never have seen one where so much power and numbers lie on the side of the opposition. This is a clash for the values of our nation. Our destiny is in our hands.

Our nation’s patchy, irregular social fabric may be strained to its limits today, and even torn in some places.  But the threat of real disintegration has brought forth multitudes of weavers and quilters to repair and protect its integrity.  I can acknowledge this ‘collateral beauty’ and contribute my part, through conversations like ours, to help mend the tapestry, and bend that moral arc of the universe more toward justice.

Thank you, my dear friends, for helping me train for this marathon.  You hold me up and make me stronger.  I hope I do the same for you.

Sincerely and with love,

Cathy

 

*Not their real names

To Train Or Not To Train

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My sister and brother-in-law run marathons.  No, wait, they are elite marathon-running machines.  By next weekend, they will have run 150 marathons between them in just a few years, including Ironmans and ultramarathons, in 39 states and at least 7 countries.  They lead training groups for Team to End AIDS and enjoy a loyal following of running enthusiasts and friends.  So you can imagine my honor when they recently told me, “You could totally run a marathon, Cathy.  You’re already more fit than a lot people who start training.”

For a moment I actually considered it, because wouldn’t that be so cool, to enter that elite circle?  Then I quickly remembered: I. Hate. Running.  …For now.  But it got me thinking recently–talking politics may be like marathon training.  Some people really like it and do it well (by ‘well’ I mean they are informed, articulate, respectful, and engaging with people from all points of view—their discourse is elevated).  They resemble my sister and brother-in-law: athletes who consistently perform at the top of their training, with few or no injuries, leading others to follow in similar aspirations.

Other people, however, would sooner feed themselves through a wood chipper than strap on a pair of running shoes, or engage in political discussions.

Most of us are somewhere in the middle, I suspect.  I can run a few miles with my trainer if she makes me–the conversation and scenery distract me and the time goes by faster.  And I know I can slow down or take a rest if I have to–it’s safe.  But I have many other preferred exercise activities.  Could we consider talking politics as the elite marathoning of communication?  It is so hard to do well!

When I think of long distance running my mouth goes dry.  I get short of breath and my knees hurt already.  I feel the incredible slog, one heavy step after another–not at all like what I imagine my family feels, bounding weightlessly like antelopes toward their next PR.  I experience a version of the fight-or-flight response, a visceral sensation of threat: I’ll have blisters everywhere, I’ll never make it to the end, they’ll have to carry me, I’ll have a heart attack and die!

Maybe some people have a similar reaction to politics?  I don’t know enough, it’s too complicated.  It’s overwhelming, I’ll look ignorant, people will judge and shame me before I can even finish a thought.  It’s all so emotional, I can’t handle that, it will only escalate into conflict, my relationships will all be at risk, I’ll lose all my friends!

As you may have read, I have been trying to get some conservative friends to engage face to face.  I am genuinely curious about their points of view; I want to understand.  I want to practice my skills—curiosity, openness, empathy, identifying shared interests, withholding judgment.  Two invitations were initially met with a non-response.  After a follow up call or two, I am scheduled to meet one set of friends for dinner this week, and the other said he was too busy.  I feel like I’m dragging them out running when they would much rather play golf or go bowling.

I have realized: we don’t all have to keep up with every day’s new political freak shows.  We don’t all need to be the debate champions of our particular ideology.  Not everybody has to be a marathoner.

HOWEVER:

We all need exercise.  The body is built to move.  Regular physical activity, as we all know, reduces our risks of obesity, diabetes, and heart disease.  Did you also know it can decrease depression, dementia, and even cancer?  So pick your sport—just do some kind of movement every day!

Similarly, even if we don’t all talk politics, we all need effective communication skills, especially in the arenas of conflict resolution, negotiation, parenting (which encompasses them all), and the like.  We are social beings—we only survive by cooperating and living well within our tribes, and by tribes living well among one another.  That can only happen if we practice getting along.

So if you’re not a runner/marathoner, what do you do?  What is your thing, how often do you engage, and what keeps you coming back?  If you hate talking politics, how else are you already a great communicator?

Maybe you’re a natural at getting your toddler/tween/teen to see the wisdom of the rules and getting their buy-in to follow them.

Maybe you can always help your boss and coworker iron out their differences because you can understand both sides (are you in HR?).

Maybe you like to debate the merits of the Marvel Comic Universe vs. DC—and you could argue both sides because it’s just more interesting that way.

We all have areas where we shine, where we contribute to the tribe through words and actions.

