Did you know that the ancient Greeks had the ability to drain lung infections?
People got lung infections but there were no antibiotics. Sometimes the infection would get so bad that pus would build up in the lung cavity and drainage was required to save the person’s life. They had a variety of metal tubes they’d use to drain it out, of different widths and lengths depending on what seemed needed. But they needed to know where to make the incision to drain the infection. They didn’t have the diagnostic tools that we have, but they did have a method to use in addition to the physical exam.
The chest cavity is not that easy to get into. It houses the second and third most vital and vulnerable organs, the heart and the lungs. Only the brain is better protected by the body (although the ancient Egyptians could drain that too).
If you’ve ever treated a patient with an abscess, you know that the skin is hot, but it’s not always clear by physical exam where the inflammation is the greatest, particularly if the infection is deep to the skin, like in the lungs or lung cavity. The Greeks used an ingenious method to find the deep infection.
They would coat the torso of the patient with a thin layer of clay. Wherever the clay dried fastest was where the skin was hottest, and therefore the nidus of the infection. This is the location they would incise to drain the infection using a draining tube.Then they’d leave a piece of linen in as a wick, so the infection would continue to drain over several days, until the infection cleared or the patient succumbed.
Coaching is like the process of covering the torso with a thin layer of clay. A person would not be able to apply the clay on their own. There are places around the torso that the person cannot reach. Also, it would be difficult to apply a uniform layer of clay by oneself, and if the layer isn’t uniform, that would affect the drying time.
And frequently the area needing drainage was in the back, where a person can neither see nor reach easily. These are things we cannot do completely on our own. We lack the objectivity to see where the greatest inflammation is. We need that broader viewpoint provided by another person with skills. And there are places we cannot see because we choose not to.
In coaching, We use inquiry and examine answers to find the location where the client’s trouble looms the largest, where they are most stuck, where their most painful thoughts reside. Like the lungs, these thoughts are often deep and carefully protected by the body’s best defenses, where they can be sheltered from the outside observer.
But not all carefully guarded thoughts and feelings serve the client. Often they are the drivers of pain and suffering, inflamed if you will, from habits and norms of society. We need assistance to find and explore these areas. We can do a lot of it on our own, but sometimes to see clearly we need the perspective of another, someone we trust, to assist us in finding these locations.
However, unlike in medicine, the coach doesn’t make the incision, merely exposes the area to awareness. The client is the one who must release the pressure, if they chose, once they have seen and felt the problem. Only the client has the knowledge of what will unlock and drain their suffering. The pain may be great, but great relief will inevitably follow when the inflammation is drained away. And then healing can begin.
More Musings
Recently, I read a post by another physician online about an experience he had decades ago, soon after he first became an attending in the ER. The experience still troubled him significantly.
The anecdote was one of so many in a long career on the front lines of healthcare, where life and death are often part of the daily events, amidst the otherwise mundane and ordinary.
Last week I drove to my favorite trails in Point Defiance Park. The roads seemed oddly empty and quiet, even for “the time between the years” as I’ve heard it called. Perhaps I hadn’t noticed it before, since in medicine it’s always been just another week when most people don’t work, but we always had a full schedule.
The day was overcast, as it so often is during winter in the PNW. The trails seemed unusually quiet and dark as well, with fog surrounding the woods and blanketing the Sound.
I was asked recently to give a talk on leadership at a pre-meeting before the annual conference of the Orthopedic Trauma Association. A friend, also both an orthopedic surgeon and coach, is putting on this half-day symposium. I was, of course, honored to be asked and saw it as a great opportunity to do some networking, gain a new audience, and also get more experience in public speaking.
This year I have become reacquainted with grief. Grief is not anyone’s idea of a desired companion. And yet, to be alive, to be in the world, to love, is to inevitably invite grief into your life. Grief is an interesting emotion. Unlike some which blaze and extinguish, grief rolls in and out like the tide, catching you off guard when you take your eye off it, it can slap you to the shore when a rogue wave hits you, unsuspecting and unprepared.
Toward the conclusion of medical school, an oath is usually taken by the graduates–a symbolic commitment to their calling and a promise to guide their medical careers. For years I had the impression that everyone either took the Hippocratic Oath or the Oath of Maimonides. However, in researching this blog I learned there are many more options and came upon some interesting statistics. Until recently, about half of medical graduates took some version of the Hippocratic Oath, with the other half adopting the Declaration of Geneva, the Oath of Maimonides, and various others.
