Dec 01

Lessons from “The House of God”

In 1978, under the pseudonym Samuel Shem, psychiatrist Stephen Bergman published “The House of God,” an iconic novel drawn from his medical internship in Boston in the early 1970s. Earlier this year, Dr. Bergman spoke at the commencement of the New York University School of Medicine. With his permission, the following is adapted from those remarks.

stethoscopeBy “Samuel Shem, MD”

I began writing The House of God as a catharsis, to make sense of what seemed like the worst year of my life.

These are times we all have each day, finding ourselves doing things—or not doing things we should have done—and we say to ourselves, “Hey wait a second, why did I just do that–or not?” There were so many of these, I started writing.

Looking back, what have I learned from The House of God?

My generation came of age in the ‘60s. We grew up with the idea that if we saw an injustice and took action together, we could change things: we helped put the civil rights laws on the books, and we stopped the Vietnam War.

In 1973 when we entered our internship, we were idealistic young doctors, wanting to learn, dedicated to treating our patients humanely. But soon we were asked to do things that we thought were inhumane.

We were caught in a profound conflict: between the received wisdom of the medical system, and the call of the human heart. And so, without thinking about it, we resisted. In fact, The House Of God can be read as a kind of medical manual of non-violent resistance.

I have four suggestions for how to stay human in medicine.

1: Stay Connected

Isolation is deadly; connection heals. And connection comes first. Think of a relationship you’re in: if you’re in a good connection, you can talk about anything; if you’re not, you can’t talk about anything!
The hospitals we entered were large medical hierarchies. In these “power-over” systems, we interns got isolated. Not only did we get isolated from each other and our friends and families, each of us got isolated from our authentic experience of the system itself. We started to think that we were crazy, for thinking it was crazy.

Isolation can mean death—as when Potts, one of the interns, commits suicide. In a power-over system, the only real threat to the dominant group—whether dominance is based on gender, race, ethnicity, class, religion, or sexual preference—is the quality of connection among the subordinate group. So in your training, please remember: Stick together. Connection comes first.

2: Speak Up

When we notice injustices and cruelties in the medical system—and believe me you will—speak up. Speaking up is necessary not only to call attention to the wrongs of the system, speaking up is essential for your survival as a human being.

If we see something and say nothing, it will gradually tear us apart. Because others before you have spoken up, your on-call hours are more humane. And believe me, that matters, a lot.

3: Learn Empathy

Once, when I mentioned this to second-year Harvard medical students, one raised his hand, “We learned empathy already.” What? “Yes, last year in interviewing. Empathy is when you repeat the last three words the patient says and nod your head.”

How do you learn empathy? By putting yourself in another person’s shoes, feelingly. By seeing, in that tiresome old lady, your mother, and in that cranky child, your son. By finding good teachers who live compassion—and following along behind, like a duckling a mother duck. Realize that any good connection is mutual; the other person is getting as much out of it as you are.

Warning: studies show that medical student empathy peaks at the end of year two—and goes downhill from there. It’s a real challenge, to stay empathic during the rigors of your residency.

4: Learn Your Trade, In the World

The patient is never only the patient—the patient is the spouse, the family, the friends, the community, the toxins, the crashing climate, where the water comes from and where the garbage goes. The patient is the world.

And here’s the good news: you graduates are totally awesome in one big way that my generation was not: you are citizens of the world. You have been everywhere, done everything. To you, foreigners are not foreign.

You are not isolated from, or suspicious of, different people and cultures, you are with them–even if only through your texts and twitters. You are the hope of the planet, and I—and your families and friends here today—are so proud of you it brings tears to our eyes!

So: Stay connected. Speak up. Learn empathy. Learn your trade, in the world.

Let me end with another moment from The House of God.

One of my patients was a middle-aged woman with metastatic breast cancer. The surgeons operated on her, found they could do nothing, and closed her up and sent her back to the ward.