I have picked up some tips along the way:

  1. Validate people’s feelings, even if you don’t agree with their position or behavior.
  2. Stay open to the 2% truth of an opposing philosophy or idea.
  3. Withhold judgment on the whole person even though they espouse an ideology you despise, at least until you know from multiple encounters that they have no shred of kindness or humanity in them.
  4. Look for what you have in common with people, and choose to focus there more than on how you differ.

So even if you’re not an elite running machine like my sister and brother-in-law, or you’re not your community’s foremost political pundit, know that your other training matters.

I may complete a marathon someday…  Never say never.  For now I’m happy to stick with my TRX, kettle bells, 7 minute and Betty Rocker workouts (once again, I have no financial interests in any of these businesses).  I appreciate my family’s invitation to run, and I respectfully decline at this time.  Similarly, I will try to be more mindful about inadvertently pressuring people to talk politics.  It’s never meant to be adversarial, only a bid for connection—I’m looking for training buddies!

I don’t need everybody to talk politics.  But I do need everybody to practice excellent communication, especially in political discourse.

We all need that.

Sharing an Emotional Request

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Exploring the Rules of Engagement for Healthier Political Discourse, Third Query.

I’m still working on how to balance it all.  Every day I wake up and before long I feel tense, asking myself, “What can I do today to make a positive difference to our country?  How can I make my voice, calling for collaboration and connection, heard?”  It’s a struggle to extricate myself from that, and be present to work, family, chores, etc.

But I think I’m doing better.  Every day I feel an urge to write.  I have ordered postcards with the Healing Through Connection photo, title, and URL, to write to Congress.  I figure, if I’m going to write to them, they might as well know who I am and what I stand for (which, I hope, this blog makes pretty clear).

I’m never sure how effective it is to send emails via senators’ and representatives’ web pages, does anyone know?  Well anyway, it probably can’t hurt, and it makes me feel better that I’m doing something.  Today I started with my US representative, writing about Donald Trump’s conflicts of interest and ties to Russia.  I then copied, pasted, and edited to send to each of my senators.  I noticed that each time I revised, I added a sentence or two that brought my personal perspective on government into clearer relief.  It’s not just about policy.  It’s about how policy gets negotiated–which is about communication and relationships.  Finally, I wrote to Senator John McCain, chair of the Senate Armed Services Committee.  The letter is below.  Ironically, I forgot to include the link to this blog.  But that’s okay, I’ll probably write him again soon.

I’m pretty proud of this letter (email).  I think it’s respectful and validating, while also challenging.  I tried to imagine Senator McCain actually reading it.  I want him to feel seen–to understand that though I am not his constituent or a member of his party, I still appreciate him as a person.  We are all in this together, and I want him to feel supported by people ‘on the other side.’  I want to embolden any part of him that wishes to make an emotional appeal to his colleagues.  Whenever we see the word ’emotional’ we immediately, subconsciously, also think ‘hysterical.’  They are far from synonymous, and I want to take that stigma away.

Two articles I read this week support my conviction for taking an emotional/limbic approach to political conversations.  The first was a detailed piece in The New Yorker that describes the science behind why facts don’t change our minds.  Second was an October article in the Harvard Business Review on how to engage and make it safe for people (Trump supporters in particular) to change their minds and positions.  It does not specifically reference the Harvard Negotiation Project, but it reminds me in many ways of the book Getting to Yes, written by HNP founders William Ury and Roger Fisher.  I plan to write more about principles from this book in the coming weeks.  I have listened to it again since the election, and it helps ground me.

I thought about sharing my letter on one of the many secret, liberal groups on Facebook, and/or on my personal page.  But somehow it felt more appropriate to share here.  I am aware that this makes me vulnerable to public attacks on my politics and positions.  With engagement comes risks, so boundaries are in order.  My boundaries here are the same as on Facebook:

  1. No ad hominem.
  2. Keep your comments respectful and civil.
  3. Read the entire post before commenting.
  4. I reserve the right to remove comments that violate the requests above.  Commenting on this blog is like coming into my home and talking to me.  I would not allow you to fling fecal words in my home, at me or my other guests, and the same principle applies here.

What do you think?

*** *** ***

Dear Senator McCain,

Thank you for your decades of service to our country.

I am a liberal independent from Chicago, a woman, a daughter of immigrants, and a physician.

I remember the 2008 campaign and how you treated Barack Obama with respect and professionalism.  I remember how you corrected the woman at a debate when she claimed he was an Arab.  You made a deep impression on me that night, for manifesting integrity with unwavering conviction.  I see you doing it again now, as we face the profoundly alarming and appalling existential threat of the new administration.

