You are smart.
You are hard working.
You are constantly striving.
You are optimistic in your planning and your schedules.

So how could you ever finish a week feeling like you “won”?

The default behaviours in general won’t do it for you - they will actually make you feel worse! And the pressure to work on the weekend to “just catch up” will be intense!

“If only you had planned better” - your productivity coach says.
“If only you had blocked off more time” - your deep work book says.
“If only you had been more intentional” - your intentional timer says.

Arg! Not helpful right now.

So what can you do?

I struggled with this a lot myself this week. I thought I had a project ready to push to completion, only to find a major error in it. But I had so much else planned, and the pressure I put on myself (and on those around me) was intense and mis-directed. I haven’t found it very useful to spend a lot of energy in stress and worry. And sadly both stress and worry seem to be contagious!

In my coaching this comes up a lot as well - especially on Thursdays and Fridays! This week it started on Wednesday for me.

I explore techniques I used to end the week well in this MakeTimeFlow article but the key point is to:

• Help yourself with your two inner advisors (I know this could sound hokey - but it seems to be able to engage more of your thinking brain when you are stressed out - give it a try)
  • what would your “ideal loving parent” say to you?
  • what would your “ideal boss” say to you?

I found the exercise helpful, and calming, and I could think straight again, and actually ended up feeling good about all that was done, and all that I learned this week. I’m even a little excited about next week (but I’d like the weekend first please!).

I’m not working on the weekend.

And next week I’m going to be clearly differentiating between “solid” goals and “stretch” goals, giving myself enough time to do a good job on the solid goals, and not feeling bad about not hitting every stretch goal.

Finally I wanted to share with you this wonderful quote from Marcus Aurelius which really spoke to me, especially this week:

“When obstacles get in your way, the obstacles become the way.” ~ Marcus Aurelius

Wow, so much has happened in this last year!

I really enjoyed the irony of my last post which was about kickstarting a new writing process - that quickly fell by the wayside and resulted in a whopping 0 posts for the rest of the year. Yeah - that worked!

So in terms of writing I’m starting chastened but still (perhaps ever) hopeful.

What has or is changed?

• New inspiration - seeing something done well makes it easier. I’ve been really inspired by Seth Godin’s writing and talks and his blog which seems very elegant in it’s readability, simplicity and focus on the audience so I’ve modelled my blog layout on his (thank you Seth).
• A new simpler design - more focused on reading and connecting (through the email newsletter) - and the delightful satisfaction of code and design as craft. In a fit of curiosity/interest/control-freakishness I decided to rebuild the template for this site by hand. This helped me to learn a lot more about how the static site generator (Jekyll) works and so made it much easier to customize. In the past I would have used Bootstrap to help kick-start any project that would involve CSS but I’d been hearing more and more about TailwindCSS and I really like their approach of reducing unnecessary abstraction.
• And a large dose of self compassion, so when one of my posts has fallen flat, I can help myself up, dust off and try again to be brave enough to write and to share.

So thanks for reading, and thanks for joining me on this journey, and let me know about your blog and newsletter :-)

For a long time, writing has sat languishing as wishful thinking amidst the cornucopia of good ideas. There are many, many reasons why it has been languishing here, including what I suspect are the usual suspects for many people. Here are some ways/motivations/tools that I am using to help me overcome this.

Make it a habit.

Write for 30 minutes in the morning. You can almost always afford this time. I do it after getting some tea, having some reflection time (where I just flow my thoughts from the previous day which helps me to clear my head), and read a little (which opens my mind more). On my really good days, I will also have meditated, and if I am really really good - have practiced some loving kindness too.

Make it easy.

Find a way to write and share it easily. For me this has meant:

• when blogging: use Vim + Goyo mode + Jekyll + Netlify to be able to write and quickly deploy
• when writing with others: use FreePlane or Vim for quick thoughts -> Google Docs/Word for sharing/reviewing, then translate it for deployment (Pandoc is helpful here too).

When you get stuck, break it down, make it real.

