Tuesday Morning Quarterback

Coming up on my 6 month anniversary at my new job, I've realized that I am slowly but surely gaining confidence in my clinical judgement. Here's how I know. Last night I admitted a child with a complaint of limping and leg pain. The story was suspicious for infection, hence the reason for admission. However, when the residents examined him his pain was gone and he was well and playing. He's already admitted at this point, it's late at night, and the seed has been planted that this child may have a bone or joint infection that needs to be evaluated. So, I did what any self respecting physician would do. Nothing. I am a firm believer in these two ideas:

1. Don't just do something, stand there.

2. A child will declare themselves when the time is right.

I figured I'd give the child the benefit of observation overnight knowing that time would tell me what I needed to know...whether or not I should pursue a workup. I explained that to the daytime hospitalist this morning, feeling a little bit silly in the light of day that I admitted a child and then did nothing, but she seemed to understand and agree.

I ran into her at the end of the day and asked about the boy. Turns out, he remained well and did not have any leg pain throughout the day so she sent him home. Here's the rub. His labs suggested a high level of inflammation going on but that did not fit the way he looked. This brings me to a third idea I hold dear.

3. Treat the patient, not the lab values.

Unfortunately for her, another physician heard about the case and clearly does not believe in the three ideas I've listed above because he felt that more should have been done and that the child was sent home in error. Despite the fact that he looked like a peach from the minute he arrived on the floor. Then this other physician asked the dreaded "Who staffed this patient last night?!" Now, 6 months ago had I heard this story I would have turned red, my stomach would have dropped and I would not have been able to let that comment go without picking it apart, losing sleep and berating myself for missing something. But today, 6 months later? I just thought, "Huh. That's funny." And let it go. I will not lose sleep over this tonight. I will not let his Tuesday morning quarterbacking make me feel less than. And I will continue to practice by those 3 ideas, because that is what I feel is best for my patients. And I am their doctor.

Plug for PLA

You’ve finished residency and are embarking on your career as a pediatrician. Maybe you are deep into fellowship and enjoying the challenge of academic life. Maybe you are comfortably settled into a group practice and building relationships with your patients and their families. Maybe you are trying to find your passion and traveling around as a locum tenens physician. And maybe, despite feeling accomplished and relieved that you are finally out of training, you ask yourself “What now?”

After finding myself in that exact position in 2007, I came across an advertisement for the Pediatric Leadership Alliance (PLA). At the time, I was struggling with how to make a name for myself in academic pediatrics as a young physician. I was intrigued by the opportunity to network with leaders in the field of pediatrics in such an informal environment and to be able to practice leadership skills in a practical, hands-on format. After attending the PLA, I possessed a renewed sense of confidence and felt part of a larger community of pediatricians who had the same values and drive to succeed. More importantly, I had the tools to channel my energy into a productive and exciting career path.

Over 3,000 pediatric professionals have attended the PLA and 79% of PLA alumni advanced into greater leadership roles within the Academy (including myself!), as well as in hospital, medical association, government and corporate environments following their training. Another PLA session is being offered March 23-25^th, immediately before the Annual Leadership Forum (ALF) at the Schaumburg Renaissance in Schaumburg Illinois. The PLA is specifically designed to provide real-life scenarios in order to practice skills and learn from one’s colleagues. Sessions include “Strategy Development: Charting Your Course” and “Dynamics of Change: Moving People & Culture”. A dynamic keynote speaker, Dr Lewis First, (Editor-in-Chief, Pediatrics) will describe his leadership journey and how leadership skills learned were embedded in advancing into more key roles in the profession of pediatrics. To promote networking among participants, the PLA has dedicated time for casual conversation during the reception, dinner and workshop meals. It was during this “downtime” that I was able to really form relationships with the other participants and facilitators. More than enjoying the company of my colleagues, I was inspired by the different people I met and by the work that they were doing.

In addition to the foundation for leadership formed at the conference, the participants will be encouraged to sustain their development through long term follow up and goal setting. Although a critical component of the workshop, the follow up is entirely personalized and voluntary – the support is provided by the PLA staff and the AAP as a whole but it is up to the individual to follow through on the goals set during the conference. This was the most difficult part for me personally, sustaining the momentum I gained at the PLA, but I was able to refer back to the PLA website and workshop materials including the book The Leadership Challenge by Kouzes and Posner. A full 13 hours of CME credit can be earned by attending this influential conference. Early registration (before Jan 30, 2011) is $395. Housing at the Schaumburg Renaissance is approximately $300 total for both nights. For more information visit www.aap.org/moc/members/PLA/ or email PLA@aap.org.

Please challenge yourself to answer the question “What now?” Consider sharpening your leadership skills with a group who pledges to “enable pediatricians to become effective learners and leaders to advance their profession, and to care and advocate for children”.

