Dance for Your Health!

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My friend posted an article with this title: “Neuroscientists Finally Revealed the Number One Exercise for Slowing Down the Aging Process.”  Well who wouldn’t click on that?  I admit, I did not think long enough to guess the exercise, but I somehow knew it would not be running or weight lifting.  Turns out, according to the article and the study it cites, it’s dancing.

“Of course it’s dancing!” I said to myself and commented on my friend’s page.  That makes so much sense.  It’s fast (or at least it can be), so you get your cardio.  It requires flexibility, erect posture, and excellent core stability and strength—all physical attributes of healthy aging.  Dance steps, taken in temporal and spatial order, require visual, auditory, and motor coordination, connecting all different parts of the brain at once, in concert and synchronization.  Moreover, I’m convinced that the simple rhythm of music resonates with something deeper in us, something transcendent, which must have anti-aging neuro-hormonal benefits!

In addition, dancing is usually done with others.  This social aspect of the activity cannot be underestimated, especially as we age.  I am convinced and have said many times on this blog and in life, it’s our relationships that kill us or save us.  And when we’re having fun dancing to songs and rhythms that move collective body and soul all at once, that has to be a good thing.

So basically, dancing activates key areas of the brain and body in an orchestrated fashion, igniting motion, joy, connection, exhilaration, sensory integration, creativity, passion, cardiovascular elasticity, and fun.  How could this not make us all younger?

The article, however, describes changes in the brain that occurred in 2 groups of elderly study participants, one randomized to dance classes with varying choreography, the other to training for strength, endurance, and flexibility. The primary measure of ‘anti-aging’ was measurement of the hippocampus area of the brain and its sub-regions.  Both groups had increases in volume in this area, but the dance group had increases in more sub-regions than the exercise group.  This is a far less exciting interpretation of ‘slowing down the aging process’ than my own instant and intuitive “a-HA” conclusions above.

It’s okay though, because I can choose to follow my own understanding while the scientists continue their quest for the neuroanatomic proof of what we all know through living.  Mine is the deduction that will resonate with people and help get my kids, friends, family, and patients moving (dancing!) toward more optimal and youthful health.

I learned from my trainer about the five factors that keep kids in sports; we agree they are the same five factors that keep adults in any exercise routine:

  1. It’s FUN. Who wants to do something three to five times a week that’s a total slog?  So we gotta find something we enjoy, that we look forward to doing.  Just this brings the exercise threshold to a low enough activation energy that anyone can do it.
  2. Our friends are doing it. I have not studied the social aspects of exercise and motivation, but I know this is a common experience.  We have more fun and work out harder, and time goes by faster when we’re with our friends.  Not to mention, the exercise becomes a bonding activity.  Here is one of many summaries of the benefits of workout buddies.
  3. We feel like we fit in. I used to think this was the same as #2.  But this is more about self-consciousness.  It’s distracting and kills motivation.  Maybe all you need is to buy the cute yoga clothes and hang out at the back of the class to feel like you fit in enough, while you fake it ‘til you make it.  Or maybe you need to go with your friend who’s been a hundred times, who can introduce you to her buddies, who will welcome you, and you will immediately feel like one of the tribe.  That acceptance fosters relaxation that allows you to engage with your full presence and then some.
  4. We feel competent. This one is key, I think.  If we walk into the gym with no idea how to use the equipment, or walk on the court feeling embarrassment about our poor skills, we are far less likely to return than if we can say to ourselves (quietly), “I’ got this, bring it.”  Competence prevents injury and breeds confidence, which fuels motivation, and then–
  5. We feel we can improve. We relish the challenge.  One more push up, pull up, half mile, weight bar; better form, faster pace, farther distance—when we feel inspired to reach, stretch, and expand our limits, we cannot wait to get back at it.  Can you not hear Gloria Estefan singing in your head right this moment??

So get your groove on, my friends.  Even if it doesn’t make you younger, it’ll make whatever time you have in this life a lot more fun and memorable!

 

Stability is Strength

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The holidays are coming.  People will be bustling up and down Michigan Avenue with large shopping bags and puffy coats, fuzzy hats and determined gait.  If someone knocked into you on the sidewalk, would you be stable enough to hold your space and not get pushed over?