I write today to request that you consider how best to use your influence and credibility, with your longstanding tenure in the military and the Senate, to encourage and empower your colleagues, especially those on the right, to stand up for the conscience of the nation.  We need a comprehensive, bi-partisan investigation into Donald Trump’s many conflicts, and especially those with Russia. I know you already support this.

I have no idea what it must be like in your work.  But as a primary care physician, I talk to people for a living, trying to help them change their behavior to more closely align with their long term health goals.  It takes kindness, persistence, patience, presence, and trust.  Simply arguing facts and positions does not work.  We need to appeal to people’s emotions–to their deeply held (and perhaps forgotten or buried?) values of integrity, responsibility, accountability, and conscience.  We humans are emotional decision-makers, though we think ourselves so rational.  Research tells us that much of the time, we simply rationalize.  Thus, to change people’s behavior, we need to shed emotional light, with compassion and empathy, on the discrepancies between their actions and their integrity.  And we need to make it safe for them to admit to those discrepancies, rather than shame them for it.  Only then will they, slowly, make meaningful change.

I imagine that over the years, you have cultivated the relationships with your colleagues that paved the way for the important conversations that must happen now.  Please, for all our sakes, engage with your colleagues around your common humanity and shared mission of protecting our democracy, and of showing the world that our government is one of integrity.

Thank you, and best wishes to you and your family.

Sincerely,

Catherine Cheng, MD FACP

 

Train to Withstand the Discomfort

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Exploring the Rules of Engagement for Healthier Political Discourse, First Query

How fascinating!  I thought this series would be so easy to write…  I spend so many hours every day deliberating on how to talk to people, fantasizing about successful encounters, and preparing mindful defenses against verbal attacks.  Yet crickets have chirped here for two weeks, and even now as I type, I feel almost overcome with apprehension.

The Better Part of Valor…

I had this lofty goal last month to seek out and engage in person, all of my friends on ‘the other side.’  I even sent a card to a couple of them on the other side of town, asking if I could come to visit and “talk.”  I feel an urgency to reconcile and reconnect.  But today I realize that you can’t force it.  Sometimes it’s just too uncomfortable.  You never know what the other person will say, or what you will say, that will trigger one or both of you and emotionally hijack the whole encounter.  So sometimes it’s best to just not go there.

Meanwhile, Back At the Ranch

But what can we do in the meantime?  How can we train now, to make it easier in the future?  It seems somewhat like exercise to me.  There is an app called TRX Force (I have no interests in this business), a twelve week progressive strength and interval training program using those torturous straps that hang from the ceiling.  When I first started the program with my trainer, I dreaded every session.  The shortness of breath, the shaking, the pain, gaaaagh!!  Every session early on, I secretly hoped she would let me off the hook.  But I also knew that with her support, I could overcome the discomfort and finish.  I have gotten through every session, some more easily than others.  Last Tuesday was Day 2 of Week 11. I felt so much weaker and less motivated than usual that day (all this stress, grrrr), and it was the hardest workout yet.  The ‘during’ part SUCKED.  My biceps and quads felt like jell-o melting off of their bones.  Then afterward, the victory of accomplishment filled me with pride.  It lit a new intrinsic fire, and my home workouts now are harder and longer than ever before.

Maybe it’s the same for talking politics.  Just thinking of encounters with ‘the other side’ can fill us with dread and tension.  We catastrophize immediately, not only about what they might say, but at how it might unleash torrents of our least controllable emotions.  So we instinctively run the other way.  What if we could train to withstand this discomfort?  What if we could find a safe space to practice, so we might feel stronger when challenged for real?  I propose two methods here.

Desensitize

We all know the satisfaction and comfort of echo chambers.  Seeing, hearing, and reading that which validates our existing positions feels so good.  But the farther we regress here, the harder it becomes to tolerate a dissenting view.  We must resist this temptation; we are called to be more disciplined than this.  I have friends and family who post articles and videos from sights like Conservative Fighter and Red State.  I find the headlines inflammatory, and my initial reaction is to cringe, dismiss, and move on.

Lately I have resolved to open at least one of these posts every few days.  To walk the talk of reaching across the divide, I must try seeing from others’ point of view.  These are my friends, people I grew up with, my colleagues.  What about these stories and articles appeals to them?  In the privacy of my home, at times of my choosing, I can practice opening my mind to a potential partial truth from any source.  I learned from life coaching a long time ago that, “we are all right, and only partially.”

