“It’s not your time”

I’m hopeful, dear readers, that we can have a bit more of a dialogue this week.  I need to learn something, and I particularly need the wisdom of the men in the audience.

One of the undeniable joys of spending last week on the road at the American College of Surgeons Clinical Congress is the time I got to spend with surgeon-friends from many places and at varied career stages. Yes, there was learning and thinking and organizational work, but at the end of the day the connection is (as ever) what means the most to me as I reflect. I came home so thrilled to know more about the work that my friends are doing, and feeling supported in my own.

As one would expect if I’m spending time with varied surgeon friends, it also means that I got to spend time with some phenomenal surgeons/ scholars/ leaders who happen to be women. As one would expect, plenty of stories get shared.  As a qualitative researcher, I’m always looking for themes in stories, and last week was no exception.

What I heard was quite a few amazing, talented, accomplished women with tales of leadership roles deferred or denied, with the standard rationale of, “It’s not your time” or “We need to give Brad* a chance.”

This is where I need the crowdsourcing help, because I only know the female experience of many of my colleagues and myself. I feel like in the last year I’ve heard more and more of this sort of deferral or denial. Is “It’s not your time” code for implicit or explicit bias that keeps women out of leadership roles they have legitimately earned? Or is this a reflection of generational shift, and is something that’s being used to keep men and women who might buck the status quo a bit out of roles that, again, they have legitimately earned?

If this is simply reflective of old institutions dying with a long exhale, we need to address it.  We need the best leaders in the most crucial roles, and we don’t need to wait for that.

If this is truly a “new” form of gender bias, it’s even more imperative that we address it. Nothing will change unless we do, and, again, we don’t need to wait.

Help me learn, readers- is this gender or generation bias at play?


*”Brad” is simply the standard guy, and is usually the standard white guy who doesn’t upset the apple cart. My apologies to any Brads out there because I do, in fact, know that some of you are amazing people and leaders who do think beyond tradition.

But I don’t WANT to!

Now that I’ve channeled my own inner toddler, I’m willing to bet I just channeled a few of your inner toddlers as well.

What is it I don’t want to do?


Admit it, you might have cringed a little when you read that word. It’s something that’s foisted upon us as a necessary evil in career development. And it’s something that makes many of us feel…well, icky, for lack of a more professional word.

Certainly there are a group of people for whom networking comes naturally; the are able to dive in and meet people and find ways to connect to them. For the rest of us, networking is a more deliberate process, and one in which to keep our integrity we also need a way to remain authentic. If you want a quick fix, here’s an HBR article on learning to love networking that has four key steps.  I want to focus primarily on the idea of finding a common interest (which I also associate with help-seeking), one of them that’s quite easily controllable and that creates a specific type of culture.

Think for a moment about someone you know who is an amazing connector (I’m going to use that word to remove any negative connotations). That person who seems to know everyone, and whom everyone seems to know, and that familiarity is consistently in a positive sense. Chances are that person will in some way align with Adam Grant’s definition of a “giver,” which may be a secret to getting ahead, and certainly fosters a specific type of positive culture.

Where am I taking this?  I’m trying to move us from the idea of networking being transactional, because that seems to be when we get that dirty feeling about it. What if we thought about networking in a purely relational sense? What if we sought things that we have in common, and we asked questions and actually listened to the answers?  To quote from Eric Barker‘s recent book, what if we shared our Twinkies by finding small ways to help one another?

When we use a relational framework, networking seems strangely akin to friend making- it’s all about liking and being interested. Or, as Glennon Doyle Melton wisely phrased this a couple of years ago, “I really, really think the secret to being loved is to love. And the secret to being interesting is to be interested. And the secret to having a friend is being a friend.”

One more tangentially related thought: if you have friends you haven’t connected with recently, take this as a reminder that it’s time. I’ve not once regretted the coffee date, the run, the weekend when I’ve made time for it.


Don’t be cruel

While none of us are eager to admit it, many of us have witnessed bullying in the healthcare environment. Sometimes it’s senior physician versus junior physician or medical student. Sometimes it’s physician versus nurse. Almost invariably it involved the presence of a power differential, someone who is advantaged versus someone who is not.