I asked this to a friend today, a woman about my height and twenty pounds lighter, ‘bird-boned’ by her own description.  I swear, she looks like a feather to me.  We were talking about our habits, what seems to be changing as we approach menopause, and how we envision our best selves in old age.  I thought about the elder women in my family, who are all healthy in general, but not necessarily fit.  What if someone knocked into them this holiday season, would I be dealing with a hip fracture over Christmas?  The mortality rate for people over 65 in the year after a hip fracture is somewhere on the order of 25%.  My friend and I definitely do not envision this for ourselves.

So what needs to happen in order for me to stand my ground in the face of some external force?  I need a stable foundation, my feet in firm contact with the ground.  I need a low, massive center of gravity.  I need fast reflexes to contract and relax opposing muscles groups to bear the sudden and unexpected load.  I cannot be rigid and brittle; rather I must exert flexibility, to absorb enough force to move with it and away from it on my own terms.  I need to stand tall and face the force head on, with openness and grace, firmness and self-assurance, ready to assess instantly whether it was inadvertent or intentional, benign or malicious.  And then I need clear-minded judgment to determine how to respond to either condition.

This may come naturally and easily in our 20s.  Today, bum knee notwithstanding, I feel confident that I could meet such a force with appropriate strength and stability.  My friend and I agreed today on a shared vision: STRONG OLD LADIES.  We understand that this will not just happen because we will it; we need to fuel and train, rest and recover, and cultivate our mind-body connections, as well as our connections with others.  Small habits, sustained over time, positive or negative, will yield predictable results.  So the time is now to pay attention and establish some excellent patterns.

It occurs to me that this idea of stability and strength relates our physical to our mental and emotional well-being.  While Amy Cuddy’s research has recently been called into question, I still adhere to the idea that power posing and physical posture can enhance or diminish confidence and self-efficacy. Wide stance, low center of gravity, elongated spine, and open arms:  Stand strong, feel strong, think strong, speak and act strong.  I have practiced power posing before presentations since 2015 and I believe I am better for it.  And if it’s a placebo, I’ll take it—the benefits so far have outweighed the risks and costs.

Lastly, I think we can also apply this stability and strength awareness to our inner lives.  Here I refer to our integrity.  Our world changes ever faster, technology offering capabilities we had not dreamed even a decade ago.  It seems every interaction these days is shorter, more ‘efficient,’ less personal.  That is the default goal—low cost, high speed above all else.  Change is often good.  But we must also exercise judgment, and practice taking the long view, casting light from our core values onto a cautiously optimistic future, attending to and addressing the shadows.  We should gut-check, with ourselves and one another.  What are we really getting here?  How will we use it mindfully? How can it serve us, rather than us serving it?  When we are stable and strong in our shared humanity and collective goodwill, we arrive at the best answers to these questions.  Then we can all be stable and flexible, and stronger as we age together.

 

Just Do It My Butt

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Happy late Monday, all!

Continuing my critical analysis of our American medical system…  This is not what I set out to do on November 1, I swear, and I have other more interesting prompts to expound on after today, I promise.  For now, thank you for indulging me in this rant of sorts:

My friend posted this article today, explaining how most methods of trying to get people to take their medications do not work.  It cited this meta-analysis, which concluded that “Current methods of improving medication adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized.”  It also reviewed findings from another study, concluding that, “A compound intervention integrating wireless pill bottles, lottery-based incentives, and social support did not significantly improve medication adherence or vascular readmission outcomes for AMI [acute myocardial infarction—heart attack] survivors.”  The piece basically asserts that behavioral economics, or the art and science of ‘nudging,’ will not by itself heal what ails our behaviors, despite what Thaler and Sunstein suggest.

The discussion on my friend’s page then centered around ideas like motivational interviewing, coaching, and the like—methods that have been shown to improve likelihood of overcoming addiction, obesity, and other behavioral maladies.  It occurred to me that this is the best part of my work: asking the important questions to help patients identify meaning and intrinsic motivation for behavior change, and collaborating in such a way that they own the plan because they have an authentic hand in crafting it.   And even then it can take years for new, healthier habits to entrain, because we are complex beings each with myriad influences affecting our actions at any given time.  When I can sit and listen to what makes meaning for my patients (if they know—if they don’t then it can get really interesting or really not, it’s hit or miss), and talking about what the future might look and feel like with a few relevant changes, I bask in my professional heaven.

