Looking for the Perfect Gift?

Want something that everyone will love, at a price you can easily afford?

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Check out this new post on Thrive Global for a radical idea you can use this year – and instead, enjoy the time you would have spent at the mall doing something you’ll truly love.

Wishing you a happy holiday season!


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A balanced assessment of our competence: physician coaching guards against burnout

We each have our addictions. Mine is the drama in human lives. I’ll stay up all night reading a book, unable to interrupt the story before its culmination. I can’t stand the Screen Shot 2016-07-21 at 9.35.13 AMsuspense of not knowing how the characters transcended their challenges or resolved their conflicts. So it’s no wonder that I’m hooked on the old TV series, Flashpoint, with its complex characters and riveting drama. One benefit of this addiction: it guarantees I stay on the elliptical trainer for 42 minutes, a good thing for my cardiovascular fitness.

What’s compelling about this series is the psychological tension balanced by the characters. In particular, Sgt. Greg Parker, the leader of a SWAT team, struggles to maintain his confidence in the face of the mistakes he makes. We see this difficulty over and over – Greg glosses over his many great calls and the positive impact he has on so many people and focuses instead on the times that his “best just wasn’t enough” and people died in spite of his efforts. Greg seriously considers leaving his position because of these doubts.

As physicians, our days are filled with decisions affecting the lives of others. While some are life or death, most decisions impact patients and their families, our families and staffs in less critical but no less important ways. Notice how many decisions you make that affect others during a day at work. My guess is that it’s in the hundreds.

How do we reconcile the inevitable mistakes we make over the course of hundreds of decisions with our belief in our competence, caring and our commitment to “above all, do no harm?”

One of the issues that create this tension, described by Valerie Young in Secret Thoughts of Successful Women, is our definition of success. Some of us believe we need to be perfect in everything we do. Does this sound familiar? If we fall short of this, we question our competence. Unfortunately, none of us is perfect. We all make mistakes, fail to integrate certain pieces of information, misunderstand our patients or colleagues. Other physicians believe they must learn everything without effort, know everything, do it all alone or excel in everything they do, or they don’t feel competent. These are impossible standards to meet.

We are taught to always ask ourselves, “How could I have done this better?” While this practice of self-examination, practiced personally and at institution-wide gatherings such as M&M conferences, is admirable and necessary, it is imperative that we also recognize our successes and make space in our minds and hearts for our inevitable imperfections.

Periodically reading thank you notes from grateful patients or keeping a journal of our successes can help us maintain a realistic view of our competence, especially when we feel we’ve made an error. Sharing what we appreciate about our colleagues helps them know that we value them. These simple practices to shift our focus away from our mistakes to a more balanced assessment of our worth can be career or life saving.

So let the last question we ask ourselves each night be, “What did I do well today?”

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Choose Freedom

Funny thing about freedom. We Americans believe strongly in the concept of freedom and will risk our lives for freedom around the world. And yet, many people live day to day with Screen Shot 2016-07-04 at 9.31.57 AMno sense of freedom at all – they feel trapped in their own lives. What keeps us wrapped in a straightjacket of work and personal responsibilities, unable to create a life of our choosing?

Often, we are lulled into the feeling that life will go on forever and a better time will come for those things we want to do. Tomorrow, I’ll call that friend. I’ll finish that project next month. Next year, I’ll take that vacation. As we all know, time goes by in its stealthy way. We never get around to many things and feel heavy with regret. We had so many dreams when we were young – how did we let our life slip by without making them a reality?

In other ways, we feel as if we are living in a box, unable to penetrate beyond its walls where we imagine fun, excitement and personal growth might reside. Instead, the responsibilities of work and life expand to fill our time. “It’s just the way it is,” we say to ourselves.

But if we look, we see people who have climbed over the walls of their boxes. They cast aside the same limitations that keep us contained and demanded the freedom that we yearn for.

What makes it possible for them and not for us?

One factor that keeps us stuck is the negative messages we tell ourselves. “You’ll never be able to do that.” “What gives you the right to do that?” Do these messages sound familiar? Consider what you would really do if that voice weren’t filling your mind and defeating your spirit?

Reinforcing that box around us is the impression that we need to make big changes in order to create the shifts that will lead to a happier and more fulfilled life. It’s important to not let the perfect be the enemy of the good. As a physician coach, I’ve seen small things make a big difference. A few minutes of meditation each day can help us feel calmer and less hijacked by upsetting thoughts.  And as our life becomes more fulfilling, we’ll have more confidence that we can accomplish even greater and more meaningful change.