This past week, this podcast was released as part of the JAMA Podcast series.  If you’re not familiar with the JAMA Podcasts, they are pretty terrific.  In this one, Ed Livingston cites much of the data about the prevalence and impact of abuse/ bullying, with a particular focus in this podcast on medical students. If you want background reading for the podcast, the original case and discussion are here.  I want to highlight the importance of ignoring behavior like that described in the podcast (as do Dr. Lucey and Dr. Livingston)- if we ignore this behavior, we’re implying that this is okay.  Note: I am particularly heartbroken by the surgeons who were so terrible to the medical student- I promise we don’t eat our young. Also, if you’re in training as a student or resident and have someone in a position of power who is bullying you, it’s likely not just you they are picking on…find someone safe to report it to who can hold them accountable.

Interesting timing of course means that during the same week something came across my email talking about how to overcome bullies at work.  An important point that he makes is at the very end: If you’re surrounded with jerks, you’re at higher risk to become one.  Choose your environment wisely. (((Related but unrelated: some of you have heard me talk about Eric Barker’s blog in the past, and this piece is no exception to his usual brilliance.  I try to subscribe wisely to things, and his weekly blog is a highlight in my email inbox on Sundays.)))

And what if this isn’t about a power differential, but is more about a peer who is a jerk when they aren’t being watched? Remember not to get hooked, and that it’s really not about you.  Then refer back to the prior piece.





Gratitude: It’s good for your team AND it’s good for you

Let’s start with a question.

How did you feel the last time someone provided you with a sincere thank you or kudos for something you did?

If I’m a good judge of human nature , I suspect it made you feel pretty good.  Perhaps your body generated a nice surge of dopamine. I would also suspect that it generated some good will towards the person who said the nice thing about you. You felt seen, and valued- two of the things that we know are so important to developing a sense of empowerment and belonging. And, of course, empowerment and belonging result in loyalty.

Gratitude is an important, and sometimes underestimated, leadership skill. Let me be clear about one thing before you decide to just go around saying, “Thank you” to everyone in sight.  That won’t get it.  Appreciation needs to be personalized, and if you can be creative in how you show appreciation, all the better. Personally, one of the best acknowledgements I’ve received recently was from a friend and sorority sister whom I work closely with. Last weekend I couldn’t run my planned half marathon because of illness.  And the text I got from her….well, it knocked my socks off.  It was a well-timed reminder that I can do hard things, I just couldn’t do them last Sunday morning.  And that’s okay.  She is someone with an incredible gift of gratitude and appreciation, and it makes her FUN to work on big projects with.  It also makes her a wonderful friend.

Appreciative Leadership has a summary table of 7 reasons to be generous with appreciation. Taken from Table 6-1  in the book, the list is as follows:

  1. Recognition lets people know they are on the right track
  2. Appreciation communicates and reinforces your values
  3. Compliments foster a positive emotional environment
  4. Gratitude is a verbal immune boost; it is good for your health (we’ll come back to this one shortly)
  5. Praise is good for the health of those you honor
  6. Acknowledgement creates a sense of safety (SO important in teaching and learning environments!)
  7. Gratitude encourages risk-taking and experimentation

The reality is that a culture of gratitude helps to promote high performance by teams.

Here’s the thing: While appreciation is the right thing to do for your team, it’s also the right thing to do for yourself. Many individual-level benefits of practicing gratitude are becoming increasingly clear: it improves both physical and psychological health, enhances empathy, improves sleep, enhances resiliency…the list goes on. If you look at that list closely and if you follow the literature on burnout, you immediately recognize that gratitude might just be one of the cornerstones in combating burnout.  Again, from personal experience I know that on days when I am feeling particularly frustrated and as if I’m tilting at windmills, the best thing I can do is pause and think about something I’m grateful for.  On bad days, it might be that I’m only on call for 4 more hours.  On less bad days, the list is typically much more robust.

Weekend homework, friends. Before you go to bed tonight, tomorrow, and Sunday night, write down (yes, write it down with pen or pencil on paper- it does imprint better that way!) three things you are grateful for.  I’m helping you to kickstart your personal gratitude practice.  Next week see if you can extend sincere appreciation to people you work with.  I’m willing to bet you’ll make someone’s day and make them want to do an even better job the next time you work on something together.

