What Exactly Is Coaching?

This being a blog made of women physicians, I thought it would be prudent to write a post about Coaching. If you haven't noticed on the socials, coaching - a fixture in the corporate leadership world for some time - is really taking off in the physician and professional wellness space. There are coaches for every sort of physician wellness niche issue you might be facing: burnout, getting unstuck, work-life balance, negotiations, finances, parenting, weight loss, etc. And with some exceptions, these coaches are predominantly women. During the takeoff of the pandemic, coaching programs around the problems of PPE stress, furloughs, homeschooling, and quarantine were everywhere. 

I used to think coaching was for CEOs or entrepreneurs. High-powered execs who use The Secret and go to Tony Robbins events. Yet now, in our current landscape as women physicians, there's never been a better time to get some coaching.

My experience

When I was in the throes of burnout and self-care failure years ago, I had a coach. He was the spouse of my residency mentor, a person versed in executive problem solving with a thriving business and book on the subject. My sessions with him were so incredibly insightful; he helped me embark on the self-knowledge journey that I started during my sick leave... which ultimately lead me to starting PracticeBalance!

Yes I have a supportive family. I have a great relationship with my husband, and we openly communicate about everything in our lives. I've also seen a therapist during particularly dark times. But until I had a coach, I never realized just how powerful it can be to have an objective person listen to you, whose sole job is to listen without judgement, and help you analyze your thoughts.

It's like, all of a sudden, you gain CLARITY: on directions, on decisions, on values. Yet YOU are the one who solves your own problems... with some gentle help. I've had other coaches since, and I have one now.

The Power of Clarity

Is coaching effective?

Aside from the fact that it's very popular to have a coach right now, it's also effective. A 2019 study in JAMA found that primary care physicians randomized to a 6 month professional coaching program reported lower rates of emotional exhaustion of overall burnout. A 2020 study in the Journal of Occupational Health Psychology of a six-session coaching intervention found the same. And these studies are now extending to medical students and residents.

Coaching can take place in different settings: group, one-on-one, in person or virtual. Sometimes sessions involve themes, lessons, or mini lectures, and other times it is completely client-led. Sessions can last anywhere from 45-90 minutes, and as the coachee, you should expect to be put "on the spot". Coaching is about YOU. And expect to have homework between sessions. Also, the most effective coaching will involve follow-up, as you see demonstrated in the above cited studies. One-off sessions aren't completely useless, but part of the coaching experience is the accountability to take what you've learned/realized and apply it to your life... then report back to your coach.

Coaching vs. other things

How is coaching different from therapy, or even mentoring? Coaching takes a collaborative approach that is often future-focused and/or goal-focused, with the intent of changing behavior or thought patterns. Therapy tends to focus on past traumas and other experiences as root causes of behavior or thought patterns. Whereas coaches ask focused questions to help clients gain better self-awareness so as to institute their own changes, mentors offer advice and more concrete guidance.

What kinds of things can you expect to discuss in a coaching session? That depends on your coach, and why you sought out the coaching in the first place. (Full disclosure: coaching is a service I offer through PracticeBalance.) While I personally love to guide physicians on journeys of self-knowledge and self-care, my approach has been to individualize coaching based on what each client needs: more frequent sessions vs. less frequent sessions, higher structure vs. gently guided conversations. But some exercises I always suggest are mindfulness techniques and self-knowledge assessments; which ones depend on the individual client's interests and lifestyle.

How do you know if a coach is qualified? Unlike the practice of medicine, the field of coaching does not currently have an over-arching, governing body of certification. A "certified" coach is not necessarly better than a non-certified one; it really depends on the coach's experience - both with clients and within themselves. Kind of like a senior resident or a newly-minted attending vs. the senior physician with tremendous academic accolades, recent life experience can trump a pedigree when it comes to the quality of care you receive. In my opinion, in addition to basic listening and questioning skills, a good coach for you is someone who's experienced the pain points you're going through and has successfully moved past them.

Have you ever had a coach - even a traditional coach for athletic performance? What was it like, and what did you learn? Share your thoughts below in the comments.

(A version of this post first appeared on the blog PracticeBalance)

My ideal medical practice - I opened up shop!

House call doctor tools of the trade. I have since gotten another rolling bag.

Over the last few years I have slowly been inching toward establishing my own practice. And this January, I did it, I incorporated my practice, Healthy Home Pediatrics! It is a house call based concierge, or direct primary care, practice serving Washington, DC and the surrounding Maryland and Virginia areas.

