Tag: Mindfulness

The Boys in the Boat (book review)

From the Everett Herald

The Boys in the Boat: Nine Americans and Their Epic Quest for Gold at the 1936 Berlin Olympics https://www.amazon.com/dp/0143125478/ref=cm_sw_r_cp_api_glt_fabc_M81Q4K17N2RTE3JE8RYA

OMG. 6 out of 5 stars. This was intended as a fun summer read. But also, it has catapulted me into the Great Depression, WW2, Leni Riefenstahl and groundbreaking cinematography, the rise of Nazi Germany, collegiate regattas, and the elusive and ephemeral ‘swing’ of rowing. I listened to the audio book. I usually listen at 1.25x or 1.5 or sometimes even 2x: the narrative is usually more important than the writing.

But this. The story, even though the end is known, is riveting. The story of Joe Rantz is the heart and soul of the tale. The author weaves so many threads into a tapestry that envelops and then propels you forward, like the coiled might of 8 undergraduate underdogs, their brilliant coxswain and a cedar-hulled shell, coming from behind as 70,000 voices yell ‘Deutschland! Deutschland!’ to the German boat several lengths in the lead.

This, I listened to at 1.0 and savored every moment.

Go ahead, read the other reviews, but don’t tarry: the Boys in the Boat await you. I am jealous that you will experience this for the first time.

Here’s an 11 minute retrospective, including the granddaughter of Joe Rantz.

NYTimes Magazine travelogue photos (Shinrin-yoku, and take a breath)

https://static01.nyt.com/newsgraphics/2019/09/20/mag-voyages-new/assets/images/29mag-airport-07-2000.jpg
from NYTimes

Is this goofing off, or is this about personal resilience? Like the idea of “forest bathing” (youtube) or shinrin-yoku, I seek out opportunities during the day to pause and reflect, and walk where there are trees. Sometimes this ends up being an online article with lots of nature photos 🙁 .

Hey, you do what you can.

The photos from this travelogue are pretty amazing.

And, did any of you watch the movie “Crazy Rich Asians”? The skyscraper-top boat-like structure in Singapore is apparently an Infinity Pool and is REAL (see the background in the photo at the top). Gotta put this on my bucket list.

CMIO’s take? Harken back to the tripartite model of physician burnout and resilience: a) develop a culture of wellness, b) work on improving practice efficiency and c) work on personal resilience. And ‘forest bathing’ belongs firmly on this list. Take a moment.

Time management regret? (NYTimes) Work-life (im)balance? Start now.


We can all benefit from reminders. And self-forgiveness. And taking a single step, (or creating the “next action”) as David Allen says in his book “Getting things Done (book summarizing video).” Atomic Habits (book summarizing video) is another book with similar suggestions. There are a growing number of books, articles, videos dedicated to this topic; go ahead and explore. After all, the ancient Chinese saying is: “The journey of 1000 miles begins with a single step.”

We are all burdened with too much work and too little time. If we are not careful, our work overwhelms other parts of our lives and we lose balance. I struggle with this myself. It is helpful, then, to have a quiver of tools to deploy in the moments when your self-awareness kicks in: “whoa, I’m out of balance; I missed my kid’s field hockey game, or that school event, or the dinner with my family.” Or maybe all of the above. 🙁

In these moments, as the article suggests, break it down to ONE action.

  • Forgive yourself. Move past it and commit to behaving differently NOW.
    Self-disappointment gets in the way of personal progress.
  • Do ONE thing. Leave today, early enough to go exercise, for example.
  • Find a SMALL thing to change. “Managing time” is a huge monster, but getting THIS particular project started involves finding THAT one phone number. There. That’s progress.
  • Read a book about process (This works for me, instead of doing better, read about doing better, maybe implement ONE idea from it, and rejoice. As you read more and pause and reflect more often, you WILL find more opportunities to change or establish a new habit. It is okay if this takes weeks, months, years, decades. We are all works-in-progress.)
  • Set yourself a task for teaching Work-Life balance. Nothing like see one, do one, teach one, like we did in medical school. Or worse yet, don’t even see one or do one, but figure out how to TEACH one, and that forces you to examine yourself and pay attention. (Speaking of which, come to the CMIO Leadership Academy where I’m going to be teaching … Work Life Balance). Hilarious!

CMIO’s take? Having trouble managing time or really getting started changing yourself? Break it down into a small “next” action. Read the article. Watch a YouTube video. I’m surprised at home many authors now offer their best ideas on video or in short articles. Are Books “so last century”? Maybe so.

Happy holidays from the Large PIGs, JIG, and CMIO

Dave Corry arriving late to our group photo, to the CMIO’s amusement and dismay

I hope that you are making plans to celebrate the season, to connect with friends, colleagues, family, and take time for yourself.