Resolved: We need to be able to have dialogues and debates

With my recent post encouraging us to seek the Other, it seems like an important time to dive into debate and dialogue as tools we use in communication. One of these is, by definition, a better way to deeply listen to someone with a different viewpoint.

Quick question for you: What comes to mind with dialogue?

I personally tend to think of open mindedness, seeking common ground, and a willingness to change in belief or action based upon what one hears.  I see dialogue as not being zero-sum.

What about debate?

It feels more confrontational, critical, difference-based, focused on winning and losing.  Debate is usually VERY zero-sum.

We know that one of these things is the place we should go when we’re dealing with people and ideas who are different from us.  But dialogue requires a lot of work. And energy. And attention.

Is debate inherently “bad”? Definitely not, and it can be used very effectively.  If you’ve been given the opportunity to argue a side in a pro/con that you don’t agree with, you know how much you learned (and that you possibly changed your mind afterwards!)

Fostering dialogue within a group, however, improves inclusion.  It helps us make better collective decisions. In the most dramatic situations, it helps foster peace.

Clearly this is the extreme, idealized version of deep listening.

However, if I think about the times when I have sincerely tried to listen like Thay describes, I have learned so much about myself, about others, about the world.

From a more business-based perspective, it is possible to foster deep dialogue among team members using a collection of tools.

And if you’re wondering, yes, one of my 2017 goals is to work on my deep listening.  I would challenge you to join me. I would also challenge you to help keep me accountable on the days when I’m struggling.




Not the usual suspects

As I mentioned in this week’s reading round-up, I am completely enamored right now with the book Appreciative Leadership. I recognize that some view my tendency to skew positive as a leader as a shortcoming, and what I most value about this book is that it takes that it’s giving me great ideas to take that positive skew and convert it into positive power.

Last week I was reading the chapter entitled “The Genius of Inclusion,” which has sections on improbable pairs and and a section encouraging us to reach out to the “Other” as an act of inclusion. The take-home message from these sections centers around the importance of truly listening to someone who is different from us; it helps us learn what we have in common with people (which may not be at all obvious on first pass) and it also helps us to build trust and foster respect. The authors encourage the fostering of improbable pairs within our teams, in which team members choose a partner whom they believe to be greatly different from them and then do a 20-30 minute appreciative interview.

Let’s extend that idea of the improbable pair further out of our comfort zone since used within a team there’s at least one thing we have in common with the other person.  What about the Other, as the authors refer to it? We all have an Other- a person or group of people whom we like or don’t trust.  American politics this year has proven just how relevant this idea of Other has become, particularly in the face of a lack of willingness to listen to ANY opposing viewpoints (which, for the record, is behavior I’ve seen at both ends of the political spectrum).

So, an exercise for you this week, friends, that I’ll admit I straight up stole about half of from the book.

  • Who are your Others? How did you learn to see them this way?  We all have them, and if you say you don’t, you’re not being honest with yourself or others.
  • What might you be missing out on by excluding them?
  • How can you reach out to an Other to learn about them? I bet you know at least one whom you can have a conversation with, and whom you might even be able to build a bridge with.  Go do that.

I know this isn’t an easy exercise, and that in some ways it’s downright scary because it challenges a core belief about your Other. But what do you have to lose? And think of what all you have to gain if you discover that while your Other is quite different from you and you have common ground with them.  You might just change your life and theirs.

Second-hand stress

The day of a highly contentious national election seems like the fitting time to talk about responding to stress in our environments.  In truth, I probably should have put this together months ago (because the campaign has been all sorts of fun, right?), and instead I’ll declare it a “better late than never.”  It’s not like stress is going away from any of our lives anytime soon either, if we’re completely honest.

If you think Facebook, Twitter, and listening to the news have all been stressing you out for the last few weeks, you’re completely right. Being around people who are stressed can stress us, even when it’s just observing that stress electronically. We’re perceiving threats and we go into fight or flight mode, even when the stakes don’t involve immediate survival.

