Tag Archives: physician

#AtoZChallenge: Humbling and Honoring

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Though I was born in the United States, I grew up very Chinese.  Honor and respect for elders was one of the highest values in my family, as it is in the culture at large.  It would never occur to me to be on a first name basis with anyone in my parents’ or grandparents’ generation; they were all uncles, aunts, and surrogate grandparents.  Teachers, as well, always had a title.  In the presence of these zhang bei (senior generation), I would sit or stand up straight, pay attention, and never interrupt.  So it feels Humbling to find myself friends—equals!?—with so many of my elders—

Joe, my 7th grade math teacher,

Dawn, my 7th grade English teacher,

Kathy, Joe’s wife and the music director for the 8th grade play,

Barbara, my 9th grade geometry teacher and freshman volleyball coach,

Lisa and Jerry, my varsity volleyball coach and her husband, one of the football coaches,

Mary and Dan, my confirmation sponsors in college, pastoral associate and pediatrician, respectively, and

Keith, my clinic preceptor intern year.

I always wondered, what did they see in me, so young, naïve, and ignorant, that would make them want to know me as a friend?  Then about ten years ago I found myself befriending students and other ‘young people.’  I gradually realized the rewards of the exchange—new perspective, fresh ideas—connection across generations, cultures, experiences.  I felt a sense of mutual admiration and understanding, despite the age gap—an appreciation that bridged the separateness.

Somehow this reminds me of a morning I spent volunteering in a free clinic a few years ago.  As per usual, patients filled the waiting room and clinic workflow bore no resemblance to anything efficient or modern.  But the atmosphere pulsed with purpose and kindness.  First and second year medical students helped run this clinic, relishing the chance to hone their history taking and physical exam skills.  They saw the patients first, synthesized all relevant data, and presented a summary to one of a few attending physicians staffing the clinic that day.  After some discussion on pathophysiology and care plan, the attending led the team of students back to the exam room to finish the encounter.  If you have ever been a patient at a teaching hospital, it’s much like that, only much slower and often with profound technical barriers and almost no support.

That morning I walked in with my team to greet an elderly Pakistani man for follow up of his blood pressure and diabetes.  I knew he had been waiting a long time.  It was almost noon and he had not eaten all day, in preparation for fasting labs he knew he needed to have drawn.  Upon greeting him, I automatically apologized for the wait, put my hands together, and bowed slightly, while I thanked him for his patience.  I felt bad about the whole situation, and I wanted his pardon.  His face lit up and he immediately turned to the students and said something like, “See?  That is how you treat an old man!”  He was not angry or crotchety in any way.  He seemed honestly and happily surprised to be treated with Honor and respect—as if he suddenly felt seen and appreciated for who he was—a member of an older, wiser generation than all of us.

In Pakistan this gentleman had been a middle- to upper-class professional.  Here in the US his resources were drastically curtailed, such that he had no health insurance and depended on the free clinic to get treatment for his conditions.  I wonder if he was used to feeling like just another immigrant patient in a busy, understaffed clinic where there were few occasions for others to ask about and listen to his story.  Since I was a periodic volunteer, I had that chance.  I get to choose when I am willing to donate my time and energy to the free clinic—everything I do there is on my own terms.  The patients there have no such choices.  If they want care, they have to show up—early—on the day the clinic is open, regardless of what else is going on in their lives.  There are no appointments, and almost no continuity with providers.  It’s a completely different world from where I make my living, on the Gold Coast of Chicago.

I am Humbled by the opportunity to meet people from all walks of life.  Students arrive at medical school from diverse backgrounds.  Patients may hail from all corners of the world, many having come through experiences I can scarcely imagine.  It is my Honor to care for all of them, and I wish to maintain this perspective of respectful service.  I have those who support, teach, and guide me in life—older and younger.  So it is my privilege to give back—to offer my own knowledge, expertise, and maybe sometimes wisdom—and help make a positive difference in people’s lives.  I can’t remember exactly, but I think I said something to this effect to the medical students that day.

Physicians have power by default and design in the medical setting.  We can wield that power with more grace and efficacy when we remember Humility, and Honor our patients as whole, rather than broken or defective.  Be they students, friends, political opponents (yeah, stuck that in there), teachers, or patients, there is always something to learn from someone else’s perspective.  Cultivating the Humble and Honoring perspective, when I can muster it, makes all of my relationships infinitely richer.

#AtoZChallenge: More Fun, Less Frazzle

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“Rule #6: Don’t take yourself so Goddamn seriously.” From The Art of Possibility, by Rosamund Stone Zander and Benjamin Zander.

This can be a hard lesson for physicians. We do such serious work, after all. There is always another patient to see, another result to review, another call to answer—now! But I have to pee, when can I pee?

In my first year of practice, I remember a particularly hard day. I was running late (I’m still always running late) and the patients that day were all complicated. No simple UTIs or colds to give me some air. I huffed and grunted my way through the visits, occasionally buzzing by Rose, my medical assistant, to answer messages in between. My bladder felt like it might actually explode, but I could not stop to go to the bathroom—there was no time! I was so afraid to fall even more behind, to fail in some way. Eventually, Rose posted a sign above my workstation: “TAKE A DEEP BREATH.” It was an instant reality check:  I couldn’t go on like this, I’d burn out before my career even started! Immediately I realized how unnecessary, and downright silly, was all the rushing and grimacing—and I laughed out loud. Since then I have never again reached that depth of anxiety and sullenness in a workday. I am forever grateful to Rose for her sign, her loving reminder to slow down and take perspective. God bless her.

