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)

Mindful Parenting and a Toenail Drama

It started back in May. She dropped her stainless steel sippy, and the bottom rim landed right in the middle of her big toenail. For hours, she was beside herself. All we could do was kiss and hug her and say, “Yep… it sucks to drop something on your toe.”

It was the first, but it won’t be the last. A week or two later, there was a good-sized, eggplant-colored bruise right under the nail. Welcome to the Black Toe Club. She didn’t seem to care too much about the discoloration, and we went on with life as normal.

Fast forward to a week ago, when I noticed that the nail was starting to unroof itself. It became so… flappy... that it started to catch on things, which resulted in fits of pain and crying. Being the Doctor Mom that I am, I devised a treatment plan involving an epsom salt bath followed by lidocaine ointment and a sharp pair of scissors. But after the bath, she had a freakout.

She WOULD NOT let me cut it. Would not let me even touch it. We fell into a cycle of hugging and talking and attempting, followed by pullback and more crying.

Her: “I’M SCAAAAAARRRRED!”

Me: “This is the best way to deal with this. Otherwise it’s just going to keep catching on things and eventually rip off, which will be even more painful. Trust me! I’m a doctor! You just took a bath! It’s soft right now! Let me cut it!”

Her: [uncontrollable sobs]

This went on and on, extending past bedtime. And repeated for 3 days. The toenail would catch on something, even bleed. It separated further from the nail bed until it was sticking straight up in the air. I got so frustrated… if you’re a physician, you’re likely familiar with the experience of family members not taking your medical advice. All those past memories welled up, compounded by a screaming, inconsolable child.

One night I threatened to rip it off after she went to sleep. One morning I told her we weren’t going anywhere until it was dealt with. We devised different plans, all foiled by her going into a crying fit… and when one involved her dad helping to hold her down, he looked at me with his peircing eyes and said straight up, “What are you doing?”

[long pause]

Um…. What WAS I doing?

I was trying to control the situation. I was worried for her, anticipating the great pain she might experience if the toenail ripped completely off on its own. So instead of letting things take their course, I tried to solve the problem for her. Like lots of well-meaning parents these days, I was coddling.

I was acting on my own aversion to the appearance of her toe (as a self-confessed Picker, if it were my toe I would have cut that flapping nail off immediately despite any pain pemature action might have caused). The sight of it bothered me more than it bothered her.

I was using logic to appeal to an illogical, 4 year old little human. Although I want to respect her as her own person, she’s not a little adult. Yet I sometimes talk to her like she is.

I was trying to control someone else’s body. Someone’s body that is not mine to control. And I was using threats (again) to try to get what I want.

These are all Respectful Parenting fails.

Before even having kids, we decided that respectful parenting was the kind of parenting we wanted to do. I read books like The Gift of Failure and The Conscious Parent. I listened to Janet Lansbury‘s podcast. But like so many things having to do with mindfulness, theory is different than practice. It’s easy to have a plan, but what matters is how you act in the moment of need. Sadly, this time it took me approaching the use of force to realize how far I had drifted off the path I meant to be on.

Defeated but brought back to reality, I admitted I was wrong. This was wrong. My emotional bank account depleted but not quite in default, I was able to salvage the day by taking responsibility.

She put on flip flops with her little nail sticking straight up, I tried not to look at it, and we went about our day. I dropped her off at the gym childcare center, assuming I would get a call about another episode when she caught her toe on the playground or something.

But do you know what happened? When I picked her up, the nail was gone! She hadn’t even noticed it fall off; it didn’t hurt a bit. After all that, leaving it be was probably the best thing to do anyways.

I’m so lucky to have her (and him); I’m always learning from them. Being a parent has been the greatest lesson in mindfulness.

(A version of this post first appeared on the blog practicebalance.com)

Quarantine Questions with a 4 Year Old

(Blubbering) "But WHY can't I go play with Sarah??"

The extent of our current outdoor adventures

How's everyone doing in the era of COVID and shelter-in-place? I, for one, am having a difficult time parenting my 4 year old daughter. Overall, I can't complain; we're happy together as a family, and we're all healthy. Despite changes in work volume, we're secure. Finding ways to balance our time with her needs, as well as physical exercise for all, is going alright. But explaining complex concepts to a 4 year old has been... challenging.

Being that she's 4, her world is pretty small. We've talked about the virus. Why our travel plans for the end of my sabbatical from academic anesthesia have been cancelled. Why Nana and Papa can't come visit this spring. Why we can't go to our gym or her gymnastic classes. Why only Mommy or Daddy goes to the store when we need things. But even a month into staying at home, she doesn't quite get why she can't play with other kids.

It's been easy with friends she's made through her preschool classes, since they're just not nearby. But little friends in our neighborhood are another story. We're in a condo complex, and for the most part, people are doing their best to remain active but socially distant. Dog walkers shift to the other sidewalk when passing. People wave hello, some wearing masks and some not. And as with any neighborhood, there are a few odd ducks. With kids.