After she woke up, a nurse came to me and said that no one had told her what the surgeons had found, and that I should. I couldn’t face it. I said that it was her private doctor’s job, not mine. I’m not sure who finally told her, but it wasn’t me. That was a “Hey wait a second” moment, an emblematic moment that I’ve never forgotten.

To this day, 40 years later, I’m still ashamed of my turning away, letting her down. And so in the novel I decided to write what I should have done. The Fat Man volunteers to take care of it:

“I watched the Fat Man [a character in House of God] enter her room and sit on the bed. The woman was forty. Thin and pale, she blended with the sheets. I pictured her spine x-rays, riddled with cancer, a honeycomb of bone. If she moved too suddenly, she might crack a vertebra, sever her spinal cord, paralyze herself. Her neck brace made her look more stoic than she was. In the midst of her face, her eyes seemed immense.

“From the corridor I watched her ask Fats her question, and then search him for his answer. When he spoke, her eyes pooled with tears. I saw the Fat Man’s hand reach out and, motherly, envelop hers. I couldn’t watch. Despairing, I went to bed. Later, after an admission, I looked into the room gain. Fats was still there, playing cards, chatting. As I passed, something surprising happened in the game, a shout bubbled up, and both the players burst out laughing.”

You never know when such a moment can happen, and change you as a person and a doctor—it’s still so fresh in my heart. You’re probably saying, “But who has the time to stay with her like that?”

True, and yet time’s a funny thing–it’s really not a matter of time: studies show that if a doctor’s intention is to listen deeply to a patient, it only takes about 18 seconds to have a moment experienced by the patient of “being with,” of good connection, of “feeling seen”—and then of being more open to revealing personal information.”

That present moment may be the most significant thing we do for someone who is suffering, that moment of mindfulness, what the Dalai Llama calls, “being a beautiful presence.” And hey—these are the moments we live for, yes? And you never know when they might suddenly appear! So be ready—as Hamlet put it, “the readiness is all!”

Or, as a patient of mine once said, “Doc, y’know, you never know, y’know.”

My new novel, The Spirit of the Place, is about primary care doctors in a small town—a young doctor joining his former mentor in practice. This was a dream of mine, to go back home to practice. It didn’t work out in life, so I did it in fiction.

At one point the young doctor is making a difficult personal decision, and hears the words: Don’t spread more suffering around. Whatever you do, don’t spread more suffering around.

This is the basic human story. We are all on the same journey. Every one of us will suffer–that’s the Buddha’s First Noble Truth. There’s no way around it. The crucial question is not suffering, it’s how we move through it.

If we isolate ourselves and try to gut it out, alone, “stand tall, draw a line in the sand”, we will suffer more, and spread more suffering around. But if we move through the crucible of suffering with others—with caring others, and that’s where we doctors come in, that’s our job!—we will not suffer as much, we will not spread more suffering around, and understanding will arise, and even kindness and awareness.

This is not a psychological healing, but a spiritual one—greater than your self. Each of you has been touched by it, the spirit, at least once, or you wouldn’t have made it here, now.

As a doctor, a writer, a husband, a father and a person, I believe in this power of good mutual connection to heal, I believe in this spirit, this redemption.

That’s the challenge, the thrill, the joy in The House of God: to become aware that the pain and suffering of others is the same as our own; to become aware that if we are ignorant of our neighbor’s sorrow, we bring sorrow to our own door; and with that awareness, to take anger and spin it to compassion; to give solace, to heal. For at our best, we don’t just doctor, we heal.

Oct 16

What Works for Me: Balance, Practice & Kindness

Kerry Bennett

Kerry Bennett, MD

By Kerry G. Bennett, MD

What works for me is balance, practice and kindness.

I have many roles—surgeon, teacher, author, life coach, mother, and yoga teacher. I have the great privilege of teaching surgical residents privilege of teaching residents and students from several medical and allied health schools in the area. I also coach doctors and teach yoga each week in addition to my surgical and home duties. I have created a diverse work life that fulfills me greatly. I look forward to going to “work” every day, and I love what I do.

