Procrastination, habits, and building a better mousetrap

Recently a friend and I were discussing our ongoing attempts at self-improvement, particularly because we were both working on similar concepts using different terminology. Her framework that she’s been using is that of Mel Robbins’ “How to change your life in 5 seconds“. I’ve been using Andrew Mellen’s idea of “Unstuffing” (because although he emphasizes physical stuff, it also applies to emotional stuff and overscheduling). The common framework? Delayed decisions, and the negative impact they have. Those piles on my desk? Delayed decisions. Those two week old emails you haven’t answered? Delayed decisions. Debating about stepping out the door for a run versus reading a few more pages? Delayed decision. You get the idea here.

Mel Robbins does a terrific job sharing the neuroscience of why her 5 second rule is so effective in preventing your from delaying those decisions that are tied to a goal- and relating them to habit formation. Simply put, the 5 second rule allows you to change habits by moving from the narrative network to the experience network in your brain.

So, how exactly do you break a habit you want to get rid of…or start a habit that is to your benefit?

I’ll admit that I’m partial to James Clear’s framework that he expands in Atomic Habits. For the quick, 5-step version of the book’s strategy, this post will get you there (and it’s got fantastic visuals!). Start small. Tiny wins. Use chunks. Never miss 2 days in a row. Be patient.

Confession that provides an example: I’m never going to feel like going for a run at 430 am. I’m simply not. But I do it not-infrequently because I know it’s the right thing to do for my physical and mental health, as well as my personal growth. And I do it because even at 430 am I love the freedom of being outdoors. On the days I know that I need to run early because it’s the only time I’ve got, I get up as soon as my alarm goes off, I put on my running clothes that I laid out the night before, I go downstairs and put on my Noxgear vest (because safety!), flip on the outdoor garage light, and head outside. No negotiation with myself- or with the cat who is sometimes trying to get me to stay in bed. No decisions to be made because I already checked the weather and chose appropriate clothes. My reward? Knowing that I have done something for ME- something that is a habit and is “automatic” and that I love doing even when I don’t love the time of day I’m doing it- before most people are starting their day.

Now that I’m motivated with all of this habit-talk, I’m going to go manage some deferred decisions on my desk. And get out my running clothes for tomorrow morning’s run.

It’s time for a Reading Round-up!

I know, I KNOW. I hear you. So, here we are at least getting back on track with a reading round-up.

While I’m likely biased because I so enjoyed doing the author interview for the podcast, this article on REBOA has some very provocative findings. There’s obviously still work to be done regarding patient selection.

Whenever people ask me what I’m excited about in surgical education right now, I consistently tell them it’s our moves that are being made towards competency-based models. This Supplement to Academic Medicine provides some excellent background reading.

This terrific work on the use of TMR at the time of amputation was led by one of my plastic surgery colleagues here at THE Ohio State. I look forward to more data being shared on the patient benefits of this technique.

I’m grateful that our burn colleagues at UNC are looking into disparities in rehabilitation following burn injury. I’m curious if their findings would hold in other parts of the country with higher LatinX populations.

Nonfiction read that I just finished and definitely recommend: Farsighted by Steven Johnson. The chapter on personal decision making, particularly its discussion of the impact of a move and the importance of literary fiction in having a holistic view of decision-making, hit close to home for me.

I’ll have a full fiction recommendation for you in April. Hint: I’m reading Washington Black by Esi Edugyan right now and am LOVING it!

“Once you stop learning you start dying”

I’ve identified that learning is one of my core values (something some of you may have figured out on my behalf long before I did). I also recognize that I spend perhaps more time than I should contemplating learning- to some degree, my own learning, but also the learning of those around me. And when I say those around me, I mean ALL those around me- students, residents, colleagues, team members, everyone. And I don’t mean that I’m the smartest person in the room, either; instead, I’m focused on how we can learn together so that we can all be more effective in our identified roles. The phrase I’ve heard once, and for which I could recall the attribution, is the idea of “never not learning.”

Every day when I’m working with my team, I start with two core concepts:

  • What do I need to learn today? and
  • What do I need to do to facilitate my team learning today?