I consider myself so fortunate to work with such a great group of informaticists or informaticians (inforMAGICIANs?!), or informatics people, whatever we call ourselves. The work we do, sometimes seems like a grind, but keep in mind, fellow informagicians, that we strive to improve the lives of patients, colleagues and staff by improving the information systems we use for the greater good. 

We try to keep it light in our naming of projects and committees. For example, our Joint Informatics Group (including clinical informatics nurses as well as physician informatics) is JIG. Our physician informatics group are the PIGs. This leads to the New PIG book club, the Small PIG leadership group, and the meeting, which encompasses all physician informaticists: Large PIG. 

And, be sure to throw up your hands and have a good laugh once in awhile. By the way, here’s an updated picture with Dave raising a glass. 

CMIO’s take? Here’s to you and the good work we all do. Cheers!

Where does creativity come from?*

“Where does creativity come from? We don’t know but we are certain that it doesn’t come from our laptops” –John Cleese

Thank you, Sir Cleese. I have enjoyed your movies, your quips, your oeuvre, and even the way you say “oeuvre.” And now, you give talks on creativity.

In my readings, I must agree, working on computers, on laptops is simple, is portable, allows us to store our thoughts in the CLOUD to avoid getting our papers lost in some stack. And yet, the non-verbal result of our tapping away at our computers, our laptops, our tablets, our phones, is an implied communication that we are in our own bubble.

Furthermore, using keyboards seems to reduce the ability for our brains to engage in encoding incoming information, with research showing that students learn better when they take notes ON PAPER as opposed to using an electronic device, maybe because SLOW handwriting forces a brain to choose the important words rather than take down words verbatim, and maybe because having an open laptop (often open to SOME other interesting website) distracts us AND OTHERS SITTING BEHIND US to losing focus and not really listening.

Finally, numerous books on creativity talk about how computers may be terrific at creating beautiful documents and flyers, but are generally terrible at restricting the free flow of ideas that is only possible with pencil, colored markers, sticky notes, lots of paper and scissors. Some advocate for having TWO desks in your office: one for creative work that has NO electronics, only paper manipulatives, and one for the computer, when the creative work is done, to put the completed work into a pretty format for printing or electronic storage and transmission.

I’ve taken to this model and try to do creative work away from my computer now. I also take notes in a small black book, not on my phone, and I’ve found this (although not searchable) a great way to better encode and remember discussions.

CMIO’s take? Keep in mind where creativity comes from
and where it doesn’t come from.

Wait But Why: the wisdom ladder by Tim Urban

“Religion for the nonreligious”

https://waitbutwhy.com/2014/10/religion-for-the-nonreligious.html

Okay, don’t get put off!

I love this kind of writing. WARNING: navel gazing ahead. The idea that we are on a stepladder of consciousness, beginning on the one end, from one-celled, barely alive organisms, rising up through insects and up to chimpanzees and then Einstein-level humans, is interesting. And then, if we believe consciousness is a spectrum, are WE necessarily the top of that spectrum? Is there someone (or something) else above us?  And, on our human-level step of consciousness, what if there were several mini-steps? This is the premise of Tim Urban’s brilliant essay. He postulates (I will paraphrase here);

Step 1: FOG obscures everything. You’re terribly small minded because the ANIMALS (our ancestral hind-brains) are running the show, amok with emotion, and the fog is too thick, you can’t see the bigger picture.

Step 2: Using meditation, learning and active reflection to “thin out the fog” and begin to see context. It is like having a cashier at the store be rude to us. On step 1, we lash out, on step 2, we understand some context that it is “not about me” and that he/she may have had a bad day.

cashier

Step 3: When spending enough time in Step 2, occasionally you will have WHOA moments, when you are in “flow” or deeply thinking about context, and have an enlightened moment about how truly small we are, how briefly we are alive, how much else is OUT THERE, and how much we STILL DO NOT KNOW. For that cashier, we are amazed that, we are billions of cells collected together to form an ENTIRE CONSCIOUSNESS and that cashier is, amazingly, another collection of billions of cells that has also managed to achieve CONSCIOUSNESS. Whoa!

cashier-2

Step 4: The GREAT UNKNOWN. What is out there anyway? We make silly comments about how dumb humans from 2 centuries ago knew SO LITTLE ABOUT EVERYTHING, not seeing the HUGENESS that we still do not know.

I love this long read. Find some time, put it aside and read the whole thing. Entire books I have read, have not been this eloquent, about our human journey to seek knowledge and self-enlightenment.

This is by deep thinker Tim Urban.

Also, he has written and given a TED talk on his procrastination monkey. A worthwhile and thoughtful listen. Having just discovered his blog, I think I will be perusing his stuff for quite a while.

