Physician Professional Fulfillment

Occasionally in life there are those moments of unutterable fulfillment

which cannot be completely explained by those symbols called words.

Their meanings can only be articulated by the inaudible language of the heart.

Martin Luther King Jr.

We each define and experience professional fulfillment in different ways.  For me, as a family physician, relationships with patients and peers bring a sense of meaning and fulfillment to my work.

One evening at about 9pm I received a call from Mary, an elderly woman who had been a patient for many years.  She struggled with anxiety about her health, so I made every effort to return her calls quickly.  When I received her call, I was tucked in bed with a high fever.  I had contracted pneumonia and had been out of the office for a few days when my pager went off.

“Hi Mary, this is Dr. Roman.  What’s going on?”

There was silence on the phone.  After a few seconds, she responded:

“Dr. Roman, is that you?  Oh my goodness, you are way more sick than I am.  I want you to hang up this phone, get some tea and wrap yourself in a blanket.  Don’t call me back until you feel better.   You hear me?  I will call to check on you tomorrow.“

As I cared for Mary, she cared for me.  These compassionate moments with patients fill me up. They give me energy for the long hours and many demands and challenges of medical practice.

My relationships with physician colleagues are equally fulfilling.  Throughout my career, when I have encountered circumstances that challenge me, I have connected with peers.  These relationships provide a stable foundation for open, non-judgmental conversations.  They help me to make sense of my world and find my way forward.

The landscape of medicine has changed dramatically over the past few decades and the daily practice of medicine has been significantly altered.  For many physicians, time with patients has been drastically reduced, making it difficult to cultivate strong, mutually respectful relationships.   My colleagues and I no longer meet in the doctors lounge each evening while completing our hospital rounds after office hours.  Many of us work in what has been described as “silos” without the benefit of regular conversation with peers.

These changes in healthcare have prompted me to look more closely at the factors that enhance and diminish my level of professional fulfillment and identify specific ways to respond in alignment with my values.

A relatively new resource for physicians seeking fulfillment is professional coaching.

Participants who received professional coaching had a significant reduction in emotional exhaustion and overall symptoms of burnout, as well as improvements in overall quality of life.

JAMA Internal Medicine 2019

During group coaching, physicians come together in community with peers who share the physician experience to explore and address issues that are relevant and meaningful to them. The participants benefit from the support and insights of colleagues as professional coaches (who are also physicians) facilitate.   

The topics for each session are determined by the physician participants.  Discussion topics may include the transition to new roles, misalignment between individual values and those of the physician’s employer, cultural biases, administrative/regulatory demands, interpersonal conflicts, disillusionment and other issues that are of interest to the group.

I am continually inspired by the insights, engagement and enthusiasm that arise during group coaching sessions. Three foundational aspects of physician group coaching contribute to meaningful and transformational experiences for physicians:

1. Respect for the unique experiences, creativity and resourcefulness of each physician participant:  A coach can’t possibly know what another physician is experiencing or which factors will lead to an enhanced sense of meaning or fulfillment for that individual.  Coaches cultivate a non-judgmental space for exploration and encourage physician participants to identify these factors for themselves.

2. Integration of deep listening and reflective inquiry:  Professional coaching differs from conventional coaching (in athletics, for example) where development of specific skills is the focus. Professional coaches do not advise, mentor or teach.  Instead, experienced coaches actively listen, offer reflections and ask pertinent questions to allow participants to view situations from new perspectives and uncover possibilities that may not have been appreciated earlier. Active listening and reflective inquiry are also practiced by the participants.

3.  Focus on forward movement:  As insight and clarity emerge, physicians decide how they would like to integrate their new awareness moving forward. Many physicians share that when they determine for themselves how they would like to respond, their experience is meaningful, sustainable and empowering.

At a time when there is a great deal of isolation and division in healthcare, and many physicians express that they do not feel heard, lack autonomy and have minimal control over factors that are significantly impacting their work, group coaching provides a unique and valuable opportunity for physicians to access their capacity to choose and achieve changes that contribute to a greater sense of satisfaction and fulfillment.

Between stimulus and response there is a space.

In that space is our power to choose our response.

In our response lies our growth and our freedom.

Viktor Frankl

The Practice of Wisdom

A few months ago, I received this text from my dad and have found the words inspiring:

Thought you might be interested in a David Brooks article today in the New York Times on the definition of wisdom. Over the ages, people tended to define wisdom as superior knowledge, but Brooks suggests that in his experience wisdom is less an impressive body of knowledge and more a way of relating to and influencing others.

Wise people usually do not tell a person what to do. They know that people only change after they feel understood and the really good confidant, those we go to for wisdom, first brings a "quality of attention" to your story, accepts it, learns how you deal with difficulties, and only then provides a non-threatening nudge to help you consider changes to your actions or relationships. It is the skillful process of walking people to their own conclusions that may constitute wisdom.