My Hero

Let's be honest. There are a lot of topics that I avoid writing about in this blog because I don't believe it is the forum for my political opinions or to inflame anyone else's opinions. However, in light of the weekend's events in Tucson, I must comment. It has been surprisingly hard and very personal to see my hometown splashed all over the news. Glimpsing the sandwich shop my husband I ate at in November in the foreground of footage of the crime scene is surreal. Seeing the hospital where I did both my medical school and residency training as the backdrop for the neurosurgeons' press conferences is chilling. The flowers and candlelit vigils at various spots around town make me ache with sorrow, homesickness and pride, all at once.

However, I can't stop thinking of the little girl, Christina, who lost her life that day. She had just been elected to student council and was thinking about a future in politics. A neighbor thought it would be fun to take her to meet the Congresswoman Gabrielle Giffords. What a gift, for that little girl to have her dreams so supported. Do you remember what it was like to be 9 years old? The world was spread out before you and you had an infinite number of choices, each one more exciting than the next. The only problem was finding enough hours in the day to explore all the things you wanted to explore. When I was young, I wanted to be a writer, so I wrote. Then I wanted to be a lawyer, so I read. Then I wanted to be a doctor, so I went to medical school. I was blessed to have a family who supported those dreams, however lofty they seemed, and made me feel like I could do whatever I wanted. And here I am, tremendously satisfied with the life that I have chosen.

We'll never know if Christina would have gone on to be a successful politician. But, given what I've read of her and her family, I believe she would have gone on to be successful at whatever she chose because her dreams were valued. She is my hero because she died following the thread of a passion without fear of failing. I only wish that was as easy at 35 as it was at 9.

I hope you will honor Christina and all the victims of this vicious attack by pursuing your own thread of passion or by nurturing a child's dreams and allowing them to believe in themselves and the endless possibilities the world has to offer. Rest in Peace.

The Stupid List

Do you know what a Stupid List is? I don't mean that thing you needlessly create everyday in your iPhone, planner, or head. I mean a list of things that routinely get neglected until something goes wrong and then you say "I can't believe I was so stupid!". That list. It's almost the end of 2010 and now is a good time to attend to your Stupid List. Want a practical example of what should be on said list?

1. Update dog's microchip when you move or else when she runs away and gets picked up by a policeman and taken to the Humane Society they will have no idea how she got from Chicago to Madison. Or how in the world to get ahold of you, her stupid owner who didn't update her microchip info.

See how easy that is? Here's another one,

2. Clean out email contact list so that when your account gets hacked you don't send emails selling *cheapest* electronics to your previous employer and your stylist who moved to Atlanta years ago and that guy you met on a cross country flight before you ever laid eyes on your husband.

On a practical note, how about checking when your passport expires? Wouldn't it be a shame to plan a big beer drinking trip to Belgium and discover that your passport expired the month before? And how about your Facebook privacy settings? Better check on that before you post those NYE pics, huh? Do you have any old email accounts that you don't use anymore? What if a long lost acquaintance sent you a holiday message? You might want to peruse your inbox. If only to remind yourself of who you used to be. My old email address is girlyhood@.... Why? I don't remember, but I like it. Oh and while you're checking old email addresses, google yourself in the advanced search option. It's important to see how you are being portrayed to the world, intentionally or not. Any random credit cards you don't use anymore? How do you know someone else isn't using them? Check your credit report. Like Wilford Brimley says about your blood sugar, "check it often".

Whew, don't you feel productive and organized? Just in time for the new year. You're welcome.

How To Live A More Interesting Life

I have this friend whom I love dearly and is nothing like me. I tend to gravitate toward people who are living lives that I would love to be living, at least a little bit. She is one of those people who has a new adventure planned every weekend and has changed careers mid-life. She always seems to 'fall into' random experiences and has the most awesome stories. She embraces life daily and does not apologize for it. She is successful at making her life interesting. So, as I struggle with building a suburban life in the Midwest and holding down a very 'adult' job, I'm conscious of holding onto that small part of myself who still craves a little 'randomness'.

I came across this blog called "The Friendly Anarchist" and I want to share with you what he says about living a more interesting life.

The mistake when trying to find out about interestingness is to look at what interesting people are actually doing. Because this only leads to even more passivity on the side of the spectator:

• “Oh, Tyler Tervooren can jump out of an airplane, but I couldn’t possibly do that because I don’t fly. Climate change is more important than having fun.”
• “Oh, Sean Ogle is traveling to South East Asia and checking off the points on his bucket list, but I couldn’t possibly do that because I love my home and wouldn’t want to leave.”
• “Oh, Karol Gadja is building a business around his Ridiculously Extraordinary blog, but I couldn’t possibly do that because I haven’t got any idea of internet marketing and writing.”

One thing is for sure: You will always find reasons not to do something interesting, even if other people are doing it. Often enough, these reasons will be pretty good. Sometimes, they won’t. But you’ll definitely find some!