But who can actually do this in the modern American healthcare system??  It takes time, and as we all know, time is money.  It also takes training and resources.  We are not born knowing how to perform motivational interviewing and cognitive behavioral therapy, and even today, these skills are not necessarily mainstream medical school curriculum (well if we’re being honest, communication skills in general are still given short shrift, which boggles me).  Physicians can and do learn these skills. But they don’t necessarily have to.  Medical systems which include dieticians, exercise physiologists, and health psychologists can deploy these team members to support patients in their health journeys.  But does your doctor’s office have this kind of set up?  Does your insurance pay for these services?

Most likely the answer is no.  It’s shocking and dismaying, because this approach is proven to be successful in important ways.  I refer here to the Diabetes Prevention Program.  This study was published 15 years ago, on February 7, 2002, in the New England Journal of Medicine.  From the link, here is the study design summary:

“…Participants from 27 clinical centers around the United States were randomly divided into different treatment groups. The first group, called the lifestyle intervention group, received intensive training in diet, physical activity, and behavior modification. By eating less fat and fewer calories and exercising for a total of 150 minutes a week, they aimed to lose 7 percent of their body weight and maintain that loss.

“The second group took 850 mg of metformin twice a day. The third group received placebo pills instead of metformin. The metformin and placebo groups also received information about diet and exercise but no intensive motivational counseling.

“All 3,234 study participants were overweight and had prediabetes, which are well-known risk factors for the development of type 2 diabetes. In addition, 45 percent of the participants were from minority groups-African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander-at increased risk of developing diabetes.”

What do you think happened?

“Participants in the lifestyle intervention group-those receiving intensive individual counseling and motivational support on effective diet, exercise, and behavior modification-reduced their risk of developing diabetes by 58 percent. This finding was true across all participating ethnic groups and for both men and women. Lifestyle changes worked particularly well for participants aged 60 and older, reducing their risk by 71 percent. About 5 percent of the lifestyle intervention group developed diabetes each year during the study period, compared with 11 percent of those in the placebo group.

“Participants taking metformin reduced their risk of developing diabetes by 31 percent. Metformin was effective for both men and women, but it was least effective in people aged 45 and older. Metformin was most effective in people 25 to 44 years old and in those with a body mass index of 35 or higher, meaning they were at least 60 pounds overweight. About 7.8 percent of the metformin group developed diabetes each year during the study, compared with 11 percent of the group receiving the placebo.”

Lifestyle modification surpassed medication alone in preventing progression to overt diabetes in these high risk patients—almost double the benefit.  Well duh, you say, we all knew that.  We just need to eat less and move more.  But did these people ‘Just Do It?’  As if we can wake up one day and open a shiny new box of motivation that suddenly removes all of our circumstantial, emotional, and habitual barriers to optimal health?  No.  These patients were intensely supported by a dedicated, multidisciplinary team, day in and day out, for the long haul.  Every week patients reject my team’s offers to explore strategy for habit change, saying, “I know what I need to do, I just have to do it.”  Seriously, if it were that easy we’d all be doing it already (she screams as she pulls her hair out in knotted handfuls).

So, if this unequivocal study came out a decade and a half ago, why have we not implemented its procedure in primary care practices across the country?  I’ll wait while you think it over…

It’s money, of course, right?

It’s not that people in charge of healthcare spending don’t care about patients.  It’s that the financial returns of such an investment occur too far in the future to make for a good P&L calculation today.  Most insurance companies do not cover patients for the long run, so why should I expend all these resources to get you healthy today, so you can be healthy later and cost Medicare less many years from now?  The more I think about it, the more it makes sense to me to have a single payer system that can truly invest in our health, as a population of individuals, from birth to death.  And since habits and behaviors are established at very early stages of development, doesn’t it also make sense to have the medical/healthcare system integrated with the education system?  If we are a nation dedicated to the health and well-being of children so they can become healthy and well adults, why would we allow junk food in our schools and cut physical education?  What private, for-profit entity in its right capitalist mind would want to take that on?

Well, I trust you get my point.  It’s late and I have committed to writing every day this month, so I must stop here tonight.  Thank you again for your indulgence as I strode into the weeds on this one.