So when will you take a stand for your life? Let’s all honor the revolutionary spirit of those who fought for our freedom by getting in touch with our own bravery and making choices that will mold our days into the life we want to be living. Pick one thing you have wanted to do. What needs to happen for you to make it a reality? What obstacles need to be moved? What steps can you take now to add it to your life? Once you’ve accomplished it, take a moment to savor how good it feels. Acknowledge your courage, your dedication to your own freedom and your own life. And then decide what you want next.


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The power of mindfulness in developing resilience: A physician coach gets coached

Medicine is a profession in which we never stop learning.  So is coaching.  It’s one of many things I love about it, so I enthusiastically signed up to learn a new coaching program. In the first class, I volunteered to coach one of my colleagues in front of the group – I decided I may as well jump right in, as one learns to play better on the field than from the side lines.  I barely had a few words out of my mouth when our mentor coach interrupted with Screen Shot 2016-06-07 at 7.16.33 AMa suggestion.  I followed her lead and then – there she was again – interrupting and offering her version.  As an experienced physician, I’m used to feeling confident about my interactions with patients.  Did the mentor think I was a bad coach?  Had I done something wrong?  Fortunately, a mindfulness practice helped me hold those thoughts up to the light and evaluate their truth.

When we’re learning anything, we have to expect that we won’t excel immediately.  As the saying goes, “Anything worth doing, is worth doing badly.”  It’s worth the effort and discomfort as we work though awkward learning stages to improve our abilities.  Giving up during this period of struggle, or allowing ourselves to be derailed by a story about the limitations of our capabilities, prevents us from learning and growing. It ignores our many, as yet undeveloped, talents.

Given that learning is accomplished through a series of instruction, practice, and feedback, we can thank those who offer critiques of our performance.  They do us a favor by providing this assessment of our work, even if it doesn’t always feel good.  As we move from unconscious incompetence (we blissfully don’t know how unskilled we are) to conscious competence (we’re confident in our ability), we go through a period of conscious incompetence when we are painfully aware that our efforts fall short of our intentions.

As I examined my feelings about my mentor’s interruptions and the concerns they raised about my abilities, I knew I was right where I should be – in that unpleasant place where I didn’t yet have the skills I was working to gain.  A perfectionist at heart, I needed a perspective that would help me tolerate this discomfort while I continued to learn. Malcolm Gladwell reminds us that it takes 10,000 hours to achieve mastery with a new activity.  Woo hoo!  I  now had one less hour to go.  I focused on the many successes my clients have already had and realized this new approach would provide even greater benefit – icing on the cake.  And then I accepted the fact that my love of learning means I will always be in some uncomfortable zone of incompetence as I continually add to my skill set.

The landscape of my life and career had shifted from the stress of performance to the joy of adventure and exploration.  I hope you will join me here – the possibilities are endless and the experience is thrilling.

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What’s Important Doesn’t Change

Rolf Benirschke, the former kicker for the San Diego Chargers Football Team and the speaker at the School of Medicine graduation today spoke quietly and  made an impression on everyone there.  As a long time patient, he acknowledged the faculty for having saved Screen Shot 2016-06-05 at 11.01.28 PMhis life many years ago.  Then, he turned his attention to the graduates – those who will be called, “Doctor,” for the rest of their lives.  He reminded them that each patient will have four questions for them – even if they aren’t articulated clearly or even spoken out loud.

The first question is, “Can I trust you?”  Can I trust you to be honest, compassionate and caring when I tell you my most important thoughts and concerns?  Second, they will ask, “Are you committed to excellence?”  Do you strive to continue to learn and integrate new medical knowledge so my care is appropriate and up to date?  Are you dedicated to being the best at what you do?  Next, they will wonder, ” Do you care about me as a person?” Do you see me as the unique person I am, or am I just another gall bladder or rash to you?  Do the particulars of my life matter to you as you care for my medical conditions?  And last, they will want to know if there is hope.  We all need hope.

The sheer amount of knowledge and experience that we pack into four years of medical school often makes it difficult to acknowledge these human aspects of medical care.  Yet, they are essential foundations of the care we provide.