In my first blog post as a new business owner, I wrote:

It feels so good to work hard for my own vision. For the last 5 years I have worked extremely hard for visions that were established by hospital administrators or the organizations that I worked for. Too often, these visions fell short of what I knew my colleagues and I were truly capable of and far short of what patients really wanted and needed.

During times like this, when I am venturing into the unknown, I often go back to one of my all time favorite books, The Alchemist, by Paulo Coelho. I have read this book countless times. In it, Coelho shares the story of a young shepherd boy who leaves home and goes in search of his dreams. Along the way he is tested and experiences both profound joy and deep disappointments. One of my favorite sections of the book shares a conversation with the boy, his heart, and the alchemist:

“People are afraid to pursue their most important dreams, because they feel that they don’t deserve them, or that they’ll be unable to achieve them. We, their hearts, become fearful just thinking of loved ones who go away forever, or of moments that could have been good but weren’t, or of treasures that might have been found but were forever hidden in the sands. Because, when these things happen, we suffer terribly.”

“My heart is afraid that it will have to suffer,” the boy told the alchemist one night as they looked up at the moonless sky.

“Tell your heart that the fear of suffering is worse than the suffering itself. And that no heart has ever suffered when it goes in search of its dreams, because every second of the search is a second’s encounter with God and with eternity.”

“Every second of the search is an encounter with God,” the boy told his heart. “When I have been truly searching for my treasure, every day has been luminous, because I’ve known that every hour was a part of the dream that I would find it. When I have been truly searching for my treasure, I’ve discovered things along the way that I never would have seen had I not had the courage to try things that seemed impossible for a shepherd to achieve.”

This is my dream. To practice medicine in the way that feels good to my heart, in a way that I know will help families and my community. To be unhindered by traditional systems such as hospital systems and clinic administrators. To collaborate directly with my patients and their families. To build sustainable relationships with families that help prevent disease and suffering. To be there for my patients when they need me.

Many thanks to KC and others for encouraging me and supporting me. A gentle nudge from her is what prompted this post. Even though it is scary, sharing such a personal detailed account on MiM, I want to share this new phase of my life because I have already received countless messages from colleagues, friends and family saying how much my business has inspired them to pursue their own dreams. I want to take you all on this new path with me. Let me know if there are particular topics about entrepreneurship and balancing work and life that you would like me to write about.

Thanks Mothers in Medicine for inspiring me!

Please follow my journey on social media:

https://www.facebook.com/pedsdrj

https://www.instagram.com/pedsdrj/

https://twitter.com/pedsdrj

On Well-being

Physician burnout and mental health have been on my mind lately. Considering the many articles I’ve read recently on these topics, I’m sure it’s been on your mind too. I’m part of an initiative at my organization to address physician burnout and improve wellness among staff, both at the individual and systemic levels. I find this recent article on Kevin MD an interesting idea. Given all the metrics we tailor our system to based on patient care, safety and satisfaction, it’s an innovative twist to ask that our wellness, or lack thereof, be a goal marker as well.

Ultimately, our well-being affects how well we care for our patients and even their outcomes. The cynical part of me thinks the only way we can really get our healthcare system to change and address the epidemic of physician burnout is to tie those levels to dollar signs. There is a strong argument for the financial benefits of physician wellness and many organizations seem to be acknowledging that reality and investing more in this issue.

As mothers and physicians we’re used to putting others’ needs before our own. But I’ve realized over the years that I’m a better caregiver - to my children and to my patients - when I’m practicing good self-care. In the world of healthcare though, systems need to be in place to support that ability.

What are your thoughts? What has been successful or not so successful at your organization? Has your workplace found ways to encourage not only personal resilience but also support an organizational culture of wellness?

Bridging the Wellness Gap

I have to give a shout out to my hospital (University of Utah*) and my department (Anesthesiology). We are trying. In the age when burnout is rampant and physicians are frequently leaving clinical medicine, we are working to foster camaraderie and resilience. A few examples:

The women in my department recently held an ad hoc Ladies' Lunch. We do this every once in a while, approximately once a year, but we should work on making it more frequent. It's merely a casual potluck lunch held at a faculty member's house for all the female anesthesia residents and attendings, but for me it represents more. Because I work part time in such a large group, I can go weeks to months without seeing some of the other faculty. Anesthesiologists practice their specialty alone, so in order to process work-related issues we have to consciously make an effort to seek out those connections. Our blue scrubs and hats were replaced with sundresses and sandals, and the conversation turned from patients to children, schools, and summer vacation plans. Resident MDs who have yet to venture into practice ate lunch alongside veteran tenured professors. Many of us are moms, with children ranging from 8 weeks to 19 years old. I learned some useful school information from a few of my colleagues with grade school-age girls. It was also interesting to talk to a couple of the ladies who work exclusively in the pain clinic, sharing stories about work environment and frustrations with the medical system. Two babies even made appearances: one wide-eyed, active 11 month old and one brand new infant attached to her mother's breast at the buffet table!