The first question reminds me to spend even 5 minutes looking up the answer to something that I’m curious about that day (for example, today I spent time reviewing the 2017 Hypertension Guidelines so we could make a good pharmacologic choice for one of my patients who seemed to be on an odd regimen). I’m not saying that 5 minutes is my ideal for learning, but on a busy day it may be what I can grab and I’ve learned to be satisfied with it in that setting. The second question is why sometimes rounds get a little long as I try to walk through clinical reasoning or relevant literature or the ethics of care we are or are not providing for a patient.

HBR recently published a helpful piece discussing how to integrate learning into our “usual” workflow. I’ve written before about my use of Twitter for my Personal Learning Network, and I consider that analogous to the “bottom up” suggestion of participating in a learning channel. I also have a few new ideas from that group of suggestions that I’m looking forward to incorporating into my learning practice- for example, I was much better as a medical student about keeping a “learning list” than I am now, and it’s a practice that it wouldn’t harm me to resurrect. I’m also going to look at blocking in an hour of each workweek that is just dedicated to learning and exploring things I’m curious about. I suspect I’ll spend my first dedicated learning hour considering the “top down” recommendations from the article so I can facilitate learning (cough…faculty development…cough) within our Department.

A practice mentioned in a different article that provides guideposts for becoming a better learner is one that I’ve already incorporated and that I find invaluable in my varied leader roles. Confession before we dig into this: I did an inventory at the beginning of the year that looked at how I manage information/ learn (Kolb’s learning styles), and my “reflection” score was exceptionally high. Thus, the idea of reflecting on experiences to think about what I have learned, what went well and what didn’t go well, and what I would do differently next time is fairly innate to me. If done through an Appreciative Inquiry lens, this can become a really fantastic way to encourage group learning as well (“What made the patient’s care great, and what can we do to achieve that every single time?”).

And with that, I’m off to reflect on my day. And perhaps to start on that cool idea of a learning list…

Amplify!

I spent my off weekend at Atlanta at a leadership conference for college-age women. No, y’all, I know how old I am and I am fully aware that I graduated from A&M 30 years ago this May…roll with my story here, please.

The first thing I want to say about Adelphean Compass is that I am a bit envious of my collegiate sorority sisters who spent their weekend learning how to lead with self, as well as how to lead with vision, action, and relationships. At age 20 they are getting information that most of us have spent many, many years learning (and often getting not-quite-right along the way). It was POWERFUL seeing that many young women learning how they can be more effective in the roles they are taking on in this world.

On Saturday evening, I had the privilege of being part of a panel designed to share how we amplify those around us and how we amplify core messages. I got to do this with two other amazing alumnae- Aly Merritt and Rae Ann Gruver. The three of us had never met before that afternoon, and I’ll tell you with all honesty…these are women who I want as “marble jar” friends. They’re smart, they’re funny, they’re fully themselves, and they have such love for the work they are doing in the world.

Now that I have had a few days to get out of the glow of the weekend I’ve gathered a few lessons based upon things that all three of us told the audience in one form or another. So what were my take-home messages that I heard?

  1. Do things you are passionate about. Do them authentically.
  2. Find YOUR way to be of service to others. Doing what is special to you on behalf of those who are meaningful to you will ultimately result in joy (and certainly with a sense of tremendous satisfaction of doing what you are on this earth to do).
  3. In your life and in your career, there will be plot twists. You can’t predict what they will be, but if you listen closely as they happen they may help guide your purpose and your passions.
  4. Getting where you are going in life? There’s no Google Maps for that. It’s more like a “choose your own adventure” and sometimes you’re just winging it. That’s okay.
  5. Do it scared. I am certain that at various points in our journeys we each discussed that we have been terrified of what we were doing. Each of us did it anyway, and so far it seems to be turning out just fine.

Who wants to be imperfect with me?