Balance is essential to many aspects of my life–doing and being, work and play, alone and together time. I ensure that I have enough time to take care of myself so I can flourish in my jobs and truly be present. I balance rest with exercise and eat a balanced diet. Over the years I have moved from thinking that going with little sleep is desirable to realizing that getting enough sleep radically improves my life, work, and relationships. If I am nauseated or cranky, I know I need more sleep. Balance doesn’t mean giving equal weight or time to everything. It does mean maintaining my equilibrium and calm.

I also practice many things that help me maintain balance in my life. I practice yoga, surgery, coaching, gratitude, forgiveness, and presence. I realize it’s all about the practice and not about the achievements. While I am meticulous, I am not a perfectionist. I do the very best I can and even try to celebrate the mistakes. When I realize I have done something that needs improvement, I practice compassion. I have learned that the practice of compassion is a gateway to forgiveness.

One of the ways I maintain balance is through a daily practice of meditation, movement and connection with nature, or “MMN.” I keep the list of MMN items I do each day short so I can easily accomplish them each and every day. I practice at least 5 minutes of meditation, 10 minutes of yoga, and some form of connecting to nature every day. I build self-trust by doing MMN every day and have balance because I am not overburdening myself with extreme demands. Often my MMN practice becomes longer, but if not, it’s okay—at least I trained my mind and body a little bit!  I have found inventive ways to connect with nature even when cooped up in the hospital. I will watch a YouTube video of butterflies emerging or look at nature pictures on Pinterest or just spend a few seconds looking out my window.

In the grueling training and work lives that we have as caretakers and physicians, what works for me is treating myself and others with kindness and having structure and daily practices. Having a daily practice allows me to be inventive and creative in how, when, and where I meet the promises I have made to myself.  I find that the daily practice keeps me grounded and allows me to perform better on any tasks or duties I have before me.

Finally, being kind to myself and others makes each moment of my day more special and fun.  The Dalai Lama has said his religion is kindness. I like that. I find that being kind leads to huge rewards everywhere with everyone and makes life much more pleasant for me. Aiming for balance, following through on my MMN practice, and being kind to myself and others is what works for me.

Kerry G. Bennett, MD, MPH, is a surgeon practicing in Worcester, Mass.

Oct 15

Flow from Blogging and Biking

Kristi Angevine, MD

Kristi Angevine, MD

By Kristi H. Angevine, MD

Martin Seligman, PhD, in his book Authentic Happiness, references a colleague, Mike Csikszentmihalyi, when discussing the concept of “flow.”  For Seligman and Csikszentmihalyi, flow is that feeling one gets when fully engaged or “in the zone” with an activity during which the passage of time seems suspended.  Often, the activity is aligned with one’s natural, signature strengths.

For me, flow comes when I’m mountain biking: there are moments without thoughts, it’s just my bike, the dusty trail, the chase, and the breeze cutting through sultry Chattanooga climate.  I also feel flow when I’m fully present with my husband and our two-year-old daughter.  It’s there when we are caught up in laughing as she runs from my tickling, pummels herself against my husband’s legs, sticks her head between them and yells, “Do it again!”

At work, I’m in sync when I’m conversing, unhurried, with my patients.  Collaborating to ensure they genuinely understand their own health is fulfilling, and the work is more vocation and less job.

I’m an Ob/Gyn in private practice in Tennessee.  My own sense of flow diminished as I struggled with a busy practice, unpredictable hours, and having a daughter.  Fortunately, I’ve reclaimed that flow, through blogging and biking.  These two rather disparate endeavors have allowed me to feel more grounded in my work as a physician.

