Category Archives: Connection

Lessons from the Operating Room

Lessons from the Operaing Room

Picture this: You’re in the operating room, performing a challenging procedure. (If you’re not a doctor, roll with me here and play along. You’ll get it soon.)

You’re feeling pretty good about how the surgery is going.

You’re grateful that your usual team is with you, because that always makes you feel more confident.

Then something happens…

Right at the most critical part of the procedure, crisis ensues and the instrument you’re using breaks! WTH?! You’ve never had this problem before. For a moment (that seems much more like an eternity), you freeze.

Your mind goes through all possible options. They whirl by like a ticker tape in your head. As each option zooms by, you quickly decide the chances of success: no freakin’ way; okay, maybe; it’s possible.

Yes, this happened to me. As much as I hate to admit it, the feeling of not having it all 100% together sends me reeling a bit. I’m a surgeon after all, and a life coach.  People like us cannot lose it- it’s just not allowed!

What do you do at that moment, when the one thing that should never happen actually happens?

I know that being still and thinking clearly is my best bet for my patient and for a good outcome. I take a deep breath on purpose, remembering that that helps.

The room is quiet, except for the continuous beeps of the anesthesia machine, the blood pressure and pulse monitoring, the radio playing in the background. All these things move forward, oblivious to the drama on the surgical field.

Meanwhile, my scrub tech, Brian, whose job it is to hand me instruments, assist in the surgery, and make things go smoother, has also been frozen. He’s worked with me for seven years now. He can read me like a book.


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Have you ever had that moment of near-panic in the operating room?


Breaking the silence, Brian finally speaks. His words are measured. He talks slowly and deliberately, so as not to topple this apple cart any more than it already is.

“How can I best help you now?” is what Brian says.

I finally look up from the field and our eyes lock over our surgical masks. He knows we are at a crossroads. Things can go either way.

I softly nod and try for a half-smile. In truth, I want to scream or cry, as I am still wondering how to fix this unfixable problem.

“That,” I say to Brian, “is the perfect question to ask right now. How did you know?”

And that gentle question gives me the power to move forward. It reminds me that I am not alone in the room. That I have a whole team at my side, ready to shoulder with me and make this all better.

My pulse slows a bit, giving me space to process things. I have a plan. It seems likely it will work.

I slowly and intentionally ask for the additional equipment that I need, remaining calm, as I know my team will feed off of my energy. I know that the ripple effect can trickle downward and impact everyone in the room. I resist the strong urge to holler at someone. I know the broken instrument is no one’s fault, and that the instrument can’t hear me.

Brian and I, and the rest of the team in the room, proceed without panic as we reinvent the surgical wheel. I can see now that this new plan is (Thank God!) working and I am becoming more relaxed. I remember to keep breathing.

Several minutes later, we get past the danger zone. We’ve conquered that damn broken instrument and the surgery (and the patient) are headed for a successful outcome.

At the end of the case, as I put a special dressing on my patient to make sure he will heal properly, I put my gloved hand on top of Brian’s gloved hand. There’s a pause.

“Thank you, Brian,” I say. “You did the exact right thing.” And then, looking around the room at the rest of my team, who followed our lead and didn’t go to the dark side when things went wrong, “And thank you, everybody. Great effort on all counts.”

As I left the operating room to find the family and let them know all was well, I thought about that question: “How can I best help you now?” And I realized that it’s a question that can be used any time we see a fellow human floundering. They can be hurting from a crisis or just wondering what to next.

It’s the best question. Ever.

Even if you’re not a doctor finding yourself in this scenario, this is for you too. Because there’s always something, whether it’s a life or death crisis, or a friend in need.

So, I’m asking you: How can I best help you now?

I’d love your responses in the comments below.

 

 

Disconnecting to Connect

Disconnecting

There I was, packing for our first big vacation in ten years. Like most people, my husband Chris and I find it difficult to take time off. And taking off more than a week? Impossible.

We were finally going to Italy. A place that had been on my bucket list forever.

As I sifted through the jeans and t-shirts, I said to Chris, “I’m trying to decide about bringing my laptop.”

The look on his face said volumes. Then a long pause. Followed by a sigh.

In measured words, very quietly, Chris said, “You have not had a real vacation from your computer for three years.”

Quickly defensive, I said, “That’s not true.”

