Tag: surgeons are surgeons

Taking care of you, because no one else will

Posted on by Amalia Cochran MD

The concept of “self-care” is definitely a cornerstone of wellness discussions. It also appears to have become something of a generational battleground. Staying at work for a week and eating poorly and not seeing the light of day is no longer considered the badge of honor it might have been. Nevertheless, we all have these pesky adult and professional commitments that preclude us from focusing on ourselves all day, every day.  Surely there’s a happy medium in there somewhere?

A lesson I learned about 10 years ago is that I need to have a list of the things away from work that bring me joy, and that it also helps me to recognize how often I need for them to be part of my life.  Examples?

  • Walks with Olivia– daily, at a minimum. This is important head clearing time for me.
  • Running– the benefits for me are myriad.  It keeps my head on straight, it gives me time to think, and I just feel better for completing a good run.
  • Yoga– I know that going to a weekly group practice is best, and it makes a difference when I keep this in my schedule
  • Live music– A couple of times a month.  The rules match my OR music rules: No rap, no metal, no Britney Spears.  I love Americana and “alt-country” (again, as many of you know) and also have a great fondness for outings to the symphony and the opera.
  • Reading, particularly literary fiction- I still remember getting halfway through my intern year and realizing that I hadn’t read a novel all year (and that I really missed it). The moment our in-training exam was done in January, I dug back into good novels and haven’t stopped since.

I put my own list out there not with the goal of making it your list, although I’m always happy to share ideas in any of these areas. I put it out there so that you can see that none of these are majorly time-consuming unless I choose to make them a Big Deal in my schedule.  In fact, it’s pretty easy with some practice to prioritize all of them in a way that I get to push the reset button for an hour or two AND still manage my grown-up responsibilities. And even though I fight it sometimes, I know that these things really do contribute to helping me be my most effective self.

So, what about making sure we’re our most effective on a day-to-day basis, even in the midst of a chaotic day?  I loved this piece in last month’s HBR, probably because all of the ideas they raise are things that I’ve espoused or embraced in one place or another.

  • Cut yourself a break: I’ve previously summarized this blog post from Karen Walrond as “Try your best, cut yourself some slack at the end of the day, rinse, repeat.” Why is it so much easier to be kind to those around us than we are to ourselves?
  • Value time, money, and resources: No is a complete sentence if something doesn’t align with what you want or need to get done.  Truly.  Practice it often.
  • Take a victory lap:  How often do we celebrate our “wins”, either individually or collectively?  This week I started something new to me on Twitter with #Wednesdaywins. If you’re on Twitter, I hope you’ll join in there.  If you’re not, I hope you’ll develop your own practice.
  • Surround yourself with good people:  Maybe it’s a product of being in my 40s, but I simply no longer choose to have time for people who drain my energy (see “value time, money, resources” above). I definitely view friendships as a mutually supportive enterprise, and have chosen to surround myself with spectacular people whom I LOVE having as part of my life.  Some of you have heard me say, “Find your tribe. Love them hard.” It’s key when things get challenging.
  • Update your workspace: Okay, I really don’t have much to add here.  I am better than I used to be controlling my desk piles.  Mostly.
  • Recharge and reboot: Those walks with Olivia?  That’s part of it when I get out of the hospital.  At work, sometimes I’ll just go for a walk between the Burn Unit and my “real” office. I’ll pause and fix myself a cup of tea. I’ll walk through our therapy gym so I have an excuse to stop and visit with one of our rehabbing patients. Or I’ll sit down and simply chat with someone I find interesting; this person can be a co-worker, a patient, or a family member. Sometimes just getting your head out of what it’s stuck in can make a HUGE difference. If you want to be Zen about it, it helps you detach from whatever is troubling you.

So, what can you do this weekend to be more effective for next week? It doesn’t have to be onerous, and ideally it will be fun.  Most importantly, I hope it brings you some joy.

 

 

 

You can have it all, just not at the same time

Posted on by Amalia Cochran MD

“The price of anything is the amount of life you exchange for it.” -Thoreau

Common refrain from faculty (that may be a symptom of Impostor Syndrome):  “I just can’t do everything.”

My response: “Yes, you’re correct.  You can’t. None of us can.”

We have essentially two key limitations in the battle to do everything, as I see it.  First, our day has 24 hours in it.  We can fight that one all we want and pretend it’s not true, but that’s the day we’ve got.  Then there’s the second limitation of energy.  We’re not set up like the Energizer Bunny to simply go…go…go…quick battery change…go…go…go.  I’m sure almost all of us can think of the last time we tried that (all nighters in college, anyone?) and the net effect is never what we hope it will be.

As mentioned in the July Reading Round-Up, I’m working my way through Eric Barker’s Barking up the wrong tree right now.  Chapter 3 has a great section talking about someone brilliant who has a chronic illness that can be incapacitating. This individual adopted a strategy for many years of accomplishing one thing a day, even on the bad days.  Sometimes that meant that he was only able to cook dinner if that was the day’s goal; the key was to choose that one thing and do it.