If we’re not careful, we physicians could all easily drown in the drama and strain, over and again, every day. And is that really what our patients need from us—to be Frazzled balls of tension and urgency, bouncing haplessly from one task or person to another, barely holding it together (and in)? Is that what we want for our colleagues and staff, to have to put up with our irritable and pressing demands?

It doesn’t have to be that way. In my third year of medical school, on my inpatient internal medicine rotation, Chip Dye was my senior resident. The service was busy; we always had a full census of sick patients. But I never felt harried or anxious because Chip set the tone for the team. Always smiling, always willing to answer any question, and finding any opportunity to laugh, he made it safe to learn. He exuded confidence without arrogance, calm without sloth. After rounds he led the team to attend morning report (daily educational conference and community gathering).  He always made sure we ate.  And there was always time to pee.

It’s not that he underestimated or ignored the work that awaited us. He just knew that we would accomplish it all better in a lighter, happier state of mind. When it came time to buckle down and divide tasks, Chip prioritized them with realistic expectations and we all got to work. No muss, no fuss, no stress. It would all get done because we laid out our plans in advance.  We self-respectfully reserved time and space for meeting basic bodily and communal needs. Thanks to Chip for leading by example.

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From Facebook, I can’t remember where or when!

We can always have some Fun at work, no matter how hard the day gets. Whether it’s telling a silly joke, watching a ridiculous viral baby video, or posting a fun meme on the workroom bulletin board, lightening the mood helps everybody get through a little easier. Laughing relaxes us. Stephen Colbert is quoted as saying, “Do you know what I like about comedy? You can’t laugh and be afraid at the same time—of anything. If you’re laughing, I defy you to be afraid.” And if we can overcome our fears of not getting it all done, of not being enough, we will all be better off—physicians and patients alike.

potheads

Also from Facebook…

 

 

#AtoZChallenge: Drudgery and Discipline

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Well this is scary… It’s only day 4 of the A to Z Challenge and I’m already feeling blocked! ACK! I had what felt like a semi-brilliant idea for ‘D’ –a week ago. I even wrote a short draft. But now I’m embarrassed to continue—it feels redundant and self-indulgent. I’m a little paralyzed by fear. What to do now?

I signed up for this challenge partly to make myself sit down and write every day, or at least attempt it. I’ve kept a running list of my favorite words, declared a theme, committed to a program. I am now accountable. It is up to me to practice the Discipline of daily writing.

I can’t imagine that writing this blog will ever become Drudgery, because if it ever does I can just stop. The blog itself is beholden to no one. But it’s something I created, something that I want to cultivate and develop. Quality of the content is bound to vary; I cannot be the perfect culmination of my best writer self every time! So regardless of how I feel about this post, I have resolved to publish something today, and I will have to find a way to make it good enough. It’s hard work, and it’s what I signed up for.

So this gets me thinking… How many physicians think of their work as drudgery? Sadly, the answer is more than we’d like to admit. Statistics abound on the alarming increase in burnout among physicians, physician suicide, and the associated decline in patient satisfaction and health outcomes. The defining features of burnout in any field are depersonalization, emotional exhaustion, and low sense of personal accomplishment. That’s as good a description of drudgery as I’ve ever seen.

Most of us experience some symptoms of burnout at one time or another. How do we get through it? Many of my colleagues rightfully look to operations—promoting streamlined workflows, simplifying documentation and coding, and standardizing protocols. But these changes come slowly, and we must function in the existing, cumbersome and inefficient systems while we advocate for the changes we want. So in the meantime, we forge ahead with gritty discipline.

Medical training remains rigorous, though in recent decades we have made it more merciful. From the premedical curriculum, to clinical rotations, to on-call responsibilities as attending physicians, our professional lives require us to be there for our patients when we’d rather be communing with friends, attending our children’s school plays, or just sleeping. We made a commitment, took an oath. And for the most part, our work rewards us with rich opportunities for lifelong learning, hearty fellowship, and the privilege of caring for humanity in the most intimate ways. The discipline—the commitment to the work—pays off in spades.

In my reflections on physician health and well-being, however, I always come back to another domain of discipline—that of self-care. Medicine attracts caregivers. Sometimes we are also control freaks, and exhibit somewhat masochistic tendencies. When we let these traits take over, they upset the balance needed to thrive in the complex medical milieu. We need to maintain objectivity with compassion and sensitivity, calm and clarity with intuition and judgment. We cannot do this effectively if we constantly run on empty. When we neglect our body/mind/spirit, we get irritable, and our work and relationships suffer. Ever seen a toddler clunk her head on some furniture while walking? If she’s well-fed and well-rested, she’s likely to keep moving, intent on getting to her favorite toy on the other side of the room. If she is tired and hungry, however, the same innocuous thump may trigger a full-scale meltdown of epic proportions. It’s no different for adults. We need regular feedings, rest, and playtime just as much as our children do. For my part, when I speak to colleagues on burnout and resilience, I focus on the discipline of self-care. It’s what we can control now, while we continue the necessary work of systems change.

Fortunately, I have chosen a profession that feeds my soul. It is a calling, a vocation. I have also chosen to indulge in a hobby, writing, that fulfills me similarly. Both require commitment, discipline, and practice to be done well. Both run the risk of becoming drudgery, under certain circumstances.

This post has been an exercise in Disciplined Writing. I wanted to write while inspired, and it just was not happening. So I had to simply sit down and get to work. But as Liz Gilbert discusses in her brilliant new book, Big Magic, inspiration did visit me, however briefly, in the process.  That will keep me coming back to practice. I will continue this exercise all month—thank you for bearing with me!