Chris proceeded to rattle off the projects that I had completed on our last several “vacations.” They included writing my book, practicing my TED talk, and working on my weekly blog.

I stopped in the middle of the closet. Busted. I hadn’t even seen it.

I flashed back to our most recent vacation, which happened a few days after my TED talk had gone live. I remembered with a heavy heart Chris standing by the hotel room door, sunscreen and ball cap in hand, ready to hit the beach. And then my reaction.

“Just a few more minutes, honey. I want to thank some more people for sharing the link to my TED talk.” Reluctantly, he had sat back down and began reading his book.

Ouch. Don’t you hate it when your spouse (or mother, or boss) is right?

It turns out I’m not alone. 40 percent of people who receive paid vacation do not use all their time, according to a recent Boston Globe article. Half of those people said it was because they were “too busy” at work to take their vacation days.

So, I mustered up my courage and decided to go totally offline during our entire trip.

No cell phone. No laptop. No emails.

Just lots of gelato. And walks on cobblestone streets. And pizza like it was meant to taste.

Guess what happened?

I learned an important lesson:

Sometimes you need to disconnect to connect.


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When we don’t really step away and recharge, we’re just pretending.


It took some planning, for sure. (I’ll be sharing that with you in a future post.)

But the important thing is, I wanted to come clean.

To let you know that I don’t always practice what I preach. And sometimes I don’t even know I’m cheating. Cheating on my health, my husband, my patients.

People who take more vacation have higher performance reviews at work, I recently read in a CNBC article that suggested the best way to get a raise was to take a vacation.

We don’t always know when it’s time for time off.

When we don’t really step away and recharge, we’re just pretending.

Mostly to ourselves. Don’t let that happen to you.

Share with me in the comments below what you’ve been lying about. Maybe it’s a promise to yourself that you’ll take more time off. Or take better care of yourself. Or spend more time with your family. Connecting and sharing with each other can only make us better, on so many levels.

Here’s to more gelato!

 

 

What Doctors Do Differently

I was in the break room at the hospital scarfing down a power bar between three-hour cases. The truth is, I was multi-tasking: eating, writing on a chart, and checking my email in my phone.

I had received an email from a businesswoman, whom I have known for a few years. She wanted to know if I wanted to join her for lunch next week.

I had to laugh out loud.

The rest of the staff, who were busy also grabbing a quick bite in between patient cases, looked up. I read the email out loud.

“Lunch!?” they all said.

Then, we all did the combo of laughing and shaking our heads.

Doctors don’t “do lunch.”

Even when I am in the office, taking a break and actually leaving the office for lunch is out of the question. On those super busy days, I bring something slightly more like real food to eat than my usual power bar. And I heat up hot water for some tea.

But always, as the water warms for my tea, I complete the morning’s charts, fill out paperwork for surgery the next day, and answer questions from my staff on patient concerns.


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Doctors experience the world a bit differently.


So, no. I wouldn’t exactly call this a true “lunch hour.”

The invitation to lunch got me thinking of all the things doctors–and most medical staff– do differently.

Here’s a quick list I came up with in a few spare minutes between patients:

We don’t always sleep through the night. Our pagers or phones are at the ready, whether we want them to be or not, for urgent or not so urgent calls, 24/7.

We don’t try to see movies or eat nice dinners out when we are on call. Yes, it’s annoying for others when our phones ring during a movie. But, what’s more disrupting is having to leave the theater at the best part of the movie to meet someone in the emergency room.

We don’t make appointments to take care of our own health. I know I am not alone when I admit that the few times I reluctantly dragged myself to a doctor’s office, I was almost too sick to walk or drive there. I remember a time when my technician insisted I be seen “Now!” I literally asked if there was somewhere I could lie down as soon as I checked in at the front desk. It turned out that I had pneumonia.

Yes, doctors’ lives are different.

But, if you know me at all, you also know that I am going to find a silver lining to this story.

On the flip side of our differences are things doctors get to do that other people never experience:

We get to wear pajamas (some call them scrubs) and comfortable shoes to work. Not always, but most of the time. Sometimes, the soft cloth of the well-worn scrubs are the most comfy part of the day.We get to hear people’s stories, their fears, their innermost concerns. Our patients trust us. They value us enough to go out on a limb with their own discomfort to seek help.

We get to relieve pain, reduce fear and reassure. Not always. But, arguably, more often than most people.