CMIO’s take? Seek out people who challenge your thinking. Learn something new. Think uncomfortable thoughts. Stretch your brain muscles. What happens next?

More craziness about food and health (Eating in a 6 hour window?!) NYTimes

IMG_2464

I’ve been fascinated recently (as you may know, reader) with meals, modified fasting, weight management, meditation. I guess I’m turning into one of those hippie, birkenstock-wearing, health-food-pushing, “hey, just use lemon juice for that” doctors from from a too-cool-for-school non-metropolitan back-to-earth backwaters.

Not really.

I’m always interested in non-traditional ideas that maybe mainstream medicine has not yet embraced. Chrono-biology for instance (perhaps a future blog post). In short, I find that the ways of our healthcare system are perhaps too ego-centric and too shortsighted to encompass the breadth of human experience, and that maybe, just maybe, folks in other cultures have figured out smart, healthful things as well.

In this case, Michael Pollan, who re-popularized the old adage, appears to be right. Not only his original: “Eat food, not too much, mostly plants” but also “Eat breakfast like a king, lunch like a prince, dinner like a pauper.”

This NYTimes article refers to a book called The Circadian Code by Satchin Panda, a professor at the Salk Institute. One of the main ideas is to consider eating all your meals within a 6 hour window each day, guaranteeing your body an 18 hour fast, which apparently is a healthy and a cycle that your tissues and organs and body expect. It results in less weight gain, easier weight loss, and lots of other downstream benefits.

CMIO’s take? Look outside your usual sources of inspiration for ideas on living healthier.

Complex Adaptive Coalitions (NYTimes), and personal sanity

I just spent some time on the phone with an informatics colleague going through a particularly tough time with an EHR replacement and upgrade. Some bad things had happened at the organization: a major visionary physician leader had quit, a department chair had assumed control and was tightening the control on “physician productivity”. Furthermore, a major EHR upgrade had gone wrong, with a major multi-day outage and some glaring gaps in “down-time procedures.” Morale was very low.

This physician informaticist questioned “Am I still up for confronting all the challenges of this job?” This person pointed out that “decisions are made and I’m left holding the bag.” “Physicians are angry and I have no good news to tell them and no resources to do anything about it.”

AND YET.

I asked “Is it time for you to quit?” In response:

“Actually, even if they asked me to step down from this informatics position, I LOVE getting in there and solving complicated problems so much I would probably still do this work. Even for free.”

I don’t know of any more eloquent statement that explains the core of a physician informaticist more than this.

Friedman, in the NYtimes article above, talks about the triple acceleration: climate change, globalization, technology acceleration, that are upending our world, rewriting the rules, and causing us to re-evaluate everything we thought we knew.

Informatics work in healthcare is very similar. The rules change all the time, leaders change, visions change. Informaticists are the nexus between IT and clinicians, and are often blamed for anything that goes wrong. True story: when the WannaCry virus struck and took out the server farms at our Transcription vendor last year (for SEVERAL WEEKS, our physicians and surgeon could not dictate their notes), the rumor spread that

“You know, I heard that CT Lin shut that down because he just wants us to TYPE in his  #*$&#$’ing  EHR.”

Would that I were so powerful. We often deal with problems not of our own making, and with no resources. “What can I do?” “I don’t have anything new to say.” Here’s what I said:

  1. Being a physician informaticist (PI) is often a thankless job. The quiet work we do: creating collaboration, understanding both IT and healthcare deeply, we translate and often avert disasters (avoiding bad design in templates, order sets, automated tools) that only we can see. When it works, the response is “Of course it was going to work. It is so simple.” When it doesn’t work, everyone knows it was you, even if it wasn’t.
  2. Your value to the leadership of the organization can be incalculable. When the PI stands up and helps calm the masses, when the PI can send email broadcasts or go to meetings and explain WHAT happened, and more importantly WHY and what is going to be done about it, he/she is usually more clear than the technologists and can speak the medical language of clinicians and patients. Over time, his/her value grows from being clear, steadfast, and a calming influence. Maybe the executives start including him/her in higher level decisions because they remember that value.
  3. Your value to the front line physicians and nurses is also incalculable. One time, a physician presumed that “Oh, the EHR project is going terribly… see how CT was walking with his head down and with that frown. Bad news.” On the other hand, being a clear explainer (even if you can’t fix it) and being transparent about what is happening now and why, allows the PI to be a beacon in a storm, and the go-to person for clarity. PI’s often become a valued representative for physician interests.

As we talked this week, I had flashbacks to my years on the front line doing this work. Over time, these memories are less like PTSD attacks and more like valued battle scars that one shows off proudly.

CMIO’s take? We don’t often talk about our histories in informatics. Our nascent field has grown from battle scars just like these, and we are all better for it. Although I did not feel like this at the time, I am grateful for everything I’ve learned and now apply for the benefit of our colleagues, our field, and importantly for my own sanity.

