Happiness: Finding the Way

You may have noticed that I haven’t posted in a while. I made a public commitment to post monthly, and a private commitment to post twice a month. I succeeded for three months, then I fell off my schedule.

Labyrinth Heart

v_rybakov/123RF Stock Photo

I could say that life got in the way. That’s believable for a busy clinician. The truth is, I simply lost my way. I didn’t have a depression, it was more of a dis-ease. I felt out of balance, and not just my regular lack of work-life balance. (more…)

You Don’t Know You’re Grieving

(Until You Do)

This week, our hospital again held Schwartz Center Rounds. The topic was organ donation, and we discussed the families of the donors, the pride in the legacy of passing life onto others through death. We discussed the unbearable waiting for the transplant recipients and their families, waiting that ended with either grief or gratitude, sometimes both.

copyright: gdolgikh/123rf Stock Photo

copyright: gdolgikh/123rf Stock Photo

The panel was made up of both Gift of Life and hospital employees, all with very personal stories to tell. (more…)

The Step-by-Step Guide to Saying No

Essentialism, Part 2

Here’s a paradox. People actually respect you more if you say no to them. Well, actually they respect the fact that you know your goals and are willing to fight for the resources to accomplish them.

Loss as Opportunity

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I’m at a phase in my career when I want to cut back on clinical hours, but I want to continue helping patients and their caregivers. I want to expand my influence in a train-the-trainer sort of way, to leverage my experience beyond my hour-to-hour, appointment-to-appointment life. Clinicians and caregivers, people who take care of people in both professional and non-professional capacities, can benefit from what I’ve learned. (more…)

How Coyote Taught Me a Lesson

The Clinician's Anti-Burnout Manifesto

If you’ve done any reading about healthcare recently, you know that medical culture can lead to burnout. You know that depression and suicides among physicians are rising at alarming rates. You know that work-life balance is practically nonexistent and self-care is almost impossible.

Coyote

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In the last 10 years, doctors-in-training have been enabled and empowered to limit their work hours, to limit the number of patients they see. Older doctors scoff, saying the younger ones are being babied, that they’ll never be well-trained if they don’t continue at the same grueling pace that physicians have always worked at. The macho culture is long and deep. Recent changes in the system, especially electronic medical records (EMR’s) have exacerbated the crisis by decreasing flexibility and autonomy for all clinicians. (more…)

Lose Track of Time

Chronos versus Kairos

This past Monday, I had the privilege of helping to facilitate Schwartz Center Rounds at my hospital. In 1995, Kenneth B. Schwartz, at age 40, was diagnosed with metastatic lung cancer. Before he died, he set up a foundation at Massachusetts General Hospital to strengthen the compassionate bond between patients and their caregivers. Today, about 375 hospital organizations in the US and Canada are members of the Schwartz Center along with 120 in the UK.

The heart has its own time.

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The member organizations of the Schwartz Center participate in rounds to discuss cases in a way they are usually not discussed. Instead of talking about what was done or not done in a case, members of the healthcare team talk about how the case made them feel. In the words of one rounds participant, “Rounds are an opportunity for dialogue that doesn’t happen anywhere else in the hospital.” (more…)

Just Say No, Gracefully

Essentialism: The Book Summary

Here’s the main thing, the essence. People become the victims of their own success, because if they do something well, they get asked to do more and more. This ultimately dilutes the original greatness. If everything is a priority, then nothing is a priority. You can spend your life moving one step in 360 different directions, with the net result of never moving at all, or you can move 360 steps in a single direction and make a significant contribution.

Just Say No

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That’s the main message of a book by Greg McKeown titled Essentialism: The Disciplined Pursuit of Less. I’m now consciously trying to incorporate this philosophy into my life. In my next post, I’ll talk about my personal experiences with this process, but for today, here are the main concepts. The basic process is to Explore, Eliminate, and then Execute effortlessly.

Explore

To be an Essentialist (as opposed to a Non-Essentialist) you start with the ability to choose. A Non-Essentialist’s motivation is “I Have To,” while an Essentialist says “I Choose To.” Subtle reframing of life’s priorities as choices undoes the feeling of entrapment and loss of control. (more…)

The Secret to Dealing With “Difficult” Patients

Simple But Not Easy

Work life in health care is filled with stress. There’s time stress, lack-of-sleep stress, role stress, and computer stress. One of the most challenging stresses for caregiver professions, though, is people stress. Every student at her medical school interview will say she wants to be a doctor to help people. That remains true at some level for all doctors, but sometimes we have to help people who are trying to control or manipulate us, who are making demands on our limited time, who are being defensive or hostile, who don’t follow our good advice, or who don’t seem to care about us and our feelings. There’s no way to avoid these people, and it’s unprofessional to be rude or hostile or aggressive in return.