We are often the first to know. We are in the operating room when the pathologist calls in to report that the lesion thought to be cancer is benign.

We get to be the bearer of great news. We tell the patient and their family the good news of the pathology report.

We get to see the miracle of life when the baby is born. We witness the joy of the parents, and the incredible love-rush that surrounds the entire room, every time.

Yes, doctors experience the world a bit differently.

But, I think it’s a fair trade for eating power bars in the break room during our lunch hour.

Wouldn’t you agree?

 

 

Embrace Your Flaws

embrace your flaws

If you spend even a moment watching TV, looking at magazines or surfing Facebook or Twitter, you’re witness to the “best of the best.”

We see famous and not-so-famous people presenting their very best selves to the world. It’s the rare post (usually a tabloid) that has a photo or article about someone in an old t-shirt and greasy hair, eating a taco with extra sour cream.

Instead we all tend to post our “Sunday best” selves. We share our awards, our children’s accomplishments, our wins.

Once in awhile, someone will branch out and let the air out of their own tires. The blog about the Thanksgiving turkey that turned out to still be frozen or the time the soda can exploded in the refrigerator, resulting in a six hour clean-up on an already busy day are two of my personal favorites (that I posted after experiencing the agony of defeat).


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Imagine – a day where it’s not only okay, but cheered on, for us to just be ordinarily human.


The ho-hum stories where we’re not pretending to be perfect just don’t usually make the press. Those stories about just getting through the day, stopping at the grocery store for the basics, not beating yourself up when you reach for the frozen pizza. And when you do post these, in efforts to keep it real on Facebook, how are the likes and shares on that day? Yeah. That’s what I thought you’d say.

What if we picked a day every week to acknowledge our flaws?

We’ve got “Throwback Thursday” and that’s been embraced.

I’m advocating – – “#FlawedFriday.” It’s a hashtag I don’t see used near enough.

What if we challenged each other every Friday with our geekiest or lamest post?

  • Picture admitting that you went to that fancy business dinner knowing that you had a huge run in your pantyhose.
  • What if you took a picture of your kitchen counter right when you were trying to decide if you should just get a large trash bag and scoop the entire contents in it, including your son’s homework that must be in there somewhere?
  • How about admitting that you pulled into the fast food drive thru for an unhealthy breakfast on your way to the office or the operating room, just because you felt like it? Even though your pants were snug.

At the end of the day, is anyone going to love you less because you have a run in your hose? Or because your junk drawer is what it’s supposed to be — junky?

 

Embrace Your Flaws

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Au contraire. I bet you’ll be that much more loveable. And from a coaching perspective, you’re being open and real about who you are is going to make you more loveable to yourself. And then the vicious cycle of happiness begins.

Sure, the first few “Flawed Friday” posts will take some gumption. It’s not easy to be authentic when we’re authentically a mess.

But imagine the fun! Comparing notes on the most delicious donuts we ate on our “cheat” days. Or admitting that we threw on scrubs because we didn’t have energy to do laundry the night before. Or sharing pictures of our family’s grins as they eat franks and beans for dinner instead of broiled chicken and salad greens.

Imagine – a day where it’s not only okay, but cheered on, for us to just be ordinarily human. Embrace our flaws. And each other. Who’s in?

 

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How To Jump Start Your Attitude, Productivity and Success

attitude, productivity and success

Mornings are always a good time for me. Luckily, as a surgeon, that works to my advantage.

Yes, I’m one of those wacky people who sets my alarm at 4:15 a.m. (6 a.m. on weekends!) and I feel like my mornings are sacred.

The downside? By 8:30 or 9 at night, I’m not a very good conversationalist. And most times, I’m heading off to bed.

So what if you’re more like that person who gets up around 6 or 7 a.m. and leisurely plods into the kitchen in your slippers, sleepily making your first cup of coffee? Does that mean you’re going to be less positive, productive, or successful than the early riser?

My take on it is this: it doesn’t matter when you start your day. Truly. It matters how you start your day.

When you first open your eyes, no matter the time, just get up. Don’t hit the snooze button.

My first thought is something positive. Usually it’s “Something wonderful is going to happen to me today.”

Sometimes, as I’m brushing my teeth, instead of dreading the long surgery day or the over-scheduled office, I ask myself, “Who can I thank today?”