Of the similar-aged children in the complex, I've seen the spectrum of parenting styles... made fully obvious now that everyone's home all the time. There's the child who's outside all the time, garage door open and toys strewn about the driveway. She's scootering up and down the roads, calling out for other children. She's wearing her pajamas and eating candy, all day. Mom is young and single, but three other men seem to be living in the home as well. Cigarette smoke wafts from the windows. On the flip side, there's the child who parts the drawn blinds and peers out the window longingly as we take our multiple daily walks. Her parents keep the house dark and quiet. Despite our previous evening chats and child exchanges, I haven't seen any of them outside for weeks - only glimpses of their silhouettes at the dining table when passing by.

My child desperately wants to play with both of these kids. The one is unavailable for even a distant hello. The other is too available. And the "family" is too tricky... When she asks why she can't see the one friend, or why I won't let her play with the other, I have a hard time coming up with what to say.

We definitely believe in authoritative vs. authoritarian parenting. I never want to say "because I said so" as a response to "why". At the same time, I want her to understand that we prescribe the boundaries. So I guess what I'm wondering is, how do I talk about these decidedly complex issues? Mamas of older kids, what have you done? What would you do differently if you could go back?

Financial Literacy Is Self Care

What exactly constitutes self care? It's different for everyone, but one thing's for certain: it's not just pedicures and massages. It's much more foundational than that.

Self care is...

• Recognizing that you must know yourself and pay attention to yourself before serving others - at work and at home. It's being attentive to YOUR particular physical, mental and emotional needs.
• Maintaining your health by keeping up appointments with a doctor, dentist or other wellness practitioner.
• Ensuring your ability to tackle challenges each day by gaining energy through nutritious food, exercise, and adequate sleep.
• Preventing defaults on your emotional bank account. And one type of withdrawal that could easily lead to a default is having problems with your real bank account.

Self-care frees you up to focus on what's most important to you

About a year and a half ago, I published this post about financial wellness. Well, I'm back on the soapbox after being motivated by a great group of financially-minded physicians in the social media sphere. We all descended on the FinCon Money and Media Expo last month, and it was an awesome display of what community can do.

I don't consider myself a financial blogger; my focus is wellness with an emphasis on how we should better know and take care of ourselves as busy women physicians. Money is a huge source of stress for many of us. Just like gaining self-knowledge, gaining financial knowledge will improve your self-care and in turn your overall health and happiness.

Figuring out how to do this in a time-efficient and effective manner is the crux. There's a TON of information out there, and it can be confusing. Here are some resources that I've found useful for learning more about finance, especially at pertains to women physicians, from some awesome ladies that I met at FinCon:

• BC Krygowski writes about downsizing and avoiding the dreaded lifestyle creep that seems inevitable as physicians transition from residents to attendings and grow their families. Ever felt like you're outsourcing everything in your life because you have no time, which in turn means you have to work more to afford the outsourcing? She and her husband (both doctors) transformed their lives over the years from New York McMansion owners to a more simple existence for their family - which translates to both of them working much less than they used to and traveling + writing much more (she also writes fantasy books).

• Eliza Minimal MD "retired" from medicine before she even turned 40 to pursue the things she's most passionate about: educating her children and traveling to far-off places. She's now back seeing dermatology patients in a clinic 1-2 days a week because she missed the mental challenge of medicine, but she exemplifies a life of minimal, intentional living. She recently published a very powerful post about stories we tell ourselves, that we're "haves" or "have-nots", and how they're completely up to us.

• Barbara Hamilton blogs at Tired Superheroine about financial wellness and navigating work-life balance as a female physician in a male-dominated field (interventional radiology). Check out her blog for practical tips about time management and simplifying life as much as possible with a young family and a leadership role in her practice.

• Bonnie Koo of Wealthy Mom MD spent years working at Morgan Stanley before attending medical school and training as a dermatologist. Her blog focuses specifically on money issues for women physicians - considerations for high income earners, blended families, couples with a significant earnings differential, etc. I've been interviewed for her "Real Women Physicians" series, and I've also guest posted on her blog to discuss parenting issues around money.

Bonnie happens to be offering a new course this fall called Money for Women Physicians*. It's an 8 week, live interactive course that marries financial education with mindset coaching only open to women physicians. A big bonus: completion of the course also awards 5 CME credits, which means you can use CME funds or pretax educational accounts for the tuition. Enrollment is only open this week (October 7 through October 14), so if this is of interest to you, please check it out!

I consider all of these ladies to be not only blogger colleagues but friends. They're examples of women employing financial empowerment as a means of self care. I hope you find as much inspiration in their stories as I have!





* The link for the MWP course is an affiliate link, which means that if you purchase the course through this link, I receive a fee. You are welcome to go through other means, but using this link in no way changes your purchase price or course experience.

Starting Young: A Bad Thing When It Comes to Body Images Issues

The other day, my 3 year old daughter said to me, "I'm feeling fat, so I need to go take a long walk."

Is this the start of myriad negative body image thoughts I will inevitably need to address during her life? Maybe she's just being a word sponge, but I can't believe she said this at her age. Where she learned or heard it, I have no idea. I just want to make sure I don't contribute in any way to it.

I've experienced my share of body image issues like most of us. When you have any unusual feature (in my case, it's being over 6 ft tall), your body becomes a point of commentary. And it can become part of your ego, regardless of whether that feature is considered positive or negative. Fortunately, comments made to me are usually complimentary. The other day, a woman in the gym locker room said to me, "Your legs are absolutely perfect. Amazing." Of note, this woman was herself tall, thin and beautiful. All I could do was laugh. I see my legs (and body, for that matter) as far from perfect - and that's ok.