Fortunately, HBR has a publication on making yourself immune to secondhand stress (as well as a one minute video if you don’t want to read today). To summarize their tips and tricks, here they are:

  • Change your mind– What I really mean here is to change your mindset.  If something is bothering you, you either need to change it or change how you are viewing it.  Complaining benefits no one, and if anything it scares people off because you get seen as being a “negative Ned.”  Don’t be that guy.
  • Create positive responses to stresses when they happen– Someone glaring in a meeting? Smile at them (no, really, do it!  It’s fun!). Lead your conversations with others in a positive way (“How can I help you today?”) versus a negative opener (“I’m way too busy for this right now.”). What kind word or show of patience can you provide today?  This is NOT hard, it does not cost money, and it makes you feel great.  Try it!
  • Build your copamine- You can handle these bad days.  You CAN.  The proof lies in the fact that you’ve survived all of the prior bad days. And if that reminder isn’t enough for you, why don’t you go for a walk/ run/ swim/ bike ride/ dogwalk/ yoga practice?
  • Practice positive habits– It’s not just about these habits being “good” habits; they are habits that when built make you more positive.  Want to know what they are?  Here’s a TED talk to help you learn.  Oh, and if you need a mediation resource, check out Headspace, and not just for Andy’s awesome accent.

Feel free to use any of these tricks today for the election, tomorrow at work, or any time that you realize you want to be in a better space.  Do not let the world get you down!

Shame, patients, and the Internet

“If we can share our story with someone who responds with empathy and understanding, shame can’t survive.”- Brené Brown

Last week over lunch, a colleague and I were discussing some of the on-line physician groups that are out there.  Some are on-line communities within organizations, others are Facebook groups. While we both acknowledged that some of those groups can be incredibly helpful for building a community around shared experiences in the challenges of our work, she astutely noted something troubling to her, and that I realized had been an intangible quality that had troubled me more than once.

It’s the fact that within that “safe” space there seems to be this more-than-casual practice of patient-shaming (Note: It’s the Internet, people. Nothing is “safe” if someone gets a screen shot.). It’s the discussion the obese patient, or the patient whose lifestyle choices we disagree with, or the patient who keeps turning up in our clinic with injuries from self-harming in a way that judges them.

As physicians we’re known to sometimes do this in person, and it seems to be we’re more likely to do it to women (yes, there’s both anecdote and science supporting that claim).  But the internet, particularly these spaces in which we’re with our own people, provides a whole new area of questions around how we talk about our patients.

I’ve heard the argument that it’s like being in the physician’s lounge to talk about patients in this sort of space. I would argue it’s nothing like that, mostly because we don’t have direct personal relationships with most of the individuals in those communities and you don’t know if someone caught a screen shot of something posted that crossed a line. It would be horrifying to post something, realize later it wasn’t a good idea, go back and take it down, and only have it come back to haunt you later because of the dreaded posterity of the internet.

I get that we’re tired, that many of us are struggling with burnout, and that we need some sort of way to process dealing with patients who challenge us.  I’m not saying that I haven’t (under a cone of silence in a true safe space) expressed frustration with a patient and/ or their family; if you haven’t EVER done that, you’re a better person than most of us in healthcare, and we also want to know where you acquired your collection of perfect patients. What I am saying is that we have an obligation as leaders and as human beings to think carefully about the reprecussions of things we say and things we write. More importantly, even when we’re tired and cranky and just DONE, that’s the time we need most to call on our compassion and remember why we chose this profession in the first place. And, of course, we need to choose our audience very carefully when we really just need to vent- and we need to stay out of judgment when we do.

Before you post that patient story in a community or group, think about how you would feel if you knew that you or someone dear to you were being written about in the way you intend to tell the story.  If the answer is either “not very good” or “I’d be furious”, it’s wise to reconsider your decision. And if you see or hear something that makes you uncomfortable, I would encourage you to let the author know that it does and why. We need to learn from one another, and we need to encourage one another to be our very best selves.


Being and belonging

Earlier this week, I got into this Twitter-sation with my friend Arghavan Salles:

Belonging and academia
Belonging and academia

As you can tell, I moved the needle a bit in this discussion, doing so based both on data I have (I’m working on the manuscript, I promise!) and anecdotes from talking to surgeons who are struggling with career advancement.

When I talk to friends who are struggling in their career, be it in academic surgery or another profession, I consistently hear two integrally related ideas from them.  One is that they truly don’t feel like the belong where they are; they aren’t aligned with their company or institution for some reason, be it an issue of core values or goals. And as part of not belonging, I find that many of them try desperately to fit in and often feeling like a round peg in a square hole.  Those attempts at conformity are, if nothing, destructive to both their satisfaction and their achievement.