Here’s what he had to learn that we all try to superhero our way out of at some point in our career: every single choice that we make to do something means we are choosing to not do something else.  When we spend hours on Facebook, we’re choosing (perhaps only subconsciously) to not work on that research project that needs our attention. When we spend time working on that research project, it comes at the time expense of watching Game of Thrones. When we spend time with our family, it comes at the expense of finishing the day’s charts.  If you have a background in economics, you’ll recognize this immediately as every choice we make in life having an opportunity cost.

If you have a young family or an aging parent, focusing on them may be your first choice for a few years and it may require you to choose to let something slide from a scholarly or administrative perspective. If you’re building a career as a researcher, you already know that forces choices about what you can and should do from a clinical perspective. If you’re trying to stay mentally and physically healthy, you might choose to save that manuscript where it is right now and leave for yoga or go out for a run (note: I often find that by doing this I end up being more productive, perhaps because it gets my brain into a different space).

Again, every time we choose to do something, we are choosing to not do something else.  That alone means that we can’t do everything.

Here’s a thought experiment for you, cribbed directly from Chapter 3.  What would you do if you were ill and could complete only one task per day?

There’s your answer to what matters most to you, and what should be done first.

And when you thought, “It would NOT be clean my house!”, that’s probably a hint to you too.

Here’s to a week of making wise choices, one at a time, that allow us to do those things that matter most.  What is your big goal this week?

(Title credit to Leigh Neumayer, content idea credit to Jamie Lewis)

 

 

Wasting of time sitting still?

Posted on by Amalia Cochran MD

I’ve made a deliberate effort of late around the concept of mindfulness and of trying to be more present.

In other words, I’m trying not to engage as egregiously in zoning out and checking email and catching up on Twitter when I’m supposed to be paying attention.  Meetings are, of course, a special kind of danger zones for these things. So are completely overprogrammed days, when my entire schedule consists of running from Point A to Point Q to Point L, with no breathing space available and…when was I supposed to have lunch? Days like those are the days that stress me out.  It’s not that I can’t handle the day itself.  It’s that when I’m doing all of the to and fro, I lose the ability to manage my energy.  And when I lose that ability to recharge, even if it’s only for 30 minutes a couple of times, I know I’m not at my most present.  I also know that I get grumpy.

When I “check out,” when I start that multitasking, there’s clear evidence that I’m probably making things worse rather than better (ladies, the link applies particularly to you).  And while I wasn’t successful in keeping it controlled the entire day, late in the day I was cognizant enough to start using the, “Right now, it’s like this” framework to remind myself that days like these are truly exceptional.

Today’s tactical error that I know has been helping of late? I did NOT sit for 10 minutes this morning prior to getting the day going (though, to my credit, I didn’t start with email either).  I’ve learned that 10 minutes of sitting and just breathing after the alarm goes off helps me to feel like I’m setting the tone of my day rather than having it set for me.  Even with that knowledge, after a late evening and with an early morning I skipped it.  Not a great choice because I’m learning that it’s a total set-up for distraction for almost the entire day- or at least the parts when I can be distracted and not seem completely inappropriate.  The day took control of me.

So tomorrow, I’ll sit again for 10 minutes when the alarm goes off (with a purring cat in my lap if I’m really fortunate). That’s the part of it all that I can control, and it lets me set the tone to make the rest of the day go more smoothly afterwards. It’s not like the day was a wholesale disaster; if anything, it all ended up fine. It’s just that process, being present and engaged through all of it, could have been less bumpy. I’m grateful that I get the chance to reflect and do better.

And if you’re looking for ideas to help you be more mindful at work, I am particularly fond of this list.

Sitting still?  Apparently not a waste of time at all.

(And for those who may have caught the slightly obscure musical reference, you’re welcome.  REM from 1984 is as good now as it was then.)

 

Staving off the demons

Posted on by Amalia Cochran MD

This review of burnout in surgeons was published online in JAMASurgery last week, as was this Viewpoint on resilience and its relationship to burnout.

Of course, the root causes of burnout in medicine and surgery are protean. Specialty, gender, workhours, EMRs (yes, the EMR is being blamed now), basically anything that can contribute to job dissatisfaction regardless of profession are possible catalysts for burnout.

I openly admit that I don’t spend much time discussing burnout. It’s not that I don’t care when my colleagues are suffering; I do care deeply about them and their distress. For me, it’s that discussions of burnout and “what’s wrong with surgery/ medicine today” tend to be problem focused.  While people have generated all sorts of inquiry around risk factors for burnout and descriptions of its impact, resilience and recovery are woefully neglected. And yes, our systems should try to help mitigate controllable things that are clearly risks…but there’s so much more to the picture than the systems, and those other things get complicated.

