How to find sparks of joy [PODCAST]

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“Keep it Simple is a bumper sticker slogan. Life during a pandemic has been anything but simple, and the holiday season presents (not the gift kind) its own special challenges. So does living alone and trying to stay humanized. In his book Together: The Healing Power of Human Connection in a Sometimes Lonely World, Surgeon General-elect Vivek Murphy describes loneliness as associated with increased risk of mental and health difficulties in the BC era (before COVID-19). All the more so within such a challenging year of physical separation and trying to maintain a connection with others, with ourselves. So much angst, uncertainty, loss …

And yet … here we are poised at the brink of a new year with vaccines being distributed and a true sense of hope and healing.  We’re medical educators who teach health professions students and professionals about resilience and adapting to adversity, but here we are, needing to walk the talk. Big-time. We met via Zoom for a Virtual Tea to share about our lives and not just our work. There was some laughter, the best medicine.  And we reflected on negotiating living alone and the stuff of life that sustains, even enriches. Daily “little sparks of joy” can help. We offer you our “21 for ‘21” and hope the simple can be profound.”

Hedy S. Wald is a clinical professor of family medicine, Warren Alpert Medical School, Brown University, Providence, RI.  She can be reached on Twitter @hedy_wald. Monica van de Ridder is an assistant professor, College of Human Medicine, Michigan State University/Spectrum Health, Grand Rapids MI. She can be reached on Twitter @MvdRidder.

They share their stories and discuss their KevinMD article, “21 for ’21: little sparks of joy.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Hedy Wald and Monica van de Ridder. Hedy is a clinical professor of family medicine and a clinical psychologist. Monica is a medical education specialist. Together, they wrote the KevinMD article “21 for ’21: little sparks of joy.” Hedy and Monica, welcome to the show.

Hedy S. Wald: Thank you.

Monica van de Ridder: Thank you.

Kevin Pho: We’ll get into your article in a little bit, but we’re going to ask each of you to share your story and your journey to where you are today. Hedy, why don’t we start with you?

Hedy S. Wald: Great, thank you so much. So it’s been kind of a joyous adventure, in a sense, for me as a clinical psychologist. I came to Brown, to the medical school there, in 2005, and I got super interested in the use of reflective writing, guided reflective writing, to enhance reflection and support professional identity formation. So I’ve been working in that space for many years now, and I direct the reflective writing curriculum in our family medicine clerkship, and I speak internationally on those topics, as well as resilience, well-being, and flourishing.

I’m very interested in moral formation, professional identity formation, and now the role of medicine in the Holocaust and the use of the humanities in medical education. So it’s been quite a joy for me, and that connected me with Monica, because we both got interested in this idea of wellness. Monica, did you want to share a little of your story, and then we’ll talk more about the article?

Monica van de Ridder: Yeah, I think Hedy and I met at AMEE, and we started talking, and soon the conversation did go deeper, so beyond kind of our professional stuff and more into the personal. And then we decided, “Let’s do a follow-up call,” especially with the pandemic, and in that follow-up call, the 21 for ’21 was born.

Kevin Pho: Excellent. And Hedy, just before we get into your article, why is reflective writing so important in medicine?

Hedy S. Wald: Yes, it’s an interesting question, and it’s something that we could spend a whole-day seminar on, but we don’t have that. But reflective capacity, the skills of critical reflection, are an essential skill set and competency for one’s professional competency, so that we can bring our intentional presence, our mindful presence, recognition of dilemma, challenge our assumptions, and gain multiple perspectives for our transformative learning.

And reflective writing, which is guided writing with a prompt and then individualized, personalized feedback, with some of the frameworks that we’ve developed at Brown and published on, is very helpful for a learner to enhance their breadth and depth of reflection. So the writing itself kind of serves as an architecture, a way to crystallize experience and work with emotional processing, which are all important competencies in being a reflective, humanistic, morally resilient practitioner.

Kevin Pho: And Monica, your training is in education. Tell me, over the past year, what are some of the challenges that you’re facing regarding that intersection between the pandemic and education?

Monica van de Ridder: Yeah, so my education is that I’m trained as an educational scientist. I’ve worked for 20 years in medical education already, first in the Netherlands, and about five years ago, I moved to Michigan and worked at Michigan State and at Spectrum Health. What I mainly do in my daily life, a large chunk of it, is teaching our clinicians how to become better at teaching. Well, teaching is all about conversations, so you learn a lot about them, and resilience is a word that definitely comes up a lot. All our teaching moved from in person to Zoom, and that’s a big transition, and you see that people crave kind of the personal attention, and that easily led into our article.

The other thing that connects with it is that the focus of my research is on giving and receiving feedback. So in that area, you’re always working on a one-on-one and very personal basis with clinicians, with learners as well. And when you are good at asking for good feedback and also giving good feedback, you’re caring for the other, and that is a topic that is very closely linked with resilience as well. And I think because of our two different backgrounds and our two different types of expertise, it blended very well.