In our ideological age, where we are led to identify ourselves in categories -- male/female, black/white, liberal/conservative etc., perhaps wisdom can be seen as the way we interact with people of different opinions, not as types but as more nuanced individuals trying to understand opposing points of view and new ideas for narrowing our differences.

My dad and mentor, Jerry Sheinbach

Root Down Reach Out

There is no power for change greater than a community discovering what it cares about. 

Margaret J. Wheatley

My grandpa Sam emigrated to U.S. alone. His family remained in Ukraine. When he learned of deadly pogroms at his family's village, he returned home to help rescue his parents and siblings. This was a difficult task even if only 5-6 people were involved, but when he arrived, scores of neighbors begged him to lead them to safety. 

He was conflicted, knowing full well that the effort was extremely challenging and dangerous, but his sense of responsibility to his community was very strong and he eventually led more than 100 people across Europe to the U.S., likely saving many of their lives.

The long trip was treacherous and required remarkable courage, ingenuity and cooperation.  Before they started on their journey, the villagers collected names on tombstones in a local cemetery so they could create new identities. My grandpa mapped out a complex escape route involving multiple border crossings while the travelers secretly packed belongings and gathered supplies.  Since many in the group did not have enough money to cover expenses, my grandpa used his savings to help them.

Demands for large payments from corrupt border guards and a clash with a pickpocket, who stole all of their money, almost derailed their efforts.  Yet, the traveling community was committed to sharing responsibilities and adhering to rules for safeguarding and supporting all members of the group.  They worked together to obtain food, spot police and assist those with disabilities.  

Remarkably, the pickpocket was tackled by one of the villagers before he could take off with their cash, and at one point, my grandpa secured an entire railroad car to carry their large group across Europe without interference from border guards.

Such extraordinary service and dedication to community, with input and participation from individuals with diverse abilities, perspectives and experiences, is integral to the success of efforts to address the complex challenges that threaten the health of our communities.

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In contrast, during the current pandemic, the desperate efforts of clinicians to manage the barrage of hospital admissions, decrease soaring infection rates and care for patients who are seriously ill, struggling to breathe and isolated from their friends and families are being undermined by disputes concerning appropriate citizen behavior.  

Our shared responsibility for the health of our communities, essential to curb this global public health crisis, has been overshadowed by societal divisions and political agendas that impede respectful dialogue and cooperative efforts to alleviate suffering. 

What are the reasons for the striking difference between the current response to the coronavirus pandemic and the response of my grandfather’s community to the threats during WW2?

How do we cultivate the deep commitment to community and innate tendency to care for each other expressed by my grandfather and his village?

These questions provided the impetus for the creation of Compassionate Communities - an inter-generational community healthcare movement organized to rekindle cooperative responsibility for the health of our communities, advance health equity and inspire compassionate action. 

Our founding chapter in Idaho collaborates with community partners to address the most pressing healthcare issues before us. We are currently focused on significant impact of the decline in air quality associated with increasing wildfires on community health, the complicated public health concerns during a pandemic and the profound health inequities that do not allow our neighbors, friends, family members and colleagues to thrive. 

Root Down Reach Out, our hashtag and the name of our “one person-one tree” initiative, reflects our vision for a healthcare movement with the foundational strength and potential of an engaged, inclusive community.  

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We have integrated a model for social change described by John Paul Lederach, a sociologist who describes his work as peace building.  John Paul has endeavored to bring about conflict transformation in war-torn areas around the world for decades.  

He proposes that social change always begins when a small group of people decide that circumstances are intolerable.  In these instances, pain and suffering drive them toward each other.  Once they meet, rather than focusing on how to address the issues, they first ask: 

“Who Do You Know?” 

NOT who do you know who agrees with us, but:  "Who do you know with whom you have a relationship who you can invite to join our conversation?”

John Paul suggests that our friendships provide an essential, sturdy and flexible foundation as we work to address complicated social and cultural issues.  With this foundation, we are more likely to listen respectfully, consider new ideas, recognize our biases and endeavor to understand each other. 

He emphasizes that if we hope to generate widespread transformational change, we must 

“Always preserve the dignity of others” 

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This past year, as infections and deaths escalated, long term, serious health consequences from the coronavirus became evident and inconsistent messaging and politicalization of the healthcare response fueled division, mistrust and violence, Compassionate Communities focused on pursuing efforts to encourage action in the interests of the overall community.  

We launched the Compassionate Connections Community Healthcare Forum to provide opportunities for community members to come together informally to strengthen relationships, explore issues that impact the health of our communities and identify opportunities to enhance understanding, collaboration and community well-being.  