Fresh out of residency, my income came from a hospital guarantee and I had leisurely time with a small number of patients.  My patient volume peaked right after I delivered my daughter and my hospital income ran out.  Quickly, I learned about the juggling act required to balance family, self-care, and seeing enough patients to pay overhead.  My struggle centered around the daily rushing between patients while maintaining a calm, happy facade, even when I felt exhausted.  In no way did I want my own stress to ever make a patient feel rushed.  Despite my wonderful partners, camaraderie at work, and my own awareness of efficient time use with patients, even if everything went perfectly, at the end of most days, I was sapped.  I kept thinking, there’s got to be a better way. How can I do health care differently?

At the pinnacle of my work stress, a dear friend and colleague, Dr. Susanna Carter, quit her Ob/Gyn position and transitioned to wellness coaching.  Her journey starting her business turned me on to the tenets of lifestyle medicine and the Exercise is Medicine organization.  That led me to read about physician burnout and Preventive Medicine.  In thinking about how I could apply lifestyle medicine and population health insights to my own life, I realized that starting a women’s health blog was part of the answer and getting back on the bike trails was the other.

I began prioritizing biking, and I started a website with articles and a newsletter.  Blogging has allowed me to efficiently get information to my community of patients and do something more creative than my usual daily grind.  It often streamlines my interactions with patients in the office because they have read something that I wrote beforehand.  Similarly, I now send patient education emails during pregnancy and do virtual pregnancy coaching via Skype and phone calls.  As for commitment to exercise, biking keeps me healthy and connected to the visceral challenge, satisfaction, and glee that come from zipping through the woods or picking my way up long, technical climbs.  Both have brought fun and flow back into my life.

Kristi H. Angevine, MD, FACOG, lives, rides, and practices in Chattanooga, Tenn.

Oct 01

8 Tips to Survive the Marathon of a Physician Career

Dr. Steve Adelman

Dr. Steve Adelman

By Steve Adelman, MD

Following the advice I give to others works for me, I wrote up the following set of personal best practices to assist front line doctors and other health care professionals.

Many physicians are discouraged by the state of medical practice in 2014. Maintaining job satisfaction and well-being for the duration of a decades-long medical career can be as daunting as completing an uphill marathon.

In addition to keeping up with the explosion of medical knowledge and maintaining certification in your specialty, what concrete practices can you adopt to insure that you will make it to the finish line in good form? Consider these strategies, all beginning with the letter “M.”

Mentors. Make use of mentors and coaches! Allow the wisdom and experience of others to guide you throughout your career. Senior physicians, informal mentors, and professional coaches who are trained to help keep practicing physicians in optimal shape are invaluable sources of assistance. Avoid the temptation to go it alone; follow this dictum from Ecclesiastes throughout your career: “Two are better than one.”

Means. Live within your means! Although few professions are as gratifying and meaningful as the practice of medicine, don’t assume that it will enrich you. Manage and minimize debt, and avoid the lifestyle “arms race.”

Move your muscles. Regular and frequent exercise is essential to health, mental acuity, well-being, and stress management. Prioritize regular exercise: the time you invest will pay huge dividends over the course of your career.

Master mindfulness or stress management. Medicine is a high-stress profession, a combination of mild-to-moderate chronic stresses punctuated by intermittent, acute stresses. Learning and adopting validated techniques such as ­mindfulness-based stress reduction helps physicians to develop and maintain resilience in the face of the tense vicissitudes of everyday practice. The Center for Mindfulness at the University of Massachusetts Medical School is a pioneer of this approach, which has been shown to be effective both for health care providers and patients with various chronic medical conditions.

Medical and mental health care. Make use of them. Physicians are not invincible; we suffer from the full range of medical problems, including mental and addictive disorders. When you aren’t feeling right, seek the appropriate help. Seek help early from qualified generalists and specialists, and obtain help as a patient, not on the fly from a well-meaning friend or colleague. If you aren’t well, don’t go to work until you are better — you’re a public safety professional!

Mix it up. Although every physician should be a master of the profession, daily practice has the potential to become tedious unless you develop strategies for mixing it up. Doing the same thing day after day and year after year is sometimes stultifying. Figure out how to inject variety into your work day and into the course of your career. Remember that physicians do not live by medicine alone. Develop interests, passions, and pastimes outside of medicine that are engaging and satisfying, and that differ substantially from the daily grind.

