Nobody Comes to Work to Do a Bad Job…

by Mary Brandt, MD

“She’s really impossible… one of the grumpiest people I’ve ever met. We’ve had nurses come back from escorting patients to her almost in tears… if I worked with her, I’d be reporting her on a daily basis.”

I really, truly believe that there’s not a single person who gets up in the morning, looks in the mirror and says “How can I go to work to do a bad job today?” So what happens? Like the doctor described above, what happens to people that puts them in such a negative frame of mind? There are probably a few real jerks out there – maybe even some with real problems (like a borderline personality disorder). There is literature on disruptive physicians and some of this I’ll address in other posts (substance abuse, depression, compassion fatigue). For now, just consider the idea that most people who misbehave at work have something else going on.

It’s a lot easier to put up with negativity (and even downright rudeness) when you are rested. When you are exhausted, it’s just a lot harder. I think the key is recognizing that being tired makes you vulnerable to act in ways that aren’t “normal” for you…. and then consciously thinking about how to handle it. Here’s a few things to think about as you are taking a deep breath (or two or three..)

1. Don’t fall to their level. Whatever you do – look cool.

2. Don’t respond at all if tempers are hot. Let silence have a minute to work.

3. Try to consciously find a sense of compassion for them. What if their spouse just left them? What if they just got called on the carpet by their program director or chairman? It’s not an excuse – because really bad behavior is never the right answer – but maybe there are some extenuating circumstances.

4. Be personal… in a good way. Watch for an opportunity to discuss last nights football/baseball/basketball/hockey game, or the latest election, or anything that is not related to work. Learn people’s names, ask where they are from, etc. Humor is an important tool, if the opportunity arises and the other person is receptive. Anything you can do to befriend the other person will help – If you are able to develop relationships it’s harder for meltdowns to occur.

5. If it gets out of control you can always – politely and sincerely – walk away with “I’m so sorry you are having a tough day. I hope it gets better for you.”

This post originally appeared May 9, 2010 on Dr. Brandt's website Wellness Rounds

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Mary L. Brandt, M.D. is a professor of Surgery, Pediatrics, and Medical Ethics at Baylor College of Medicine and a practicing pediatric surgeon at Texas Children’s Hospital. She is involved in education on a day-to-day basis in her clinical work. She also thinks about medical education on a bigger scale through her work as Vice Chair of Education of the Michael E. DeBakey Department of Surgery and Associate Dean of Student Affairs at Baylor College of Medicine. She actively blogs and tweets.

Compassion: Lessons from Roshi Joan Halifax

by Mary Brandt, MD

It’s not often that a talk completely changes the way I think about something.

I’ve been thinking and speaking about compassion fatigue for many years. I recently had the privilege of hearing a wonderful talk by Roshi Joan Halifax. She made a strong and convincing case that “compassion fatigue” is a misnomer… and that we should think about this in a very different way.

We can never have too much compassion nor can true compassion result in fatigue. 


Photo credit

Empathy and compassion are not the same thing.

Empathy is a necessary prerequisite for compassion, but compassion goes beyond empathy. Empathy is the ability to be with someone who is suffering, to be able to feel what they are feeling. Compassion, on the other hand, is being for someone who is suffering, being moved to act and find a way to relieve their suffering.



Link to Roshi Joan Halifax TED talk “Compassion and the true meaning of empathy”

Self-regulation is the key to being able to remain compassionate and this skill can be taught.
We all respond to situations of suffering with “arousal”, a state that varies in intensity depending on the severity of the suffering, and our own memories and experiences. How you respond to this state determines whether you can stay present, effective and compassionate. Roshi Joan Halifax offered the mnemonic “GRACE” as a way to teach this skill to medical students, residents, physicians, nurses and other health care professionals.

G: Gather your attention. Take three deep breaths. Be present.

R: Recall your intention. We choose careers in medicine to help heal the sick and to reduce suffering. It’s not easy to remember this intention when we are overwhelmed. But, in the moment we are faced with a human being who is suffering, we must let our own response (and the demands of the day) go and remember why we are here.

A: Attend to yourself. Being able to detect what is going on in your own body is the same “wiring” you use when you feel empathy. After gathering your attention and recalling your intention, pay attention to what is going on in your body. Watch your breath, feel where there is tension, pay attention to sensations.

