Rebecca Elia's Blog

All about Feminine Health, Healing, and Greece

Thursday, October 29, 2009

Will Mindfulness Meditation Cure our Healthcare System?

On October 15th, The New York Times posted an article written by Dr. Pauline Chen that discussed the benefits of teaching mindfulness meditation to physicians. In a quest to help alleviate physician burn-out (along with depression and suicide!) and increase meaningfulness at work through improving the physician-patient relationship, mindfulness meditation was found to be beneficial. Why then did this article make me so angry? As I read it, my breathing became labored, my heart started to race, and my cheeks became red. By the time I had finished, I, myself, needed to practice my mindfulness!

I have long observed the amazing benefits of mindfulness meditation, both personally and professionally. Any practice that brings us into the present moment, that allows us to fully experience the present and removes our thoughts from past and future, has incredible healing effects. Many years after I first practiced mindfulness, I was working at a major HMO. Our typical work day had become increasingly hectic, just as was described in Dr. Chen’s article. Advances in information technology were, in many ways, a godsend, but, in other ways, a contributor to our living hell on earth. We physicians, by nature, are excellent multitaskers. It’s as if we represent a fast-forward version of survival of the fittest. If you can’t multitask, then you have no place in medicine. The increased use of electronic charting played into this skill. If we hadn’t been so good at multitasking, the technological advances would never have made a significant difference.

One of these so-called advantages allowed us to perform most functions from one computer screen. We could chart the patient’s visit, order lab tests, order radiological tests, make future appointments, conduct billing, answer emails, converse with colleagues and contact patients—all on one screen and, quite often, simultaneously. This all seems great, right? Think again. Most systems, whether one is in a HMO, group practice or private practice, do not allow for the extra time required to conduct all of these functions. Let’s face it—there’s only so much one can do in an allotted amount of linear time. So we had two choices. Work longer hours (show up earlier, work through the lunch hour, fall behind in seeing patients, leave later) or cut out face-to-face patient time.

For most of us women, this was a no-brainer. Almost all of us chose to work longer hours, because we weren’t willing to sacrifice time with our patients. I haven’t run across a single physician yet who chose the practice of medicine in order to enter data into a computer. But, regardless, our patients pay the price, and we pay the price. Our patients get less and less face-to-face time. Their visits are abbreviated. Almost worse, we as physicians suffer—not just from inevitable burn-out, but from loss of job satisfaction. Mindfulness meditation is not only a useful tool; it’s become a necessary way of life. But no amount of mindfulness meditation can make up for an ailing abbreviated healthcare system.

Some of you may be wondering why I am writing this on a blog about feminine health and balance. Others of you have already identified the common denominator. Most of the systems in which we currently find ourselves (healthcare, law, higher education, marketing, etc) are using information technology advances in this very same way—as a fast-forward, as a way to squeeze more and more out of each individual. Everyone is moving so fast that the merry-go-round is no longer merry and is, in many cases, spinning out of control. We need to recognize this first before we can decide what to do about it. For those of you who can’t heal your present situation with mindfulness, you may need to step off your merry-go-round.

Take a few moments to assess your own merry-go-round. Is it out of control? Do you really need to be on it? What are your choices? Are there internal steps you can take to make it manageable? In other words, by changing you—your beliefs, your responses/reactions/attitudes, by acquiring certain skills, such as cognitive behavior techniques or mindfulness meditation, will this be adequate? Or is it time to step off?

Monday, October 19, 2009

Is Perfection Your Middle Name? vs. If I Only Had a Brain!

Do you allow yourself to make mistakes? Or do you share my middle name, “Perfection?”

I lost my brain again today.* It’s been happening a lot lately. Perhaps it’s menopause. Or maybe I’m just letting go of perfection and allowing myself some mistakes.

I didn’t want to leave Delphi, but, alas, I did…only to get stuck at the rest stop in Livadia. I was texting a sick friend and sitting right in front of the bus. When I finished and looked up, the bus was gone! I hadn’t seen, nor heard, a thing. I looked up at a few Greeks standing lazily outside the café and asked “Eh-fee-gay? (Did it leave?)" Their answer, with characteristic Greek shrugs: “Yes. Of course.”

I ran inside and saw the kind ticket-taker-man sitting in the café sipping his coffee. He looked at me in disbelief saying, “I announced it inside the café!” I answered, in equal disbelief, “I was sitting outside, next to the bus, texting a message on my cell phone. I didn’t see anything; I didn’t hear anything.” He dialed a number on his cell phone and pleaded in Greek, “Please wait. Only five minutes.” The bus couldn’t have been more than a half kilometer away; I was sure it had just left. He asked a dignified trustworthy-looking gentleman to take me to the bus--in his Mercedes. I apologized profusely the whole-like-five blocks, and thanked him, telling him, repeatedly, what a good man he was. I explained that I didn’t know where my brain was today, that I had been sitting right in front of the bus and didn’t notice a thing, that in twenty years, this was the first time that this had happened to me.