Minimize risky behavior. Many physicians sabotage their careers by misusing psychoactive substances, social media, or violating boundaries with patients or staff. Play it safe and never assume that risky behavioral choices will go unnoticed.

Mensch. Be one! Urban Dictionary defines the Yiddish word mensch as “someone to admire and emulate, someone of noble character.” Be a role model, and don’t let the ego strength that many physicians develop over the course of our careers give way to egotism and arrogance. Maintain and sustain warm connections to friends and family, and utilize these connections to talk about the things in life that most matter.

Clearly, it is far easier to write and read about these strategies than to implement them across the board. You might start by identifying the “M” opportunity that speaks to you. As your medical marathon progresses, adopt a strategy of ongoing personal quality improvement. See you at the finish line.

This article originally appeared in the October 2014 edition of the Massachusetts Medical Society newsletter Vital Signs.

Steve Adelman, MD, is a psychiatrist and director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society.

Sep 17

What Works for Me: Being Actively Involved in Organized Medicine

Dr. Eric Reines

Dr. Eric Reines

By Eric Reines, MD, FACP

What makes my patient tick?  What can I do about it?  What makes this health care system tick?  What can I do about it?

I had my nose to the grindstone with the first two questions till the grindstone wasn’t paying the bills after ten years of solo practice in internal medicine. And I resigned from the Massachusetts Medical Society because I felt no support for primary care. Then at Harvard Community Health Plan, I learned how a team works, how to make a request, what it feels like to say and to hear “No.”

Bit by bit, my nose was rising from the grindstone to look around and learn how things work. I was assigned to quality assurance, and I learned how uniformity can improve quality and how systems cause more errors than people do. Then as a hospitalist I learned the power structure of a hospital and as chair of the Pharmacy and Therapeutics Committee, the inner workings of Medicare.

Now I am practicing geriatrics at Element Care, a Medicare program of All-Inclusive Care for the Elderly (PACE), working on an interdisciplinary team whose mission is to keep elders at home in their community and out of institutions.

Friends urged me to look at MMS again. I rejoined when I saw that MMS was leading the AMA to participate in the building of Obamacare and the strengthening of primary care. I went to delegates’ meetings and learned the scuttlebutt of politics and legislation. I became active in the committee on geriatric medicine and prepared resolutions that were ultimately passed, addressing issues of primary and elder care. At courses for medical directors convened by the Society for Post-Acute and Long-Term Care Medicine (AMDA) and PACE, I learned the history of Medicare and the plight of nursing homes.

I’ve been lucky to find another satisfying job in medicine every time I approach burnout. Going from solo to team-based care has been gratifying. But Medicare regulations and documentation and coding requirements disrupt my dreams of working till I drop. Nevertheless, involvement in the big issues informs my work with individual patients and vice versa. By participating in organized medicine, I feel that I am nudging the health care behemoth in a better direction.

Dr. Eric Reines practices geriatrics in Lynn, Mass.


Aug 14

What Works for Me:  Solving Puzzles

Dr. Steve Adelman

Dr. Steve Adelman

By Steve Adelman, MD

First there was the Daily Jumble in The Philadelphia Inquirer. My urge to turn written gibberish into a recognizable word started at an early age. I moved on to decoding Cryptograms. I started with pencils, switched to pens, and now, on rare occasions, I crack the entire code in my head, without writing anything down. A peak puzzle-solving experience that tells me that “I’ve still got game.”

Reading Freud’s riveting case histories as a high school student convinced me that a career in psychiatry, solving human puzzles, was my destiny. To me, nothing is more gratifying than helping people learn how to stop tripping themselves up so that they can move forward and lead more fulfilling lives. Watching mental anguish give way to confidence and accomplishment is enormously gratifying.