Kevin Pho: And Monica, you could argue that physicians are really just teachers at heart. Not only are we teaching other clinicians, but we’re in the exam room teaching patients as well. Now, what would you say is the number one thing that’s missing in the clinicians that you teach? What’s the number one tip that you can share with them so they can become better teachers?

Monica van de Ridder: So I think what we all need to work on is to help each other recognize the teachable moments. There are many teachable moments during a day, but when you’re so focused on, for example, patient care or your struggling learner, you don’t always recognize them. And I think we all, and with “all,” I mean not only people like me, but also the nurses, the residents themselves, the colleagues, we all need to help each other point out where the teachable moments are, and that’s the lens we have to set up. Then teaching will go easier, because a teachable moment doesn’t mean an hour. That can be two minutes, half a minute, but it’s all about recognizing that.

Kevin Pho: All right, so let’s transition now into the KevinMD article that both of you wrote, and it’s titled “21 for ’21: little sparks of joy.” Hedy, for those who didn’t read the article, can you just walk my audience through it and share the story of why you and Monica decided to write it?

Hedy S. Wald: Sure. So I wanted to start by saying that it originated with a Virtual Tea, and thinking about connecting and bringing our personal narratives to the work that we do as professionals. I talk about that a lot, kindness and connection, and there have been higher statistics, even on the Medscape surveys, of more loneliness, even during these tough pandemic times.

So Monica and I got together and just started chatting, and she was mentioning some of these lovely things she was doing, not only to take care of her own well-being, which we know is a moral imperative, because we know when we’re more well, there’s less patient error. So it’s actually a nice thing we do, but it’s also an imperative for us as professionals. And I was struck by how sweet they were. She was helping others, and she was helping herself, and she was doing things through Zoom and not using excuses of, “Well, we can’t see people right now.”

And I said, “That’s amazing. I love that. And let me tell you about some of the things that I’ve been involved in,” whether it be music or connecting through support groups or self-compassion. And then I just said, “Gee, these sound cool. Maybe we need to put together some practical tips,” along with the fact that both of us are very involved in scholarship on resilience, well-being, and flourishing. But maybe there are just some practical tips that people would love, and that’s how it got started.

Kevin Pho: Excellent. I know both of you wrote a set of tips. So Hedy, why don’t you go first? What are some of the tips that you could share that you wrote about in the article?

Hedy S. Wald: So I think what Monica and I were both doing was bringing the idea that simple can be profound, and capturing those beautiful moments of joy. And the spark: I think it was, wasn’t it, Springsteen who sang, “You need a spark to light a fire”? Each of these things can have ripple effects, and we know that, like there’s negative contagion, there can be positive contagion, and we impact others’ wellness in our attitudes and what we bring.

So one area that’s gotten a lot of attention recently is self-compassion, to say that, yes, we have empathy for suffering patients and even colleagues going through difficult things in their lives, but what about us? And it is a pandemic, and yes, we had to switch things very quickly, as Monica was saying, so there’s a shared humanity in some of that, and really feeling that for ourselves. So that was one of the things that I mentioned.

Another thing was that I love music, but I never got into it as much, and I joined, through Twitter, Doc Through Rock, hashtag DocThroughRock, and watched doctors playing instruments and sharing music. And we have jazz; Paul Hayden has talked about jazz for COVID, and beautiful, peaceful moments. So I got very involved in that on my long walks, using music. I loved that. And then several other ideas of what I was doing: There have been some physician support groups that get together to discuss different aspects of things on a personal basis, and that’s been helpful as well. And then talking about joy: JOY, meaning “just one you,” is what I like to say it stands for, and maintaining a sense of hope through all of this. I’ll punt it over to Monica, because I know she also had some lovely ideas and different ideas that she was bringing through in the sparks.

Monica van de Ridder: Yeah, I think for me, before I wrote it, I started to realize I have quite a bit of other-focus, and sometimes I forget to focus on myself. I have a Christian background, and one of the commandments in the Bible is that you have to love your neighbors as yourself. And it says not above yourself, but as. So that means you have to equally love yourself as you do love your neighbors. And then I thought, “You know, that is something I need to start working on.”

And I think by doing the simple things, because we couldn’t do a whole lot with the pandemic, I really forced myself to focus on the simplicity. I had a tough month in December, because all my family was in the Netherlands, but the borders were closed, so I couldn’t go there. So I started recording, for example, little pieces of stories for my nieces and nephews, and I sent that every day. And then it turned out a lot of my other grandnephews and great-nephews, or whatever they were, were listening to it too. And then, you know, it is that vibe that you get back that gives so much, but also, for me, the enjoyment of picking a story and reading it to them, the joy that gave me.