At various times in my life I have been a full-blown perfectionist. In hindsight, I can see how unhappy I was when I was held hostage by perfectionistic tendencies. In spite of near-constant efforts to measure up, I could never quite achieve some metric that (as it turns out) I had made up for myself. And, of course, with not measuring up comes an unhealthy dose of shame (remember Brené Brown’s helpful definitions here: shame = I am incompetent, guilt = I did something poorly and could have done better; these set out VERY different frameworks for interacting with the world). At least for me, when I head into that place of shame and not measuring up I have learned that it’s too easy for me to become unkind and start looking for all of the ways in which everyone around me isn’t measuring up either. I move from assuming positive intent and believing that people really are doing the best that they can…well, to being a mean girl who is totally fed up with everyone, myself included, because we just are incapable of doing anything right. At times this has been transient episodic behavior; some of those episodes were more prolonged (second year of surgery residency, I’m looking at you). I am certain I still have some apologies to spread around, but more importantly I’ll say that I’ve learned from those times not just how rotten I can make people around me feel, but how rotten it makes me feel too. It’s not a good place, and having been there helps me have empathy for how people end up in spirals of addiction and depression when they are living shame and are obsessed with perfection.

Another lesson: When I’m “in” perfectionism, I also can act as if success and achievement as a precious and limited commodity…not something of which there is plenty to go around. If someone else gets ahead, I can’t possibly get ahead, right? (Wrong!) “What did HE do to deserve THAT?” “I can’t believe she got that award. I was so much more deserving.” (((insert your own scarcity response to someone else’s achievement here))) Y’all have heard my sermons before on success not being like pie, that there’s plenty to go around, so I won’t reiterate them in detail today. I’m merely using it to highlight the relationship- at least for me- between perfectionism and scarcity.

Perfectionism in the workplace is known to have mixed effects. Certainly perfectionism helps things get done well- when they get done, that is, because sometimes they get stalled while we’re putting on finishing flourishes that never end. Perfectionism also contributes to burnout, addictive behaviors, depression and anxiety unless it’s harnessed.

I’ll never write a treatise as thoughtful and comprehensive on the topic of perfectionism as The Gifts of Imperfection (which I recently included as one of my favorite books on Twitter). The entire book is a reminder of the unhealthy ways in which perfectionism can permeate our being…and provides antidotes to the voices of those gremlins who tell us we’re not enough, not doing enough, can’t be enough. The book was a game-changer for me; it articulated some things that I knew in my bones but couldn’t describe very effectively, and (perhaps more importantly) the research methodology started me down my sometimes crazy-feeling path of qualitative methods based research. I feel compelled to state that one cannot effectively do scholarly work using grounded theory AND be a perfectionist; these are mutually exclusive categories.

I’m not perfect. Not even close. You’re probably not either because we’re all human and we’re all walking this journey together as best we are each able. If I know one thing for sure, it’s that the more okay I am with my own fallibilities, the more joy-filled and satisfying my life is. I hope in the new year we can find ways to be our imperfect best selves in community.

Failures and goal-setting

I expect you to read about failure during the holiday season? Yes, I do. Sorry-not-sorry for that, but the timing on goal-setting is perfect, and failure provides an ideal framework. Here’s my one disclaimer: I’m not a failure-focused person. I’m a success-focused person who is candid about the times things haven’t worked out (and is okay with the majority of those). Most importantly, I recognize that “failures” can be defined in many ways, and that a constructive approach to those times and events involves learning from them.

Taking risks, hopefully in an environment in which they are “safe”, provides us with opportunities for improvement in both the professional and personal aspects of our lives. If we don’t try new things…well, we will simply keep getting what we’ve had before. I’m not advising recklessness. What I am encouraging is curiosity. What if you looked at something you are afraid to do (handle snakes!) and redefined it by articulating what you fear will happen if you do it (no actual fear unless they’re poisonous, I just think snakes are icky). Tim Ferriss provides a fabulous Ted Talk on his process to manage fear, which provides many ways to understand that most of our fears are completely irrational. What IS the worst thing that can actually happen?

I’m not going to go quite as far as he does to say that you should define your fears instead of your goals- we still need goals. I do agree that naming those things we fear is critical to conquering them. We still need goals, we just need to articulate them differently than we often do. I recently learned about the concept of approach goals (things we work towards) and avoidance goals (things we work to avoid). Boom! There’s the tie in- avoidance goals are often based upon things we fear. The important thing about avoidance goals (“I don’t want to crash on my next ski run”; “I can’t handle it if this manuscript to get raked over by reviewer #2 AGAIN”) is that they’re not healthy for us. Constantly scanning the horizon for bad things creates a vicious cycle that results in diminished well-being. In contrast, an approach goal (“I am going to ski this next run with strength and confidence”; “I have made some thoughtful revisions and am ready to resubmit this manuscript”) sets up a pattern of scanning the horizon for the good things.