Men vs. women... Although both sexes are prone to chasing perfection.

"Perfect" is a word we should stop using for many things. None of us can have a truly perfect body, be the perfect parent, the perfect spouse, the perfect doctor. There is no such thing as a perfect home, a perfect job, or a perfect anything. Someone's idea of perfect (in the case of my example, legs) is completely different than another person's vision. Maybe you value strength and thus enjoy the look of muscular legs, while another person desires very thin legs. You can soften the P word by saying "this is perfect for me", but I even have trouble with that. We're never done learning or improving. Why do we spend so much time comparing ourselves to other people and trying to measure up to some sort of perfection endpoint? Endpoints are for fixed mindsets.

Social media, which is a powerful tool for helping us as physicians reach a broad audience with our message, is also a huge conduit for comparison and the pursuit of perfection. And it's frighteningly problematic when it comes to our young girls, who tend to deeply value social inclusion and are very sensitive to shaming. I heard an interview with psychologist Jonathan Haidt, who recently cowrote the book The Coddling of the American Mind. He pointed out an alarming trend of increased depression and suicidality among young girls, which has suspiciously spiked with the ubiquity of social media.

I do love my own body, but I didn't always as a child. I remember wishing to look like "everyone else", to be shorter, smaller, etc. As an aging adult and physician who sees very broken bodies, I appreciate that my body's gotten me through some serious health challenges. I would never trade motherhood for a flat abdomen with no signs of a pregnancy. And I believe in striking a balance between accepting ourselves in the present moment while also trying to make improvements. However, my acceptance only came with age and life experience. I know it'll be difficult to instill these ideas into a young girl's concrete thinking.

What body image issues have you come across with your daughters, and how have you dealt with them? Do you let your girls have social media accounts? I'd love some positive solutions.

A Beloved Mentor Falls

I walk by the closed double doors and frosty windows of the ICU. You’re lying in there, intubated. It feels weird to go to work now. I can’t see you or talk to you, don’t know the drips, don’t know the plan... and it’s killing me. I, along with many others, desperately want to express my love. So many feelings are swirling inside:

Guilt... For having a chill workday that day, leaving early to sneak in a pedicure before the evening’s family duties. All the while, you collapsed in the OR. Our colleagues rushed to your side. Emergent intubation. Hours in surgery... A trivial moment for me that was horror for you. It hurts my head and heart to contemplate that this is the case for any two people on Earth at any given moment.

Bitterness... For the memories that have surfaced of my own health crisis. My own rush to the OR and surgery and stay in the ICU. The immediate change to everything in my life, the upset of all routines. The label of a disability, the worries about the future. A dark time that I try to forget but never can. For having the knowledge that you will experience this same bitterness later on... if you’re “lucky.”

Gratitude... For my health now. For the part you played in it. You were the one I went to when I knew something was wrong with me all those years ago. My tears didn’t phase you for a second, and you helped arrange my much-needed absence from training. Others thought I was just performing poorly; they judged and moved on, but you knew what mattered. When I was finally diagnosed, you facilitated my prompt surgery with our most skilled surgeon. The same one who is now taking care of you.

Admiration... For your completely nonjudgmental approach to everything and everyone. I have experienced it myself but never realized it was your M.O. with all people. We all exchange stories quietly in the lounge, then fall silent with sadness and worry. For your goofy sense of humor. For our days in the OR and call nights together during my training; you were the one I felt most comfortable failing or struggling in front of; only now do I realize why.

Anger... For why this had to happen. What higher being would take down such a beloved leader, such a good doctor? At you for not knowing something was wrong inside sooner, so as to maybe prevent this catastrophe. At your family for keeping us from seeing you now. They don’t understand how much we love you, how much doctors bond together in a practice, working in parallel to preserve life and limb. Damn you for not sitting up in your bed right now, pulling that tube out and cracking a joke with a mischievous smile.

I have to write all this here to get it out of my head. Work is not the same without you there. I miss you.

I Am Kristie Reynolds

A little snippet of a recent email

At work, I go by Dawn Baker MD, MS. But at home, I’m sometimes known as Kristie Reynolds.

I don’t mean to give away my husband’s “Wizard of Oz”-type work secret here, but I will elaborate for the sake of this post. I highly doubt any of his clients are reading anyway. He has his own law firm, and a while ago he came up with the idea of creating a dummy admin email address for sending unpleasant or mundane emails, like reminding clients to pay their bills. It preserves the professional air of his one-man law firm and also allows him to not be “the bad guy” when it comes to collections or deadlines. It’s genius, actually. The admin’s name that he fabricated is Kristie Reynolds.

Well, Kristie has also started ordering (and apparently picking up) coffee beans for our espresso machine, and facilitating document exchange, and she recently became the voice for the firm’s voicemail greeting. Her duties have grown to the point where sometimes she is now required to perform these transactions in person. Guess who gets to be her?