In alignment with our vision, every time we meet, we each invite people with whom we have relationships to join the conversation. Salient questions serve as starting points for our conversations.

At the core of our work is our commitment to welcome diverse voices and strive to identify common ground.  Even when the issues are critical or life threatening, and perhaps especially then, we ask each other:  “what can we agree upon?”  Sometimes, the only thing we can agree upon is that we love fresh coffee - so we start there.  

Identifying common ground when exploring emotionally charged issues is especially difficult. Last year, when searching for a productive way to address masking, rather than reducing our conversation to “pro” and “against,” we worked together to identify situations when masking may be unnecessary (when taking a walk outside alone) as well as those when masking may be beneficial (when visiting an elderly grandmother).  

When our views and experiences are very different, we challenge ourselves to prioritize relationships over ideology and consider unfamiliar perspectives with curiosity and humility.  We are often reminded that we share similar opinions about fundamental issues, like the health of our families and our hopes for our children.  This common ground inspires a willingness to reorient our relationship to each other and work together to identify creative and compassionate solutions that serve and represent the diverse people in our community. 

At a time when we are witnessing anger and estrangement among our neighbors, family members and friends simply because we have different opinions, it is our hope that our Compassionate Connections Community Healthcare Forum will provide a useful model for productive dialogue and move people to reconnect with friends, family, neighbors and colleagues - not necessarily to change their opinions, but simply to talk, openly share ideas and hopefully, rekindle affection, thoughtfulness and a sense of community solidarity.

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My grandpa recognized the value of belonging to an engaged community and embraced his responsibility to his neighbors, friends and family with courage and generosity.  

Engaging with community may seem a daunting task, but each day, in small and seemingly insignificant ways, we have opportunities to share our views on community issues with neighbors, co-workers and others, and even solicit community support to address issues that are important to us.  As individuals, our impact and reach may be limited, but an organized community’s voice is widely heard. 

As we navigate the profound healthcare issues before us, we invite you to share your voice with us, participate in our grassroots efforts or even consider starting your own local group so we can build strong community voices, steadied by common ground and guided by a sincere commitment to care for each other.

The really important kind of freedom involves … being able truly to care about other people and to sacrifice for them over and over … every day.

David Foster Wallace

Deb Roman co-wrote this article with her grandpa’s oldest son (and her dad), Jerry Sheinbach.  Deb and her dad, who turned 90 in 2021, have worked together on many projects to enhance community health and have written essays together since Deb was a young girl.

Loosening My GRIP on Control

Sheltered at home for several months in 2020, I spent much of my day integrating a tele-health practice, exploring evolving research with peers nationwide and searching through the daily barrage of information to find answers - how does this virus work, how do we mitigate the impact on the lungs, how do we keep our community safe as we identify treatments?

Even once I returned to my office, masked and socially distanced from my patients, clear answers were not available.  We were still learning, and while we had gained valuable insights, we did not have enough understanding to prevent the devastating consequences of this disease. 

My uncle was awake and talking upon arrival to the ER.  Yet, within 24 hours, his ability to oxygenate plummeted and he was transferred to the COVID ICU and connected to a ventilator.  Motionless except for the artificial inhalation and exhalation mediated by a machine, pressor medications were prescribed to help him circulate blood to his vital organs. 

Physicians and nurses did all they could to keep his body functioning while searching for effective ways to treat this novel infection. Without a clear understanding of the pathophysiology of the virus or proven treatments, the virus was free to attack his body unimpeded.

Lack of control is sobering - compelling me to sit with feelings of uncertainty and helplessness and respect their power.

The patients I have been privileged to work with over the years have often provided me with insights.  People who awoke one day to a new reality, a life threatening illnesses that challenged everything they held dear.  

I recall the day Yvonne came in to the office. Convinced that her headaches were due to chronic sinus infections or stress, she looked at me incredulously when as gently as possible, I informed her that her brain scan was abnormal, likely identifying a tumor. 

Twenty years later, I still remember the feelings of that day.  As we talked, the air in the room felt heavy and the lights seemed to darken.  This patient who I had known for many years, who had sent me gifts when my children were born and remembered their birthdays, seemed to pull away, occasionally glancing up at me as if to say:  “do something … make this different… say something else.” 

But I couldn’t make it different - and in that moment, my body ached, my breathing quickened and I experienced a profound feeling of helplessness.

Yet, in the days that followed, in small ways, we learned together how to navigate this new normal - a world inclusive of a brain tumor - a world filled with unknowns, immense challenges and pain, and paradoxically, opportunities and blessings.

We became familiar with the unexpected and unwelcome.  We confronted our perceptions of helplessness by strengthening our connections with each other. 