C: Consider what will really serve. Moving from empathy to compassion is defined by considering the actions that will relieve suffering. Really consider the person and the situation and decide what is most likely to improve the situation.

E: Engage ethically.

“Developing our capacity for compassion makes it possible for us to help others in a more skillful and effective way. And compassion helps us as well.” Joan Halifax



Photo credit

This post originally appeared January 13, 2014 on Dr. Brandt's website Wellness Rounds

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Mary L. Brandt, M.D. is a professor of Surgery, Pediatrics, and Medical Ethics at Baylor College of Medicine and a practicing pediatric surgeon at Texas Children’s Hospital. She is involved in education on a day-to-day basis in her clinical work. She also thinks about medical education on a bigger scale through her work as Vice Chair of Education of the Michael E. DeBakey Department of Surgery and Associate Dean of Student Affairs at Baylor College of Medicine. She actively blogs and tweets.

Making time to take care of you.

By: Christina Cellini, MD, FACS, FASCRS

It’s easy for us to get caught up in the day-to-day caring of others – whether patients or family – that we forget to take care of ourselves! I recently experienced this when I found that my eyesight was declining.  When I thought about it, it had been an embarrassingly long time since I had had my eyes checked.  Making an appointment with the eye doctor was quite the ordeal given scheduling restraints. When I had an opening during the week, the doctor didn’t and vice versa. 

I took a moment to take stock of all the health maintenance appointments that I have been remiss in making. There were quite a few!  I realized that although I am healthy enough now, I need to acknowledge that I need to pratice what I preach to my patients and make the time to take care of my own health! 

I made a list of health maintenence appointments and blocked out time far enough in my schedule so that they were a priority.  Making these appointments far enough in advance so that you get the earliest morning appointment (less chance for the physician’s clinic to be running behind as we all know!) tend to be less disruptive to my working day.  And once it’s on my Outlook I know it will be done!

The following links from the NIH outlines what the recommended health screenings are for women by age group: 

• http://www.nlm.nih.gov/medlineplus/ency/article/007462.htm
• http://www.nlm.nih.gov/medlineplus/ency/article/007467.htm
• http://www.nlm.nih.gov/medlineplus/ency/article/007463.htm

Dr. Christina Cellini is an Assistant Professor of Surgery and Oncology at the University of Rochester Medical Center in the Division of Colorectal Surgery. After obtaining her undergraduate and medical school degrees at Cornell University she trained in general surgery at the NewYork Presbyterian Hospital-Weill Cornell Medical Center. Following residency, she completed a fellowship in Colorectal Surgery at Washington University in St. Louis. She recently completed a Masters in Medical Management at the Simon School of Business at the University of Rochester. She lives in Webster, NY with her husband and 2 children and enjoys running and snowshoeing in her free time. Dr. Cellini serves on the AWS communication committee.  

A bit of kindness

by Amalia Cochran, MD

The following is an excerpt from an email I recently received from a mentee:

“I love, love, love surgery, but even as someone who has thrived in this environment, I now acknowledge that there are some aspects of the culture of surgery/academics/surgical and medical education that I am deeply unsettled by and wish very much to change. I see fellow students, residents, fellows, young faculty transform from being full of zeal and goodwill into angry, bitter, jaded people, and it’s absolutely disheartening to see. What’s more infuriating (to me because of the wrongness of it all and because I’m such a fixer) is that those who have been negatively affected and are the very ones capable of enacting positive change because they’ve “been there” sadly become the very ones who perpetuate the indignities of the broken culture, and they don’t even recognize that they’re doing so.”

Her important question that she asked me, and one that I found incredibly wise, was, “Did you ever struggle with this during your training or see this among your colleagues? Or even now?”

I asked her if I could answer this on the blog, and she graciously said yes. It was important for me to do so because I feel obliged to make some confessions related to her concerns.

The biggest one? I had many days during my residency when I was so tired, so broken, so frustrated that I wasn’t a nice person. While I was able to focus on doing the right thing for my patients, I could be and often was impatient with students who needed nurturing and staff who were still learning too. I was so Hell-bent on my own survival, on not making mistakes, on not showing any shred of evidence that I might not be able to succeed as a surgeon that I had no qualms about running over people. I nearly quit surgical residency during my PGY2 year because I didn’t like what I was my self becoming (then was nurtured by some VERY kind mentors who managed to help me hang in there).