It’s got me thinking about all the other roles we take on in our lives. Besides “Doctor” and “Kristie”, I’m also “Moo” - my husband’s longtime term of endearment for me. Of course, I’m now also “Mommy” - a name I’ll never get tired of answering to. And while these personas don’t have particular names, I’ve also been known at home as a cleaning lady, a driver, and a short-order cook. To my parents, I'm Daughter and Doctor; yet, they still rarely take my advice. Lately, I'm working more on blogger/entrepreneur as well, trying to grow and expand my personal blog (which means I'd better write more)!

Who are you outside of work? What are you known as besides "Doctor"?

Morning Routines: Is There Such A Thing As A Mother In Medicine?

Years ago, I wrote this blog post about morning routines and how much I adored my "slow" non-workday mornings. I was in the midst of a 3-year IVF journey, but I wasn't pregnant yet. A friend of mine, who at the time had a small baby, laughingly said in response, "That sounds blissful, but wait until you have kids!"

So what's my routine like now? It's still a bimodal scenario: as a part-time anesthesiologist, the morning "routine" varies dramatically depending on whether or not I'm headed to the hospital. On a morning when I don't have to work, the old way I described of waking up to the natural dawn of the sun is a thing of the past. In contrast, many of my mornings start with my two year old daughter either crying or yelling, "Mommy!" I stumble into her room, change her diaper and make her bed/assess for any damage that might have occurred in the nighttime. I may or may not have been in there multiple times during the night prior to the actual wake up. We head out to the kitchen and immediately take our vitamins (me and her), drink a large glass of milk (her) and make a large cup of coffee (me). I tap dance around my husband in the kitchen, which despite being adequately sized, feels like we are bumping into each other constantly. Here's where the "slow" part comes in: we have a little time to chill, play, hug, talk, etc. Eventually we make a breakfast, usually eggs +/- bacon. Once the sun comes over the mountains, we take the dog for a walk to the park.

Those last steps are especially important to me, since I definitely don't make food on my workdays. In fact, on those days I have no idea what my daughter actually eats for breakfast. One thing that has really helped to smooth over my (sometimes rough, always rushed) workday mornings with a baby and a husband with his own agenda has been to hire what I call our Morning Nanny-Taxi. This person comes to our house at 6 AM, plays and takes care of our daughter, gets her ready for the day, and then drops her off at her daycare/preschool at 8 AM (she only goes on my workdays and a smattering of random other days). I've found that this is well worth the market price for 2 hours of service by a driving babysitter. Amazingly, there are people who will do this! Many of the people I've interviewed for this position have another job that is either part time or has a later start time. The few wonderful women we've hired so far were found through websites such as Sitter City and Care.com. (Note: I am in no way affiliated with these sites but have used them successfully to get good babysitters. I would also offer the opinion that Sitter City's pool of applicants seem more suited to random and part-time work as opposed to Care, which tends to have more applicants for regular or full-time nanny work.) While our household is very often awake prior to 6 AM, I don't have to leave for work on my workdays until 6:30. This little half-hour buffer gives me a small chunk of uninterrupted time to get ready, which I now relish just as much as my old pre-baby slow mornings.

You can find mommy blogs and parenting books everywhere that stress the importance of a consistent, daily routine in children's lives. Important for what? My daughter seems to be doing fine despite our undulating schedule. With complicated call schedules and specialties that rely on shift-type work structures, I'm sure I'm not the only mother failing at the routine game. And what about double-doc families? More than one child? Large age ranges? The complexity multiplies...

How do you deal with mornings?

I Get To...

I had just survived one of those hyper-scheduled "days off." Early morning short work assignment at the fertility clinic, my daughter’s first gymnastics class, squeeze in a quick workout for me (as long as she agrees to stay in the gym daycare), back home for a fast lunch, then out for a mid-afternoon doctor’s appointment with babe in tow because I couldn't work out childcare. It was the kind of day that used to get me very frazzled, but I’ve been working on my organizational techniques lately, which has really been helping. I won’t lie, though, it’s hectic making that many logistical moves in a day with a two-year-old. It can be as busy or busier than a day in the OR! As the sun was going down, I pulled out my journal to reflect on all the day's events. Instead of the typical narrative you often hear from moms like us, “It was so busy today, I had to… (insert long list here)”, I decided to turn it around. I wrote at the top of the page, “I get to…”

I Get To:

• Wake up at 5 AM to provide anesthesia for two women at the same fertility clinic where I was a patient, giving them hope and reassurance that they too will someday be an IVF success story

• Take my daughter to a Mommy & Me gymnastics class on a weekday when I don't have to be in the OR

Warming up in Wednesday gym class

• Do a workout for myself, since after suffering for months with both a back and a shoulder injury, things are slowly resolving and I'm able to perform some of my favorite exercises such as the overhead press and barbell deadlift again

• Spend more time with my lovely daughter by bringing her to my doctor's appointment (she surprisingly behaved perfectly)

• Argue with my husband about what wording to use in a text to a landscaper, who we are fortunate enough to afford to pay for landscaping services, as opposed to arguing with my husband about something less frivolous (such as where our next meal will come from or how we're going to pay bills, etc.)

• Clean up potty training messes x 3 ("Oops, mama! There be poo poo on the seat/floor/etc."), including a wipe down of the whole bathroom each time, and then bathe my beautiful baby by candlelight before laying her down in her bed, where we read books and sing songs and have a cuddle-fest

• Have a few minutes of silence to myself after everyone in the house is asleep, where I prepare healthy foods for lunches the next day, and then reflect like this on my "crazy" day

What did you "get to" do today?