Summer marked the start of medical school, with July being when clinical rotations commenced in the third year and when the transition to the fourth year occurred. July was when internship began, followed by each new year of residency. Fellowships began later but still in the summer. Each year brought advancement and a new role commenced, finally culminating in graduation to being an attending. An independent practitioner. Free to practice medicine out in the real world. With each advancement, I found myself thinking, “I’m not ready for this. And yet, I can’t imagine what would have prepared me further.” This makes me wonder, did I receive informed consent for medical education and training? Did you?
Doctors have been conditioned since childhood to experience not knowing information as a trigger. Daily messages telling you you're not doing it right bring back memories of implied or overt criticism from school and training. There are steps you can take to minimize this effect.
There have been changes to how residents are taught, with the hours they work. There has traditionally been a lot of pushback to this.
The unhealthy pushback goes like this: “I was trained that way. I’m fine. I survived, they can survive too!”
The healthier pushback also has concerns: “If they work fewer hours, they’ll see less patient care, participate in fewer surgeries, and not see the same evolution of a patient’s condition, following the clinical course from beginning to end. This could hurt their eventual knowledge base and clinical acumen.”
I recently read a story written by a friend and business coach about a time when she volunteered at an event. During the event, she had given away all her food to support others. Now she was hungry and the event was still going on. Instead of being praised (as she had expected) by one of the more senior volunteers, she was told “If you don’t take care of yourself you can become an emergency someone else needs to tend to.”
That’s what has happened to our healthcare system.
It’s become an emergency that someone else has to tend to.
“Until I know you better, I will be telling you how to breathe!”
It’s my first day at the Pediatric Orthopedic Hand Specialty Clinic on my peds rotation in my third year of residency.
I have just been barked at by the Professor Emeritus, a retired Army colonel, who runs the service.
When I have clients going through a transition out of clinical practice, they often say things like “Who am I if I’m not a doctor?” There can be a lot of angst created by this thought. (And this is also true for people leaving whatever job they have been doing for a while–it’s not a thought exclusive to doctors.)
Acceptance means taking stock of the situation and not fighting it. Instead of judging it or having a strong emotional reaction to it, take a deep breath. Stop arguing with yourself or others about how it “should” be. You can easily argue that you’re right about how it should be. But being right won’t really help you. It just keeps you stuck fighting an illusion. How it “should” be is a distraction. It is different from the reality you are actually facing.
What if I told you there was a medicine that would improve your wellbeing, productivity, and creativity while decreasing your risks of heart disease, stroke, and chronic illnesses caused by stress?Because that medicine exists. It’s called vacation. It’s not exactly free, but the money you spend on it is well worth it for your longevity in work and in life.
You already know how to round on patients. Now you need to learn how to round on yourself. Self awareness is critical to your health and effectiveness as a physician. Your physical, emotional and mental health.
One of the biggest lessons I’ve learned about perfectionism is that done is better than perfect. In my medical school and residency, we learned about “The Enemy”, a shortened version of “The enemy of good is better.” This is a well-known aphorism that originated in the 1700s and not in medicine.
Perfectionism seems to help physicians succeed in school and in training. Chasing perfection appears to be the acceptable standard during that time. But after we arrive at our intended destination–medical practice–it can make our life miserable if we continue to adhere to it. Not just work life. All life. It is no way to create a happy life because it adversely affects our relationships, both with ourselves and with others.
World events have me thinking about boundaries. Boundaries are created over time and they often change for a variety of reasons. So too are our human boundaries. Physicians need boundaries as well to function at their best. We can mean the physical boundaries of our skin or the cell’s boundaries of membranes. Or we mean the psychological or social boundaries that we live with, and sometimes without. These boundaries can protect us from burnout and enhance our sense of well-being.
Recently I’ve been sharing some coaching tools that can help doctors experience more of what they want in life and less of what they don’t. But just like in medicine, it’s not enough to memorize facts or steps in a procedure. Practice is necessary to really make progress.
Since I’ve retired from practicing medicine, people ask if I miss surgery. It’s certainly been a big life adjustment. But what I’ve realized is that while I’m no longer doing physical surgery, I now do a kind of thought surgery in my new career as a coach.
Many people who work in healthcare were burned out even before Covid made it so much worse. Guilt and shame arise when we judge ourselves for the things we think and feel. It’s important to differentiate between guilt and shame. Let's delve into the differences, and why they matter in solving burnout and cultivating calm for physicians.