I believe we have to look at what these people are not doing. And then we have to stop doing that, too. For example:

• Stop worrying 18% of your life.
• Stop overthinking everything.
• Stop remaining seated comfortably.
• Stop accepting things as they are, even if they suck.
• Stop taking the path of least resistance.
• Stop living the life other people planned for you.
• Stop worrying 18% of your life. (This comes twice, as it’s really the basics.) The good thing is that interestingness doesn’t always have to be confronting pickpockets or jumping from airplanes. It may be small things:

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• Buy unknown food at your supermarket (or an Asian / African / Latino shop) and try to cook something tasty with it.
• Go to a new bar / restaurant instead of always going to your old favorites.
• Watch a recommended movie from a genre you normally ignore.
• Engage in a street fight.

It may be big things:

• Quit your boring job.
• Write and publish that novel you’ve got inside.
• Sell everything you own and travel the world.
• Have and raise five children.

And it’s really your personal choice. Each of us is different, each of us has different ideas of how to live an interesting life.

There’s one thing interesting things have in common, though: They make us feel at least a tiny bit uncomfortable. Anxiety is the perfect indicator. Instead of worrying about or trying to ignore it, maybe we should let it be our guidance. This is not about becoming an adrenaline junkie, though. It’s not about extreme sports, about permanent travel, or about becoming an entrepreneur. It’s about taking the direction that you want to take in order to make your life more interesting.

Just wanted to share something in the blog-o-sphere that brought a little bit of clarity to my day. Hopefully you get something out of this and make a small change today!

Another Awesome Word I Didn't Create

Intrapreneurship. Know what it is? I didn't think so. It's another awesome word I didn't come up with myself. Like 'bromance', 'bootylicious', and 'staycation'. It is defined as follows:

While an entrepreneur ventures out on their own to pursue an idea, an intrapreneur does this within the organization in which they already work. It could be creating a new product, coming up with an innovative idea, or improving a service.

I'm an intrapreneur right now and I didn't even realize it! Here's what i'm up to. As part of an academic hospitalist division, I felt that we needed to do more...academic things. So, I am in the midst of trying to drum up enthusiasm for starting a divisional journal club. That's important right? We are responsible for teaching and modeling for medical students and residents so we should attempt to uphold the academic standards on which our profession was built. Here's my issue, albeit a minor one. I'm not sure that everyone is quite as passionate about reading journal articles as I am. So let's say that only half of our division wants to participate and the other half aren't that interested. Should I make it totally voluntary? I foresee that becoming pushed by the wayside when other 'mandatory' things come up. Soon enough it might be a club of 2 members. And that's sort of sad. But, if I make a schedule with everyone assigned to a month in which they are responsible for journal club, I'm afraid I will make some enemies. And they will whisper "who the hell does she think she is?!", preferably to my back and not to my face. Yes, I worry about these things.

So, the concept I am "intrapreneuring" is a division journal club. But really maybe I should be inventing a way to make learning a passionate endeavor for all.

I'm Ridiculous: Part 2

I just finished up a weekend of call and I'm exhausted. Yes, I slept in my own bed. No, I did not have any "middle of the night" admits. So why the heck am I so tired??!! If you read the first year of my blog you will understand how ridiculous this is. I spent 2 years working nights and weekends in the NICU and would've been overjoyed to have a job where I could sleep in my own bed at night and not be up for over 24 hours multiple times a week. Our call from home currently requires us to personally see every admission within 2 hours regardless of acuity or time of day/night. But herein lies the rub.....I like to be prepared for whatever situation may befall me. "Plan" is my middle name. So what do I do when i'm on call from Friday night to Monday morning and I don't have any nighttime admits? I anticipate them. I lie in bed and anticipate the beeping of my pager. I anticipate dragging myself out of bed at 2 am. I anticipate getting into the car and driving to the hospital in the 10 degree weather. And I anticipate getting home with just enough time to get comfortable before my alarm goes off signaling a new day of rounding on patients. I think subconsciously my body does not want to relax because it is so much harder to get out of bed during a dead sleep than not. So I lie awake waiting for the inevitable admission that never comes.

This is problematic on so many levels. There is no way I can justify being tired after a night of call when I don't even get called. I have to carefully conceal the bags under my eyes and tell my coworkers what an easy weekend of call I had. I can't blame my less-than-enthusiastic teaching and blunted affect the next day on the rough call night I just had. Sometimes, and I can't believe i'm saying this, I think I would sleep better if I just stayed at the hospital. The mere anticipation of leaving my bed and driving to the hospital in the wee hours of the morning clearly throws off my tenuous grip on stability and sends me into a spiral of anxiety the likes of which prevents my brain from shutting down. Any advice? Meditation? Hot tea? Peanut butter chocolate chip cookies? My battle against sleep deprivation continues...