Wisdom comes from a multitude of teachers, and not always from expected sources

Looking back at the people who taught me throughout residency, there was a multitude -  nurses, residents, faculty, ward clerks, and various techs all taught valuable lessons. I’m not forgetting how integral patients were to my education, but I’ll save them for a future blog.

 

My very first code was as the medicine intern on night call. When the code pager went off, I ran a short distance to the MICU and entered a room as the only physician.  The nurses looked at me and gave me a quick rundown. 65-year-old septic patient, now unconscious with unmeasurable blood pressure. Adrenaline flooded my brain; a myriad of code medications and doses swirled in my head; and, instead of fight or flight, I was about to freeze.  I locked eyes with an experienced ICU nurse who said, “Doctor, what can you do quickly to help the blood pressure,” as she then looked down to the pedal on the bed and back at me.  I said “Trendelenburg?” as she...

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Cultivating relationships during residency training

Many residents cultivate friendships during residency, others cultivate more intimate relationships, and some cultivate their marriage relationships. One thing is certain, personal relationships take more effort during training due to the demanding hours and stress. They also can suffer without that effort. 

 

One of the most important things my husband and I did during medical school and residency was learn how to carve out time for ourselves as a couple.  I know this is a common thread for all parents no matter their professions, but we were definitely on the overloaded/swamped end of the spectrum. I love the analogy of a marriage being a garden and the need to tend it so weeds don’t take over and it doesn't die off due to neglect.  

 

On the day to day, we used a strict bath and bedtime for the girls in order to save space for ourselves.  After the kids were tucked in, we had time to chat, watch a movie, conquer the original Myst or Zelda,...

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The building of a home

My neighbor, from my medical school and residency era, text me last week to tell me my old house was on the market.  The whole family linked to the MLS listing to reminisce over the photos. 

 

Wow! All the memories came flooding back. We purchased the 1896 historic home near downtown Mobile as medical students - talk about a fixer-upper! My husband, the main renovator and contractor, hired some key craftsmen who cared more about restoration than making money. Over 7 years, during the heart of medical school and residency for us both, we completely renovated the structure, keeping as many of the original details as possible. 

 

 

It had become a piecemealed house broken into 6 apartments during the depression that had back porches later enclosed upon back porches. It was in one of those enclosed back porches that my oldest daughter claimed her first solo room since her sister had been born.  She even had a playroom off of it. Oh, so many hours were...

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A perspective on family medicine residency training.

Uncategorized Aug 21, 2020
 

Your years in residency training can be hard, but what if they could also be the best years of your life? A perspective on family medicine residency training that you may not have considered, as offered by an Alaskan resident physician coach.  

 

Have a joy filled day - Tonya

Don't miss out on my 6 week coaching plus program at the pilot price.  Starts Sept 7, Sign up by Sept 1 - https://www.joyinfamilymedicine.com/store

 

 
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It's okay not to do all the things.

I likely learned constraint earlier in my career than others out of sheer necessity. My husband and I were a 2-resident-physician home with 2 children. Admittedly, I served on some committees and took on a recruitment in residency that I didn’t have to, but I enjoyed the experiences and they weren’t a strain on my time or energy.  At other times, I declined small opportunities even though I enjoyed them because they strained my family time, such as working the sidelines at extra sporting events or working another team sport physical session. I limited the number of specialty journal clubs held after hours I attended. And there were things I didn’t enjoy even though I may have been good at that I didn’t sign up for, such as sitting on policy writing committees.

 

The biggest opportunity of taking on a new role became one the hardest decisions of residency.  Should I throw my hat in the ring for chief resident? My husband, after completing his...

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Trusting your gut, hand-off bias, and building your 'why's'

I was a second-year resident on my pediatric emergency medicine month. I had worked enough shifts and to become comfortable with the duties, the nurses, and the attendings. I listened to the attending take a radio call and was told they were “bringing in an 8-year-old who is playing possum,” implying that the child was faking an unresponsive state. 

 

Though comfortable walking into any room by this point, I still experienced some anxiety while waiting for a patient arriving via ambulance. Not knowing what would roll in, exactly, along with my catastrophizing imagination always seemed to put me on edge, given time.  But on this occasion, I was reassured it would be non-urgent. I was feeling confident and at ease.  As the paramedics rolled in, I saw an 8-year-old girl with a braid, lying on the gurney with her head to one side being very still. I walked toward them to show them in which bay to place her.  The one paramedic said, “I think...

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Diving into perfectionism

How many of you in residency feel (felt) that perfection is (was) your standard?  Do you recognize the sensation of defeat or inadequacy when you realize you didn’t execute something flawlessly? Do any of you ruminate on constructive feedback as evidence of failure? For those who are parents, do you always feel less than? Maybe you can glean a couple of small tips from my past growth lessons. (I like that word better than failures).

 

As a married resident with 2 children and a husband who was also in residency, I realized in order to survive, I quickly had to loosen some standards. 

 

The first one to go was the house.

 

A perfectly organized and clean home just couldn’t take priority. Cleaning floors, windows, dusting, went to the bottom of the to do list that was never completed. We had bare minimum standards: dishes had to be at least rinsed off while awaiting washing, clothes had to be in clothes bins and not on the floor, toilet stayed...

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Guilt as a resident physician

Let’s talk guilt.  Many in medicine excel in this emotion, especially residents. Mom guilt. Partner guilt. Friend guilt. Doctor guilt.  Food guilt. Work-out guilt. It stems from a couple of places. 

 

One root is that many of us high achievers are wracked with perfectionism.  We want to be perfect as a physician – and for family medicine that means cradle to grave, inpatient, outpatient, prenatal care and labor and delivery, rural and urban.  We want to be perfect as a friend, partner, spouse, parent.  We want to be a perfect mentor to students or interns.  We want to be perfect parents, neighbors, community advocates. We may never intentionally think to ourselves – “I want to be perfect” but we show our colors when something we do is “less than.” We think something has gone wrong. We are very hard on ourselves.

 

Perfectionism is a close cousin of a “should/shouldn’t”...

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What is physician coaching?

Coaching has been around in other fields for a couple of decades. Leaders in the C-suites of large corporations have long-since used coaching to keep up their A game. And though a small subset of physicians have found the benefits of coaching over the years, it was only in the last 5 years that data has been published about the benefits of physician coaching. The most well known study, released August 2019, showed decreased emotional exhaustion, decreased burnout, increased resiliency, and increased quality of life with physician coaching. https://pubmed.ncbi.nlm.nih.gov/31380892/

Let's talk about what coaching is and what it's not.  

First what it's not - coaching is NOT therapy. It is not advising - advisors give advice - they guide, direct, and steer.  It is not mentoring.  Mentors are people the physician naturally looks up to and wants to emulate.  

Coaching is officially defined as "partnering with clients in a thought-provoking and creative process...

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