We started an intra-department monthly wellness newsletter (managed by my colleague Dr. Jennifer DeCou), which not only includes interesting personal tidbits about faculty members but also links and info for wellness resources. In addition, Jen has spearheaded a plan for immediate support, in the forms of work relief and counseling, when any anesthesiology practitioner experiences a sentinel event or a bad outcome in the OR.

Our hospital just opened a Resiliency Center on the medical school campus. It provides a space and some resources for relaxation, but the main advantage of this addition is a dedicated space where for on site, free and confidential counseling services. I have personally utilized the services of the third party counseling group on two occasions during my employment already: once when I experienced a health scare during my residency, and again when I underwent infertility treatment. It was invaluable to me, and now it will be even easier for employees to access the benefit since it will be in such close proximity to our workplace.

The piece de resistance... our hospital recently opened a faculty lounge that feels like an airline sky club. Attending physicians from all specialties are invited to use it for eating, changing, working, conferencing, meeting, sleeping... it has all of those features. Not to mention two fully automatic coffee drink dispensers! We have never had a physicians' only lounge before, and I'm excited to socialize there more with doctors of other specialties.

Where we could do better: childcare. As physicians, our schedules are often unpredictable and out of our own control. I live in fear of the midday call from my daycare that my child is sick on a day that my husband is unavailable to extract her, or the moment I get stuck in the OR with no one to pick her up at the end of the day. Some physician friends work at places where there is on sight, low cost childcare with extended hours, which to me would be the ultimate benefit. Within the past year, my hospital has at least added a backup care resource to their benefit package, but my experience using it so far has not been seamless.

Does your hospital, clinic, or practice group offer any unique services or facilities to enhance your work experience and promote wellness? Share them here so we may all get ideas to bring back to our own places of work!



* The opinions expressed here represent my own experiences and are not those of my hospital or department.

How Many Balls Can I Juggle?

I've been trying to dig deep and reflect on my own work-life balance... I feel like I'm living in a world in which my mantra to my learners and advisees is "Do as I say, not as I do."

I love to teach. I'm in an academic position because I thrive on teaching while working clinically. I teach medical students, residents, fellows and am engaged in faculty development. I'm encouraged by my mentors to "be academically productive" however I'm not entirely clear what that means. Write, publish, be educationally innovative, do research, stay sane and be a good mom and a good doctor. 

I need a new organizational scheme. My most successful portion of my organization is my google calendar. I literally cannot do anything without it. I've got it color coded and labeled. My week in view is dizzying with color coordination and notes. My to do lists, however, are scattered between different notebooks, notes on my phone, loose pieces of paper that find their way into the ether. I need a new work flow solution. I need to find a way to keep track of things and move my academic work forward in meaningful ways.

I sat down in a coffee shop the other day to try to make sense of it all and stratify things into columns and was overcome by this subtle feeling of butterflies and anxiety in the pit of my stomach. I've never really been ridden with anxiety, however this discomfort is rearing its head more and more frequently... feeling like I'm missing something, am forgetting something, am going to drop a ball, be found out as a fraud who cannot "do it all."

While I'm not junior in life, being a "non-traditional" physician, prior career as a nurse, I am early in my career as an academic physician. As such, I feel this pressure to continue to do things which further my personal and professional development. At the same time, I want to be sure that I am giving my son the time and dedication he needs from his mom.

As an ER doc, my schedule is widely variable, shifts in the day, evening, night, weekends, holidays. Sharing my son with his father affords me the opportunity to work academically without interruption about half of the time. There's still work which needs to be done when I have him. So, I try to balance it by not working while he's awake. Sometimes I'll have a random Tuesday free and we do arts and crafts, read, go to the park, ride bikes, run around playgrounds, run errands. These are the precious moments I hope he will remember and treasure... I know I do. We make meals together, he shares his days spent with my nanny and daycare and at night, I tuck him into bed, sometimes dozing with him. He looks at me beforehand, puts his little hand on my face and says "Mommy, I love you bigger than the Earth." After drifting off with him for a bit, I get up and set my sights on my late evening tasks... emails, curriculum development, evaluations, mentoring grand rounds presentations via chat mediums or Google Hangouts or FaceTime. 

