Self-Help


I’ve decided that every week between now and when I start working as an intern in July, I’m going to try something I’ve never tried before. With graduation on the way and having completed both my clinical rotations and my book, I haven’t been writing a lot about medicine lately. And that clears up a whole ton of time to take on new hobbies! Not the least of my reasons for doing this is that I really, deeply believe in constantly showing myself new facets of life that I suck at.

Two weeks ago, I went snorkeling in Puerto Rico. When we signed up for this, I clarified with my husband, “So in cartoons, when they sneak around underwater and look out through a tube… is that what snorkeling is?” I’ve always been a terrible swimmer, so naturally, I have the floaties to thank for my life.

Last week, I broke out my new camera and made my debut in portrait photography. Not only do I now totally understand why people keep taking unflattering photos of me, but I can also now take my revenge. (Shown here are my husband in his historical fencing gear, my sister before Prom, and my other sister with her date.)

Portraits

 

This week, I took up golfing. It is pretty much obligatory for a doctor to play golf, and my family consists entirely of competitive golfers. On day 1, my average drive was an impressive 10 yards. On day 2, my average drive increased to 100 yards. I was SUPER excited for day 3, but I’m sorry to say I did not average 1000 yards.

Of course, now I’m looking for other fun things to add to my list! I will consider all plausible suggestions that comply with my moral standards. =]

Seriously. I have thought about this, and I’m pretty sure I meet clinical criteria for addiction when it comes to studying.

Consider these criteria for “substance dependence” (and kindly think of studying as a substance for the purposes of this discussion):

(1) Tolerance, as defined by either of the following:
– An increased amount of the substance is required to achieve the same effect.
-A decreased effect results when the same amount is used.

I first tried studying when I was in elementary school. I liked how it made me feel. I got a buzz from being smart, like I was on top of the world, and often I could see things that other people couldn’t. But as time went on, it took more and more studying to get that same feeling. Now I’m in medical school, studying 40, 60, 80 hours a week in order to feel smart. I can’t just feel smart after studying for half an hour, like I did when I was young.

(2) Withdrawal, as manifested by either of the following:
-The characteristic withdrawal syndrome occurs.
-The substance is used to relieve or avoid withdrawal symptoms.

When I don’t study, things can get out of hand. I start to feel resentment toward the people (usually family members) who are taking up my time and keeping me from studying. I get anxious about what’s left of my evening and when I will get to study again. I get headaches, sometimes I lose my temper. If it goes on for a long enough time, I can even get delirious and do things that are completely out of character—like shopping, baking, or scrapbooking.

(3) The substance is used in increasingly larger amounts, or over a longer period of time, than desired.

Sometimes on a Friday night, I think, “I’m just going to study a little bit, since it’s the weekend and I have plenty of time.” Monday morning hits and I am left wondering how I managed—yet again—to get nothing done besides studying all weekend.

(4) The patient attempts or desires to decrease use.

Believe me, I’ve tried many times to cut back on my studying habit. I’ve stayed clean for a couple weeks at a time, maybe even for a whole summer. But it’s only a matter of time before I go back to the same old environment, with classrooms and teachers and all my friends who are studying… and I always cave in again.

(5) A significant amount of time and resources are spent obtaining, using, or recovering from the substance.

I know that I have spent a lot of time, and even squandered my life’s savings, on studying. Textbooks are at least $50-100 a pop on the streets. Sometimes you can get them cheaper, but you don’t know what’s been put in them (scribble marks, highlighting). And I don’t have a job, so I can’t keep up with how fast I go through them. I’ve ended up in a lot of debt!

(6) Important social, occupational, or recreational activities are given up or reduced because of substance use.

I try hard to make time for family and other things. Sometimes it hurts their feelings when I don’t make it to their golf games, or to their graduation dinner, or to their wedding. I can’t seem to hold down a job for long either because I end up studying so much. And that’s too bad. I really do mean well at heart.

(7) The patient has knowledge that the substance use is detrimental to his health, but that knowledge does not deter continued use.

Sure, I know that my habit is going to kill me sooner or later. I don’t always sleep, or eat, or use the restroom when I know I should. I keep studying even when I am sick. I just… can’t help it.

There was a patient who made a huge impression on me the first day that we met. He was a diabetic who’d let himself go, had multiple amputations, and was now undergoing a long course of treatment for widespread infections. He knew he wouldn’t live much longer when our team visited him.