As I write, I am aware that only six days remain on my schedule to see patients.  Having spent the last few years caring for patients, teaching medical students and coaching physicians who are burned out or struggling with aspects of being a doctor, I’ve known  that I needed to give up at least one of these endeavors.  After 34 years as a clinician, I’ll be leaving the practice of medicine to focus on supporting other physicians.

So, each day in the office, I find myself saying goodbye to my patients.  Some I have known only a few short months.  Others I have cared for over decades.  What’s striking to me is how few people comment on the medical therapy I’ve provided.  While most are appreciative of the improvement in their venous condition, they focus instead on the personal – the trust they felt, the comfort they experienced as they discussed their true concerns, and the things we shared and learned together about life.

As Maya Angelou once said, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”  And as Teddy Roosevelt remarked, “People don’t care how much you know until they know how much you care.”  The wisdom of these comments was certainly apparent to Rolf Benirschke and he felt it important to pass it on to these new doctors.  Throughout 30 years as a physician, they have remained important guideposts to me as well.

As physicians, it’s our job to diagnose and treat our patients.  But finding their diagnosis requires that they trust us first.  And treating them appropriately requires that we understand who they are as people.  Fortunately, patients come to our offices wanting to trust us.  They want to partner with us to obtain the best care we can offer.  What we can do is listen, show concern and compassion, and ask our own questions so we can learn what is most important to them. Only then can we most effectively use our hard-earned knowledge and experience to do what’s best for them.


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When Doctors Have Time to Care

If you’ve visited a doctor recently, it’s likely that you’ve felt unseen and unheard.

Sadly, “healthcare” is often dictated more by corporate requirements and a focus on the Screen Shot 2016-05-15 at 10.48.33 AMbottom line than by creating a healing interaction between doctors and patients.  Doctors are asked to see patients in such short visits that true connection and relationship aren’t given the chance to develop. Patients don’t feel they are cared for. Physicians wonder why the experience of being a doctor is missing the fulfilling interactions they imagined. Over half of our physicians are burned out.

It doesn’t have to be this way.

A kind and thoughtful internal medicine specialist struggled to help her patient with diabetes. At each visit, they reviewed his lab results and discussed a plan to decrease his blood sugars.  Sadly, his blood sugar remained dangerously high. The doctor realized she must be missing something and gently asked her patient what else he wanted to talk about. “Nothing,” he replied. She patiently persisted. “There must be something on your mind that you’d like to talk about, “ she said. After several requests, her patient finally hung his head and told her that his son had killed himself a year ago. The grief and guilt he felt were clearly the reason why he was finding it difficult to take care of himself. This created the opportunity to discuss the real issue, and her patient was able to get the help and support he truly needed.

Interactions like this may take time, but they are the heart and soul of medicine.

I became a general internal medicine specialist in 1985, at the start of the HMO era. My daily schedule was filled with 20-25 patients, each with an array of concerns. As we delved into what might be at the root of their symptoms, they shared important details of their lives – the challenge and stress of raising children as a single, working parent left little time to exercise and eat right; or the childhood abuse they had never told anyone about had left them with chronic pain. I recall one day, when eight patients began to cry as they told their stories. Rushing patients through such a visit is inhumane, uncaring, and deprives them and me, as their doctor, of important information that can lead to healing and better health. Ordering tests or prescribing medicines without understanding the cause of the symptoms misses the point and adds unnecessary costs and risk to healthcare.

We need a healthcare system that cares for our health and doesn’t simply offer medicines or procedures for our symptoms. Doctors must have the time to care for us and we patients must demand that they be given this time. It’s up to all of us to speak up so that, together, we can restore the health of our healthcare system.


Posted in building relationship with patients, physician coach, physician coaching | Tagged , , , | 4 Comments

Doctors in the Crosshairs

We’re in trouble.

No, really. We’re in a lot of trouble.

Screen Shot 2016-04-03 at 9.16.07 PMWe’re an aging population. Health care consumes an increasing amount of our budget. And we’re attacking our strongest allies.

I became a physician in the HMO era and was encouraged to minimize the tests I ordered and specialists I consulted. The consequence was that some patients didn’t receive timely care. One young man, treated for cancer a year earlier, yelled at me when I explained that his referral to an oncologist would require three weeks. Understanding his frustration, I suggested he pay out of pocket to see the oncologist he already knew and trusted. He angrily left my office.