Financial Wellness?

Do you know how social security works? Are you maximizing contributions to your retirement accounts? Have you ever heard of a 529 account, or a backdoor Roth IRA?

I combed the archives of this blog, and while there are a smattering of posts on money and costs of being in the field of medicine, I didn't see much about money management and financial planning. It's not a topic people commonly like to discuss, and yet it's so important to our overall well being. Physicians are notoriously horrible at managing money, and yet many in our profession shoulder a huge debt burden, one that can amount to hundreds of thousands of dollars by the time all the training is over. And at that point, the last thing most people want to do is continue "living like a resident", so they commence with lifestyle inflation and remedies for their delayed gratification.

                             

Last weekend I had the pleasure and opportunity to attend the first Physician Wellness and Financial Literacy Conference, aka the White Coat Investor Conference. It took place in beautiful Park City, UT with two days of CME talks, broken up by mid-day skiing time. The conference featured valuable information presented by physician experts in the areas of finance, financial independence, and burnout, along with some financial professionals (who did not have an interest in charging huge fees to physicians for their services, an issue common to many physician-targeted financial advisors). There was even a talk by one of the only female physician financial bloggers, Miss Bonnie MD, who also happens to run the very active informational goldmine Women Physicians Personal Finance Facebook group.

On day two of the conference, I represented both PracticeBalance.com and Mothers in Medicine on a panel of six bloggers for a Q&A session. Despite being the only blogger there who does not primarily blog about finance, it was a lively discussion with lots of inquisitive attendees. It left me with inspiration to blog more, and blog more about financial issues that I deal with!

Over the course of the weekend, I met so many inspiring people - especially women - who are taking control of their finances so as to not become an "underwater doctor" statistic. We often say in my household that debt = slavery, and that sense of lost control is what often leads to burnout for many professionals. While debt is for most people unavoidable on some level during medical training, we physicians have the power to manage it and at the same time plan sensibly for the future. I felt so much more empowered after attending this conference, and I highly recommend that you all check it out the next time it comes around. At the very least, take a look at the blogs (linked above) by the White Coat Investor, Physician on Fire, and Miss Bonnie MD. They are a great starting point on the path to proactively managing your money.

The Little Echo

Almost a year ago, I was worried about her lack of verbal expression. Now, she talks constantly. She knows so many words, it’s amazing. But I'm starting to realize that having a highly verbal child exposes your own verbal ticks.

She adorably engages in imaginary play with lots of critters and stuffed animals. When they “take naps”, she shhhhhs them really loudly and pats them quite vigorously. Hopefully that’s not how she sees my pats and shhhhs. She scolds the dog in the same booming tone and inflection as my husband. She rattles off “thereyago” all the time. Apparently I say this a lot. Along with some choice swear words, particularly the ones that start with S and F, when I drop things or mess up in some way. Bad mama.

But most concerning is actually her use of “sorry”. I’d rather have her throwing around an occasional swear word than apologizing for everything she does. I didn’t realize it, but I do this too. It’s such an easy word to say, yet the meaning is both diluted and potentially detrimental when used to frequently. Saying sorry is apparently epidemic among women. There have been so many pieces written about this in the past few years, but I found this one most entertaining (replete with GIFs). Sasha at Brave Enough gave examples of how sorry is frequently used by women in the OR. After reading this, I'm going to think about what I say the next time there is an anesthesia delay during surgery.

What about you? What do you say that your child echoes back to you, and has it prompted you to change the way you talk?

(Helicopter) Doctor Moms

As my toddler becomes more and more active, I've been grappling with an internal conflict: how do I balance my desire to let her experience life and take chances within the reality of my risk-averse, medical background? The other day, my mother almost had a stroke in the park, watching my 20 month old girl teeter along on the edge of a three foot tall retaining wall while she laughed with glee at her cousins. Below was grass on one side and a stone tile on the other. "Get her down from there!" she cried. I hadn't thought anything of it: if she had fallen on the grass side of the wall, she would have been fine. She would have learned a lesson on how to place her feet to balance. If she had fallen on the tile side, things might have been fine... or they might have resulted in a broken ankle, or a broken head. Flashes of my baby intubated with a head injury in the ICU swirl through my head, and I have to slap myself to break loose.

So much potential badness and goodness in this picture

I don't want to be one of those helicopter parents. I want my child to learn problem solving, to take chances and learn consequences, and to feel the exhiliration of meeting physical challenges. And yet, as an anesthesiologist, I've seen the worst. I've seen the pediatric traumas and the burn unit cases. I've heard the PICU stories ("How did this happen?"), and I'll admit that I absorb these details differently now that I'm a mother. The information is clouded by a background wonder of what I would do if I were in the parents' situation. Sometimes I see my own child's face in that hospital bed or on the OR table.

As a teenager, I had some friends whose fathers were policemen. They always had lots of restrictions, and because their dads had similarly clouded lenses through which they saw everything, I now understand why. But overbearing parenting has been associated with what Jessica Lahey, author of The Gift of Failure, describes as "emotionally, intellectually, and socially handicapped children." How do we as parents allow our children to grow up with freedom, autonomy, and challenge while still appropriately protecting them from physical harm? If anyone has some good insights on this, I'd love to hear them!