I’m also not saying I never have a sense of being burned out. There are weeks when I fear that I’m generally in over my head, when I’m exhausted, and when I feel like I have very little control over anything. Had you asked me to fill out a Maslach Burnout Inventory at 11 pm last Friday night, I’m reasonably certain that I would glared at you and ended up with a score very consistent with burnout. In contrast, had you asked me to complete one at 11 am on Saturday (after 6 hours of uninterrupted sleep on Friday night and an 8 mile run with my running “tribe”), it probably wouldn’t have looked nearly so dismal even though I was back in the trenches of patient care and was having a busy day.

Here’s the thing: I could have skipped my Saturday run and slept more, and I’m certain some would say I should have done just that. However, physical activity that is a challenge is both grounding and restorative; thus my love of running and the basis for my nine half marathons in the last year. And while some days it really is about the running to process and running to manage on energy, Saturday was a day when it was running for connection. I knew that the best thing (again, for me) to get my head back where I wanted it, to feel like I had just a bit of control over my crazy life, and to enjoy simply being in the moment was to get up early and meet my running group.

8 miles later...
8 miles later…

I’m going to tell you that your mileage may vary- your “thing” doesn’t have to be running. But what your “thing” does need to include is connection. Saturday morning I needed time with these friends- friends who cheerlead, who love unconditionally, who are incredibly funny, and none of whom are in medicine. I didn’t need for them to understand what my week had been like.  I just needed to be with them for a while doing something that we all love.  Brené Brown is right– we are all hard wired for connection.

Find your tribe. Love them hard. Most importantly, spend all the time with them that you can.  What if it really is that simple?

Put me in, coach!

Posted on by Amalia Cochran MD

Caveat: Today’s post is not necessarily specific to surgery, but may be able to be extrapolated to surgery and reaching performance plateaus.

Granted, there is interesting discussion going on around the idea of coaching for surgeons.  Atul Gawande gets credit for first bringing this concept to my attention with his piece in the New Yorker in 2011.  I would be lying if I haven’t considered trying to bribe my retired practice partner to come back in and observe for a couple of days to help me find ways to improve my practice, much like Atul did with one of his mentors.

Carol-Anne Moulton at the U of Toronto leads a group that has looked at cultural barriers to implementation of coaching; apparently we’re not as far past the culture of shame as I keep hoping that we are.  Caprice Greenberg at the University of Wisconsin has developed a surgical coaching program as her scholarly focus, and I am hopeful that the structure of the Wisconsin program overcomes some of the barriers identified.  If coaching is a “normal” part of culture then institutional resources are directed to the benefit of all, not just low outliers as might be expected.

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I started out saying today’s post is not about surgical coaching, and it’s truly not.  Instead, it’s about my personal life experiment in the form of hiring a running coach.  Here’s my second disclaimer of the day:  I will never, ever, EVER be the fastest runner out there.  Ever.  I just want to be clear about that.  So, if I know I’m a solid, middle of the pack runner and don’t aspire to being a master’s champion, what possessed me to hire a coach? Let me lay out the scenario for you:

  • My training has been a hot mess for the last 5 months.  Some of that has been a result of clinical demands and call schedules.  Some of it has been accountability, or lack thereof.  Some of that has been sheer laziness.
  • I’m both practical and pragmatic in how I approach my training and my running overall.  And while I’m moderately knowledgeable about lots of running-related things (some from approximately 37 years of running experience, some from reading, some from friends and family) I am by no means an expert.  I trained well enough to get away with a 2:30 in my first half-marathon last December, admitting that I did not fuel right during the race and bonked big-time at 11.5 miles. So, I do some things okay, I do some things not-so-okay.
  • I’m tired of my IT bands screaming profanity at me when I run more than 6 miles in a stretch, and I somehow thought it was a good idea to register for not 1, not 2, but 4 half marathons this year.  I know I should be able to do this with less discomfort (and fewer naughty words), right?

Enter the coaching program at my friendly local running store.  While it’s coordinated as a group coaching program, Coach Lisa writes programs that are individualized to ability and goals and she truly provides a personal touch.  She’s kind, she’s encouraging…and she expects you to work hard.  I’ll admit I’m just completing my second week with her and I’m already feeling great about this choice.  Why?

  • I’ve been able to adhere to my training schedule and got the most miles in last week that I’ve accomplished in a while.  It’s funny how paying someone to help you provides the encouragement to do the right thing.
  • Lisa’s working with me on ideas for fueling and pre-game planning, so to speak, for my half marathon next Saturday.  Most importantly, she’s provided me with appropriate encouragement to do it, even though I know my training has not been perfect.
  • My IT bands?  Well, we did a little gait work last week and it’s amazing how much they don’t hurt when I don’t stride out in front of myself like I have for years.  I won’t say they are perfect, but I came out of 11 miles on Saturday feeling no worse for the wear.  That’s a great sign.

Am I trying to tell you that running and/ or a running coach is right for everyone?  Definitely not.  What I am telling you is that I felt stagnant, even frustrated, with my running the last couple of months and this has been the nudge that I needed.  Now the question becomes what the impact will be on my performance over time…I’ll report back on that later in the summer, maybe after half-marathon #3 for the year?