But also other things: I made it a point that I had a little vase of flowers on my desk, sometimes only one, sometimes more, and it’s those little things that can make a difference if you have an eye for that. A third one is, I like cards, museum cards. I used to buy a lot of them, but I always thought they were too nice to send away. And then I thought, “You know, after a while, I should start writing a card to myself,” the friendly Monica to the Monica that needs kind of some support. And it’s very healing, even now, to read those cards back and to reread the lessons that I thought I needed to work on. And then sending out those cards to others, it’s just that unexpected smile, imagining that you can put on somebody’s face.

Hedy S. Wald: It just reminds me, Monica, also that we talked about this, and I included this in the article: Some of those beautiful praise cards that we get, or thank-you notes in the mail or whatever, or even emails where someone said something nice, print it out and put it on your desk to remind you on those tough days. It’s just so beautiful to have it right there, right in front of your face. I mean, I had students once, after a seminar I gave, who actually wrote a note and mailed it, which was such a gift, because everything’s always email, and I put it right in front of my face. So I love stuff like that, and just seeing the good things that are around us and can give us that kind of joy, which then is the ripple effect, or even wave effect, of people around us.

Monica van de Ridder: But what I also learned is you have to make it a point. So for example, one of my strategies was reading a chapter a day to kind of keep myself energized. Normally, I put a chapter at the end of my day, when I felt I was finished, but I realized I never came to reading that chapter, because I never had that feeling of being finished. So I started planning it in the middle of my day, and taking that deliberate effort to create a couple of minutes of me time, I think, is very important.

Kevin Pho: We’re talking to Hedy Wald and Monica van de Ridder. Hedy is a clinical professor of family medicine and a clinical psychologist. Monica is an educational scientist. Together, they wrote the KevinMD article “21 for ’21: little sparks of joy.” Hedy, we talk about physician burnout a lot on this podcast, on my site, and I always cite the statistic that more than 50 percent of physicians are burnt out, even before the pandemic. And the pandemic, of course, is making things a lot worse. You see physicians getting furloughed, and they’re just asked to do more, and budgets are being cut.

Now, I think a lot of these tips that you give, a lot of these stories, are very, very inspiring. I was wondering, for that clinician who is overwhelmed with paperwork, under all these time constraints, what’s the single biggest actionable tip that you could give to them that would make a difference?

Hedy S. Wald: First and foremost, we know from the literature that even 20 percent of meaning in your day, meaning and purpose, can be super helpful in pushing through some of the tough realities. But the other aspect of this, and this is one of the tips that I had mentioned in our article, is that I wrote a piece that actually has over 9,000 views now, for Medical Teacher, with over 100 references, on integrative resilience. So one of the things I would say is think about well-being and resilience in an integrative way: It’s not just “go fix yourself, go feel better,” but there are other things we can do in the learning environment and also within the organization system, in ways of getting involved in committees, for example, and having some participation within all of that.

Hopefully, we will get that message out there, that even in these tough, challenging times, it’s a collaborative effort, and to try our best. There are talks now of trying to develop a more humane EMR, for example. And I think that as we see that it makes sense on the bottom line for the corporations to get their physicians, nurses, and other health professionals in a better space, perhaps then we can see some changes.

I wouldn’t say that there’s just one answer here, but I do think that even within the organization system challenges, we have to work on some of our individual skill sets as well. We have to do that. And I think this article was one way of kind of thinking about it, that even small bits of wellness during the day may make a profound impact and effect.

Kevin Pho: And I’m going to end off with take-home messages from each of you to my clinician audience. Monica, what’s your take-home message you want to leave with us?

Monica van de Ridder: Make it a deliberate point to care for yourself. And related to your previous question for Hedy, what I have encountered myself. A colleague of mine, and that’s one of the tips in the article as well, we were both going through a tough time. We decided to meet every week for half an hour and talk about our wellness and our wellness actions for the next week. I mean, it doesn’t cost anything, but she’s a very good therapist, and I think I’m a good one for her. So connecting, showing your vulnerability, that really brings you far.

Kevin Pho: And Hedy, what’s your take-home message?

Hedy S. Wald: And Kevin, as you and I spoke about earlier, I was honored to have a piece about coping with my husband’s, who was a neurologist, diagnosis of glioblastoma, as a cancer caregiver. It was published on KevinMD and received a lot of readers and a lot of response to me. What I wanted to say about that is to always remember that kindness is a lifestyle, and that it means so much. Maybe the culture change we’re looking for is the words, “How can I help?” And always remember the narratives of the people around you and your colleagues, that you never know what people are going through and what their situations are. And we need to help each other and connect in that way, and give the benefit of the doubt.

So I think that some of the wellness work we do, you know, when we bring our well self, it helps others around us, and we reach out to those who need a little bit of extra help, and that can make a huge difference in all our work. And the narrative of us individually, and the narrative of “we” as the organization, makes a huge, big difference. Remember that the sparks start a fire. And the quote that I had in the piece was, “While I breathe, I hope.” So I like to always say that, and maybe end on that.

Kevin Pho: Hedy and Monica, thank you so much for sharing your time and insight, and thanks again for being on the show.

Hedy S. Wald: Thank you so much.

Monica van de Ridder: Thank you.

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