When I became the director of a large mental health service some 14 years ago, I quickly learned that intense problem-solving that involved a bevy of clinical, administrative, organizational, interpersonal and financial issues was now the stuff of my everyday work life. As the business and funding of health care became more complex and rapid-changing, I sometimes felt like I was playing three-dimensional chess and drinking hot coffee while riding a surfboard.

Eighteen months ago I left the world of traditional clinical medicine to work at Physician Health Services, a non-profit that provides assessment, triage and monitoring services to physicians with health challenges that have the potential to interfere with their ability to deliver optimal medical care. On a daily basis I hear about the trials and tribulations of everyday practice from hard-working physicians who are failing to thrive in this challenging environment.

With this in mind, we launched to build an archive of success stories that would provide support and inspiration to others in the profession. We believe that many health care professionals have developed successful strategies and techniques that promote personal well-being and good patient care.

If you’re one of these physicians, please take some time to share your wisdom with others who may benefit from it. Send in a short (300 to 600 word) piece on What Works for You. We will help you edit your submission and will post it so that your fellow physicians can learn from your success.

Sharing personal best practices may help other solve the ever-challenging puzzle of how to thrive in a high-stress profession that demands more and more from those of us who dedicate our lives to the relief of human suffering.

Steve Adelman, MD, is a psychiatrist and director of Physician Health Services, Inc., a corporation of the Massachusetts Medical Society.

Jul 14

Redefining My Passion Through Creativity

Sara Taylor, MD

By Dr. Sara Taylor

I wholeheartedly support the message behind this project “What Works For Me.” As health care professionals, we continually encounter human suffering and work under stressful conditions. As a family physician for the past 14 years, I have been fortunate enough to work in a variety of clinical settings, including several in general family practice.

Currently, I practice family medicine in the sexual health clinic of a community health center. This has allowed me to pursue other interests and avoid on-call conflicts with my husband. As a radiologist, my husband works in a stressful, uncontrollable environment, and I continue to grow increasingly concerned with the risk of burnout that he and our colleagues face. Sharing our stories related to self-care and stress-relieving practices will normalize the importance of finding ways to recharge and unwind.

What has worked for me recently has been to turn a creative goal into a reality.  Over the past few years, I researched, read, and explored the areas of wellness, personal development, and lifestyle medicine. The more I learned, the more passionate I became. I knew I had to think creatively in order to follow my passion. But the question remained, “How can I actualize my passion into a tangible project?”

After many stumbles, wrong paths, and uncountable hours spent navigating the Internet, I took a course on blogging and creative writing. I applied the skills I learned to create a website with a blog on wellness and lifestyle medicine.

It has taken a lot of self-discipline and encouragement from my husband, but so far I have fulfilled my commitment to myself to write a new post every week for the past 16 months.

My next step is to create customized programs and retreats as a consultant, as well as a self-paced workbook. Currently, I am excited about a physician wellness anthology project I just started working on.

Why does this work for me?

Ever since I was a young girl, I have enjoyed writing and the ability to express myself through the patchwork of words. Writing relieved stress, but I often did not take the time to write as an adult. Writing blog posts has allowed me to create a satisfying piece of work every week. The fear of criticism and potential judgment continues to melt away in place of resiliency and confidence.

What is even more profound is the knowledge I have gained about wellness, personal development, and lifestyle medicine. In turn, I have become more aware of what I need to practice in my own life, such as gratitude, meditation, yoga, and more. I have always believed in physical activity and the importance of healthful nutrition, but through researching my weekly topics, I continue to learn about how to manage stress and enhance well-being in my own life.

Another important lesson I continue to learn through my website is that you have to quiet the self-doubt that exists and accept that an element of failure may be essential to personal success and growth. Letting go of my ego has allowed me to follow my passion, keep me energized, and remain connected to the preventive side of medicine.

Physician wellness is a concern for me as it is for our patients, communities, and health care systems. Taking time to focus on what works for you is never selfish nor time wasted, but rather necessary to take care of the most important person—you.

