Posted on 01.05.09

As the nation rallies around a new administration, I am excited about the potential of having a fresh perspective on health. Health is not just about the health care delivery system.  The health care system is a participant within the larger arena of our communities.

Though family physicians know the importance of disease prevention and coordination of care, acknowledging a broader definition of health is useful.   With a public health perspective, we can advocate for healthier communities every day, encouraging health promotion and disease prevention within the socio-economic, political, and environmental context that surrounds our patients' lives.  We must advocate for reducing social inequalities, bridging the economic and racial divides.  Let's acknowledge the health of our economy, education system and environment.  There sectors are inextricably linked.  What I know for sure is that we will need to expand our definition of the health of our nation.

I've been speaking to mentors, peers, friends, and colleagues about my leadership project, thinking largely about health. All the residents are required to conduct a leadership project over the three years of residency.  Some have started an integrative medicine clinic, a weekly yoga class, a safety net for new diabetics, teen health education, etc. I am not sure how to label my leadership project since my interests are so broad, but I do know what I want it to feel like. I want to belong to a like-minded group of people that inspires cutting-edge innovation and encourages interdisciplinary approaches to wellness that include business, education, faith communities, environmental, social and governmental collaboration.  I want to see the village come together to help the villagers within.  If we are spread too thin, how will be form the social bonds that connect us back to well-being?

The picture attached shows dogs and their owners at a watering hole as a snapshot example of health. There is joy and socialization with a strong sense of belonging and community.  People are out being physically active, making friends and feeling safe and good about their morning.  This is just one example of community health.  How can each person feel a strong empowered sense of healthy community and belonging?

I am hungry to find out what communities are already doing in cities such as Sonoma and San Francisco as well as courageous cities, counties and states all across the country - and countries around the world. The Commonwealth Fund, World Health Organization, Robert Wood Johnson Foundation, and Kaiser Family Foundation are all doing great work on reporting on the health of our communities.  In California, the Center for Civic Partnerships http://www.civicpartnerships.org/ helps networks cities in California towards health.  They feature publications about city projects, free toolkits, and other valuable resources.

Our families are doing what they can, given the barriers of time, energy, and cost restraints.  Nonetheless, Americans know how to persevere. There are common-day leaders in every family making small, yet big, decisions every moment.  Perhaps someone today will recognize them for that.

Posted on 12.5.08

As I sit here in Shanghai, China, I've come to realize just how vast the American social sector is. I Googled "social innovation China" and was surprised to see how little information there was on the web. In contrast, there are so many social sector organizations in the U.S.

tackling problems in local communities--everything from education to health, the environment to job training. We are very fortunate.

In China, there is construction on every block and around every corner. The people seem both hard-working and humble. I see building cranes for miles and miles in every direction; skyscrapers fill the skyline. I'm staying with my father in the Zhangjiang area, a place that looks and feels like a new Silicon Valley. While the Bay Area feels like innovation and health, New York feels like raw energy and Shanghai feels like bustling growth.

Since I'm still on California time, I spend the wee morning hours surfing the net. I can spend all my free time reading about the interesting things people are doing around the world. I get inspired every second to be a part of this new thriving movement.

Here are a few tips for exploring this movement that I've found helpful:

1) Surf the net

2) Check out Stanford's "The Social Innovation Conversations" podcasts

3) Watch "Ashoka: Innovators for the Public" [http://www.youtube.com/watch?v=DttTSJEO47g] on YouTube for inspiration

4) Download key articles from a few of your favorite organizations' Web sites

5) Attend local social sector events in your community and talk to people there

6) Join organizations/associations for causes that you care about

7) Register at www.change.gov to tell your story on "An American Moment"

8) Start having conversations with everyone you know about your passion

9) Write for yourself and for a larger audience

10) Set up meetings with people who work in the social sector that interests you

Posted on 11.19.08

This month of Behavioral Medicine/Leadership Development has been so rejuvenating and needed after my Medicine month.  I've never been one to like hospitalist work because holistic healing that acknowledges simple dignity and respect for humanity is, for me, so difficult to come by. Now I have to say, our hospital has some of the sweetest people taking care of our patients.  But, our health care system makes the care feel fragmented, incomplete, and disorienting. We are working within an acute care model when most of these folks have chronic conditions that are too difficult for them to manage on their own.