Hope to see you back tomorrow!

 

Whole Physician Health: Standing at the Precipice

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I published the post below two years ago, and all of it applies even more so today. This week I presented to my department chairs and hospital administration leaders on the importance of addressing physician burnout and well-being. There is a growing sense of urgency around this, some even starting to call it a crisis.

Still, I feel hopeful. Darkest before the dawn, right? Reveal it to heal it, my wise friend says. Physician burnout research has exposed and dissected the problem for 20 years, and now we shift our attention toward solutions.

I will attend the American Conference on Physician Health and the CENTILE Conference next month. I cannot wait to commune with my tribe again, explore and learn, and return to my home institution with tools to build our own program of Whole Physician Health. While we focus on physician health in its own right, we must always remember that it can never be achieved without strong, tight, and fierce connections with all of our fellow caregivers. When we attain this, all of us, especially our patients, are elevated and healed.

Onward, my friends. More to come soon.

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Ever since my presentation to the American College of Surgeons earlier this month on personal resilience in a medical career, I cannot shake the feeling that we need to do more of this work. Physicians from different fields need to talk more to one another, share experiences, and reconnect. We also need to include other members of the care team as equals, and let go the hierarchical thinking that has far outlived its usefulness.

I do not suggest that physicians, nurses, therapists, pharmacists and others should play interchangeable roles in the care of patients. Rather, similar to the central tenet of gender equality, the unique contributions of each team member need to be respected equally for their own merits and importance. As a primary care internist, I must admit that I have seen my professional world through a rather narrow lens until now. I confess that I live at Stage 3, according to David Logan and colleagues’ definition of Tribal Leadership and culture. The mantra for this stage of tribal culture, according to Logan et al, is “I’m great, and you’re not.” Or in my words, “I’m great; you suck.”

“I’m a primary care doctor and I am awesome. I am the true caregiver. I sit with my patients through their hardest life trials, and I know them better than anyone. I am on the front line, I deal with everything! And yet, nobody values me because ‘all’ I do is sit around and think. My work generates only enough money to keep the lights on (what is up with that, anyway?); it’s the surgeons and interventionalists who bring in the big bucks — they are the darlings of the hospital, even though they don’t really know my patients as people…” It’s a bizarre mixture of pride and whining, and any person or group can manifest it.

Earlier this fall, Joy Behar of TV’s “The View” made an offhand comment about Miss Colorado, Kelley Johnson, a nurse, wearing ‘a doctor’s stethoscope,’ during her monologue at the Miss America pageant. We all watched as the media shredded the show and its hosts for apparently degrading nurses. What distressed me most was the nurses vs. doctors war that ensued on social media. Nurses started posting how they, not doctors, are who really care for patients and save lives. Doctors, mostly privately, fumed at the grandiosity and perceived arrogance of these posts. It all boiled down to, “We’re great, they suck. We’re more important, look at us, not them.” The whole situation only served to further fracture an already cracked relationship between doctors and nurses, all because of a few mindless words.

It’s worth considering for a moment, though. Why would nurses get so instantly and violently offended by what was obviously an unscripted, ignorant comment by a daytime talk show host? It cannot be the first time one of them has said something thoughtlessly. What makes any of us react in rage to someone’s unintentional words? It’s usually when the words chafe a raw emotional nerve. “A doctor’s stethoscope.” The implicit accusation here is that nurses are not worthy of using doctors’ instruments. And it triggered such ferocious wrath because so many nurses feel that they are treated this way, that they are seen as inferior, subordinate, unworthy. Internists feel it as compared to surgeons. None would likely ever admit to feeling this way, consciously, at least. But if we are honest with ourselves, we know that we all have that secret gremlin deep inside, who continually questions, no matter how outwardly successful or inwardly confident we may be, whether we are truly worthy to be here. And when someone speaks directly to it, like Joy Behar did, watch out, because that little gremlin will rage, Incredible Hulk-style.

I see so many similarities to the gender debate here. As women, in our conscious minds, we know our worth and our contribution. We know we have an equal right to our roles in civilization. And, at this point in our collective human history, we feel the need to defend those roles, to fight for their visibility and validity. More and more people now recognize that women need men to speak up for gender equality, that it’s not ‘just a women’s issue,’ but rather a human issue, and that all of us will live better, more wholly, when all of us are treated with equal respect and opportunity. The UN’s He for She initiative embodies this ideal.