What if we practiced self-compassion and helped ourselves to “belong” in the same ways that we include others?

My approach goal for the blog? I’m going to keep finding items that I find interesting, some medical and some not, to curate and share here on a semi-regular basis. I enjoy it when we all learn together.

Thankful

“There is no joy without gratitude.” – Brené Brown

I don’t know how many of you have a gratitude practice per se, where you make a conscious daily effort to identify at minimum one (and ideally up to three) things each day for which you are grateful. I typically tend to be pretty informal with my approach to gratitude, though lately I have been deliberately making myself write down one thing each day for which I am grateful, trying to be more intentional in my approach to gratitude.

I do tend to think of gratitude as going into one of two buckets- one is the “basics”, those things that allow us to do life on a daily basis.  For those who know my life, my number 1 on this list would be my Mama, who keeps my home and non-professional existence “on the rails” so I can focus on (1) work and (2) chasing joy. While Mama C is anything but basic, she is definitely the key to my daily life. Other basics? My menagerie. This beautiful home. Having a career that I am truly passionate about and feel blessed to “do.” My teams- clinical, administrative, and scholarly. Adventures. My running friends. Hopefully you get the main idea.

Bucket #2 for gratitude is more complicated because it’s predicated on those hard things that happen in life.  While I’ve had at most a handful of these things (again, another basis for gratitude!), it can be too easy to “silver lining” them and to not dive into the real learning that happens from them. In 1990, as I started my 2nd year of graduate work at CU-Boulder, my apartment burned and I lost everything except for a cat I carried out with me and the pair of pajamas I was wearing at 3 am. The easy lesson here would be that it led me to what I’m really supposed to do with my life (partially true), or that it gave me an opportunity at age 21 to start over (really true, but not an experience to be wished for). While those things may be true, the basis for gratitude around the experience is more complicated. I learned how resilient I am. I learned how amazing people in my life were and are. And I learned how to live the Buddhist principle of non-attachment in a way we seldom get to in our lifetime.

The gratitude for hard things should be rare, and it’s something that takes both time and distance to fully process; it was more than a decade before I could make it past September 10 without being conscious of what had happened on that date. Basic gratitude is where that daily practice comes in that helps us find meaning, joy, and keeps us whole.  It can be incredibly easy to forget to be grateful for some of those things- after all, I did just throw a cat out of my lap for sinking her claws into my thigh- but they are the things that provide that day in, day out rhythm of life that ultimately can and should be a source of deep and abiding joy.

“Those days when I keep my gratitude higher than my expectations…those are the really good days.”- Ray Wylie Hubbard

You never even called me by my name…

I continue to think about civility and its importance in how we interact with one another. 

And then I hear tales of medical students who feel completely excluded from their clinical teams because the faculty never learn their name, much less anything about them as people, and the residents may or may not include them in patient care and learning. Passive incivility, perhaps, rooted in simply ignoring our learners.  Passive incivility that results in dehumanizing our learners.

Y’all…really? We can do better.  We have to do better. When this happens in surgery then we wonder why students won’t pursue surgical careers, we have no one to blame but ourselves. Had you been treated like this during a clerkship, would you have chosen that specialty? My gestalt- and some of my older research-tells me the answer is no.

How can we be more welcoming for our learners and help them recognize that we are walking the walk of #youbelonghere?

  • Learn names!  Introduce yourself to them. And introduce your learner to the patients when they haven’t already met.
  • Where is their hometown? Where did they go to college? What was their major? WHY did they choose that? What got them interested in medicine?
  • What identities do they have besides “medical student”? Do they have hobbies? What excites them?
  • What do they want to learn from you? (Reminder: They’re paying tuition.  While our patients always, always come first, we actually are working for the students.) What do they hope to get from their time on your service?
  • What are they curious about today?

I wouldn’t expect one of us to pepper a student with all of these questions in the first 15 minutes (in fact, that could have the opposite of the desired effect!), but they provide healthy, welcoming starting places. More importantly, can you share questions with me that you use to get to know your learners and to help them feel welcome?