Sara Taylor, MD is a family physician and writer in Alberta, Canada.

Jul 07

Public Health Work: My Serenity Prayer

By Dr. Tony Schlaff

Anthony Schlaff, MD, MPH

Three days after finishing my residency, I became the medical director of the community health center where I had taken my first job.  It forever changed, and probably saved, my career.

The risk of burnout hit me early. While I loved patient care, I also found the stress, the lack of control of my time, and the inefficiencies of my clinic’s system hard to accept and to manage. I knew I was greatly privileged and well paid compared to most people in the world, and I did get joy from caring for my patients. Why was it so hard?

My serendipitous and early promotion to medical director gave me a new perspective and, over time, new skills.  I could actually do something about what made daily practice so stressful and inefficient. After a few years, I earned my public health degree, in part to better learn medical management, and found myself with an even broader set of perspectives and skills—ones that allowed me to understand that there was a lot more to my patients’ health than the care I could give them. That understanding helped me put the challenges of care in perspective, adding yet another level of burn-out protection.

Now, I spend part of my time trying to address, or at least teach about, broader determinants of health. Many of the medical problems physicians see have social and environmental causes and remedies that lie beyond the tools we are taught in medical school. I think this mismatch between much of what we see, and what we feel ourselves called upon but unable to do, is one of the sources of burnout. Public health work is my serenity prayer. It gives me the understanding of what I cannot change, and also access to a larger toolbox so that I can change more things. When the rigors of daily practice exhaust me, I can lift up my head and see the bigger picture. When I get frustrated by the lack of immediacy that comes with teaching or policy work, I can ground myself with a day in clinic, doing good — one patient at a time.

Thirty plus years into my career, I still see patients, and I still love it. I practice part time, but what I have come to realize is that it is not that doing less patient care prevents burnout. Rather, it is my other work outside the clinic, that complements patient care, keeps it in perspective, and keeps it joyful.

Tony Schlaff, MD, MPH, is from Brookline, Mass. where he practices General Preventive Medicine and Internal Medicine.

Jun 11

The Secret of the Bottom Right Desk Drawer

Starla Fitch, MD

Starla Fitch, MD

By Starla Fitch, MD

In my office the other day, I was running on time (hurray!) and had a few extra minutes to visit with one of my patients.

As we swapped stories about what’s going on in our worlds, I mentioned my passion for helping doctors love medicine again. I told her I hoped it would help with physician burnout.

As a teacher with years of experience, my client knows a thing or two about burnout. She shared a tip that might help us doctors, too.

She told me about The Bottom Right Drawer.

Over the years as a teacher, many of her students have sent her gifts of acknowledgement and thanks.  She’s received loving notes from children; a postcard from a college student, thanking her for all she taught him about English grammar; an email from a parent, letting her know the extra effort she had shown their child was appreciated.

She saves all these treasures in her bottom right desk drawer.

At the end of each semester, she gets a cup of tea, opens her bottom right desk drawer, and savors the memories of all the wonder tucked inside those notes.

On those dark days when she feels frustrated with her work, she returns to her desk and opens that bottom right desk drawer.

She closes her eyes and picks out a note at random, like drawing gems from a treasure chest.

She sits back and slowly reads the message of love and gratitude, and reminds herself of why she became a teacher in the first place.

I love this story.

I have started my own practice of saving my treasures in my bottom right desk drawer.

When I get an email from an overwhelmed surgical resident, thanking me for the lifeline one of my blog posts has given her, it goes in the drawer.

When one of the doctors I’m coaching has an “aha moment” and brims with new inspired zest for their practice, a note of that conversation goes in the drawer.

When one of my patients reminds me of why I went to medical school, it goes in the drawer.

Pick a drawer. A basket.  A box.

I’ll bet you can even think of two things right this minute that could go in that drawer.

Take the time.

Start the practice.

It’s a good first step to acknowledging how special you truly are to the world of medicine.