I got onto the bus, offered an apology to the bus driver and sat down, but not before noticing how completely uninterested the Greeks were…no big deal. There was a foreigner, however, whose judgmental glance was paired with thoughts so loud the whole bus could hear: “Oh, of course. It would be YOU, stupid American.”

I recognized his look and his thoughts, realizing that, for most of my life, I have shared the same opinion of myself. My mind then wandered to the times in my life that I had made similar mistakes, like showing up late. I could only come up with two others. One was during the shooting of My Life in Ruins (also at Delphi) when I was Nia Vardalos’ stand-in. I left the set to pee, and, of course, this was the one time that they needed me…so my absence suspended the shoot for a few minutes. I never heard the end of it from the Assistant Extras' Casting Director (who, to this day, probably has no idea that I’m a gynecologist with responsibilities far beyond what he can imagine). The Extras' Casting Director, thought nothing of it, and reassured me that it was no big deal.

The only other time I could recall was to an important job interview on the East Coast. Somehow, I managed to sleep through my alarm, or perhaps it never went off. I woke up to a ringing phone and my future boss (yes, she still hired me) asking if, perhaps, I had slept in.

I could come up with these two incidences, only, in my entire life and, yet, I still berated myself. Even I realized that something was terribly wrong. How have we come to this point, when no one is allowed a simple mistake? When did we start treating ourselves and others as glorified machines, instead of as human beings? If my medical career, we continually strive to minimize, if not eliminate, human error. This has been one of the arguments in favor of electronic charting, prescription and lab test orders. But even the most elegant system is subject to human error. And even if we do everything correctly, there’s always the possibility of technological problems, ranging from viruses to system shutdowns.

I remember one such situation when our medical practice was transitioning to electronic charting. Paper charts were soon to become a thing of the past. Everything moved along smoothly until one day, we had a heat wave. The electric grid couldn’t handle the extra stress and the system shut down, throwing off access to electronic charts for several hours. We had no access to patient history, medications, lab results, orders, and electronic communications. We were, essentially, operating deaf, dumb and blind, as far as technology was concerned. The administrative response was, “What can we do? Do the best you can. It will be back up as soon as possible.” To this day, I have never seen such a response for human error. Why is it that we treat ourselves more harshly, expect more from ourselves than from technological systems that are far superior to human capabilities?

Please don’t wait until you go through menopause, or, if you’re a man, until you reincarnate as a menopausal woman, before you allow yourself some leeway. This is one area in which the Greeks are ahead of us. They have had to learn patience (after a several hundred year Turkish occupation) and accept lower expectations. I wouldn’t be surprised if this practice adds years onto their lives, as well.

Remember, you’re so much more than your brain. You’re human.

*Originally written on October 2, 2009

Thursday, October 15, 2009

What You’re Not Hearing About “Balloon Boy”

Did you, like me, get caught up in the “Balloon Boy” story? I long ago promised myself to stop watching the news since I was fully aware of its devastating effects on the immune system. Research supports that bad news wreaks havoc with our immune system, potentially making us more susceptible to such diseases as infections and cancer. I often wonder if the news came with an attached hazardous health warning label, similar to cigarettes, whether or not it would convince more of the general public to turn it off.

As everyone was calling the Balloon Boy story a “good story,” I was left questioning what was good about it, beyond, of course, the obvious—that he was safe and alive. Was anyone else out there upset by all of the usual drama? It was quite familiar to me. It was the same drama that the news strives for, the same kind that had convinced my father, several years ago, that the new strain of Japanese flu was going to lead to the worst outbreak ever. Sound familiar? This year, same story, different flu… While the newscaster excitedly reported that this was going to be the most devastating flu ever, that it would lead, potentially, to thousands of deaths, I turned to my father and said, “Every year tens of thousands of people die from the flu. This doesn’t appear to be any different than usual.” Ignoring my expertise as a physician and accepting, instead, that of the newscaster, my father answered, unconvinced, “But he said it was going to be the worst, ever.” My father is not a stupid man so he’s reaction was shocking. I was witnessing the power of the media, of sensationalism, right before my very eyes, with someone who “should know better,” who was rarely swayed by others. I continued, “Watch, in a few days, they’ll have to retract everything they’ve just said, because they are wrong, and what they are doing, scaring hundreds of thousands of people, is wrong.” Sure enough, three days later, what I predicted took place, very quietly, so that one could have easily missed it. Again, I was sitting next to my father when he heard the good news. He barely reacted. I asked if he had heard it. He said “yes,” and shrugged it off, like an afterthought.