I attribute a significant portion of my behaviors when they weren’t outstanding to sleep deprivation and not having a functional set of skills for coping with my chronic exhaustion. I also attribute some of my less-than-ideal behaviors to the surgical culture in which we were supposed to prove that we’re tough and don’t have flaws. Reality check: I may be resilient- I far prefer that word to “tough”- but I do have flaws. Sometime around my 40th birthday, I became okay with that.

• I want to believe I was asked about this topic because I’m seen as someone who is generally patient and supportive. A few key lessons have helped me get back to this place, one in which I think I existed prior to my 7 years of complete exhaustion and chronic stress.
• We’re all struggling. Every one of us is, in one way or another. That’s not a source of shame, it’s a source of humanity.
• If those moments in which your lesser self shows up are rare, people believe you when you apologize for your behavior.
• We are all learning, ever hour of every day. That’s what we’re here to do in a teaching environment.
• As someone in a position of leadership, my team and those around my team rely on me to set a tone. I don’t want that tone to be one of nastiness, blaming, and negativity because I want/ need a high-achieving team. Therefore, it’s up to me to be supportive, to be patient, to take a deep breath before reacting, even when my gut wants to say, “WHAT were you thinking?!?”
• When people are intimidated, their ability to think critically is impaired. Working in an ICU, I need everyone around me to be a critical thinker. Kindness does much more towards that end than bullying.
• If all else fails, go for a walk with the dog. Dogs are masters of this moment being the very best moment ever and that influence is contagious- particularly on a snowy day if one has a Siberian Husky in their life (as I do).

If nothing else I wrote tonight resonates with you, it’s my hope that a picture of an incredibly happy husky will help you pause and be a bit kinder.

This post originally appeared March 24, 2014 on Dr. Cochran's website Life in the Wild West

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Dr. Amalia Cochran is Associate Professor of Surgery at the University of Utah.  She is heavily involved in undergraduate medical education, serving as the Surgery Clerkship Director and the Director for the Applied Anatomy track for 4th year medical students at the University of Utah.  Her research interests lie in surgical education and in clinical outcomes in burns.  She is completing her term as Vice President for the Association of Women Surgeons. 

At the End of the Day -- Advice to a Young Surgeon

by: Carol EH Scott-Conner, MD, PhD, MBA

When I finished surgical residency and took my first job as an Assistant Professor, I emerged from a fog of chronic sleep deprivation and became conscious, as if for the first time, of a myriad of new emotions associated with work and home. Over the years that followed, I developed some methods and rituals that served me well. I pass them along to you, in the hopes that some small measure of what follows may be of assistance. As you read these words, remember that for more than three decades I was a general surgeon and it is only in the past four or five years I've concentrated on breast cancer.

As you read these observations, put them into the context of something in your own practice that you might find unutterably sad or difficult. For example, when a critically ill teenager lies up in SICU dying of massive head trauma; or, perhaps, when you have had to perform a “peak and shriek” when you had hoped to do a definitive resection of a tumor.