The medical professionals caring for my uncle similarly endeavored to develop meaningful connections with him and with our family. They joined us as we navigated our unprecedented new normal. 

My uncle lived for 28 days on a ventilator, enduring severe secondary infections, two gastrointestinal bleeds, kidney and liver dysfunction and a myriad of other serious complications.  The physicians and nurses compassionately shared what they knew -  and acknowledged what was still unclear.  We walked together into the unknown.

In an unexpected turn of events, my uncle recovered.  The day that the endotracheal tube was removed, the healthcare team that had worked so hard to provide him with the best available care despite limited scientific data, cheered him on, cried with us and expressed gratitude for this unlikely outcome.

At times in our lives when we do not have answers, our relationships provide us with the strength to weather inconceivable storms.   They help us make room for both the tragedies and the gifts, and recognize the ever-present opportunities for compassion and connection.

My Uncle Harold - 6 weeks after discharge from the hospital.

He celebrated his 88th birthday with his family.

Authentic But Not Seamless

In 2018, with the help of wonderful friends, family members and colleagues, I organized a 2 day medical conference. Our hope was to address the suffering of physicians who due to the many changes in the healthcare system, are often unable to provide the quality of care that they feel patients deserve.  Physician suicides had escalated to more than one physician per day in the U.S., and many of us in healthcare felt that it was imperative to actively respond.

Developing this initiative was a full time job with a steep learning curve. As an introvert by nature, I found myself far from my comfort zone. Yet, at the same time, I was inspired by the opportunity for creativity and the possibility of bringing people together to explore ways to address this public health crisis.

On the morning of the first day, I arrived at the conference center at 6am with boxes in hand.  As I looked around the room, an overwhelming feeling of fear arose:

What was I thinking?  

Why did I think that organizing and facilitating a medical conference

to address a major public health crisis was a good idea? 

For 3-4 minutes, anxiety washed over me, imploring me to focus on all of the ways that this could go very wrong. I sat down near a window as the sun started to rise.  I took a few breaths to quiet my body, hoping that my meditation practice would enable me to find my ground and expand my perspective.

I looked around at the beautiful conference room, appreciating the funky blue sofas with colorful pillows, dramatic artsy structures and bright sun streaming in through the abundant windows.  The aroma from the organic coffee and the freshly cut flowers was nourishing.

Grace, an ambitious and talented pre-med student was scurrying around the room, setting up tables and anticipating our needs.  Joe, a gifted flutist was arranging his beautiful wooden Native American flutes so he could share his music with us during the conference. 

After driving all night from Montana to support me, my two sons were nursing large cups of strong coffee and grateful for comfortable couches at a professional conference.  My daughter and husband who had survived two years of evening discussions about the details involved in organizing a 2 day medical conference, woke up extra early to bring me food and encourage me to eat.

Painfully aware of my increased heart rate and rapid breathing, I thought about the advice my youngest son Nick had offered to me a few days earlier. Moose (that is my nickname and another story!), just remember:

It is more important to be authentic than seamless.

Before I could give my feelings more consideration, attendees starting filing in - friends and colleagues who had worked with me to identify ways to create an experience that would facilitate connection and productive collaboration, peers who had changed their schedules and awakened early to provide support for me, their colleagues and this initiative. 

I felt comfort in the recognition that I was not doing this alone - but more importantly, I remembered why we had organized this event. We believed that if only one doc felt heard and understood, more connected to his or her community, more hopeful or inspired, our vision was realized.

The days were definitely not seamless:

On the first day, a beautiful sunny day with out a cloud in the sky, while I was in the middle of my presentation, an entire city block (including our conference center) lost power.   It took me a few moments to absorb what had happened and realize that our finely tuned schedule had just evaporated.

But the memory of that moment that stays with me was captured in a picture taken by my oldest son Angelo.  My husband, daughter and son Nick, who know that I get nervous when presenting in front of large groups, were sitting on a couch nearby. When the lights went out and the screen went blank, their mouths dropped open and eyes widened as they looked on with disbelief.  I still laugh when I see this photo.

My fear and doubt did not simply disappear that day, but upon reflection, I have come to believe that rather than trying to suppress or eliminate uncomfortable emotions, it is valuable cultivate my capacity to accept and explore these feelings. Doing so provides me with the opportunity to learn more about myself and choose my responses with enhanced awareness and compassion for myself and others. When I lean into the discomfort, I find it easier to show up unedited, and hopefully, make it easier for others to do the same.

Authentic but not seamless

These words carried me through the conference and convinced me that when I align with a commitment to stay fully present, prioritize relationships and embrace the unexpected with curiosity and kindness, details and expectations loosen their hold on me and I can more easily embrace and appreciate the experience.