Tag Archives: health

On the Lightness of Moving the Body

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NaBloPoMo 2016, Letters to Patients, Day 7

To Patients Who Struggle With Exercise:

Anything is better than nothing!

Are you a natural exerciser?  Do you move your body every day because you just can’t help it, as opposed to the rest of us, who do it occasionally because we know we ‘should?’  If so, this post is not for you.  But I do have a request:  The next time you’re with us, the unnatural exercisers, don’t judge us.  We are secretly inspired and awed by you, even as we hate you.  Your active non-judgment, which serves as passive encouragement, may be just enough to lower our threshold for doing something.

Okay so, for the rest of us:  How can we overcome the exercise barrier?  Wouldn’tcha know it, I have a suggestion!  Wait for it…  Do anything!  It sounds silly, right?  Too simple?  I have learned that simple is key, and silly can be fun.  Three years ago I was decidedly a non-exerciser.  In early 2014 I connected with a personal trainer and have since rediscovered my inner athlete, one baby step at a time.

Our initial sessions focused on awakening my core (apparently I had gluteal amnesia).  I never knew I could break a sweat holding a simple yoga pose.  I got discouraged at the prolonged lack of progress in cardiovascular endurance and strength.  But little by little, I could do more.  Early last year I downloaded a free workout app and aimed to exercise 7 minutes (read: get through one circuit, however feebly), 3 times a week.  Holy cow, how humbling to discover how 30 seconds of jumping jacks could make me so breathless?  Suffice it to say, I established an unequivocally low baseline.  But somehow I was able to let go the judgment of the failure to be fit already.  I congratulated myself for trying at all, and decided to keep going.  I bet I can get better, I thought.

And that’s the point:  We can always get better.  So often we don’t even try because our expectations are unattainably, if unintentionally, high.  We can tell because it feels pointless.  The workaround is to set our expectations stupendously low, guaranteed success-low, simple- and silly-low…  Then trust that iterative success will drive progressive improvement.  By mid-year I had a smiley sticker for every week, mission accomplished.  This year I set a new goal: 5 times a week, 3 times ‘intense.’  Don’t get the smiley stickers every week, but now it feels positively abnormal to not move for more than one day.  That progress is remarkably gratifying.

When we take our short-term goals more lightly, we allow for the freedom of modifications (push-ups on the knees at first) and trial and error.  We become open to previously unseen options.  We live in the present and appreciate what we can accomplish already today.

If it helps, read this article and repeat to yourself, “Floss one tooth, ” or “One push-up.”  ONWARD!

 

 

On the Critical Importance of Self-Care

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NaBloPoMo 2016, Letters to Patients, Day 6

To Patients Who Feel Overwhelmed:

Put your own mask on first!

In my spare time, I go around talking to other doctors about how to take care of ourselves.  You may or may not be aware of physician burnout.  It’s quite the trendy topic in medical circles these days, and not in a good way.  Over 50% of physicians report at least one symptom of burnout (emotional exhaustion, depersonalization, or low sense of personal accomplishment), higher than the general population.  Physicians also kill themselves at much higher rates than the general population.  I’m grateful for the opportunity to study and speak on physician health and well-being, because it informs my practice in ways I had not anticipated.

To be clear, physician burnout is not a problem of personal weakness on the part of doctors themselves.  The healthcare system in the United States has evolved to such a dysfunctional state that some of its best and brightest find themselves despondent, depressed, and ready to quit.  And yet, we are called to persevere in the system as it is, even as we strive to improve it.

I see the same pattern in American society generally.  Technology and other advances have created a world of 24/7 hyper-stimulation, global comparisons of productivity and innovation, and immense pressures to be perfect, or at least appear so.  Men and women live under constant scrutiny and competition.  Do I make enough money?  Is my work impressive enough (to others)?  Are my children in the right activities?  Am I doing enough?  I see, hear, and feel it from my patients every day—the anxiety, the uncertainty, the angst.  The suffering is real, if not totally tangible.

For those of you whose exercise routines hold you up, how quickly do you abandon your workouts when things get really busy?  What about quality time with your friends?  What about your painting, knitting, writing, reading, skating, volleyball, music, and sleep?  Everybody recharges a different way, but I see a common pattern of ignoring the low battery alerts and pushing ourselves to empty—physicians and patients alike.

Our systems need to change, no doubt.  Medicine, business, education, politics…  We need to get clear about what and whom we really serve.  In medicine, I believe physicians should lead the movement toward a more humane internal culture.  There is no way we can take excellent care of our patients if we are not well ourselves, and we cannot wait for corporate leaders and policy makers to advocate for us.  The same is true for you, our patients.  What do you need to be healthy?  What can you change in your habits, environment, and relationships to meet these needs?  And in making such changes, what positive ripple effects could you have on those around you?  Can you lead by example?

If we all put our own masks on first, like they say on airplanes, how many other people’s masks could we help with?

On Mutual Respect

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NaBloPoMo 2016, Letters to Patients, Day 5

To Patients Who Abuse Medical Staff:

Let me be clear: That is not okay.

Let’s define some terms first:  By staff, I mean clinic receptionists, medical assistants, nurses, phlebotomists, schedulers, hospital nurses, housekeepers, pharmacists, food service workers, billing and medical record staff, social workers, case managers, and anyone else who contributes to your care.

By abuse I mean insulting, yelling, name calling, intimidating, swearing, threatening, and otherwise conveying hostility and aggression toward others.

I have very specific behaviors in mind here.  I’m not talking about the inevitable frustrations that we all face in over-scheduled clinics and understaffed hospitals.  Exasperation, disappointment, and even anger are appropriate emotions we all share.  We understand that you may make surly faces and splutter a little when your expectations are not met.  Most medical staff are trained and expected to handle such interactions with patience, compassion, and calm.  They are frequently also given only narrow parameters within which to convey information, and almost no decision-making authority or autonomy.  Believe me, they feel terrible when they cannot help you, and often there really is nothing they can do in the moment.  But they can always ask for help, so I respectfully request that you give them the time and space to do so.

The medical community has a lot of work ahead to integrate our care teams.  We serve you best when all team members are empowered to exercise their best judgment, within their scope of practice, to move care forward toward your best health.  We are all here doing our best.  Physicians play a crucial role in both local and global medical culture.  But we are only recently stepping up as actively collaborative leaders, rather than authoritarians and paternalists.  You may see us physicians abusing our own staff, so let me be clear again: That is also definitely not okay.  Never mind that it undermines morale.  It can also endanger patients.  I hope in my lifetime to see an end to this contemptible behavior.

If I witness you abusing my staff, be sure that I will call you out.  I will do it respectfully, even lovingly, especially when I know you’re going through a hard time.  I understand how hard it is to control our emotions when we’re unwell and frightened.  It’s good for all of us, however, to know exactly where the boundaries of acceptable behavior and language lie.  Expect that if you cannot abide them, I will ask you to leave.

If you witness me or my colleagues abusing our staff, we need you to call us out, too.  Relationships are never one direction.  In medicine and health, the webs of connection are inextricable—one person’s mood and attitude can rapidly infect a group—and the stakes can be high.  I expect myself and my staff to conduct ourselves professionally.  We expect you to behave humanely.

Thank you for your cooperation!