Copyright: Bela Hoche/123rf

Copyright: Bela Hoche/123rf

So, what’s a healthier way to deal with unpleasant encounters? Several years ago at a Humanities in Medicine retreat, I wrote about this encounter. I was called to do a consult for a patient who was in isolation for MRSA. When I got to the floor and asked the nurse about the patient, she just rolled her eyes.

I pulled on my yellow isolation gown and then my blue gloves, left first, then right, always in the same order. The patient sat with arms crossed answering my questions with mono-syllables. I sat on the fake leather sofa across from him. Experience and intuition prompted me to ask him, “Do you know why you’re in isolation?” “No,” he said. “They told me I have MRSA, but I don’t know what that is.” (more…)

Don’t Be a Cooked Frog!

Legend has it that a frog will jump out if placed into hot water, but if you raise the temperature gradually it will stay until it’s cooked. This is an apt analogy for how older physicians currently view their jobs. If we were to jump from college graduation into our current high-stress, low-control jobs, many of us would jump right out. Yet, our current jobs have evolved gradually over the last 20 to 30 years, and we manage to stay in them. The key to not getting cooked is to prevent and treat burnout as it arises.

Photo Credit: Yotrak Butda/123RF Stock Photo

Photo Credit: Yotrak Butda/123RF Stock Photo

I recently came across a useful way of organizing my thoughts on my personal struggle against burnout. I found it on Dike Drummond’s website (TheHappyMD.com). He calls it “The Burnout Prevention Matrix,” and it’s readily available in exchange for opting in with your email address.

I had been searching for some time for a framework that doesn’t put the entire onus for health on physicians and nurses. Dike’s matrix includes responsibility for organizations to reduce stress and energy drains on their employees, to increase recharge activities and efficiency for their employees.
Organizations will hone in on the word “efficiency” here, I’m guessing, because increased efficiency can lead to higher revenues, but what about the need for employees to have time to recharge? (more…)

Cold Hands, Warm Heart

For me, physical symptoms are a clue to something I don’t want to know about myself. If I have a sore throat, I wonder if there’s something I need to say that isn’t being said. If I get a neck pain, I might attribute it to stress or a virus, but I also think, “Who or what is being a pain in the neck to me?” The pain in my right shoulder stumped me. I asked myself, “Am I shouldering too much responsibility?” One of my employees was making everyone around her unhappy. She was the puppy in the practice, charming at first, but very disruptive when any form of self-discipline was required, even after three years of training. The office dynamics were beyond the help of a dog whisperer. I eventually made the painful but right decision to let her go, but the shoulder pain persisted. I began to think the pain was a protective armor that no longer served me, but I couldn’t let go of it. That’s when I turned to my friend Ed for help.

Copyright: sifotography / 123RF Stock Photo

Copyright: sifotography / 123RF Stock Photo

The hallway at Seashore Healing Arts Center was chilly, but the space heater was on in Ed’s massage room. I sat against the wall in a metal-framed chair with an aqua vinyl seat. Ed sat across from me, holding his tape recorder. He always recorded his intuitive sessions. He asked me why I was there before he closed his eyes to center. A few minutes later, he turned on the tape recorder. First, he listed the muscles which were involved. He knows I’m a doctor, so he can be technical: anterior deltoid, subscapularis, pectoralis, rhomboid. Then he delved deeper. (more…)

Follow Your Passion

I am in the process, as many of you are, of helping to launch a young man into successful adulthood. One thing my husband and I decided a long time ago was to try to nurture our son’s true interests rather than force a path on him based on financial prospects. This has turned out to be wiser than we knew. Who could have predicted 20 years ago, when our son was 2, that his interest in computer games was just as likely to lead to a successful career than if he had been interested in business, or law, or even medicine? Of course, nurturing interests has its downside, too. Over the years, our home has been filled with multiple musical instruments: alto sax, tenor sax, EWI (electronic wind instrument), keyboards, synthesizers, guitar, drum set, erhu ( a Chinese bowed-string instrument), sitar, not to mention the electronic game controller “instruments”  for Rock Band and Guitar Hero (multiple versions of each). The point is, had we limited him, or if he had limited himself out of fear for the future, rather than his loves in the present, he wouldn’t be happy now or in the future.

In my parting comments as former president of the medical staff, I continued some of the threads I began in previous comments. In my first article, “Culture Medium,” I shared some of my own journey through adversity, in the forms of both physical illness and burnout and fatigue. I talked about the importance of self-care. My healing antidotes included mindfulness, music, and especially reading and writing poetry. (more…)