Friday, January 27, 2012

Physicians Have a Natural Role as Advocates

This is an article I wrote that was published on Kevin Pho's blog: 

As physicians, we are often called upon to be advocates for our patients.  Sometimes they have no other person to turn to.  At those times, in particular, we evaluate their health in the context of relationship, family, and workplace.  Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, and with their employers.  I take this responsibility very seriously.   more


Wednesday, January 25, 2012

New Year’s Resolution

Tradition asks us to use the onset of the New Year as a time to make resolutions for changing our behavior for the better in the coming year.  In fact, making – and breaking – those resolutions is the topic for conversation and news articles every year at this time.

I actually get this opportunity twice a year: January 1, with everyone else, and in the fall during the Jewish holidays of Rosh Hashanah and Yom Kippur, with others of the greater tribe.  One would think that I would get used to it, perhaps even good at it – that somehow my resolutions, like the bare root trees of winter, would ground themselves in the fertile soil, and grow strong and leafy, signaling my success to everyone.

Instead, I find myself revisiting the same basic resolutions twice a year (at least!), though the context and details may vary slightly. 

So, again, it’s January, and I plan, over this next year, to take better care of myself and to put myself and my own needs, first.  Just writing that I will “put myself first” makes me so uncomfortable that I feel compelled to add, “most – or more- of the time.”  Then, feeling that I have chickened out, I go back to the stronger statement, and say “yes, I will put myself first.”

Why is this so hard for me that I must resolve, over and over again, to make these particular changes in my life?  The concept is not foreign to me; as a physician, I advise my patients not only to take care of themselves first, but how to do it.  With this advice, I have told my favorite parable (“Reflections”), familiar to all who travel by airplane, where, at the beginning of each flight, the flight attendant tells the passengers “In the unlikely event that the cabin should lose pressure, and the oxygen masks are released, put on your own mask first, before you help others who need assistance.”

What would it mean for me to put myself first?  Certainly, it means prioritizing behaviors and activities which make me strong and diminish pain, decrease stress and make me happy.  These include exercise, regular rest, meditation, creative expression, and attentive scheduling.  In reality, I actually do these things, but not consistently and not enough.

So it is ironic that I have counseled innumerable people, my patients, through these same lifestyle changes.   The results are varied - often people make at least some changes, but sometimes they don’t.   Perhaps most of them, similar to my own experience, do take on practices that help them focus on their own health, but can too easily get derailed by the needs of others.

Our personalities, experience, and training influence the direction of attention.  Some of us tend to turn our attention first to those around us who are in need.  As a woman, a mother, and a physician, my natural predisposition to notice and attend to those in need became more compelling.  It is what I tend to do first.  It becomes automatic. 

The antidote to automaticity is mindfulness.  When we notice our thoughts and feelings as they occur, we can recognize that we have options, and choose what to do in that moment.  In choosing, we do not react automatically, but thoughtfully.  If I plan to go to the gym and exercise, but before I leave my daughter tells me her computer isn’t working and I need to fix it so she can do her homework, my automatic response would be to try to fix the computer because her homework seems more important than my workout.  But if I stop and examine my options, I realize that this is the only time today I could go to the gym, that my exercise is very important, that she could clean her room first, or hand-write her work for now, and that I can easily look at the computer when I return, while I rest after exercise. 

We don’t usually think about heroes as making choices to care for themselves.  Heroes traditionally care for others at the expense of themselves.  Yet when we examine the qualities of heroism, we find courage, steadfastness, and the ability to make split-second choices which save lives.  The hero does what is right, regardless of the expectations of others. 

Sometimes we find the qualities of heroism inside ourselves, and apply them to situations which do not seem like the stuff of legends.  Still, they are the same qualities, which we use on a micro-scale every day.  With them, we do things to save our own lives, a little bit at a time.  In the Jewish tradition, the person who saves one life saves the world.