We were led by a well-respected physician, one that I’d known in my first two years as exemplifying competence and bedside etiquette. When this doctor started to explain the plan, the patient became hostile, hurling insults and profanities. “My surgeon told me the opposite! What you say doesn’t count. You’re just the University doctor.”

The doctor nodded quietly and continued to listen as the patient ranted about the surgeon, the infectious disease specialist, the nurses, the lack of communication, and other problems of the American health care system. Finally, he deescalated to asking how long our doctor had been living in Reno. “You see! I knew you weren’t from here! I’ve lived here for 55 years, and you and I both know that what they’re doing ain’t right!”

Within days, he became a vegetable. But until then, every day of his remaining life, this man made a dogged effort to burn all his bridges with the medical staff.

This is the part where I would like to say that his demeaning attitude did not affect the quality of his medical care, that we were just as concerned about him as we would have been about a sweet old lady who brought us cookies. But that would be a blatant lie. And this is hard for me to accept, at this stage of my training. I want us to be impartial. I want us to uphold the exact same standard for everyone.

But we are human, after all. And the doctor-patient relationship is a relationship. Don’t get me wrong, this guy had his meals brought, blood pressures checked, labs drawn, wound dressings changed. Actually, a great many extra hours were spent trying to figure out how to deal with him. It just could have been a better experience for everyone involved.

Being human, we can also be influenced to provide better care. That’s why most of the time, we are encouraged to practice medicine with “humanity.” Caring about our patients motivates us to go that extra mile.

Here are some things that patients can do to maximize their benefit from our humanity:

1) Treat us like human beings. This should start with basic courtesy to us and our staff, but also goes beyond that. If you act like your doctor is “just the check-up person” (as one girl put it), that’s probably all you’re going to get out of that relationship. We like jokes and insights. We like to hear about major life events. Looking back on my own writing, the patients who really stood out have had a sense of humor and a positive outlook. They were able to teach me about overcoming adversity.

2) Treat us like allies. Bad outcomes do happen, but believe it or not, it’s not because your doctors are trying to kill you. Demonizing and alienating us usually will not make us sympathize. Like everyone else, doctors are more willing to keep trying when our best efforts are acknowledged and appreciated. If you do have a complaint, try to make it constructive.

3) Pull your own weight. We all love patients who exercise, eat healthy, stay on top of their meds, and generally heed our advice. Show us that you care about your health! Because if you don’t care, why should we?

4) Tell us about the “alternative medicine” you’re using, but please spare us the lecture about how that is superior to our methods. Just wanted to throw that in there in case you didn’t realize that was a turnoff. =]

Of the 45% of the population that sets New Year’s Resolutions, a quarter proclaim failure within the first week. Why? They’re bad goal-setters.

For example, bad goals I’ve heard people set are “Lose weight” or “Get over my ex-boyfriend once and for all” or my favorite, “Don’t be so negative.” These are ambiguous, measure success subjectively, and even seem to acknowledge defeat in their very statement as goals.

But if you’re going to do this, it’s crucial that you get it right! Your emotional well-being is at stake every time you set a goal. When you declare a failure, your self-esteem deflates, and you may be one step closer to a miserable death (…only partially kidding there).

The following guide is based on psychological research in human motivation, and I think everyone would benefit from approaching their goals this way.

How to set a goal:

1. Select a goal that is self-determined, that comes from who you are and love rather than who you responsibly “ought to be.”

2. Make it challenging, but also realistic. Keep in mind that your will power is limited, so you can only force yourself to do so much before you quit out of self-pity. Also, the more capable you feel, the more motivated you will be in following through with your plan.

3. State the goal in positive terms, as something desirable to approach rather than something undesirable to avoid. For example, “Spend 4 hours in the library everyday” instead of “Stop being a slacker.”

4. Be specific. Set a time frame to get a certain amount of work done. Break it down into small, manageable chunks so that you have something to account for every time you work toward your goal. So the big picture of “Lose 10 lbs by Valentine’s Day” might also mean “Run 3 miles on the treadmill, 3 days a week.”

5. Define how you will measure your success. “Improve my game by 5 strokes” instead of “Be a better golfer.”

How to attain a goal:

1. Set standards. Have a notion in your mind of how things would ideally run from day to day if you were already attaining your goal.