It’s no different in medicine. At this point in our collective professional history, physician-nurse and other hierarchies still define many of our relationships and operational structures. It’s not all bad, and we have made great progress toward interdisciplinary team care. But the stethoscope firestorm shows that we still have a long way to go. At the CENTILE conference I attended last week, I hate to admit that I was a little surprised and incredulous to see inspiring and groundbreaking research presented by nurses. I have always thought of myself as having the utmost respect for nurses — my mom, my hero, is a nurse. The ICU and inpatient nurses saved me time and again during my intern year, when I had no idea what I was doing. And I depended on them to watch over my patients when I became an attending. But I still harbored an insidious bias that nurses are not scholarly, that they do not (or cannot?) participate in the ‘higher’ academic pursuits of medicine. I stand profoundly humbled, and I am grateful. From now on I will advocate for nurses to participate in academic medicine’s highest activities, seek their contributions in the literature, and voice my support out loud for their important roles in our healthcare system.

We need more conferences like this, more forums in which to share openly all of our strengths and accomplishments. We need to Dream Big Together, to stop comparing and competing, and get in the mud together, to cultivate this vast garden of health and well-being for all. I’ll bring my shovel, you bring your hose, someone else has seeds, another, the soil, and still others, the fertilizer and everything else we will need for the garden to flourish. We all matter, and we all have a unique role to play. Nobody is more important than anyone else, and nobody can do it alone.

We need to take turns leading and following. That is how a cooperative tribe works best. It’s exhausting work, challenging social norms and moving a culture upward. And we simply have to; it’s the right thing to do.

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.

 

 

 

 

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. 

On You, Team Captain and Tribal Leader

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NaBloPoMo 2016, Letters to Patients, Day 29

To Patients Who Think What You Do Doesn’t Matter:

Think again.

Yesterday I described You, the Elite Athlete.  All great athletes know they do not succeed alone.  They also appreciate the unique contribution they make to their teams.  What teams do you serve?  How do you lead?  It doesn’t matter whether you have a title or designation.  One of my favorite ideas is that no matter our instrument in the orchestra, according to Ben Zander, we can lead from any chair.

For now, think of yourself as Team Captain, or Tribal Leader.  You have invested in yourself by fueling and training, resting and recovering, managing your stress, and cultivating excellent relationships.  Now you can take the returns and reinvest in those around you:

Appraise:  Prioritize self-care

  • Like on an airplane: “Put your own mask on first.” Tribal leaders know that to effectively care for others long term, they first need to be healthy themselves.
  • Practice awareness and management of your emotions, and prevent emotional hijacking, so as to be emotionally available to our teammates and tribe members.

Empathize:  Speak the team’s language(s)

  • Think of your favorite teachers and coaches—they were able to relate to learners at all stages of development and team morale—and lovingly lift us all up.
  • “People don’t care how much you know until they know how much you care.” –T. Roosevelt

Inspire:  Lead by example

  • Effective leaders reject victim mentality, take responsibility for our actions, and model accountability for fellow tribe members.
  • When we captains can take our own mistakes in stride, as learning opportunities rather than shameful horrors, we make it safe for our teammates to do the same.
  • Everybody is then free to take more risks, voice more ideas, offer more of their authentic selves as a contribution to the whole,
  • Because they see us, their leaders, the ones who set the tone for the group, doing it, too.
  • Key here also is leading out loud—excellent captains articulate and coach the methods of self-awareness and self-management that help us all succeed.
  • By inspiring individuals to pursue personal excellence, leaders create a supportive milieu for collaboration and collective achievement.

Motivate:  Empower team members

  • Effective captains (coaches, leaders) recognize team members’ strengths and potential, as well as areas for improvement.
  • Rather than shaming teammates for mistakes or deficiencies, good tribal leaders provide feedback and encouragement, and more opportunities for practice and development.
  • They take into account each team member’s personal goals, and help to align them with those of the collective—excellent captains connect individuals to the whole.

If your actions cause others to

Dream more, learn more,

Do more and become more,

You are a leader.

–John Quincy Adams

What would happen if you treated yourself like a true leader?