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Each time you choose to take another step forward, it’s a win.


According to Mel Robbins, in her viral TEDx talk, we have five seconds on awakening before our brain talks us into snuggling under the covers and not taking action.

When I first heard about the “5 second rule,” I thought it was that rule about how if a brownie drops on the floor and you pick it up within 5 seconds, it’s still okay to eat it. While a study in the National Geographic is still debating the merits of eating off of the floor (yikes!), Robbins’ 5 second rule has to do with behavior of a different sort.

The way Mel explains this is that whenever you have an idea that seems like a pretty good one, don’t give your brain the time (over 5 seconds) it needs to trick you into thinking it’s not at all a good idea, “Because your brain’s main job is to avoid trouble and risk, so in less than five seconds it will persuade you to abandon your idea.”

She recommends counting down from five when your alarm goes off and then getting the heck out of bed. Just – as Nike says – do it!

And when you have an impulse to call that new person to meet for lunch or apply for that new job… just do it!

Each time you choose to take another step forward, it’s a win.

It might be getting dressed for the gym or eating healthier or staying off social media for a day.

Did you know that 85 percent of us start our day with other people’s agendas, by checking our email inbox? What would happen if that changed? I tested this out over the past few months.  I’ve been starting my day writing and sending an email of gratitude before even looking at my inbox. The difference has been nothing short of amazing.

After sending a simple two-sentence email of thanks to one of my business partners for his hard work for our medical group, I got a response within 20 minutes from him. He said he was grateful that I acknowledged his efforts and he valued my friendship. Who knew?

How can you jump start your day today?

There’s surely someone you can send a message of gratitude to. Or you might write just one paragraph of that book that’s in your “idea file,” or maybe hit the gym. . .

Give us your best ideas in the comments below. We all need help when it comes to jump-starting our day!

 

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The Fastest Way To Get What You Want From Your Life

get what you want

Somewhere along the way, I’m pretty sure you’ve had that experience. The one where you know you need to break up with someone or something: your partner; your dry cleaner; your neighbor; even your job.

And then you have “the discussion.” You know the one I mean. The one that starts with, “It’s not you, it’s me.” This is usually followed by a string of stories . . . “I’m just not ready” . . . “I’m really picky, so that’s why your dry cleaners doesn’t work for me” . . . “I’d love to meet for coffee, but I’m too busy with my child/my work/my needlepoint.”

You get the idea.

And sometimes, that’s the easiest, safest, quickest way to play it.

But what if (gasp!) — it’s not them. And it really IS you.

Crap.

What if you are outgrowing that person or situation? What if it’s holding you back from what you know your purpose to be, and the goals you’ve not yet achieved?  Whether it’s your practice as a physician, your yoga class, or your best-friend-since-high-school, something’s gotta give.

Now what?

The way I see it, you have two choices: stay or move forward.

Once you know the truth, staying causes a little bit of chipping away at your True North. Every day.


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Are you treading water or swimming toward your True North? Only you know.


It’s like eating too much sugar when you’re diabetic. You know it’s bad for you. But old habits die hard.

Here’s the stronger option:  Own your power and move forward.

Staying where you are is an option. And sure, you may not die from it (or you could), but you may die a little inside each day if you choose to do nothing.

The first thing to do is to begin. To do this, sit down and write out the things you are doing today that are holding you back.

  • Are you staying with the same work schedule and losing some joy in your world every week?
  • Are you procrastinating taking up that new hobby or pastime because it takes too much effort to begin?
  • Are you just treading water?

One of the reasons people fail to accomplish their goals is due to lack of accountability. Moving forward means taking action on the things you say you want to do.

As a life coach, I’ve learned that accountability is one of the fastest ways to make desirable change a reality.

A lot of people think you can find accountability with a friend or family member. And that works for a little while. But things get sticky when you’re using your personal relationships to help you move toward your goals.

I’ve invested in myself by hiring many coaches over the years. And I’m not one bit regretful of that. Imagine what would happen if you had clear goals and it was someone else’s mission to make sure you get from point A to point B? You get there a lot faster than meandering and just talking about it. That’s the beauty of accountability.

Now try this: List three goals you want to reach by this time next year. And next to each one, write what you think is holding you back. Share them in the comments below – I’d love to hear.

 

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How You View the World Can Lead To Burnout (Or Save You From It)

view the world

The eye is the window to the soul.