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.

Mother's Day?

I'm not even posting this close to Mother's Day, and that's just fitting. My second Mother's Day as an actual mother came and went, and a pattern has begun to emerge... I am realizing that this Hallmark holiday is a bit of a joke among many mothers. I read a funny post in an online moms' group where a woman described her Mother's Day with biting snark. She was "allowed to wake up early" while her husband slept in, enjoyed "a peaceful few hours of cooking brunch items for my family with a toddler attached to my leg" after rounding in the hospital, and then ended her day with a hot shower that was interrupted by her husband asking her to scrub the shower walls with his "fun new electric cleaning brush. So. Blessed." It got me thinking about my own two Mother's Days so far.

Last year, we had a plan to go visit my parents for the weekend. My mother makes a big deal of the holiday and holds an annual pool party, the yearly unveiling of their pool for summer use coinciding with agreeable Arizona weather right around the May date. She had a big event planned, as it was my first Mother's Day, and yet things were strained between us. At 43 and with disposable income plus a new baby, my husband and I had decided we were no longer going to stay in my parents' cramped extra bedroom on their uncomfortably small bed (replete with foot board) in their poorly ventilated home. The nearest bathroom is down the hall next to their master bedroom, and last Christmas my mom caught my husband running to the toilet in his underwear in the middle of the night. "Never again," he had exclaimed with stern eyes. Anyway, this decision to stay on our own had unexpectedly hurt my mother's feelings, given her memories of her own young married years visiting their own parents. Painful conversations had occurred, I had put my foot down, and a plan for alternative accommodation was in place. On the morning of our flight, my husband woke up feeling under the weather. I thought nothing of it and continued packing the car with myriad baby equipment, as this trip was also going to be our 6 month old's first flight. He is the picture of health, lean and muscular with no medical problems except for some recurring hemorrhoids. A week prior, I had talked him into having a band procedure, which I thought might solve the problem. In between schlepping loads, he stumbled, perspiration poured from his face, and all 6'6" of him slumped onto the couch. It took a scary minute to revive him, so we rushed to the ER, and in the harsh fluorescent lights I finally appreciated how pale he was. Hematocrit was 20%, and he was admitted overnight for a blood transfusion. I spent my first Mother's Day bringing him barbecue and magazines in the hospital (as if I don't spend enough time there already) and of course apologizing for suggesting the banding in the first place, in addition to playing single parent to my child. Trip aborted and difficult conversations sure to arise again at the next Arizona visit.

This year, Mother's Day happened when I was in Spain on a long trip... which might sound to some like an idyllic scenario. I understand that many people crave an escape from their work and hectic lives at home, but being long time rock climbers and slow travelers, my husband and I normally plan longer trips abroad where we fully immerse in a micro culture for periods of time. We had chosen the Chulilla area for its long climbing routes on tall limestone walls and its balmy spring temperatures. Only we hadn't gotten much climbing done because traveling with an active, headstrong toddler was turning out to be more difficult than we expected. The first week of our trip involved the rental car keys being thrown into the toilet by someone and then - recurring poop theme - me using said toilet before realizing where the keys were. I will spare you the details of the retrieval procedure. A couple of days later, I made the catastrophic mistake of filling our (unleaded) rental car's gas tank with diesel. WHY is the handle for diesel black and the handle for unleaded green in Europe?? Even though our pickiness and frugality usually keep us from eating out much even on trips, we decided to go out to a Mediterranean buffet in Valencia for Mother's Day. The hours for lunch in Spain are 1-5, while the hours for dinner are 8-midnight. Our normal eating time? 5-6 of course, like every other American family with a child. So lunch it was, and it was busy. We waited forever for a table in a sizeable crowd of Spaniards (we are very tall, so envision this as two giants with a giant baby swimming in a sea of tiny Europeans) on the sidewalk outside the glass doors to the buffet. The hostesses didn't even take our name; they just asked how many were in our party and we stepped back, hoping for the best. Over the course of waiting, baby grew tired and hungry. I read her stern face: What's with this late lunch business, during my naptime? We tried to calm her, but the whining grew louder, and then suddenly they took pity on us. We were seated at a cramped two-seat table near the buffet, knees touching under the table and backs of chairs touching the people behind us, and when I asked for a high chair they gave me some sort of booster seat contraption. I fussed with it for a while and then laughingly realized I had situated her in it just perfectly looking like the picture on the side - the red one with the big "X" over it. She ended up on my lap, and I barely ate anything. Hubs came and went happily many times while I entertained our crazy girl, who proceeded to fling paella and jamon in a several foot radius around our table (luckily no other diners but me became covered in food). Lunch came to a hault when she threw a plate that shattered into many pieces and then leaked through her diaper all over my lap.

A glorious day spent at the gas station after my "oh shit" moment

Like lots of mothers this recent holiday, I just might have posted some cute pictures on social media of my family frolicking on the beach (not on the day shown above), followed by comments about how lucky I am. Given the fact that for years I wasn't sure I was going to ever be one, I really do feel grateful to hear that faint little voice say, "Mama". But the sunny travel photos don't necessarily reflect the un-glamorous reality of motherhood that happens every day, with or without a dedicated holiday. Next year on Mother's Day, I don't know exactly what I'll be doing but I'm sure I'll be mothering again. And I'm sure that poop will somehow fit into the picture.