In no way does opening my mind to possible other truths mean that I abandon skepticism or critical appraisal.  It does mean, however, that I practice excluding prejudice.  It means looking and listening with objectivity as much as possible.  “I have to pace myself,” a friend told me recently.  Yes.

In a recent episode of Bill Maher’s show, he interviewed the controversial alt-right figure Milo Yiannopoulos, during which he admonishes his audience, “Don’t take the bait, liberals.”  I think I agree.  The goal here is eventually to rise above the reflexive, emotionally hijacked state.  When I feel my brow furrow, lips curl, heart rate accelerate,  and armpits sweat, I know I’m close to my limits.  I can choose to disengage and try again next time.  Just like with TRX Force, my tolerance and openness core will strengthen the longer I stick with the program.  I can then engage with an intact and rational intellect, guided by my core values of connection and shared humanity, seeking common interests and goals.

Uphold the Devil’s Advocate

Since the election, I often feel attacked by people on ‘my side’ whenever I suggest that ‘the others’ may not all be racist and misogynist xenophobes.  It’s not safe in some of my own circles to consider the humanity of the other side.  This refusal to consider multiple points of view, even among those who mostly agree with us, seriously threatens our capacity for meaningful discourse, from the inside out.  The echo chambers reverberate ever louder, drowning out our intellectual and emotional calling for generosity and connection.  Us vs. Them group-think oppresses, and it’s dangerous to our dialogue.  I wonder if moderates on the right also experience this.

Hereafter, I resolve to stand up a little taller in defense of people in general.  When I hear broad brush generalizations, I will play Devil’s Advocate and speak up for a valid alternative point of view.  I will ask questions starting with phrases like, “What if they also…” and “What is a more generous assumption we can make about…”  I hope more of us can practice holding this precious space.  Making room for another’s point of view does not weaken our own.  Respectful debate of dissenting opinions makes us more agile and articulate.  And the best place to practice is first within our own tribes.

Moving Forward

I had a list of ideals for this series, like “Rehumanize the ‘Others’” “Mind your limits,” and “Stay in Curiosity.”  It’s hard to separate and prioritize them; as I think of any one, the others inevitably intertwine.  So it will take me a while between posts to disentangle my thoughts.  Thank you for your patience and your feedback.  Maybe we can all be training buddies on this long journey.

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.

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.

 

On What Helps

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NaBloPoMo 2016, Letters to Patients, Day 22

To Patients Preparing for Uncomfortable Holidays:

Seek what helps.

What did I write recently about staying off of Facebook and minimizing my social media exchanges?  How fascinating, look what I just did—spent the last two hours on Facebook!  I also write about trying, falling down, and trying again…  So this is me both falling down (in my attempt to stay off) and trying again (to engage meaningfully).

The holidays are coming, yay!  …And, not so yay!  The conversations we have with friends and family in the next 6 weeks or so have enormous potential—for division as well as connection.  Personally, I feel optimistic.  I plan to evoke my core values of open-mindedness, empathy, and integrity.  I want to look back on the gatherings with gratitude and deeper connection.  So today I share with you all the things I have read (today—see?  I endure Facebook for your benefit! teeheehee) that have helped me.  These pieces validate, challenge, reassure, alarm, question and motivate me to Hold the Space, Stay on the Path, and Seek Love.  Please share yours, also!

A fellow physician’s acknowledgement of the humanness of bias, its potential for harm in caring for patients, and a reminder for self-awareness and –management.

Posts by Michelle at The Green Study, reminding us that internal conflict is normal in the face of world events such as ours, with concrete suggestions for actions that align with core values:  “We cannot strengthen our character unless it is tested. We cannot defend our freedoms unless they are threatened. We cannot become better writers or artists or humans unless we have obstacles to overcome.”

An article from The Guardian that points me to reputable sources of alternate points of view, so I may understand better.

A call out from the Wall Street Journal—to help me own my shit before I call out others on theirs.

A gentle message from fellow blogger John Pavlovitz: “Friend, however you choose to navigate these holidays, know that it’s the right way. Give yourself permission to pretend or confront or abstain as you need to, and forgive yourself later if you decide you chose poorly. You’re probably going to get it wrong or at least feel like you did.

“But remember too, to save a little of that mercy for those who sit across the table from you or those who choose not to. They’ll be doing the best they can too.”

And finally, the Prayer of Maimonides, the twelfth century physician and philosopher:

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These holidays, wish me persistence and ‘stubborn gladness,’ as Liz Gilbert calls it.  I wish you all the same!