In case you missed it, I’m a board certified practicing ophthalmologist. My main “day job” actually involves a subspecialty of ophthalmology. I tell my patients, “We divide the eye into parts. Some people focus on the cornea; some on the retina; I focus on the eyelids.” Yes, it’s a “thing.”

But at the root of my training is the eye. I joke that ophthalmologists focus on the eyes and all they see.

And I’m only half-kidding.

Here’s the thing. . .

Some people are near-sighted (they can see things up close) and some are far-sighted (they can see things at a distance much better). I was the near-sighted kid. But I didn’t know it.

There I was, at the circus with my best friend, Connie, to celebrate her turning 10. She kept talking about the lions in the center of the stage. We were up in the nosebleed section, and all I could see was blurry colors.

It wasn’t until she handed me her glasses in the car on the way home, and I tried them on, that I realized, “Holy moly! There’s a whole world out there. The trees have leaves!”

So why the lesson on eyeglass prescriptions?

Because there’s a lesson in it for all of us. Even if you think you’ve got 20/20 vision.

When you’re near-sighted, in terms of how you view the world, it means you can’t see your vast potential. You can only see this moment’s action. You can’t see the future implications for what you’re doing right now.

When you mutter a curt word to your staff, or roll your eyes at your mate — you can’t “see” how that taints your future. You also might not see how spending that extra twenty minutes with a patient today, to explain her treatment options and encourage her, may impact her and her family for years to come.

And then there’s the other side of the spectrum…

When you’re far-sighted, you can’t appreciate what you have in your hand.

You keep thinking you’re not fulfilling your “purpose.” You miss the little things happening every day, right under your nose — your child’s smile when she scores a goal at the soccer game, your spouse’s hug as you leave for work — and forget to cherish them. Because you keep looking outward, further on down the road.

According to research, when you’re not seeing clearly, that lack of clarity and ambiguity can lead to burnout. This happens on so many levels. It’s in how we perceive ourselves, our lives, and our professions. This even happens to volunteers when they’re not clear about their role in the organization.

What’s the answer? How can we find the balance we need to nourish our souls? Oh, I wish there was corrective vision surgery that would cure what ails us, every day.

It might be that “we’re all becoming blind to each other.”

But remember this:


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Keeping your world in focus gives clarity. And that’s real 20/20 vision.


What could you be seeing more clearly to take you from burnout to balance?

Please share in the comments below.

 

Doctors with More Empathy Win Patients and Improve Hospital Scores

doctor empathy wins patients

We’ve known for awhile that doctors who show more empathy have better patient-physician relationships and can actually have fewer medical errors.

And there’s a direct correlation between job performance and empathy. Forbes writer George Anders calls empathy The Number One Job Skill in 2020, naming this the common trait in a wide range of occupations—from teaching to healthcare to customer service.

The truth is that the position we’re in as doctors and leaders requires a higher than average level of empathy. So, if we know that empathy wins friends and influences people, why don’t we just use it?

One thing that stops us is the roadblocks along the way, according to David Swink’s Psychology Today article. Roadblocks like lack of attention, not knowing how to communicate with empathy, and just not “feeling it” all make it tough to show empathy for our patients and others.

So what can we do?

Should we fake it till we feel it?

A new study suggests that there’s a way we can gain empathy as we feel it.

Niki Gianakaris reported that when people experienced mild discomfort by rubbing their hands on sandpaper, they became more empathetic.

According to the findings in the Journal of Consumer Psychology, when participants touched the rough surface of sandpaper, they felt more empathetic and were even more inclined to give charitable donations.

Okay, where are we going here? Does this mean we need to keep a stash of sandpaper or an emery board in our lab coat and give it a rough go before we interact with a patient, especially the grumpy patients? That might actually work, but that’s a research project for another day. 🙂

So how CAN we use this in our medical practice?

What if we were to find a way to connect with every patient?


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Connection with your patients can lead to empathy.


Here are three easy ways to foster connection and improve empathy that I’ve learned through coaching clients over the years:

  • Find something in common: a sports team you both love; a hobby; pets.
  • Decide that something about them reminds you of a loved one or an old college friend. Do they wear the same perfume as your grandmother? Have a Southern accent like your Uncle Fred? Or have that funny way of grunting at everything you say?
  • Invite them to join with you, and make them part of the process. Let your patient know that the two of you are a team when it comes to their surgical outcome or their health goals. You’ll find this will get your patient on board with the plan, and make them feel less guarded or defensive.