“Patient-centered care” is now in vogue. I believe strongly that the patient’s wishes must be central to any evaluation and treatment plan. But a twisted version of this concept is encouraging dangerous behaviors. Health care organizations, eager to ensure their doctors are the best, rely on patient satisfaction scores to assess quality and pressure doctors to generate high scores. If patients want an MRI, even if it won’t provide relevant information, or if they want a particular medication, even if it won’t help, physicians are afraid to say no, lest patients give them a bad rating. With online ratings, patients can mar a good doctor’s reputation if the doctor falls short of a patient’s expectation, such as refusing to fill out a disability form if the patient isn’t disabled. Doctors find themselves caught between their ethics and the chance of being fired or having their reputation smeared by an unhappy patient.

As expensive technologies become commonplace and our aging population requires more care, insurers have reduced payments to doctors. To maintain revenue, healthcare organizations ask doctors to see more patients each day, decreasing the time doctors can spend with each patient. There is just enough time to check the most important things and write out a prescription, order a test, or send the patient to a specialist, where care will be even more expensive. If doctors spend more time, they are penalized because of their diminished productivity or because patients have to wait. I want a doctor who will spend the extra time with me, even if I have to wait while someone else is getting that type of attention, don’t you?

In the last few years, healthcare has implemented electronic record keeping. While this has advantages, doctors are asked to enter most of the data. Why do we ask the most highly trained people in the system to spend hours each day, inputting data? It’s because the other members of the team would have to be paid for the additional time, while doctors are not paid a penny for this. This extra time cuts into their ability to live a balanced life. It’s one of many reasons why more than 50% of American doctors are burned out, and why that number is rising rapidly.

I’m not excusing my profession’s shortcomings. There are times we don’t listen, make poor judgments, or are uncaring. What I am saying is that demanding that we put productivity above care, that we satisfy the whims of patients, and that we spend precious hours doing work that doesn’t utilize our knowledge and skills is compromising the vitality and effectiveness of this important part of society. And that’s dangerous.

Doctors spend countless hours learning and training to take care of us. We need to give them the time they need to listen, to consider what is really going on, and to do the right thing. We need to value their skills and let them focus on interacting with patients, not a computer monitor. We need to appreciate the experience and perspective they bring and not rush to judge or penalize them if they refuse a request that isn’t medically indicated.

As a society, we get what we reward.

What behavior do we want from our doctors, and how can we reward that?


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Let’s nix “Yeah, but…” A physician coach explores her “upper limit problem”

We physicians interact with many different types of people. While some of us may prefer more action-oriented patients and others prefer more introspective patients, one type that is challenging for most of us is the patient who immediately tells us why none of our recommendations will work.  It’s frustrating to have our ideas dismissed without even a try or a consideration.

It’s hard to admit, but I do the same thing myself.

Screen Shot 2016-03-07 at 11.54.08 PMI know I feel better when I exercise.  Yeah, but it’s dinnertime and the gym will be too crowded.  I know my day is more enjoyable when I sit and meditate every morning.  Yeah, but there are probably 100 emails waiting to be answered.  Someone once complimented me on a presentation I gave, sharing how much they learned and how inspired they felt.  Yeah, but I knew that I forgot to mention something and could have done better.  When I feel the excitement of planning a group coaching program I want to offer, a voice inside of me says, “Yeah, but what if no one signs up?”

This is what Gay Hendricks calls the Upper Limit Problem, described so well in his book The Big Leap.  Dr. Hendricks explains that most of us have a limited tolerance for feeling good.  As we reach our limit, we sabotage ourselves with a variety of behaviors that serve to move us back into more familiar, less joyful,  territory.

Worrying is one of the most commonly used behaviors.  As we enjoy any type of great feeling – an accomplishment, a celebration, an anticipated event – worry thoughts often enter our minds, even when the worry is quite implausible and serves no useful purpose.  I’ve had many experiences waiting for my husband to return home after working late.  I start out thinking about how happy I am to be married to him and, before I even know it, I’m worrying that he’ll be in a car accident on his way home.  Other upper limit behaviors include criticizing ourselves or others, squabbling, getting sick or hurt, not keeping agreements, deflecting – the list is long.  Yeah, but…is certainly on the list.

The solution is to become aware of our patterns and gradually increase our tolerance for joy.  Each time we begin to feel really good about something, we can stay with that feeling as long as possible.  If we find ourselves reaching for an upper limit behavior, we can interrupt it and return to feeling good again.  Eventually something will steal our attention or we’ll bump up against our upper limit again.  But in the meantime, we’ve stretched our ability to acknowledge and take in the good that each of our lives hold.