(Those of you with appreciation for 1970s Country music may get the reference in the title.  For those who don’t have that appreciation, or for those who haven’t spent evenings drinking beer at the Dixie Chicken in College Station, the title is “The Perfect Country & Western Song”)

R-E-S-P-E-C-T

The context:

I could start with the horrible, saddening week filled with nothing short of rage-fueled crimes in our country.  Really, I consider them a more extreme manifestation of a key issue.

Instead, I’ll refer to a Facebook post from the Association of Women Surgeons networking breakfast that apparently incensed some women because (as has been the custom for many years) there were fashion tips and tricks provided by a professional stylist. While some of the commenters applauded what was for them a fun social activity, others were incensed that AWS felt this was appropriate.

Or a Twitter post today by one of my mentee/ friends, showing her a year ago today when she was VERY pregnant and scrubbed for her last case prior to delivering her 4th child. While some of the commenters were supportive of her ability and willingness to “have it all” (a daunting task that isn’t exactly how it actually works…thus the quotes), others (none of whom had full context) were highly critical of her choices.

What if, for just a moment, we all paused to take the perspective of someone else, someone who thinks differently from each of us?

What if we held that perspective with as much care and thoughtfulness as we would want our own perspective held?

Rest assured, I am not asking you to hold the perspective of someone who is mailing pipe bombs or shooting Holocaust survivors during a bris. I’m a practical person, and there are certain behaviors and thought processes that are simply beyond the pale.

But what if we were able to ease our everyday frictions, particularly those on social media (y’all, it’s the INTERNET for heaven’s sake…it didn’t even exist in a recognizable form 30 years ago!), by taking the perspective of the other?

Is it possible that just for a moment we could add to the kindness that is so desperately needed in our world today?

Our world is filled with injustice and violence.  Let’s figure out how to work together to ease those things, not compound them. Ask more questions. Stay curious.

Priorities FTW!

I’m going to start with a scenario that I suspect isn’t unique to me, but I’ll tell the story from my own experience.

It’s been a long day.  I got up at 4 to run before catching a 7 am flight. I then hit the ground running in the city I’m visiting with lunch followed by a series of meetings on a variety of topics. I have an hour and a half, give or take, to unwind, then it’s off to a working dinner.  Then I’m back to my hotel room at 930 pm (give or take). This is about the time when I realize that I’ve got a LONG list of things that I perhaps should do.

Perhaps.

Should.

And won’t.

The primary reason for this choice is that if I delve into some of those things that are out there, it’s a bit like going down a rabbit hole in terms of the commitment involved. Sleep is a precious commodity that has a strong influence on our ability to perform at a high level. If you don’t believe me, this recent HBR podcast provides additional terrific information on the benefits of sleep, nutrition, and exercise. Given a choice in the evening, it’s never a bad option to shut down and shut your eyes.

Now, I didn’t go immediately to bed. What I did was triage the things that I could do: read to learn something new, answer emails, work on drafts of two different manuscripts I’m in the midst of finishing, have some dedicated creative time and draw something, do some yoga, “play” in my workbook/journal for the day, read everything on Twitter for the last 3 hours…plenty of options, right?

Instead of choosing some dreadful hodgepodge of things that results in Brownian motion (and ultimately feeling like I’ve done absolutely nothing), I stopped to instead consider what was more important for me to rest well and be ready for my day today. 

I triaged email for 15 minutes, and only 15 minutes.

I did my pre-bedtime rituals (skincare and dental care matter, and I have those pesky asthma medications to keep up with).

I laid out my workout clothes for this morning.

I played in my workbook/ journal to document my day, think about what’s been inspiring me, and to consider what creative thing I did yesterday…because that’s part of my wind-down ritual at home.

I set the alarm for 5 am.

I turned off the lights before 1030 pm.

It could have been really easy for me to make some less-optimal choices that would leave my brain busy-busy with that original list of things I should do. It required a moment of being really intentional about what was most important in the moment, and the things that I identified were all designed to help me sleep well (which I did, then I had a great workout and amazing cup of coffee before my day got truly started today).

We’re all faced with almost-endless lists of things that we must and things we should do.  That’s unlikely to change (though that should list is often negotiable). What we can change is the intention we bring to managing those lists. By asking what is important in this very moment we can make the best choices and set the best priorities.

So, what’s important now?