I often find that by being curious about small things, larger issues can be revealed. This means that your writing can balloon into bigger pieces. These are important for me, and I love diving into them, since they can really help to deepen my thinking. But it can also become a real blocker. In this case, I keep the larger beautiful mess to myself, and extract smaller, easily explainable pieces to share with others.

By making it real, I mean that you should start a new document that you plan to share with others on the extracted topic. This can create just enough momentum to get you over the activation energy needed to help you start and complete the smaller piece, and it gives you an easy way to share it and get feedback!

I want to share what I consider a treasured reminder of the humanity within the sometimes gruelling practice of medicine.

A few years ago, I was part of a team in Africa that developed an open-source system that notifies doctors of critical lab results within their hospitals. We developed this system to support bi-directional group based and closed loop communication. This work leapfrogs the system that we had been using in one of the best hospitals in the US. When I returned, I wondered why we still used the system we had. With some wonderful mentors, we studied this in our article - “Why do we still page each other?”.

In doing this work, I also ended up doing a word frequency analysis of the messages from all of the pages that had taken place in my hospital over a month, and was very surprised and touched when it showed this.

As one of the clinicians on the receiving end of these pages, I would never have guessed this. It showed me how human the communication was even when its main purpose is supposed to be critical results and action. It moved me so much that I have it printed on a canvas on my wall and inspired me to write the poem below. During this dark time of COVID, while society is suffering and healthcare workers are continually called on during crisis, this image and the resulting poem help to ground me in the deep humanity of what we do. I hope they are of some comfort to you too.

Continue …

This is a longer format article (there is lots to worry about after all - and lots to do!). To give you a quick sense of what is covered (and where in the article) this is a quick overview and table of contents. In this article major areas I cover are:

• Concerns and questions during the different phases of the pandemic:
  • During the Initial Phase
  • During the First Surge
  • After the First Surge
  • Ongoing Swells and Surges
• What can we do about it?
  • Understanding Disease Pathophysiology, Diagnosis and Treatment
  • Clinical Practice and Capacity
  • Improving Communication and Collaboration
  • Improving Education and Training
  • Reducing Inefficiency
  • Addressing the Disproportionate Impact on Certain Communities
  • Addressing Violence & Structural Racism
• Thinking about the Future
  • How can we think about being safe balancing social distancing vs relaxing and reopening?
  • Is there a large clinical backlog developing and how will we be able to catch up?
• Emerging concerns
  • When vaccines become available

Continue…

COVID-19 has resulted in a surge of patient cases, and also of information. Some of this information has been helpful, some harmful. The amount of information itself, and the feeling of urgency that accompanied it, has been felt by everyone, especially by physicians who are asked by almost all their patients to help interpret this for them. The speed with which we read has not changed, and the time available for reading has often decreased, filled with clinical surges or family responsibilities.

The large increase in information has itself become a possible problem in accessing good information. When there is an explosion of information without an effective way to select higher quality information, that increase in volume decreases the useful information for almost everyone: the noise (low quality information) overwhelms the signal (high quality information).

I’m certainly experiencing this. As a primary care doctor at a large academic medical center (and one that is conducting many therapeutic trials for COVID-19), I have both the opportunity and obligation to be as informed as possible. However, it has quickly become clear that I could spend all day reading news, journal articles, pre-print articles, and attending conferences and still not cover all the material.

COVID is a stress test not only for our public health infrastructure, but also for our organizational and personal learning systems.

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Sometimes the most amazing lessons happen at the most unexpected times.

Yesterday I did a ‘wellbeing hackathon’ with my daughter. Since she’s twelve, I thought I’d be teaching her a lot of what I knew about innovation and well-being. Instead, I did a lot of learning myself.

She and I have been building an internet-of-things connected device, thanks to an innovation award from the Brigham Health Physicians Organization. Our device was designed to be as simple as possible, measuring one thing: “are you happy or stressed?”. It is an early detection system for the epidemic of physician burnout - a ‘happy button’ to measure stress among healthcare workers.

And then the pandemic began in earnest…

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