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BOOK EXCERPTS

PREFACE

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“A Doctor’s Dozen is a collection of lessons I have learned on my own journey towards wellness and my quest to promote health and self-care in others. The setting is my office and I invite you to come and see what I have seen, hear what I have heard, and learn what I have learned. I will introduce you to patients, including health professionals, across all phases of life, with a range of health challenges and unique personal stories.

 

Achieving a healthy life comes from knowing ourselves, prioritizing personal wellness, and embracing change. The twelve lessons are organized into three parts: Self Awareness, Self-Care, and Self Improvement. There are four lessons in each part. Each lesson is illustrated by a patients story, backed by science and linked to a strategy that can be applied by everyone in his or her life. A Doctor’s Dozen can be read and applied continuously or used as a monthly toolbox, focusing on one strategy at a time over the course of a year.

 

Personal wellness is a gift to oneself and to others. A Doctor’s Dozen is my gift to you on your journey to the healthiest life possible. I hope that in reading this book, you will learn as I have from others’ successes and challenges, apply these twelve strategies to yourself and advance your pursuit of health. I congratulate you for making a commitment to your own wellness and thank you for advancing my vision of “healthy individuals contributing to healthy communities.”

INTRODUCTION

 

The Cause and Effect of Burnout on Health Professionals,

the Health Care System, and Society

 

“The quest for health transcends age, time, and culture and is vital to personal performance and societal success. Health impacts life and is critical to each of us in our roles as parent, child, spouse, teacher, mentor, and citizen. The health and sustainability of a team, an organization, and a nation depend upon and are determined by the health of each of their members. Strengthening the quality of health within a population requires prioritizing the health of every individual. Healthy individuals who model healthy behaviors create healthier communities.”

 

“Understanding factors that threaten well-being is necessary in order to design effective solutions. Individual and system-wide evidence-based wellness initiatives are emerging, but quality research is limited.  Interventions aimed at individuals can also be used by organizations, as leaders within organizations must change for systems to change, and systems-based changes are needed to support individual change. The power to improve health in the general population lies within each individual’s capacity to advance self-care, as culture is ultimately the practices and beliefs of its members.”

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CHAPTER EXCERPTS

Being a physician is an honor and a learning experience, and caring for Carmen would be no exception. My learning curve, however, would be steeper than usual, not because she was transgender and not because she had not previously considered many of the questions I would ask of her, but because she would become such a willing teacher and I, new to the care of transgender patients, had much to learn. I knew that providing a safe space for inquiry without judgment would be critical. Given that my experience caring for transgender patients was nil, I had no box to put her in, and so I began with a clean slate. I was curious and assumed nothing, like the novice meditator and ancient philosopher who apologized to the scholar for not having the answer, saying, “I do not know what is right, but in not knowing I am open to learning more.” For thousands of years teachers have described the power of a good question to aid in the learning process. As Voltaire directs, “judge a man by his questions rather than his answers.” The Socratic method establishes questions as valuable tools for critical thinking and fostering active learning in all settings. Teaching through questions is powerful in the office, in the classroom, and in life.

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Teaching mindfulness is a bit paradoxical. It can’t be taught with traditional methods used for biology or anatomy. Learners must experience it; experts serve not as teachers but as guides or role models. The master multitasking medical student asks, “How can I be mindful?” My response is based on my own continuous e ort, which always needs practice. I highlight children as our best role models. Children evoke the “hurry up” response from adults as they stop to smell the roses, listen to a re truck, feel a grain of sand, taste cookie batter, and see the intricate patterns of snow flakes. Nothing is too mundane for a child’s curiosity. Mindfulness is a skill we are born with, but, like muscle mass, it atrophies with disuse. We lose it when we race through the present, worry about the past, and fear the future. Simply refocusing on the current moment permits us to recapture our childlike appreciation of the world around us. Mindfulness requires practice, but in this case practice does not make perfect. The practice is the reward itself. In the words of the Zen master Shunryu Suzuki, “the practice of becoming a Zen is the enlightenment itself.” He said, “When you eat, eat! Taste your food. Be in the moment. Be yourself. Just be present. That is the practice.”

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In residency I struggled to achieve balance in health and in life. My exercise was limited to walking across hospital floors, and I kept my blood sugar from falling in the middle of the night by drinking cans of Ensure in elevators between admissions. Dr. Brock taught me that no one is immune to imbalance and that I am equally vulnerable and as much in need of personal health and wellness as my patients. I came to appreciate how fundamental my personal health was to my success as a doctor. No matter what my task, my own health must be tended to first. In my journal, where I keep my values, purpose, and vision, I now scan my health. I set yearlong goals and list them on the back cover to review regularly. My goals vary each year, but over the past decade many, such as those focused on eating, sleeping, and exercising, remain constant. My journal is a powerful reminder to assess and fill my tank. With each goal I set and achieve, I trust myself to prioritize me.