1. When talking with the patient or family about a bad thing: breathe slowly and deeply, relax all your muscles, and listen. Let them talk. Sometimes that is all you can do to help them. It will help you as well. Repeat your explanation simply and carefully. Be as accurate as you can. Remember that what you say may be different from what they hear. Bring a third party with you – the family clergy, a hospital chaplain, a nurse, social worker – if it seems appropriate. Don’t be afraid to reach out. Human touch is good.
2. End your work day with something good. If you have three patients in hospital to see on evening rounds, and two are critically ill and the third is recovering nicely, see the one who is doing well last. Sit down at that patient’s bedside, breathe and relax, talk and listen. Hold our your hand and nine times out of ten the patient will take your hand and hold onto it. Rejoice in the success. Live in the moment with that patient.
3. When you get home after something bad has happened, cue your “best friend” as to your mood. My “best friend” is my spouse, but it might be your partner, your housemate, or even your dog. Whatever. When I go home, the first thing I say is “I love you and I missed you.” But then, when we are standing side by side and making dinner, I say something very nearly like this, “Something bad happened today,” and I pause. Then I might say, “We admitted a teenager with a bad trauma. I don’t think he’s going to make it.” That’s all I need to say. My husband knows what mindset I’m bringing to the dinner table. My burden lightens almost immediately.
4. If your “best friend” tries to console you (which is a normal human response) don’t shoot back, “you just don’t understand” (another normal human response), even if that is what you feel like saying. Say, “it wasn’t like that, it was…” or, “I’m not ready to talk about it yet…” They don’t understand until you explain it to them. If you are fortunate enough to have a person in your life who has chosen, of all the people in the world, to stand by your side, then you should share your world with them. I don’t necessarily mean all the gory details. My husband was a medic in Vietnam and went on to medical school, but even he doesn’t want to hear it. I am always struck how spouses of soldiers with PTSD say, “he shut me out. He won’t talk about it.” Remember, your “best friend” is attuned to your moods, but isn’t a mind reader. Unless you tell that person why you are moody or depressed, they won’t know.
5. Then, immediately, let it drop. Don’t use your bad day as a cop out or an excuse. Wipe the slate. Have dinner, play with your kids, walk the dog, whatever. Live in the moment with your family (or dog). Later, read, write (journal), think about the incident, talk to colleagues, whatever works for you. But let the naming of the problem be a signal to put it to rest for the evening.
6. Give your “best friend” some follow up, if they wish. A couple of days later, you may be able to say, “that teenager we admitted the other day? He’s starting to wake up. He’s doing a lot better than we expected” or “He died today.”
7. Exercise is good. Get some exercise every day. I like to bicycle to and from work whenever weather permits. On the ride home, I try to concentrate on my surroundings, rather than the day that has passed, or the day ahead of me tomorrow. When bicycling isn’t feasible, I try to swim. Find something that works for you, and concentrate on your body and all of your senses.
8. Drugs and alcohol are bad. I’m not talking about a glass of wine with dinner, I’m talking about stopping at the bar to knock back a couple of stiff ones before you go home.
9. Be a warrior. By that I mean, acknowledge that you have chosen a noble and dangerous path. A path that will take you into daily contact with death and the deepest mysteries of life. Draw strength of that. And always remember that you are not walking the warrior’s path alone.

Dr. Carol Scott-Conner is an Endocrine and Breast Oncology Surgeon and Professor of Surgery  - Surgical Oncology and Endocrine Surgery at University of Iowa Carver School of Medicine. 

The 2013 AWS Foundation Awards

by: Susan Kaiser, MD, PhD, FACS

AWS Foundation Awards

Monday, October 7, 2013

Washington DC

Dr. Susan Pories & Dr. Joyce Majure

The Nina Starr Braunwald Award (given first to Claude Organ MD in 1993), recognizing outstanding contributions to the advancement of women in surgery, was presented to Joyce Majure MD, a member of the AWS since its very first meeting in 1981, who practices general surgery in a small city in Idaho.  Dr. Majure produced the first AWS newsletter and created the Pocket Mentor, first published in 1993 and now in its fifth edition, initially designed to help women surgical residents who lacked female role models in their training programs. Dr. Majure herself has been a role model for generations of AWS members.

Dr. Susan Pories & Dr. Hilary Sanfey

The 2013 Olga Jonasson Distinguished Member Award (given first to Christine Haycock MD in 1990 as the Distinguished Member Award), recognizing a member surgeon who exemplifies the ideals and mission of the AWS, was awarded to Hilary Sanfey MD, a transplant surgeon,Professor of Surgery and Vice Chair for Educational Affairs at Southern Illinois University.  Among her very significant contributions to and activities on behalf of the AWS, Dr. Sanfey founded our first local chapter.

Dr. Marsha Moses & Dr. Susan Pories

The 2013 Past Presidents’ Honorary Member Award (given first to Judith Briles PhD in 1990 as the Honorary Member Award), for important activities in support of the mission and values of the AWS, was given to Marsha Moses PhD, a teacher and biochemist, Director of the Vascular Biology Program at Boston Children's Hospital, and posthumously to Keith D. Amos MD, a beloved surgical oncologist and researcher at the University of North Carolina in Chapel Hill.

Dr. Meera Kotagal & her parents

The 2013 Hilary Sanfey Outstanding Resident Award (given first to Janice Cormier MD in 1999), for a resident who demonstrates potential as a future leader in surgery, was awarded to Meera Kotagal MD of the University of Washington. 

