NaBloPoMo 2019:  What Makes Me Better

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My friends, it starts again woohoooooo!

National Blog Posting Month occurs every November, a 30 day daily blogging challenge apparently founded in 2006, inspired by National Novel Writing Month, or NaNoWriMo.  I think this will be my fourth attempt, and it gets easier and more fun every year!

This year’s theme originates from a sense of both gratitude and anticipation.  Increasingly I feel compelled to do more, contribute more, help more.  When I look around I am consistently humbled by those who go before me, on whose broad and strong shoulders I stand.  So I dedicate this month to all of you.

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November 1:  Role Play Makes Me Better.

I was converted to the Church of the Necessity of Role Play in 2003.  I had previously belonged to Tribe of Full-Socket Eye Roll at Role Play.  That year I had the privilege of attending a Stanford Faculty Development Program series.  It was a 7 week clinical teaching program for physicians.  Every week we practiced a specific teaching skill, on camera, then had to watch ourselves and critique our own and one another’s performance.  Even though each ‘encounter’ was only a few minutes, and we were all pretending, it felt real enough to translate into concrete behavior changes in real life—for all of us.

Since then I have always employed role play when teaching motivational interviewing (MI) to medical students.  At first I played the noncompliant or resistant patient, and had students take turns trying MI skils on me.  When I noticed myself feeling defensive and belittled in that role, I realized what the students were missing, and how it could enhance their empathy.  So I started having them take turns playing both patient and physician.  That was an epiphany for us all.  When I attended the Harvard Lifestyle Medicine Conference MI session in 2015, I experienced yet another layer of important experiential learning.  In dyads, we not only took turns playing patient and physician, but we practiced both directive and MI styles of counseling.  The contrast on both sides of each of those interactions solidified in both my cognitive and limbic brains why MI is a superior counseling method for behavior change.

This week at ICCH I innocently volunteered to play the physician in yet another role play.  Little did I know what I was in for.  I should have seen it coming, as the workshop title was “Teaching Medical Students How to Deal with Challenging Patient-Physician Encounters.”  I, unknowingly, stepped into a scenario of recurrent asthma exacerbation brought on by stress, due to domestic violence.  I felt anxious with a circle of international colleagues watching, and also confident that I could enter the play encounter the same as I aspire to enter a real one—present, open, grounded, kind, loving, and smart.  The physician teacher who played my patient stayed solidly in character and immediately drew me in with her slumped posture, dejected facial expression, and barely perceptible voice.  And she, like so many victims of violence, was not giving it up easily.

I had to conduct a medical interview as well as a psychological one, at times alternating between them.  I wanted to get at what I suspected (first generalized stress, and then clearly violence at home), but we had just met, and she really wanted to get out of the hospital.  Her fear was obvious; but she held its cause close to her chest, like the rest of her, until she could trust me.  I approached with general words at first, “Anything else going on lately?”  I kept my questioning as open ended as possible, and tried to leave space for her to answer.  Nothing.  Then I confessed my own inner dissonance:  “I feel like there’s something else…”  When that didn’t work, I continued with the general history.  No other chronic medical problems, no surgeries; allergies that can trigger her asthma, but no recent exposures.  You have 4 young kids, a full time job, a house to take care of.  Are you partnered?  Yes, married, to Bob.  Pause; a breath.  Then, “How does Bob treat you?”  Pause.  Why do you ask me that?  “I’m asking about abuse.”  And then it opened.  How did you know?  “I’ve been doing this a long time…  And someone close to me was abused.”  Do I look like her?  “You remind me of her.”

She was mortified that I would tell anyone.  How could I possibly help, then?  There were longer silences as I, frantic on the inside and slow breathing on the outside, racked my brain for solutions.  The harsh reality eventually settled on us both:  Neither of us could do much about her situation in that moment, her asthma attack was resolved, and the longer I kept her away from her family the worse I might make everything for her in the near term.  We agreed that I would look for ‘stress management’ resources, and I would give her my phone number.  And I would discharge her later that day, back to her violent husband, who had promised he would never hit her again.

It was so real.  I was almost able to forget about the audience.  I was personally invested in the health and well-being of this one person in front of me.  I imagined if she were a real patient.  Would I actually give her my phone number in this moment?  Absolutely I would.  We had to start somewhere, and I was the only person who knew, who could connect her to resources for help.

After it ended, I felt pretty drained.  We had both been tearful at times.  I also felt proud to have gotten through—both the exercise and to my patient.  I connected.  And even though I had no immediate solutions, I had established a relationship that had hope for helping a person who really needed it.