Redefining Dr. Mom - A Review of the First PMG CME Conference

If you're a mother in medicine and you haven't heard about Physician Moms Group, you might be living under a (social media) rock. PMG, which started in 2014 as a Facebook group for exchanging advice and support between women physicians who are moms or moms to be, has morphed into a community of more than 60,000 women with an influential internet presence. Any group of women that can sell out the entire stock of Instant Pots on Amazon in minutes or lobby to get discounts on coveted clothing or other products has some serious clout! As part of the group's continued evolution, founder Hala Sabry, DO and her best friend Dina Seif, MD recently held their first CME Conference in Las Vegas on April 1st, 2017, entitled Redefining Dr. Mom. And I was lucky enough to be able to attend!

Let me start out by saying that this was by far the most interesting and engaging CME activity that I have ever witnessed. There is the tendency at such events to plop down in the back row, pour yourself a large cup of coffee, and whip out your phone to scroll email or social media. Instead, this conference was chock full of useful and relevant information, presented in a dynamic and interactive format. Presentations ranged in topic from recognition and prevention of burnout, to financial planning strategies, to nonclinical paths in medicine. To top it off, there was a female physician entrepreneur panel moderated by ZDogg MD (Hala's friend and local Las Vegan)!

ZDogg in the house!

When I looked around at the other attendees, I was struck by the diversity of women in the room. I saw many ethnicities, shapes, and ages. Some women wore jeans while others were clad in suits. Some had bouffants, others had beach hair. There were bare faces and full makeup. Yet we were all physician mothers, present to discuss what might be lacking in our careers and learn what might enhance our current work-life balance. Each excellent presenter shared a personal experience as part of her talk that represented a watershed moment in her journey, something that had led her to question or change her presumed path in medicine.

Another common thread throughout presentations was the emphasis on identifying core values as a way to assess happiness and drive future direction. The presenters also prompted attendees to think outside of standard paradigms - regarding self-care, business, and leadership or mentoring roles. Included as well were optional organized social events for the two nights surrounding the conference - a spa outing and dinner, plus a dinner and Cirque du Soleil show. Being somewhat of a "local" to Vegas (I travel there frequently in the winter), I also led a small group of PMGers and their families on a hike in the Red Rocks the next morning!

PMG is definitely planning more CMEs for the future, and I would highly recommend attending. Also, if you are not a member and are interested in joining, visit MyPMG.com to supply your own credentials, or have a Facebook friend add you to the closed group.

The Request Case

One of the things I really enjoy about being an anesthesiologist is the wide variety of patients that I see. You never know who you're going to have the privilege to care for on a given day. Although my group is large, I will occasionally be assigned to a patient that I personally know. And occasionally, someone I know will request me as their anesthesiologist.

Last month I took care of a friend who requested me for her surgery. It was a very straightforward case, everything went smoothly, and she expressed abundant gratitude at the end of her experience. I was also asked to do anesthesia by a friend for a surgery that, knowing her history, was going to be fairly complicated. That one gave me pause, but I did it and everything turned out well.

Gizabeth recently wrote about being a doctor to her friend, and I'll bet that some of you have also taken care of friends (or have become friends with some of your patients). I would venture to say that being an anesthesiologist or surgeon to a friend adds an even further layer of complexity because there is an immediate "life and death" aspect to what we do. However, either fortunately or unfortunately, patients don't usually appreciate this.

On the "pro" side, patients can feel a great sense of empowerment in choosing their own anesthesiologist. A good attitude and sense of empowerment going into surgery can translate to less stress on the patient and better overall recovery. During my residency, I had a scary brain surgery. At first, I thought it would be awkward to personally know my surgeon and anesthesiologist, but out of convenience and timeliness, I chose to have the surgery at my own institution. I was able to choose my anesthesiologist - who at the time was one of my supervisors! In the end, I felt great comfort in personally knowing my healthcare team.

On the "con" side, there is a phenomenon in our specialty called VIP syndrome. Taking care of a VIP subconsciously makes people pause and do things slightly differently than they would normally do, rendering the whole process vulnerable to errors. What if your friend suffers an adverse event under your care? And are your decisions objective enough in the situation?

What do you think? Would you and/or do you take care of friends? How about family members? Let us know your experiences with requests for care by friends, acquaintances, or family.

Witness the Sickness

I am so sick. Like miserable, no energy, hacking cough, congestion, achy muscles type of sick. Who knows what it is, but does it really matter? At work the other day I desperately had one of the X-ray techs do an AP on me. No pneumonia. That would have been too easy. How did I get this? From my 14 month old daycare attending daughter. Only she's moved on and is back to her normal, playful self.

The same thing happened around Christmas, but my husband was the innocent victim. She brought something home that knocked him down with a viral malaise that turned into a raging sinus infection. The babe got better in a few days; he lingered on with "man cold" for a couple weeks. We all know how painful that is for everyone!