I sit here sipping my chai tea, reviewing important dates for the next academic year, the next evolution of my growth and development as an educator, curricula which need updating and modification to be in line with current educational methodology, exploring alternative ways in which to teach and engage learners in an overall curriculum which has less and less "time" for what I feel needs to be included. 

I feel fortunate to have been given some incredible opportunities to take on leadership positions and influence our future doctors. How many of these am I capable of managing? Am I giving each of these precious opportunities the time and dedication required? Am I being the best educator and physician that I can be? Am I being the best mom I can be? Am I seeking out mentorship appropriately to optimize my productivity? Am I interfacing with the right people? Am I serving my learners to the best of my ability?

My life is a concept map.

What's This Week Been Like For You?

I’m sure we all have an opinion about the election outcome; most likely, a strong one. I was following with intense anticipation as a Canadian. I am utterly despondent with the result. The day after, I met a friend for coffee and together we tried to process the reality. It felt much like the morning after 9/11, where we knew we were facing a ‘new world’ and an uncertain future. 

Our national public radio station’s coverage was filled with interviews with Americans relaying their uncertainties about the future. One gentleman felt a sense of betrayal by his neighbours; that he did not feel he really knew his city as he thought he did. I know that some of you are heartbroken, as I am. Others may be elated, or at least satisfied with the outcome. Some of you may feel conflicted. Still others may be Republicans who feel dismayed that Trump was their candidate. Maybe none of these captures your sentiments. I know many people are struggling to talk to their children about the outcome. Many American citizens and residents of colour and other vulnerable populations are especially worried about the “Trump effect” on their children, and perhaps some of you are seeing its effects in your daily life in medicine. In Family Medicine, it's not uncommon for some patients to bring up political topics, but I try to stay pretty balanced and general.  Personally, I found inspiration here, which cites this great article about talking to your kids about the result. Reading personal accounts and opinion pieces by those who are processing the results thoughtfully is helping me deal with the result. 

I realize that politics in general, and this election in particular, can be polarizing to discuss, and I know this blog does a great job of being a safe space. A refuge from the constant barrage that was so consuming during this campaign, perhaps. I think we can maintain that safe space by respectfully sharing our own personal experiences, fears, and worries. Because no matter your political stripes, I think it’s fair to say that the months ahead are uncertain for the United States, and the world.  

I have great faith in the American people, and the American system, to uphold their democratic values. I believe that most people are decent and that political and social tides ebb and flow throughout history. Let's help one another navigate the best way forward for our families, communities, countries, and the world. 

Summer Book Recommendations

Ah, summer. There's nothing like the joy of sitting with an iced tea and a book on the deck... or waiting in the dentist's waiting room reading tiny print from a reading app on your phone.

1. Vaccinated by Paul Offit. It was completely fascinating to learn about the early days of immunization. Even if you've learned the science before, reading about the social context is so interesting.

2. Overdiagnosed by H. Gilbert Welch. This book changed the way I look at my practice, every day. Welch is an epidemiologist and explains the principles in a very accessible way.

3. Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters. A must-read, especially if you work in mental health. I see a lot of refugee and newcomer patients, and do some element of cross-cultural mental health most every day. It's challenging because our entire mental health assessment is rooted in the culture in which it was created, and the very definitions of mental illness vary so widely in different contexts.

4. When Breath Becomes Air by Paul Kalanithi. I know you are hearing about it everywhere. It is beautifully written and helped me reflect on medicine in a different way. "But if I did not know what I wanted, I had learned something, something not found in Hippocrates, Maimonides, or Osler: the physician's duty is not to stave off death or to return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence."

I was on a female memoir kick last year, and thoroughly enjoyed the following:

5. Julia Child's My Life in France. Transport yourself to France and witness the early days of her love affair with French cuisine.

6. Nora Ephron's books of essays, I Feel Bad About My Neck and I Remember Nothing were, of course, hilarious.

7. Laughing All the Way to the Mosque by Zarqa Nawaz. Zarqa Nawaz is the creator of the TV show Little Mosque on the Prairie. She diverted from her parents' expectation for her of a career in medicine and found her way to journalism and the arts instead. As a fellow Canadian Muslim woman, I loved hearing her always-funny perspective on issues she faced along the way.

8. I Was a Really Good Mom Before I Had Kids by Trisha Ashworth and Amy Nobile. A down-to-earth book about the real issues we face every day as mothers, I found it totally affirming to read.

