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.



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?


Don’t call it a comeback…

Nope, the blog isn’t dead. It’s just been taking a really, really, REALLY long nap.

The easy thing to do would say, “I’ve been busy.” It’s true for me, as it is for all of us.

The underlying truth is that I was busy when I was writing routinely- and may have been even more busy then, if I’m completely honest. While I’m in this moment of honesty, there are few things I detest more than people telling you how busy they are.  Again, we’re all busy.

Factually speaking I’ve made other choices with my time for the last several months. For those who haven’t done it, moving as an adult can be exhilirating and a really good life choice and (by the way) require huge amounts of cognitive bandwidth and energy.  I had to spend a few months consciously thinking about where the grocery store is, or which turns I take to get to work, or how long it takes to get anywhere. It’s been amazing for my brain plasticity to do this.

And learning to work in a new place for the first time in a really long time- even if it’s a great place (and it is) it’s still all new. I spent the first three months at work reveling in those days when I would walk around the building and actually see a familiar face. That’s a huge change from 20 years of social capital and not being able to walk down a hallway without seeing someone you know, even in the middle of the night. Not good or bad necessarily, just different, and what is required to learn to navigate a new place and new system is not inconsequential. It’s decreasing all of the time, but it’s still a real “thing.”

Of course there’s also the whole piece of moving as an adult and having to rebuild those social networks away from work since I refuse to maintain a unidimensional identity as a surgeon. For those who missed the memo, I am actually an introvert and socializing requires moderate amounts of energy for me until I’m completely comfortable with someone. Making new friends, finding new people to do things with is work- worthwhile work, but work nonetheless. Running has definitely been the facilitator for several new friendships, and I am so grateful for that.

I also had some health “stuff” this summer that really impacted my energy levels and my ability to sit here and type. It’s nothing life-threatening and it’s slowly and surely improving; I’ll just say if I never see poison sumac again it will be too soon.

Why the rambling story? To make the point that I could have kept writing this summer and it probably would have been okay. Instead, I made other choices to focus on learning how to be in my new life here in Ohio and to manage my energy when I felt pretty crummy for a while. Everything we do in life is a choice, not just to do that thing we choose but also a choice to not do something else. Hopefully both of those are deliberate and intentional since we really are saying no (whether we mean to or not) when we say yes.

I’ve been saying no to the blog, and that’s okay. I also have realized in the last couple of weeks with the change in the season that I’m craving more reading, more writing, and more creating. It’s time to say yes again.







To give proper attribution to the term “wholebeing” (which I adore perhaps a bit more than work-life integration), I need to link you to a post on Karen Walrond’s blog from a few months ago. If you know me at all, you know I’m a HUGE fan of Karen for many, many reasons. Her post knocked my socks off, primarily because she very eloquently and effectively described what many of us are aspiring to in our wellness programs.

Please note my use of the word “aspiring.” And please note that she explains that they aren’t all things that you have to do every single day. For example, I know that yoga is good for my physical flexibility and my mental processing, and I recently learned while reading When that practicing yoga in a class may also benefit my ability to sync with people around me.  Does it need to be an everyday thing to reap those benefits? For me, no. Once a week is adequate, twice a week is ideal, and when I can get to a long-weekend yoga retreat once a year or so, it’s simply bliss. It’s all about figuring out our personal “sweet spot” in those various areas of our lives, then having the discipline to make them happen.

And making them happen…it’s not about “shoulding” all over ourselves.  It’s doing them because we know it’s a commitment to our best selves and our healthiest selves. We do this for our present and future selves. We do it for the people who love us (even on the days we’re pretty sure we don’t deserve it). We do it for our patients. We do it for the people on our team. We work on our #wholebeing because that’s how our best self can keep showing up every single day.

I’m putting a challenge out there because a holiday Wednesday during the first week of the academic year in medicine seems the perfect time. This Wednesday, July 4, will you join me on your favorite social media channel for #wholebeingWednesday? Share an image of you doing something that keeps you whole- reading a book, drawing something, running with a friend (that will be mine), whatever it is that helps you be your best you, and even if it was only for 2 minutes. I can’t wait to see what all of you are up to!