I have not encountered this scenario in real life in a while—that I know of.

I hope I’m not missing something, somewhere, for somebody who needs me.  Yikes.

Role play makes me better.  It reminds me to always beware my blind spots, to keep practicing, and to remember the deep humanity of every person I meet.

Training My Better Angels

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First, Happy Mother’s Day to all!

So friends, what do the Better Angels of your nature feel like?  What do they do, how do they speak and act, especially when encountering those with opposing political views to yours?

A New Tribe

Yesterday I attended a skills workshop run by Better Angels, an organization I have admired for a while.  Their stated mission:

Better Angels is a citizens’ organization uniting red and blue Americans in a working alliance to depolarize America

  • We try to understand the other side’s point of view, even if we don’t agree with it
  • We engage those we disagree with, looking for common ground and ways to work together
  • We support principles that bring us together rather than divide us

On the garden level of a Lutheran church on a drizzly afternoon, we sat quietly in a big circle of folding chairs.  I noticed one black woman, one other Asian woman, and everybody else was white.  Most of us were at least Gen Xers; I estimated maybe one third were Baby Boomers.  It seemed about equal numbers of men and women.  Among the 30 or so participants, 6 of us identified as ‘red-leaning.’  The moderators set a clear and firm expectation that we all respect one another, and especially attended to those in the political minority.  As the facilitator explained the objectives and skills, people listened attentively.  Expressions and postures demonstrated eager engagement.  A sincere and almost sad, desperate longing for bipartisan connection permeated the air.

We were all there to practice listening skills to help one another feel heard.  Speaking skills would also be taught, to facilitate ourselves being heard by our counterparts.  Though I felt confident in these skills already, I looked forward to strengthening them in a new group setting.  When I saw we would do role plays I got super excited!  The method, designed by family therapist Bill Doherty, was brilliant—we paired with a same-color partner, and took turns playing blue and red, challenging ourselves to resist judgment, stay open, tune in to our own and each other’s whole presence, and imagine the minds of ‘the other side,’ inviting all of our whole selves to connect.  The central objective was to create an atmosphere of openness, non-judgment, and balanced, mutual engagement.

The Spark

Even before the activities started I thought, “I want to learn how to lead this.  I want to participate, to contribute in a bigger way.”  So when they invited us to stay afterward if we were interested in moderator training, I practically leapt out of my seat.  Turns out you have to apply—no problem—and good, they have standards, yay!  Once accepted, you complete about 15 hours of online training and a Zoom call with established moderators.  Then you commit to moderating three workshops in the coming year.  Woo hoooooooooo!  There are only 8 moderators in all of Illinois, all from north of I-80.  Better Angels holds firm a 50/50 ratio between red and blue volunteers, and disproportionally more blue folks apply, so I may have ‘competition.’  That’s okay—we’re truly all on the same team here!

Ready, Set, Wait–I’ Got This.

When I got home and opened the application, I hesitated a moment.  They seek, first and foremost, volunteers experienced in group facilitation.  Yikes, I don’t have that, I thought.  And yet I felt intrinsically comfortable in that group setting, imagining myself co-leading with relaxed confidence and grace.  Huh, interesting.  I own this communication skill set, as well as the ability to teach it—I feel eminently qualified for this role.  Where did I get that?

Part of the application required a condensed resume, so I pulled up my CV.  Maybe I’ll find something in here to make the case that despite my lack of group facilitation experience, I’m still qualified, I hoped.  I laughed out loud when I realized, I have been facilitating groups for ten years now—every month with my medical students, discussing topics like professionalism, medical errors, burnout, difficult patients, and interacting with industry, among others.  I’ve also conducted workshops teaching motivational interviewing, the quintessential skill set in open and honest dialogue!  In all of these settings it’s my job to make the environment safe for candid discussion, to model non-judgment and open, honest questions.  I lead role plays in which people take on both patient and provider roles to practice empathy for their counterparts.  I have written on this blog multiple times about how much I learn every time I meet with these groups.  No wonder I felt so at ease in the workshop yesterday, I’ve been doing this—training my and others’ Better Angels—for a decade already, and I did not even realize it.  How cosmic.

So my application is submitted!  I should hear in 15 days.

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Friends, would you consider joining this group?  What are you curious about?  What makes you hesitate?  Who in your circles would be great at this work, and will you share this information with them?

Thank you for reading, and wish me luck!