Dr. Starla Fitch is an ophthalmologist, speaker and personal coach, based in Atlanta, Ga.

Jun 02

Finish Line Feeling

Susanne Carter, MD

Susanna Carter, MD

By Susanna Carter, MD

During my third year of residency I trained for and completed an Ironman triathlon. I’ve discovered, despite its growing popularity, many people have no idea what a triathlon is and often nod at me in hesitant approval when I talk about this particular passion of mine. An Ironman triathlon is a 2.4 mile swim, a 112 mile bike ride, and a 26.2 mile run, completed in succession, all in one day. And it happens to be the most exhilarating and self-actualizing ride of your life. During the grueling training and racing process you learn more about yourself, your inner demons, and your body’s capabilities than you could possibly imagine. The glory at the finish line is infectious and monumental and if you love humanity you want everyone to feel the rush of life that comes from such an accomplishment.

After competing in several shorter triathlons I went to my first Ironman distance event as a spectator and felt like I had come home. I immediately thought, “Here are my people!” Amidst a sea of beautiful bodies, there were energetic, positive, inspirational pictures of health everywhere. By no means was everyone there a lean machine, but everyone there was fit and in the process of getting fitter. There were people with significant physical challenges, people recovering from or beating cancer, people in their 70s and 80s, all defying the common limiting mantras of our culture: that I’m too genetically disabled, too busy, too tired, too sick, or too old to push my body to new limits.

The determination that crowd exuded rang a bell in my head and lassoed my heart. I knew I had to join their ranks. I competed in my first Ironman in 2009 in Tempe Arizona, and have been hopelessly hooked ever since. This September I will return to the town where I completed my residency, Chattanooga, Tennessee for my fourth, and hopefully my fastest.

Triathlon is my lifestyle. I spend ten to fifteen hours a week training my body in the pool, on the bike, and on the road, day in and day out. How I feed and hydrate my body takes preparation and constant attention so I am never depleted or hindering recovery. I stick to a regimented sleep plan, I don’t watch TV, I don’t stay up late. For me, the reward of living this way and making what some might call sacrifices are plentiful. I feel fit and energetic, strong and confident, I feel fully alive and grateful.

Training and competing at this distance are extreme and I don’t believe we need to exercise at these lengths to be healthy. But the experience I had watching people cross the finish line at my first race was part of a bigger lesson. They cried, pointed to the sky, put their hands up to there faces in disbelief, laughed, jumped, fist pumped the air, and bowed down to kiss the ground. Some even cart-wheeled over the finish line. They had worked harder and longer than they ever imagined they could to accomplish their goal and the intangible sweet reward was written all over their faces. It wasn’t about the Ironman per se, it was about the process of doing something they didn’t know was possible.

I believed in the value of the experience so much that I stopped my practice as an OB/GYN and began committing myself to health and wellness coaching. During my training and racing something in me began to shift and I noticed I was feeling off purpose in my practice. Though I knew I was providing a valuable service to my patients, I couldn’t help but see that so many of them really needed lifestyle changes in order to get healthy. I didn’t feel like I had time in my office to make the impact on their lives that I wanted to. I wanted to motivate people to get off medication and get on the move!

In my coaching, I love watching people experience the transformation of their bodies from inert dead weights to beautiful machines in motion. The process is arduous and takes consistent effort and soul-searching, but that’s exactly what makes the eventual transformation so powerful and sustainable. Looking for a quick fix when it comes to weight loss and fitness cheats us out of a meaningful whole life transformation. But when we embark on a journey of reshaping how we think about ourselves, digging deep to push past our own inertia and self-imposed limitations, a whole new world opens up to us. And because it takes time, sweat, heartache, and surviving a million tiny defeats, it also brings extreme joy, confidence and a million little victories. I live and breathe that process in my triathlon training and in my work. And that’s what works for me.

Susanna Carter, MD stopped practicing ObGyn in December 2013. She is a dedicated triathlete and the creator of, a brand new health and wellness coaching business designed to get people moving.