Whatever happened to waiting your turn, doing it all by hand?

It’s time for several random observations, because that’s where I am right now.

  • The hardest part of moving somewhere new after being somewhere for a long time? For me it’s been that every single thing I do is a conscious act. It was possible in Salt Lake for me to zone out and remember nearly nothing of my drive to and from work…going to Whole Foods was pretty well an autopilot activity…I would head out for a six mile run and suddenly be back at the house with the run done…everything was routine, perhaps even automatic. Now, not so much, though I know at some point some of those things will start feeling easier (or at least will require less cognitive bandwidth). I do think that in general I’m down to using Google maps a few times a week, as opposed to multiple times each day. It’s a start.
  • I miss quite a few people, and I miss some aspects of the “old” job. Overall, though, I am loving the new work adventure, and I really love Columbus/ Worthington. The change has been good for me. It was time for new challenges.
  • My biggest source of normalcy outside of the house and the menagerie? Unsurprisingly, it’s been running, and I’ve only made one route error wrong turn since arriving here (and it wasn’t dangerous, just took me on a bit of an adventure, and was easily righted with Google maps).  Today was the first run I’ve “dropped” since sometime in the winter, and the only reason I dropped it is because I have an injured ankle. I had some hopes for a triathlon this summer (ha!), but adding swimming and biking in to my schedule along with learning all of my new jobs would be about two too many things. So, in summary, running = normal. And, as ever, a source of sanity.
  • When I’m in the midst of a flurry of academic activity with lots of writing and editing and writing and thinking and writing, the blog seems to go by the wayside. The good news is that I need the blog less to keep my writing skills up when I’m doing copious professional writing.  The bad news is that I miss the creative outlet. Missing that creative outlet is why you, dear reader, are the beneficiary of tonight’s brain dump.
  • Tonight’s blog title is courtesy of Miranda Lambert’s song “Automatic”, in case you were wondering where it came from.

Fall down seven times, get up eight

General comment: Moving and starting a new job is HARD. Nothing in life is “automatic” right now. Nothing. My learning curve is vertical every single day.  That said, it’s all going well and I’m loving it.

While there will ultimately be a manuscript from my Presidential address last week at the Association for Surgical Education meeting, I wanted to share some key points sooner than later.  The address was entitled “You Belong Here” and was focused on how we create an environment of belonging for each other and for our learners.

As you might expect of me, I issued a series of dares for those in attendance with a series of action items. If you weren’t there, or if you need a refresher, here are the dares and their associated action items:

  • Dare #1: Have a conversation with someone who “pushes your buttons”
    • Action item: Take a hard look at your core network (and find people who are different from you in any way in which they can be different)
  • Dare #2: Nurture two-way relationships
    • Action item: “How can I help you?”- This question will completely change your relationship with everyone around you.  Especially if you ask it of people who “push your buttons.”
  • Dare #3: Know who you are
    • Action item: Lean into the mess.  No one can be you as well as you can, even when you’re imperfect.  Especially when you’re imperfect.
  • Dare #4: Practice “Radical Candor”
    • Action item: Speak your truth. Respectfully.  And listen, listen, listen.

Stay tuned for more details on any/ all of these items.  Oh, and I know it’s reading round up time.  Look for that later this week!



March 2018 Reading Round up

I know…it’s about time.  Boxes all were successfully packed and made it out of Salt Lake and now we relate their arrival in Columbus.  This month’s reading round up will focus more on general media than the medical literature, mostly because there have been plenty of juicy tidbits out there recently.

OHSU has added “compassionate communication” to their medical school curriculum.  The rest of us should likely follow suit.

While the letters in response to this New Yorker article appropriately took issue with the failure to represent the perspectives of the staff who cared for Jahi McMath, her story itself remains fascinating.