I hear that what my household is experiencing is a thing. People tell me, "I've never been as sick as I was my first winter with a child in daycare." I hear, "Every time they change classrooms you'll get deathly ill." I have also heard, "It gets better once they turn two." Please God, let this be the case.

So Mothers in Medicine, my question is, what are your strategies for dealing with this? Is there any preventative magic I should be invoking? Because I don't know that I can go through something like this (two plus weeks of feeling like utter crap) again. We all know how hard it is to take care of our patients (and our children) when we are the sick ones, and we as a profession are the absolute worst at staying home and nursing ourselves back to health! What do you all do?

I Want To Hear Your Voice

I had a dream when you were only six months old that your first words were the complete sentence, "You can't tell me what to do!" You babbled so early and so prolifically that I figured you'd be talking by the time you turned one year. But now here we are two months past that, and I'm still in the dark. At least you've started pointing, but many times I still don't know what you want.

Why are other babies your age using words when you're not? Aren't you the child of a doctor and a lawyer who speak to you constantly in both English and Baby-ese? Who read you books every night? I Google the milestones, and you're definitely lagging in the language department. Have I done all the right things? What did I miss? Is this how it's going to be, you giving the overachiever but unsure parent in me an anxiety attack at every developmental step? I know comparison is futile, but I still fall prey to it sometimes. It's going to be a long parenthood if I don't learn how to stop now.

My thoughts of worry really are just fleeting; all I want is to hear your voice. Your real voice. Not just "mamama", "dadada" and "uh oh". As your mother, I keenly know your cry and your coo, but I want to know what you sound like when you express yourself with words. The lilt in your voice when you're delighted. How the words come out when you're angry. The tones you release when you're sad. I want to talk to you, to hear your thoughts and feelings and desires. Right now all I can do is wonder, but I'll bet it's going to be a beautiful voice.

The Buffer Zone

It's July, the time of year when new interns and residents begin their training programs. It's our busiest time at my academic hospital, where all of the anesthesiology attendings pitch in and teach the newcomers. When I'm teaching in the OR, I always ask a simple question: Why do we care about the patient's blood pressure? They usually get it right - adequate blood pressure ensures good blood flow to the brain and other vital organs. Then I sketch this diagram:

Remember the Circle of Willis from medical school? Along with redundant vasculature, our brains possess an elaborate sensor system that autoregulates cerebral blood flow in a sort of "buffer zone". (This curve may also look familiar to you as the representation of how a buffer acts to regulate the pH of an acidic or basic solution.)

Autoregulation is an evolutionary survival mechanism that is meant to ensure adequate perfusion of the brain at a wide range of blood pressures. But at the extreme ends of measurement, autoregulation breaks down. I love how analagous this is to living life. We proceed through our busy days, oftentimes like a pinball falling through a pinball machine, while stressors are flung at us like flags and obstacles in the vertical maze. Too much or too little input leaves us in dangerously unhealthy territory. The next thing we know, we're fighting a virus... or worse.

How can we stay in our own buffer zones? I try to reprioritize self-care. I take some extra vitamin C, drink warm fluids, sit in an epsom salt bath, write in my journal... Make sure I'm nourishing my body with nutrient-dense foods. Say no to extra responsibilities when I can. Sleep as much as possible!

What are the steps you take when you feel you're falling off your autoregulation curve?

The Return From Maternity Leave: Rusty or Rested?

This article on KevinMD was published a week or so before the end of my maternity leave. As I read it, steam emanated from my ears. How dare the author insinuate that physicians lose their technical skills from taking time off equivalent to more than a mere weekend? What about those who must take prolonged time off for sick leave? And what about maternity leave? Are all physician moms, by the sheer reasoning that they had babies, now deemed incompetent?

It goes without saying that we physicians are humans who need adequate time to heal physically in order to perform well mentally. We all need vacations (longer than a weekend) to help stave off burnout, and we all become sick from time to time. During my training and career as an anesthesiologist, I have taken significant periods of time off for vacation, maternity, and sick leave, and yet I've never had a problem integrating back into the basic flow of my job. In fact, on my first day back to work after three months of maternity leave, I had a patient go into anaphylactic shock in the OR - a very rare and deadly event. End tidal CO2 dropped from 37 to 10 and blood pressure was 50/30, but once I identified it I knew exactly what to do. I counteracted the reaction and saved his life with the fortunate and timely assistance of a couple of colleagues who I immediately called into the room (having extra hands is obviously essential in these kinds of situations).

I recently posed this question of competence to physician moms in an online discussion group. Most respondents agreed with me but cited other issues they had returning to work. Some had to regain their prowess with the EMR, others stated that they had a little trouble multitasking, but all felt confident in their abilities to do their required work tasks. I would say that the hardest part for me has been transitioning each day from Mom to MD and back to Mom again. Preparations the night before a workday seem endless, and morning routines take longer than they used to. Picking up my daughter from childcare after work increases the commute time and anxiety depending on how late my OR day has become. I have yet to be the last parent to pick up their child at night, but I'm sure there will be a day like that sometime. Evenings go by so quickly, and I feel I have barely seen my daughter before bedtime comes. Add in being a part-time physician, and suddenly I feel what some moms warned me about: not enough at work, not enough at home.

So Mothers In Medicine, I ask you: how did you feel returning to work after maternity leave? Rusty or rested? Share your experiences here.