A Gentle, Hairy, Non-English-speaking Co-pilot

Have I ever told you about our dog Swayze? Well, she's crazy. She's part Boxer and part Lab and part Wookiee and super excitable, especially around other dogs. And squirrels. And fast moving children. When we lived in Chicago, our back deck was surrounded by a high fence and whenever she would hear people or dogs she would go crazy whining and clawing at the fence to get out. So, when we moved to Madison we bought a house with a big yard and no fence. Solved that problem didn't it?

Under the influence of our realtors and the fact that we could not imagine the ridiculousness of putting Swayze on a leash to walk her in our front yard, we had an invisible fence installed. The way this works is that she wears a special collar when she goes outside that delivers 'an uncomfortable sensation' when she gets too close to the perimeter of our yard. The discomfort level is really variable dog to dog and since our dog has bloodied her own paws while playing we honestly had pretty low expectations that this would work for Swayze.

It took a couple of weeks for her to 'get it' and make a definite association between straying to the edge of the yard and getting 'shocked' but alas....it happened. Now when children ride by on their bikes and couples walk their dogs by our yard and a squirrel darts across the road, sometimes all at the same time, Swayze automatically sits and wags her tail and stares. Sometimes she trembles with the effort, but she makes herself stay far from the edge of the yard. She knows that the 'uncomfortable sensation' is a powerful motivator for avoiding that situation.

A coworker was in an unfortunate situation last week where she felt she had not managed a patient in a manner in which she felt proud. The patient was ultimately transferred to the ICU and there were rumblings about her 'sitting on the patient' for too long. She was in my office beating herself up about this and she asked me "How do I get over this? How do I move on?" And I responded that the only way I have gotten over this same awful feeling is to remember it and the situation that gave birth to it. Not trusting your gut and deferring to someone else just because they have a few years on you = this same awful feeling. So, next time I encounter that situation, I remember and I make a different choice. A choice that will hopefully allow me to avoid the 'uncomfortable sensation' of feeling like I failed a patient.

Learn from your mistakes and move on. Take comfort in that. If Swayze can do it, so can you. Trust me on this one.

Feedback Sandwich With A Side O' Chips

I went to a faculty development session the other night about feedback. Who knew there is so much to learn about feedback? I know when I was a medical student and resident, I craved feedback from my attendings. But only if it was positive. Then when I was a fellow and pseudo-attending I just wanted to be told if I was doing something wrong. Now that I am faculty, I just want to be told how I can be successful.

I raised my hand and admitted at this session that I was uncomfortable giving feedback because I don't like to hurt anyone's feelings and I want everyone to like me. Do you know what the speaker said to me? He said "The people who are most worried about hurting another's feelings are the least likely to ever do so." Wow. I don't think I could have felt better if he had said "Have you lost weight? Because you look thinner." Well, maybe a little better, but you get the point. In that instant I lost so much of my hesitation to give the students and residents with whom I work 'constructive criticism'. I now see it as a chance for me to help them to be successful...without having to wait until they are faculty.

When I started on the wards this week with my new team I warned them in advance that I would be giving them feedback immediately after their presentations in front of the rest of the team. I've done it in a way that is matter-of-fact and nonjudgmental, all the while thinking of how I want them to be better doctors because of their experience on my team. I'm not perfect at it, but I think they are learning....and I think they still like me.

When You Play This Record Backwards, It Says "Get Over It"

Have you ever held your tongue when you really wanted to speak up but didn't think it was your place? I know everyone has. Being a quiet person by nature, this happened to me often growing up. I would stew and vent and replay all the things I should have said but the same thing would inevitably happen to me in another situation. My mom used to tell me "Angela, when you get older and more confident you won't care so much what people think and you won't be so afraid to speak up for yourself." Weeeeelllll, I'm definitely older, and maybe a tad more confident, but I'm still not speaking up. When is that magical age when I won't defer to someone older and more experienced to make a decision that I should feel confident making?

I was in a situation (again!) last week where I didn't listen to my gut. I allowed the opinion of another physician to comfort me and didn't think independently enough to make my own decision. Everything ultimately turned out fine, but in a much more circuitous and unattractive way than I would have liked. I have been beating myself up about this for 6 days now...I've replayed all the things I should have said and done numerous times and you know what? It feels different. I can't explain why but for some reason I feel like a switch has been flipped and this won't happen to me again. At least not like this. I am done with this feeling of insecurity about my lack of experience. I may not know all the answers but I know that I can trust my gut to lead me to someone who can. I think if I say this mantra to myself enough times, I just might believe it by the time I'm another year older.