 

What’s one way you’ve found to add empathy in your practice? Please share!

 

 

 

How Ordinary People Inspire and Teach Us

Inspire and Teach Us

The author and Buddhist nun Pema Chodron said, “Nothing ever goes away until it teaches us what we need to know.”

When we find ourselves in tough situations, there’s usually something to learn. This also goes for people in our lives, even the ones that feel ordinary.

I have a practice of having my O.R. team name 3 things they’re grateful for every day, as those of you who’ve seen my TEDx talk know.

This has served me well and gets me, the patients and the staff in the right mindset.

But last week I decided to change it up. I asked them to each describe someone who had helped them in their career. I was blown away.

And it made me realize this…


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Each of us has an impact on others beyond our imagination.


Here’s what I learned:

  • My scrub technician had started his training in the military. He was assigned to a war zone and was right in the thick of it. One day, it got to him. He was in the supply closet, crying and scared. Who could blame him?

His commanding officer came in and talked to him. After a long talk and some tears, the commander said, “Remember that you are an AmeriCAN, not an AmeriCAN’T.” That stuck with him and gave him the strength to hang on.

  • My circulating nurse worked as a floor nurse in the hospital years ago, and she had several bad weeks in a row. She questioned if nursing was really her calling.

A good friend of hers who was also a nurse said, “You do all you can do with the situation you have, and that’s all you can do. Then you go home and sleep, knowing you did the best you could.”

  • My anesthetist trained with an anesthesiologist who not only taught her everything he knew about medicine, but about the importance of taking time for oneself, having a family life, and enjoying the journey.

In fact, he offered her a job when she graduated but recommended that she not take it, as she was a young single woman and he didn’t think she’d find a life partner in their little town. (He tracked her down several years later after she married and had a baby and said, “Now you can come to our town!”)

  • For me, my story starts with one of my professors in residency who encouraged me well beyond the “usual and customary” at a time when I was doubting my ability to stay in ophthalmology.

The weird twist of fate is this: When my professor was five years old, his neighbor (who was six) saved him from drowning. Now, had this neighbor not been there, would I still be where I am today? Only God knows.

 

Each of us has an impact on others beyond our imagination. And how we approach others matters.

Who has shaped who you are today? I’d love for you to share in the comments below.

 

 

 

The High Achiever’s Guide to Being Enough in 3 Steps

Being Enough

How do you feel when you need to refer a patient elsewhere because their problem is outside your expertise?

I used to feel inadequate and think my patients would be upset with me. But time and again, they just seemed grateful that I was getting them to the right person for their problem. The only judgment in the room was my own – which probably comes from being a high achiever.

It got me thinking about why burnout is more of a problem these days for high achievers. How much is our own negative self talk adding fuel to the fire? Is it that we really aren’t enough, that we aren’t trying hard enough, making breakthroughs enough, accomplishing enough? Or do we just think we’re not enough?

We’re not robots. Medicine is not as exact a science as we want it to be. People don’t always respond as we think they should to our surgery or our medical treatment.


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Stop beating yourself up for imperfections only you perceive!


And that’s a problem.

When the negative nellies overwhelm us, the conversations we have in our heads are either going to support or sabotage us.

We’ve got to start believing that we are enough.

Cut yourself some slack, already.

Just like my patients who are perfectly okay with me not being able to perform a procedure outside of my realm of training, you need to be okay with not being able to perform miracles in the O.R., in the board room or at home.

It all begins by putting yourself first.

Here are 3 ways to remind yourself that you are enough:

1. Make a list of your strengths. Those strengths are your super powers!

2. On the same page make a list of your weaknesses. You can’t be great at everything. Love your super powers, accept your weaknesses and move on.

On the same page, make a list of ways you can spend less time and effort on the “weakness” category. Can’t bake a cake? That’s why God invented bakeries!

3. Acknowledge your “enoughness” every day. Positive affirmations (“You did great today.” “You are a loving parent.” “Your speech was amazing!”) can make the difference between feeling just okay and feeling awesome.

 

If you were coaching yourself, what would you say? What positive feedback would you give yourself?

True confessions time. Which of these is the toughest for you to do?  Share your comments with me below.