Having long waited for this moment, I eagerly reflected her words back to her. “You don’t deserve it.”

She repeated, “I don’t deserve it.” We went back and forth repeating her discovery. Lee was like a child having just written her name for the first time. Rereading her journal, she reflected that writing her story had allowed her to see she was in an “abusive relationship.”

Nelle read everything available on MS and felt fortunate to learn that she had “relapsing remitting” MS, the most common and most benign type. She shared how she felt fortunate to begin treatment quickly and to return to her activities in weeks compared to the months of prolonged chemotherapy and radiation that her husband received. She was advised that interferon immunotherapy would help prevent the progression of her fatigue and was grateful to find how fast steroids worked to recoup her energy. When her husband died, she vowed to stay as healthy as possible in his honor.

“Living with Bianca was wonderful and horrifying. We did everything together, and then we didn’t. We built so many traditions, and then we had none. We danced and we sang. We swore and we cried. She was beautiful, and she was dangerous. She was an angel, and she was the devil himself. She cared and she cuddled and she lied and she stole.” Christina sobbed as she spoke. “She was kind and gentle and scary and manipulative. She was home for days and then she was gone, missing for weeks. Then she would appear for meals as if nothing had changed. She asked for money and would go missing again. She stole her father’s prescriptions for oxycodone and did worse under my roof.” Her sobbing continued, but her words paused. She caught her breath and continued:

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One night Bianca went into her bedroom, and the next day she didn’t come out. I went in and found her. She looked dead. The ambulance came. They said her heart was still beating, just slowly. They said she was still breathing, just slowly. They said her pupils were small. They were always small. They gave her a shot. She came alive. They said it was an overdose. They asked if she had attempted suicide. They sent her to rehabilitation. Three weeks later she came home. She said she was fine. I believed her. I refused to acknowledge she had a drug problem.

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I knew it, and I should have stopped it. I should have, but I didn’t. It happened again. She was dead and then she was alive, like Lazarus, over and over again. I became numb to her death, grateful and resentful of that resurrecting naloxone shot.”

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In addition to celebrating challenges, we can view each and every step toward large achievements as a mini-success. Life is a long-term investment, and if we embrace the glory of our impermanence, we can enjoy the journey. We don’t need to wait for the whole; celebrating the sum of the parts can be superior. Jonathan Haidt, in his book The Happiness Hypothesis, presented the progress principle by acknowledging that “pleasure comes more from making progress toward goals than from achieving them.” He advised readers “to feel the pleasure as you walk, and not wait for the thrill of removing the backpack at the end of a long hike.”

We all face challenges every day. Our ability to overcome them depends on how we view them. We can’t change past experiences, but we do have the power to change how we interpret them. Changing our interpretation does not mean that we convince ourselves that a bad experience was good; it means that we practice realistic optimism and consider how the situation might look from another’s perspectives or from a different angle.

Thank you for a great session. I was so grateful to you for sharing your experiences. I walked into class feeling stressed and tired but left feeling rejuvenated and more optimistic! You hit the nail on the head in mentioning what none of our professors yet have acknowledged: “Medical school is draining. Keep at it, you’re almost there.” I have felt a palpable slump both for myself and among my classmates, and by addressing it up front this morning, you have made it easier for those feelings to be acknowledged, accepted, and—hopefully—uplifted.

The nonsmoker relies solely on intellect and makes the claim, based on facts, “I would never smoke.” But for even the most educated smoker, a personal decision to quit is not so simple; the smoker must overcome the battle between an internal voice of reason and that of feelings. Emotional arguments to smoke often conflict with intellectual arguments to quit. Rational thinking is undermined by stress. Feelings can be more potent than beliefs, and fear often trumps fact.

David married his high school sweetheart after college and has two young children. When he came to me for care, he was at the end of his first year of a cardiology fellowship, having completed three years of a pediatric residency, four years of medical school, and four years of college. He had moved to each new program with the hope of returning home to practice after training.

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Growing up in rural North Carolina, David had loved to fish and hunt. He had participated in fishing tournaments year-round and had won a local fishing championship at age eleven. At a small college in North Carolina, he began hiking the Blue Ridge and Appalachian Mountains. In medical school he took up biking, and in residency, surrounded by athletes, he biked or ran daily. While in residency, he maintained his outdoor activities with family and colleagues and viewed himself as productive and con dent, and a model of health.

This is not a test. We all get the same 24-7 amount of time, but how we use the time is our choice and varies day to day and week to week, based on our needs and situations. The goal of the log is not to judge how you allocate time but to become conscious of and learn from it. The exercise is a success if you analyze your results and make purposeful change. There are no right answers, but there are some best practices that you can shoot for when you’re feeling “out of time.” For example, seven hours of sleep daily is recommended for adults, having daily “me” time promotes personal balance, and having a greater percent of activities that replenish rather than deplete is always advantageous.

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