Increasing amounts of research demonstrate the benefit of self-compassion in staying healthy both physically and psychologically. Many of y’all know I’m an Eric Barker fan, and he had a recent blog post on how to be our best selves that focuses on the role of self-compassion in success. The question of “How should you treat you?” is incredibly important as a cornerstone.

Here’s my one medical journal contribution for this month: opioids for chronic back pain and for osteoarthritis really, truly are the wrong answer. Changing our practices around opioid prescriptions in any specialty is urgent.

Last but not least, in honor of the time change tonight, can we just make the nonsense stop? Here’s some interesting information regarding why (at least in DC) year-round DST isn’t a bad idea.

Happy reading, y’all!  And more soon as I get settled in.


February 2018 reading round-up

Apparently moving and travel and…well, life have all been a little hectic.  Let’s get back on track with the February reading round up, if we may.

Opioids and our role as surgeons in the current “opioid crisis” is an ongoing hot topic.  This study helps to establish an evidence based for duration of postoperative opioid prescriptions.

If you’ve worked with me clinically you know that I am a big advocate for our pharmacists having a high level of engagement in the care of our patients, particularly those who are critically ill.  Not surprisingly, this new French study shows that having our pharmacy colleagues enforce quality bundles decreases LOS and drug costs.  Friends, listen to your pharmacists.  They are very smart people!

Sexual harassment is yet another hot topic; I wish that Academic Medicine had made this statement free to all readers, but I want to let people know it’s out there if they have access.  We’ve all got to work together to get harassment and discrimination of ANY sort into the “historical interest only” category. Zero tolerance is a key piece in that.

Closely related to this Academic Medicine viewpoint are two things from HBR.  First, their current Big Idea focuses on “Now what?” around the #metoo movement.  HBR podcasts also have a new “Women at Work” series that so far is worth the time invested in listening.

My other reading right now is Shawn Achor’s new book Big PotentialIf you are leading a team or aspire to lead a team, or simply want to succeed in life, I would call it “highly recommended.”



Nevermore. It’s time to get uncomfortable

This blog post by medical student Jamie Katuna (who does wonderful creative work!) cites 20 anecdotes of things that women in medicine hear.

It’s prompted lots of additions on Twitter, in which friends and colleagues have added spins to the comments from their own experiences. Some of these additions have been perhaps more egregious than anything cited in the original blog post.

Reading these comments, as well as recently hearing stories from women in training about ongoing flagrant sexual harassment at a variety of institutions, has me in a place that falls somewhere between rage and disgust. Sure, there are some physical things that men can do and women can’t and vice versa, but the modern social professional contract accepts that there should be equity in opportunity and equity in pay, and that gender, race, and other defining characteristics should not be limits. Nor should these defining characteristics provide a basis for degrading commentary or debasing actions from those who are threatened with the changes occurring in the professional power structure.

Yet here we are in 2018 with exactly those things continuing to occur.

Before we go any further, I’ll state that I know that MANY very good people who stand up routinely for those who have less power, who believe in social justice as something we have to actively pursue every single day. You know who you are, and I see you and appreciate your efforts.

Yet here we are in 2018 with people in positions of power who continue to deny opportunities to those who threaten their comfort zones and their world order.  After all, we can’t have too many women in charge, can we?

Here’s something for you that’s not exactly a secret:

Sexism and misogyny are not just a women’s issue.  They’re an everybody issue.

Here’s another not-so-secret idea:

Racism is not just a minority issue.  It’s an everybody issue.Yet here were are in 2018, in which many are uncomfortable with sexism and racism AND have a fear of disapproval if they try to change the narrative.

How do we change this?

For those in positions of power and leadership who “get it”- you have to make sexism and racism unacceptable. Zero tolerance. And you need to “help” those who are sexist and/ or racist and have power by removing their power.  It’s hard, it’s scary, and they’ll be angry.  Without action they won’t change because so far they haven’t had to do so.  Call. Them. Out. Use your power for good.