2. Monitor your behavior in relation to these standards. Keep a chart if that’s your thing. It’s amazing how dramatically people underestimate their bad behaviors, both in terms of how often and how severe. So be honest! Face it: “I ate two extra Twix bars after dinner, for a total of 3132 calories.”

3. Make steps to adjust your behavior to better suit your ideal. Your goal probably entails delaying gratification, avoiding procrastination, etc. These things are not easy all at once, but can be trained. Remember that this self-control thing is like a muscle: you can exercise to get stronger, but you can also get fatigued or injured if you work harder than you are ready for. So keep at it and don’t burn out!

With that, have a Happy New Year!

(Thanks to Dr. Richard Koestner at McGill University for teaching me many of these ideas in my undergrad Human Motivation class.)

Every day, people ask me what I’m going to be when I grow up. For us kids in our mid-20’s and 30’s, this means which medical field we’re going to specialize in when we graduate in a year and a half. To me this is a tough question, kind of like “What is the meaning of life?” The answer is a really big commitment.

But I’ve been going about it all wrong.

I thought that finding a specialty was like finding a husband: “In a perfect moment, I will simply know that my life was meant for __.” In my perfect specialty, I will maximize all of my talents, I will adore the patient population, I will save lives in the most glorious of ways, and I will be happy every single moment. I will withhold my decision until that specialty comes along. (Turns out, that’s not how you find a husband either.)

It’s not that those things won’t be true in the life I choose. It’s that those things don’t come pre-packaged.

For me, and I think for most people, there are many ways to be happy. And this is why I’ve been running around in circles trying to figure out how to align my preferences: if I like cutting, if I like thinking, if I want to treat diabetes or gallbladders, etc., etc., etc. But that’s like comparing apples and oranges when what you need to do is make some lemonade: It’s not about your wish list. It’s about making the best of what you’re given. Because if you’re opinionated enough, every last possible choice has at least one deal-breaker.

I’ve finally stopped thinking about what I want to do, and started thinking about the kind of person I want to be.

I want to be a good colleague. Someone who is kind, fun, and competent, who adapts easily to challenges, and who takes things in stride. I want to be a good wife and mother. One who listens and heals and strengthens. I can’t afford to crash when I get home each day, or take out all my work anger on my family. I want to be a good person. I don’t want to constantly yell at others to get their work done. I want to be the doctor who respects nurses, scrub techs, cafeteria workers… because we are all human beings. The answer then becomes obvious: I will choose something less stressful than what I think I can handle. Because whatever I do, I should do with grace.

Truth is, I’ve seen enough frantic, stressed-out people who claim to be doing what they love most. Choosing a career is about finding a way to serve, uplift, and bring about the best in others. And these are daily choices, moment-to-moment choices. Obviously there is not a single specialty that would automatically make me all of the things I want to be. That’s why it’s dangerous to think that it’s a once-in-a-lifetime choice: once you’ve committed, the work has only just begun.

Ever heard of Histology? On my first day of medical school, I hadn’t. I sat through 4 hours of Histology lectures and 2 hours of Histology lab. I was overwhelmed. I couldn’t type fast enough. I assumed I was the only one who had no idea what was going on. I went home and Googled “histology” before launching into a 10-hour study session. And thus my medical career began.

When my national board exam came back, Histology was one of my strongest areas. I wouldn’t have guessed it in the beginning, because learning it was always such a struggle.

Almost everyone is smart in medical school, but not everyone does well. Some of the smartest people in my class were wait-listed or even rejected the first time they applied, while some of the highest pre-med achievers could barely scrape by. What determines our success here? I believe it’s how much we choose to dig in. The truth is, none of us were born knowing the things we are learning now. Our job is simple: to figure out how best to study, and then to get down to business.

For me, this affirms the realization that there is no such thing as “talent” and “intelligence” anymore. Those things mattered in high school maybe, when things were easy enough we could cruise through just by being smart. But after we’ve reached a certain level of achievement, it’s all about perseverance. It was an empowering realization to make, one that was critical to my success.

I think this applies in any domain. Inborn gifts can only take us so far (and honestly, without practice, that is not very far). Conversely, we are never so limited by our lack of talent that we couldn’t make up for it with hard work. If we view our setbacks as a greater opportunity for growth, there is no reason we couldn’t exceed all expectations and come out even farther ahead. The sooner we figure this out, the more empowered we are to become what we dream of being.

Have you ever felt like your best wasn’t good enough? Or that other people seemed more talented than you at something you really cared about? Did you get past that, and if so, how?