But well before that third day, the damage had already been done…to hundreds of thousands of immune systems.

So, when I watched the “Balloon Boy” saga, I couldn’t help but notice the drama, the excitement of the unknown, the fear, the terror. It was disgusting. And I couldn’t help but wonder what toll this drama was taking on our immune systems. How many parents were thinking about the possibility of their own children being in danger? How many were filled with anger that the child could have been in such an unprotected situation?

When they announced that he had been found, safe, at their home, hiding, some two-plus hours later, my relief was coupled with a bad taste in my mouth. Once again, we had all participated in this wasteful drama. And our payment goes beyond the enormous financial price tag of such a rescue mission. One of the crazy hopes I have is that, in my lifetime, I will see those who purposefully create negative drama pay the price for the harm that they cause to others. I wonder--am I the only one who sees it this way?

Sunday, October 11, 2009

Would You Intervene to Stop a Bully?

I was walking back from the farmer’s market today, trying not to think about a different farmer’s market, one that I had walked by a few days ago, 6700 miles away in Greece, when my daydream was interrupted by a disturbance from the middle of the street. Now this certainly got my attention, because, unlike Greece, it is rare to hear anyone shouting in my neighborhood.

There was a young man, probably in his upper 20’s, taunting and harassing an elderly man in the middle of the street. Traffic was stopped in both directions. Observing this outburst from the sidewalk was a group of half a dozen young men, roughly the same age as the bully. None of them came forward, but continued to watch. The bully became more inflated, was shouting something at the elderly man and dancing around him like a boxer trying to find his opponent’s weak spot. I started racing down the street with my cell phone in hand (Greek phone numbers dancing in my head), while trying to remember how to dial the police in the United States. I was a quarter of a block away when the situation escalated and the older man attempted to take a swing at the young bully. Only then did the half dozen male observers step in, en block. I could overhear them quietly telling the bully to, “Just get in the car and go.”

I, the only woman amongst the (sorry guys, weak) testosterone pack, called out, “Has anyone called the police yet?” One of the young men looked at me, apathetically, and said, “The police can’t stop a bully.” I replied, “He will continue to do this to others. If observers file reports against him, then the police can do something!”

I was appalled by his response. It was as if some unspoken code kept them from breaking up the confrontation. Didn’t any of them have elderly parents or grandparents? Didn’t any feel the least bit responsible for stopping such an incident? Certainly they seemed oblivious to the fact that people who harass, people who bully, are only one step away from violent behavior. Quite frequently, emotional abuse leads to physical abuse, and even if it does not, I know, too well, its equally damaging effects.

Another young man turned to me and quietly said, as if he didn’t want the other guys to hear, “Yes. The incident has been called in.” So, I proceeded up the street and was stopped by a female shopkeeper who asked me what had happened. I explained what I knew. I shared that I did not know what had precipitated the conflict, but that I was quite disturbed by the men’s lack of response. Her opinion was, “No one wants to get involved.” She also said that she had seen the woman in the car behind make a call on her cell phone.

What has happened to us that we are unwilling to step in? That we are so willing to claim no responsibility? What is this silent male code not to interfere, that trivializes and therefore accepts bullying, labeling the abuser as “just a bully?” What allowed these men to equate a call to the police as “weak” or labeling them as “tattletales?”

People, get the word out: bullying is abusive. Emotional abuse is as damaging as physical abuse, even when one does not lead to the other. We have become socially irresponsible to our elderly and to one another. The bully certainly did not exhibit any admirable masculine traits, but the group of male observers fell short, as well.

It’s a sad day when it takes a fifty-year old physically weak woman to step in.

This post may, at first, not seem relevant to the theme of feminine healing, so let me point out just two significant links. First, the acceptance of abuse and violence to others or to ourselves or, its opposite, too easily accepting the position of victim and the entitlement that goes with this, is a common state in our society and one that needs to change in order for all of us to heal.
Secondly, taking responsibility for ourselves and others, assigning worth to interdependence equal to the status of independence is another necessary change towards balance and healing, not only in our own society, but in our global world.

What do you think? In what ways have you been a bully to yourself or to others? When have you taken on the victim role? When have you left it behind? To what do you feel “entitled?” When have you valued interdependence as highly as independence? When have you stepped in, taken a stand, begun your path toward healing?