For those who are not in positions of power and leadership, you can still make a difference once you choose that the outcome (dismantling unjust systems) is of value. What small things can you do?

  • Ask someone to repeat their comment.  It’s easy enough to throw the, “I must have misunderstood you…can you please repeat that?” card in a non-confrontational way. If they repeat something that seems mind-boggling to you (“General surgery is not an appropriate field for women”), another non-confrontational response might be, “Help me understand why you think that because I know of many successful women in general surgery.” Oh, and feel free to report your discussion to someone who has power over them and who understands why this isn’t okay.
  • Step in if you see someone in an uncomfortable or awkward position.  If you don’t want to look at the person causing the issue and say “This seems very uncomfortable” it’s easy enough to shift things by coming up with something you need to discuss privately RIGHT NOW with the person being victimized. If you can, get their whole story and share it with a powerful ally who has influence over the perpetrator.
  • Was there something you wish you had said in a situation? Remember it and use it later!

What other ideas do you have for how we can create a climate that is fully respectful of our differences, both in little ways and in big ways?  Please share here, or @ me on Twitter (@AmaliaCochranMD). What have you seen done well? We must do this together.

And we must do it together NOW.


New Year, Newly Organized

Last week on Twitter a sort-of related discussion evolved into a discussion about how people keep their ideas, concepts, and projects organized. Everyone’s got their own system, of course.  Here’s the issue: not everyone’s system works for everyone else.

Confession that I believe I’ve made before, both on the blog and on Twitter:  I have failed pretty much every list-based organization system out there.  Remember the Milk is great if you do to-do lists well. Same for Todoist. I failed Remember the Milk before it was even super-cool.

If you’re a bit like me and are frustrated that you can’t seem to get systems that work for everyone else to work, I have a helper for you.  Carson Tate is a Very Smart Woman who identified productivity styles amongst people she coached, and she has a free on-line assessment.  I took her assessment a couple of years ago and it was mostly helpful because it allowed me to stop wasting my time on organization systems that are more linear and structured; it turns out that I am a Visualizer, according to her descriptions. We won’t discuss those bits in there about “spontaneity and impulsiveness” and “hasn’t seen the surface of their desk in years.” What I do know is that identifying my visualizer tendencies, putting my projects on a Personal Kanban white board using color-coded Post-its for different domains, and keeping my somewhat notorious Case of Markers close by has been undeniably useful.  I wouldn’t recommend it for everyone (especially not the “kill me now” section of the Kanban board!), but for me, it’s effective, and far moreso than any other system I’ve identified. And for day-to-day as a place to store almost any of my crazy ideas, either short or long term, I’ve become a huge fan of Bear– and I want to believe I’ve converted a few of my Apple-using friends to it as well. I mostly love that I can use it on my MacBook, my iPad, or my iPhone, and I keep both personal (list of things that need to be done in the new house prior to move-in) and work (notes for my upcoming talk at the Wyoming/ Montana/ Idaho ACS Chapter meeting) in it. I’m also in the process of a trial of Lifetick- stay tuned on that one.  It may be a little too organized and linear for me, but time will tell.

I hope that those of you who have a successful organization system will share ideas, either here or on Twitter.  Or if you’ve failed one or more systems, please share that too. I’m hopeful we can all learn a bit from each other to start our new year off.



January 2018 Reading Round-Up

Happy New Year!  In truth, around my house we’re very much looking forward to the Lunar New Year’s arrival since this will be the Year of the Dog.  Olivia is very pleased with that prospect.

As our population ages, providing best care is a growing focus.  This report provides a thorough overview of proposed standards for surgical care of older adults.

More clinical findings relevant to the opioid epidemic.

Healthy conflict really is just that- healthy. And it’s good for our organizations because it fosters intellectual diversity.

This is a beautiful cross-cultural essay on end-of-life care in this week’s New Yorker.

Last but not least (since I’m mostly going off-medicine this month, it seems) is this reflection on kindness. Please use it liberally.

Onward and upward, y’all, and happy 2018.