Shaming Feedback vs Growth feedback - take homes from Duolingo.

Can we talk all things feedback? Feedback can be beneficial for doctors to gain awareness of strengths and opportunities for improvement.  As physicians that went through innumerable tests and critiques before and during medical school, throughout training, and in ongoing board certification and quality measures, we can fall into some unhealthy patterns around evaluations.  The impact of any feedback actually depends, not only on the methods and the giver, but on how it’s received. 

 

Thankfully over the last few years, there has been an emphasis on quality feedback processes in residency training.  I personally feel it’s better than 20 years ago - intentional encouragement for feedback to be specific, timely, positive and constructive, involving the self-reflection of the resident, with mutually designed goals and action plans. I also know in the world of academics, it’s not perfect every time.  But the effort is in place. So, this...

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Committing to your health as you serve others regarding their health.

 

My latest Vlog on exercise and movement as busy physicians.

Pro tip: Don't add it to your "should do" list - add it to your "I get to list" and then commit to it but allow flexibility and self-compassion.  

Start low and build up slowly if it's been awhile.

 

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Self-care as a busy physician

Self-care can consist of many things.  Good nutrition, exercise/movement, mindfulness, meditation, prayer, reading, spiritual practice, connection with others, gratefulness, giving, setting boundaries, getting out in nature, relaxing, play, restorative sleep, pampering, goal setting/prioritizing, vacations, scheduled alone/down time. Basically, self-care means taking time to improve and prioritize your physical, spiritual, and emotional/mental health.

 

Many of the self-care items above can lead to rejuvenation in the short-term. The definition of rejuvenate: a transient verb that means to make youthful again; give new vigor, to restore to an original state.  Synonyms of rejuvenation: revitalize, freshen, recharge, refresh, renew, repair, restore, resuscitate, revive. 

 

Which areas are you neglecting? Which of those areas will benefit you most? Which will feel the best even if you can't imagine fitting them in? Rejuvenating self-care can take...

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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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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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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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