We see this sense of exclusion, of not fitting in around gender in male-dominated fields like engineering (full disclosure- my best friend is a woman engineer, and she may have more awful gender bias stories than I do, though she has also stuck it out and is incredibly successful). We see it in policing around organizational culture and institutional racism.  Ironically, we could use social accountability, in this instance playing on leader’s interests in fitting in, as a way to improve diversity and inclusion.

As leaders, we have to embrace that it’s not fair of us to try to fit round pegs into square holes; when we’re recruiting, we need to have the courage to tell someone that their interests or ethos may not be a good fit for our organization so that we don’t set them up for failure. As leaders, we also have a responsibility to create a culture that is inclusive and that can accept differences. I understand that resource limitations mean that every department cannot have expertise and resources in every area that might be relevant for a junior faculty member’s career development.  The time to think about that is during recruitment-do we have it or can we build it for them- rather than once the new faculty member shows up only to realize they won’t be able to do what they view as meaningful work.  They’ll be forced to try to fit in, rather than to belong, because they’re always going to have a sense that what they do doesn’t have value where they are.

I want to also be clear that I don’t expect every single academic department to be a cookie cutter of other departments.  That would be boring, and wouldn’t be good for our patients or our profession.  We should institutionally embrace our strengths and capitalize on those and recruit appropriately. If someone wants to be a public health researcher and trauma surgeon, we should support that person going to the best place to fulfill both of those professional goals. If someone wants to be a surgical educator and a vascular surgeon, we should do the same. What matters is that there is a “home” for everyone who wants to be here within the house of academic surgery (yes, we need to redefine what being an academic surgeon means!), and that we find them that place where they can thrive and belong.  It’s time to move past fitting in.  Our profession deserves that, and so do our junior colleagues who have plenty of amazing ideas.

I’d like to phone a friend…

This piece in WSJ this week generated quite a bit of conversation on Twitter within my circles.

You see, at times there is still this culture around the idea of calling for help being a sign of weakness.  I still know of too many faculty (because more than 1 is too many) who have reputations for being bears when called in the middle of the night- a reputation I consider only slightly more favorable than those who are known for ignoring calls and pages outright. And I still remember what it can be like to be on the resident end of those phone calls; you know that you’ll get berated for calling, but you also know that you’ll be in even deeper trouble if you don’t.

Teaching our trainees to call us for help is important, both for them and for the patients.  The trainees need to feel supported and we have an obligation to the patients to direct their care.  Residents shouldn’t expect to be spoon-fed, and I know that most of our residents will tell you that the first question I’m going to ask after, “What can I do for you?” is going to be, “What would you like to do?” because I still want them to be problem solvers.  I just want them to know that they have a safety net, which results in the last question I often ask: “Do you need me to come look with you, or are you okay?”

An important piece that extends beyond training is by calling for help when we’re concerned that we are getting into a bad situation. When I was freshly out of training, I didn’t think twice about calling my senior partner to look at things with me in the OR.  I can only think of once the he scrubbed in; more often he gave me someone to bounce ideas off of, and he validated that I really did know what I’m doing.  In the last 6 months, I’ve called one of my partners for help in the OR when I had unanticipated and impressive bleeding while doing a trach (he scrubbed, we fixed the problem together, patient did okay), and that same partner called me to look at a patient’s wounds with him intraopratively when he had concerns. I recognize that this is part of the culture that we have within our practice group, and I’m grateful for it; it supports us in making the best decisions for our patients and providing them with the very best care possible. And, as was astutely pointed out by a former student who is now a surgical attending, we’re providing good role modeling for our residents and students that calling for help is, in fact, the right thing to do, and that you’re never too senior or too experienced to invite someone else in to a complex situation.

While I value the culture that the Harvard hospitals are promoting around calling for help, I worry that the “card” described in the WSJ piece may be a bit too directive.  I can think of many scenarios that don’t necessarily fit the items listed and in which a trainee might wonder if they should call.  Ideally, they need to add one more item:

If you think you should call, call.

(Or, as I explain it to our residents- I’ve never gotten upset with someone for calling.  I have become very upset with someone for not calling when they should have.)