Hey, time for JOMO! (NYTimes)

Tough thing, about being in on fads. Hate and love it at the same time. Our latest fad, is the idea of Physician, or Clinician, or Professional Burnout, and that maybe 60% of all US physicians are burned out. Terrible, right? Yes.

The great thing, though, is the global mental effort dedicated to thinking about this, writing about this, working on this. One of the most clever things I’ve seen in awhile on this topic is the opposite of FOMO, called JOMO: the Joy of Missing Out.

Read the link above.

CMIO’s take? Time for JOMO. Have a great weekend.

Talk to the Hand (11 seconds, seriously?) and 3 tools to FIX THIS PROBLEM.

Yes, talk to the hand.

Our smart colleagues have published in JGIM (Journal of General Internal Medicine) and have updated the classic study: how long does it take for a doctor to interrupt the patient at the beginning of the interview, when patients begin their opening statement about “why I am here today.”

https://www.springer.com/gp/about-springer/media/research-news/all-english-research-news/wait–just-a-second–is-your-doctor-listening-/15963052

In years past, we found that the time it takes for a doctor to interrupt the patient used to be …

18 seconds! Then 23 seconds (hey! we’re getting better!) and now … 11 seconds?!?! That is, IF the doctor asked an open-ended question AT ALL. Yikes.

Seriously disappointing. But, are we surprised? The time pressures on doctors have increased over time. More regulation. More required elements in the documentation. Meaningful Use requirements of Electronic Health Records. Decreasing reimbursement. Not sufficient time or effort dedicated to redesigning the exam room, or to redesigning teamwork so that doctors can be doctors and not clerical workers.

This is what our EHR 2.0 Sprint and our Practice Redesign has been about.

Beyond that, we have an internal clinician retraining program at UCHealth to improve communication in healthcare encounters between patients and physicians, we call Excellence In Communication. Led by our inimitable Patrick Kneeland, executive for Patient and Provider Experience, and a team of a dozen physician coaches (myself included), we are teaching our docs highly effective communication strategies. In a four hour workshop, we can improve clinician experience, patient experience, and reduce physician burnout. Who doesn’t want that?

Of the many techniques and tips, here’s a trio that work particularly well:

  1. Open ended inquiry “How can I help you today?”, and then WAITING UNTIL the patient is done with their opening statement. The published data on this indicated that the vast majority of patients complete their opening statement in far less than a minute, and the exception will go up to maybe 3 minutes, if uninterrupted. The trouble is that docs feel like they’re under so much pressure that every second of listening is excruciating, and the other parts of their brain are already; categorizing, creating a list of possible diagnoses, worrying about completing checklists, wondering about quality metrics, and are too “full” to be present in the moment. We train docs to practice listening for up to 2 full minutes to a colleague’s statement and committing to trying this in an exam room with a patient. Simple, but the behavior change is IMMENSELY challenging and yet IMMENSELY rewarding when done well.
  2. The second technique is “What else?” That’s it. Just keep asking “what else” until the patient runs out of stuff. This, of course is the petrifying fear that docs have: “But that opens Pandora’s box and I’ll never get it shut ever again!” and “But then they’ll bring up stuff that I can’t help them with!” and “OMIGOD this will be 75 things and we’ll be here all day and night!” Yes well, we also know that the FIRST thing that patients bring up with their doctor is only 10% to 50% of the time, the most important thing they want to talk about. So, guess what, if we RUN with the first thing patients say, we’re going to be wrong 50 to 90% of the time. So there.
  3. Finally, and this is the piece-de-resistance, say: “Well, we have discussed quite a few things so far. Which of these topics would you like to cover today in the time that we have? I would like to discuss A, and sounds like B is also important to you. How does that sound?” Negotiating the agenda is a critical skill, and makes items 1 and 2 really useful, creates a win-win agreement between patient and physician, and EVEN SAVES TIME. Imagine: a tool that increases patient and physician satisfaction, and saves time.

Notice that this has NOTHING to do with the EHR being for good or for evil. This works regardless of what you have in the exam room, as long as you have the presence of mind to remember to practice and use the tools.

In this, the winter of our discontent, when everything seems to be going in the wrong direction, when all of our institutions are under attack, and public courtesy and discourse seems to have gone awry, and everyone has a complaint, it seems that so few have ideas to help us climb out of this morass.

These tools could be a glimmer of hope.

CMIO’s take? Use these three tools in the exam room (or the meeting room, the board room, any professional or personal setting where important conversations occur), see what transpires. They are EASY TO understand, but require discipline and hard work to make them work for you. Persist, and they will pay off in large ways for you and for your patients.

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