As for me, I’m committed to laughing at “yeah, but…” and doing what I need to do to step over or move through it.  I know there’s a lot more fun and joy on the other side.



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What makes you come alive? A physician coach asks herself this important question

We recently visited the Dominican Republic, a beautiful nation with many kind-hearted people.  After we pulled off the road with a flat tire, a man came to our aid and helped us access our spare tire. He then returned with a jug of water so we could wash our hands.  DR.HandiworksSo we understood when we met a young woman here who had left her country to attend Parsons School of Design in New York, only to leave the dynamic, NYC art world to return to this sleepy island she grew up on. While she enjoyed the fast pace and stimulating art climate, her life felt hollow without the strong connections she enjoyed with the people on the island. She loved art, but she loved her people more.  She is now passionately involved in helping Dominican artists teach and market their artwork and uses her skills to disseminate Dominican traditions and allow people to support themselves and improve their standard of living.

Personally, I wrestled with confusion and fear about doing what I was passionate about for many years.  As a venous disease specialist for 30 years, I enjoyed seeing my patients’ bothersome veins disappear or improve and hearing about the positive impact the treatment had on their lives. But what was most satisfying for me were the long conversations we had, during which my patients were able to see truths about themselves that resulted in their recognizing how many possibilities there were, how much choice they actually had, and how powerful they could be in their lives.  It was for this reason that I became a coach. The most exciting and fulfilling thing I can imagine doing with my life is having those kinds of transformative conversations.

As the visionary author, philosopher, theologian, educator and civil rights leader, Howard Thurman, said: “Don’t ask what the world needs.  Ask what makes you come alive, and go do that.”

What makes YOU come alive?

How can you bring more of that into the life you’re leading?

Or is there a change you need to make so you are truly following your passion?


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Work Life Balance – Does it Exist? A physician coach suggests a new perspective on an old challenge

I began my first presentation on work life balance by asking for the audience’s questions. Someone blurted out the big issue on everyone’s mind – does it exist?                    

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Great question.

The answer is yes, but it depends on our definitions of work, life and balance.

When I asked everyone to balance on one foot, people quickly realized that the act of balancing involves lots of movement – feeling out of balance and then adjusting to feel more in balance again. We’re never perfectly in balance, nor do we stay that way for long without having to shift something. This is true in life as well.

And then there’s that division between work and life.

With the integration of electronics into our lives, that line has blurred. Our phones interrupt our “life” with “work” at any moment, even when we’re not in our workplace. The pace of our lives has risen to a constantly stressful level. We seem to work round the clock. Our “life” has become crowded out of our waking hours by our “work.”

One answer, suggested by Michael O’Hara http://smartblogs.com/leadership/2015/12/15/stop-using-work-life-balance-and-start-using-work-life-integration/?utm_source=brief, is to adopt the idea of “work life integration” instead. O’Hara concludes “it’s no longer possible to divide them into two neat little categories.” But by considering how we can best integrate these two aspects of our experience, we can make choices that allow us to be fully engaged with both. The success of this approach depends on two pivotal skills – knowing when to take a break and setting boundaries.

Leaving the office before our charts are complete so we can have dinner and spend the evening with our family, and then logging into our EHR after the kids are asleep is smart integration. Taking a break in our work flow to have important family time can allow us to nurture those important relationships when our children are available.  Conversely, if we know we’re expecting an important phone call on a weekend, alerting our family to the anticipated interruption allows us to take a break from a family activity when we’re needed elsewhere. Having participated in the call, we can resume our family interactions with enthusiasm.

The importance of communicating these boundaries can’t be overstated.

When we set a boundary, we let others know definitively what we will or won’t do. This gives them an opportunity to make other arrangements and builds a level of trust that allows us to have even more control over our lives. If we let colleagues and administration know that on Tuesdays we need to leave at 5PM to attend our child’s soccer game, they know not to crowd our schedule on Tuesdays, and that we’ll be more flexible on other days.

Whether we call it balance or integration doesn’t really matter. The foundation of having a life that honors both realms of our lives requires honesty and action on our part. We need to be clear about what we value in our lives, be willing to state those priorities clearly, and then maintain our commitments in and out of work. If we take those steps, our life will feel both balanced and integrated.

Posted in physician burnout, physician coach, physician coaching, physician work life balance, work life balance | Tagged , , , , | 2 Comments