Dr. Susan Pories, Jamie Anderson & Dr. Patricia Numann

The Patricia Numann Medical Student Award (given first to Sudha Jayaraman in 2003), established to encourage and support female medical students pursuing a career in surgery, was awarded to Jamie Anderson of the University of California at San Diego.

Inspired by these award winners and their stories? Make a contribution to the AWS Foundation today. Please help us continue this wonderful tradition. 

The AWS Foundation is currently accepting nominations for the 2014 Awards. Check out our website for more information and applications. Deadline to submit a nomination is July 14, 2014. 

Health and Surgical Residency

By: Bharti Jasra, MD

People like me are more interested in talking about healthy living than actually living it, since our lifestyles are often the direct opposite of healthy. This article is based on my experiences during residency and is meant to create a broader perspective of health.  I am going to categorize health into three systems: body, mind, and soul. All three systems are interdependent, and together in harmony, lead to a healthy lifestyle.

Physical Health

Breakfast is the most essential meal of the day and should not be missed, as the rest of the meals are not guaranteed in residency. Try to start your day with a good breakfast, and you will see the difference in your performance immediately. Keep water with you, and actually drink it. Snack with fruits and nuts instead of sugar-loaded food and drinks.

Don't postpone bathroom breaks until they become emergencies. Physical exercise in the form of running, pull-ups, swimming, dancing, or playing your favorite game is refreshing. Remember anything is better than nothing. Stretching at the start of the day with yoga, even if it is for five minutes can make a huge difference.

Respect Sleep Hygiene. Try to sleep and wake up early. Sometimes we try to push ourselves to stay up late and study. Learning in this circumstance is usually sluggish at the best with minimal retention. On the other hand, being able to rest at the earliest when you need it the most is more natural and energizing. Early morning reading is usually more efficient and retentive. For night shifts, make a sleep schedule and follow it regularly. Don’t underestimate the power of a good shower at the start and end of your day.

Mental Health

At the start of the day, remind yourself of the love you have for the work you do and be thankful for getting this opportunity.

Remember to smile and even laugh. It's infectious, creates positive energy, and prevents any burnout

Talk to someone like your mentor or a friend if you feel yourself becoming overwhelmed with work-related stress before it is too late. Try not to carry work-related issues back home where they can be injurious to the mental health of your family. Also have some time set aside for your family once in a day or in a week—whatever is possible. Don't take your family members for granted, as their support is very valuable and they deserve your time too. Very little but pleasant family time reboots our mind for another challenging day ahead. Remember: residency is a marathon and perseverance matters a lot. Develop a mechanism to cope with complications and deaths on your service. If it’s not learnt during residency, the lack of an appropriate coping mechanism may blunt your professional progress post-residency and can make people quit, too. Discussing with your peers is very helpful in developing a better understanding on how to avoid complications if possible in future. Learn from others’ complications too.

Passive TV watching can be deleterious for mental health as it leaves you unsatisfied at the end wanting for more. However, doing activities of your interest like playing games/ cooking/ writing/ teaching/ etc. gives you a sense of accomplishment and satisfaction.

Be a better you everyday than wasting time in being better than someone else to avoid placing a limit on your own abilities. Constructive criticism from anyone is very helpful in that regard. Try and resist anger and arrogance as you grow through residency. Look at the most successful surgeon that you ever met and you will notice that they are the most humble people.

Spiritual Health

After listening to successful people of various fields, I have realized that the key to their happiness is staying connected to their inner self.

It not only makes them very focused, and hence, efficient in their work but also builds mental strength over a period of time. It is also very helpful in maintaining balance in work and family life. Most people following various paths achieve this state with meditation. It doesn't have to be for days, hours, or even minutes. It can be as little as meditating a breath at a time. Regretting for our past mistakes or worrying too much about future makes us forget the beauty of now. I would strongly recommend listening to Google talks by Ekhart Tolle or reading his book, ‘Power of Now’. As we start living in the present, life becomes more beautiful and meaningful.

As a member of a health care delivery system, it is essential for us to strive for a healthy lifestyle and then lead the society by our own examples.

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Bharti Jasra, MD is a medical graduate from India finishing up her General Surgery Residency at Saint Louis University Hospital. She is interested in specializing in Breast Surgical Oncology.