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

~~~

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

~~~

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.

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

~~~

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. 

Powerful Tweets

by Lauren Nosanov

Social media have come to play a growing role at national conferences, serving not only as a convenient vehicle for information dissemination, but also as a forum for idea sharing and discourse. This year’s AWS and ACS meetings featured a significantly increased Twitter presence, with tweets from @AmCollSurgeons and @WomenSurgeons as well as several Twitter correspondents and meeting-goers. A review of content tweeted using hashtags #AWS13 and #ACSCC13 offers a wonderful snapshot of ideas discussed and wisdom shared. (For those unfamiliar with Twitter and associated terminology, see our Twitter 101 from Dr. Heather Logghe (@LoggheMD) and consider checking out Twitter’s FAQ section for new users.)

From Dr. Susan Pories on Networking

• Women are often excluded from networks and from conversations that open doors
• Networking: start small and begin with people you know (friends, family, etc)
• Build 3 networks: operational, strategic, developmental
• Don’t be afraid to take risks!
• Smile, ask a question, listen, have a handy business card, make a point to say the person’s name - Dale Carnegie’s five points
• Always be sure to follow up - it confirms that you are someone who can be trusted
• Moral of the story - you never know what will come of the random connections that you make
• “The way of the world is meeting people through other people”
• Key to networking: “building sincere relationships with mutual generosity"

From Dr. Mary Brandt (@drmlb) on Physician Wellness and Avoiding Burnout

• We talk about “quality of life” but not necessary “quality of work”
• Taking care of ourselves is a key part of taking care of our patients
• > 80% of surgeons experience discomfort or pain while operating
• Crucial to pay attention to ergonomics at work, both on the computer and in the OR
• Try to plan exercise every day and do something you really enjoy - focus on rotational core exercise
• When are you eating, are you eating enough, and what exactly are you eating?
• Call nights are similar to jet lag - stay hydrated, eat q3-q4h, repay the deficit
• Human beings heal by telling stories - communicate frequently, sincerely and with intent
• Spend some time every day being still and contemplating awe
• Down time is not wasted time, it’s essential time
• People at the top love to mentor those who are responsive and show potential for success

Dr. Gretchen Purcell Jackson (@pedssurgery) on Planning for Family

• You cannot plan perfectly or be fully prepared (hard for the Type A personality)
• Important to assess values, goal sand priorities prior to starting a family
• One of the few things you can control is your general state of health
• Think about child care options early on
• Know what your institution’s leave policy is and what you need to do to take advantage of it
• Important message from @LeanInOrg - don’t leave before you leave
• It’s okay to have help, and don’t fuss about things you can’t control

Dr. Hilary Sanfey (@hilarysanfey) on Leadership

• Leadership: the process whereby an individual influences a group of individuals to achieve a common goal
• Effective leaders utilize more than one style of leadership
• Watch leaders around you and decide for yourself what style they are using and whether or not it is effective

Joint AWS (@WomenSurgeons) and AAS (@AcademicSurgery) Panel on the Business of Medicine and Professional Development, Moderated by Dr. Carla Pugh (@CarlaPughMDPhD)

• Seek out those who can provide you with objective advice when you find yourself in a difficult situation - Dr. Andrea Hayes-Jordan
• Jobs are not forever - it is ok to change - Dr. Danielle Walsh (@walshds)
• Mentors are a bit like the Easter bunny or unicorns - they can be quite hard to find - Dr. Julie Ann Sosa
• As with all good relationships, mentee-mentor relationships take work to maintain
• You really have to respect your mentor, like them personally and trust them deeply - Dr. Julie Ann Sosa
• Assigned mentors may or may not work out - Dr. Rebecca Sippel
• Good communication is key to effective mentorship - Dr. Julie Ann Sosa
• Mentorship takes effort on the part of the mentee as well. Change mentors as the need arises
• Societies like AWS and AAS place a big emphasis on networking and mentorship - get involved! - Dr. Julie Ann Sosa
• Don’t lose sight of the fact that mentors also stand to gain something from involvement with mentees, it’s a two-way street - Dr. Danielle Walsh
• It’s ok to be a stalker, it’s ok to be a groupie - Dr. Amalia Cochran (@AmaliaCochranMD)
• Mentor opportunities - You give someone a rope and they hang themselves or make macrame - Dr. Mary Brandt (@drmlb)
• When you are asking for something, be sure you’re being realistic about what you need when negotiating - Dr. Andrea Hayes-Jordan
• Know your own value - Dr. Wei Zhou
• Stick to your values during the negotiation process. You will be respected for that. - Dr. Hayes-Jordan and Dr. Wei Zhou
• Write out a description of what you want from your position and get that into your contract - Dr. Joyce Majure
• If you are in a position where you are hiring/firing, work with your HR department to get guidance - Dr. Sandra Wong
• Negotiation is a long dance. Learn the steps. 

A key theme brought up by a number of speakers was the value of advocating for yourself. Whether this is seeking out the mentor that can best meet your needs, prioritizing your own health and well-being or successfully negotiating a competitive salary, conference goers were repeatedly reminded of a crucial point: you cannot expect to get what you need and/or want unless you speak up and ask for it.

Some food for thought:

• What challenges have you faced in advocating for yourself?
• Do you think women surgeons have more difficulty advocating for themselves than their male colleagues?
• Are you on Twitter? Why or why not?
• If so, how has Twitter (or any other form of social media) enhanced your experience of a professional meeting?
• How can the professional use of Twitter enhance your practice as a surgeon? How might it cause harm?

This post can also be found on the blog page of the Association of Academic Surgery.

~~~

Lauren Nosanov is a fourth year medical student at the University of Southern California Keck School of Medicine. She has spent the last year as a Dean’s Research Scholar, dedicating her time to clinical research in the field of Trauma and Critical Care. Having loved surgery from the very beginning, she is excited to embark upon the process of applying to General Surgery residency this fall. She is passionate about issues surrounding surgical education, mentorship and finding a balance between motherhood and medicine. Outside of medicine she enjoys practicing Taekwondo and spending time with her husband and son.