Fiction:

9. On Beauty by Zadie Smith. "And so it happened again, the daily miracle whereby interiority opens out and brings to bloom the million-petalled flower of being here, in the world, with other people. Neither as hard as she had thought it might be nor as easy as it appeared". Filled with breathtaking passages but also dry humour and wit, On Beauty was captivating.

10. Everybody Has Everything by Katrina Onstad. Following years of infertility, a young professional couple takes guardianship of a young child when their friends suffer a terrible accident. The struggles of being thrust into parenthood of a unique sort; with the same truth that we all live with - the uncertain future.

What books would you recommend?

The Zuckerberg: Space Does Matter

Hello everybody!  I am one new to the group and just wanted to introduce myself.  I'm originally from Massachusetts, currently a Bay Area Internal Medicine Hospitalist with a 2 year old daughter, siberian husky (mini) and techie hubbie.  Hope to contribute some entertaining stories.  The following is something I wrote last month after we moved into our new hospital. 

            The ‘space’ can make a difference.   I had already spent two years working as a physician/hospitalist at San Francisco General Hospital, and I had become accustomed to the old building and all its challenges.  Fast forward to the end of May 2016 to one my first shift working in the new building … Zuckerberg San Francisco General (ZSFG/The Zuck); change had never felt so good.

            I walked across the bridge connecting our old building to the new ZSFG which consisted of expansive windows and white beams that outlined the hall. It was a sunny day in San Francisco, and I was able to witness it for once.  At the entrance there was a quote etched into the wall  “Be the person who touches the lives and hearts of people. Be a positive light to others as you put a smile on their faces”.  I found myself taking a brief pause and a smile was taking form and there was no stopping it. 

            Onwards I trudged, only to be greeted by a security officer who looked at my badge, and then said ‘Good Morning Doctor’.  As I stepped off the large steel elevator onto the 6^th floor, different routes presented themselves; I was warned about this and the likely confusion that would ensue. Nonetheless, the room numbers were highlighted with San Franscisco themed unit names like “Mission Dolores” and I walked to the zone I needed to get to.  The heavy blue doors which were often manually opened were now beige and badge activated, opened by a mere hand wave.   This might sound trivial given that its 2016, but let me emphasize that it is not.  The design of the building was doing work for me instead of me pushing my way through everything.  

            Now came the real test…how were the actual work floors and units.  What struck me immediately was the lack of noise; it was completely quiet! A brief instance of panic set in and I thought, ‘ Oh my god, I’m on the wrong floor…. Is this the morgue’ but no, I was exactly where I needed to be.  As I walked further around, there was a spacious work station with an lcd screen showing patient room information and nursing assignments with call numbers. 

            The time had come to finally enter my patients’ rooms.  I knocked and then with ease opened the door only to find my patient sitting in bed comfortably with the most spectacular backdrop of the city I had ever seen. The room had ceiling to floor windows that beautifully displayed San Francisco at its finest, and the sunlight poured in.  I sat down at his bedside, and began to go through my assessment and learn about his concerns.  Usually at this point I would be raising my voice to overcome my patient’s neighbor who was either watching television, or talking to others in the old building.  The rooms had no natural light, so lights always had to be turned on, which was of course bothersome for many as some patients were sleeping, and others were not.  The rooms were also filled with walkers, trays, and other medical equipment that were strewn about as there was minimal space, and it became an obstacle course for staff, patients, and family whenever anyone moved about in the room.    Now with this all gone, feng shui was in full effect.  I reviewed the plan with the patient, and calmly exited the room.  As I entered the next patient’s room, similar exchanges and observations happened.  With my mind unburdened by the environment, I just focused on the subject at hand.  My patients too were not being set off by surrounding stimuli; they now had peace and quiet.

            I finally ended that morning with some downtime in one of the new provider rooms to start the lovely exercise of completing my documentation, and again I was struck by the silence.  It was like a library where I actually had the space and time to think about what I was doing.

            Noise and chaos was often the defining feature of our intense environment, and as faculty and staff, we perfected our ability to deliver high quality care to our troubled and sick patients despite our surroundings.  Now with ZSFG, San Franciscans along with our many generous donors have contributed to a building that has shifted the mileu of our work environment.   My patients now have a space that truly honors them in tough times and gives them the space within which to heal.  As a provider, I now have the space to work more seamlessly and to think and reflect on my work.  Of course our space is not perfect, but you have to start somewhere right? So let the healing begin…