In these last few weeks I've had the wonderful opportunity to peek inside local community organizations.  I had meetings with the county department of health, our local CAFP chapter, an adult day care services organization, a hospice interdisciplinary group, an HIV clinic, a women's homeless services/shelter, a drug rehab center, a local WIC office, and a parenting institution.  WOW! I had such an amazing time talking to the directors of each of these places; passionate people who reconfirmed for me the importance of community social capital. Robert Putman describes this in his social capital book Bowling Alone: The Collapse and Revival of American Community.

Whereas physical capital refers to objects and human capital refers to the properties of individuals, social capital is our connection among individuals-social networks and the norms of reciprocity and trustworthiness that arise from them. In that sense, social capital is closely related to what some have called civic virtue. The difference between is that social capital calls attention to the fact that civic virtue is most powerful when embedded in a sense network of reciprocal social relations. A society of many virtuous but isolated individuals is not necessarily rich in social capital.     

This is the stuff that really gets my gears going. I find the community networks, family dynamics, fellowship, business, and neighborhood - all of these alliances that build a culture and reinforce behavior - so fascinating. How can I tap into this gold mine? How can I learn from these community leaders and members?  What can I do?  I ask a million questions because I know people have answers that I don't. I love listening to podcasts about social innovations across the world.  I believe people have answers and are already doing great work out there. It is very centering and empowering to participate in this dialogue for social change.  As this particular leadership rotation ends, I hope that I won't get too bogged down by medicine.  I've got to keep an open mind.

Posted November 3

In the movie The Matrix Reloaded, Agent Smith tells Neo: "It is purpose that created us. Purpose that connects us. Purpose that pulls us. That guides us. That drives us. It is purpose that defines us. Purpose that binds us."

This quote weighs heavily on my mind when I think about my patients who are "lost" in the system of life. I think about the alcoholic who made a pact with me to teach me about his alcoholism. Then there are the two unemployed parents who have been on welfare their entire adult lives, raising six children without a single method of birth control in sight.

I try to make partnerships with my patients. As we shake hands on a deal, I look deep, deep into their eyes - as if to cement their promise and convey my seriousness. I drive home wondering if these people will have the drive and the will to live a good life.

If I am truly a cog in an architecturally designed wheel, the purpose that drives is the experiences of real people and the public's health. It is my purpose that drives me to seek and understand. But what, I often wonder, drives my patients to do the things they do?

I've spent a lot of time thinking about why my alcoholic/substance abuse patients return to their addiction when they're so tired of it. They are old, too old for the hard life of withdrawal and homelessness. They become regulars in the wards, where between the jail cell and the hospital bed, they rotate through our familiar hallways. For you and me, we go grocery shopping, take hikes along the coastline, pair ties with shirts, and go to our favorite spots to eat. For them, it's just us, the social service sector, the jail, and their vice. This is why we call many of our patients "frequent flyers" - people who keep coming through the hospital doors over and over ... and over.

I can't explain why we allow this to occur, why we put so little ingenuity on lifting fallen souls, why welfare can fail us when I see able bodied people work the system. Let's fix problems from the root causes. Let's educate and get educated. Let's volunteer. And for Pete's sake let's balance budgets responsibly.

Come on already!!

Posted Oct. 21 

Being in inpatient medicine reminds of being a medical student again. With doubt creeping in, I have to constantly remind myself to be gentle. Each day, I make it a point to provide compassionate, effective, efficient, and informative care to my patients in the wards. Quite honestly, it has been a tough juggling act.  I have to be gentle with myself because I can easily find fault in my own lack of timeliness, thoroughness, patience, knowledge, and communication.  I remember this feeling well as a medical student, fumbling through new departments each month like a tourist lost in translation. Alas, residency is about training and mentorship. I have to remind myself to be gentle with my own sense of inadequacies and find humility in the pursuit of competency. 

Most of my patients have problems larger than their illness - financially, socially, and psychologically.  I try to talk through their problems and find their humanity, find the health within them and help them identify it. This takes time, as well as vulnerability - theirs and mine.  But it is this connection that makes doctoring rewarding. Even if the connection is slight and fleeting, this partnership could mark the beginning of a long road towards well-being. 

Yet, a frustration lingers in the wake of my inpatient interactions.  This is not the place to have a medical home. Though for many of our "frequent flyer" patients, the hospital is their fragmented and broken medical hotel.  If I could, I'd have a village of ordinary citizen volunteers, social workers, rehab facilities, innovative family support networks, and mental health services to help our most vulnerable populations.

There are many social innovators who are taking on this task of building stronger safety nets in resource-limited communities.  It can be done.  A doctor in Rio de Janeiro created a network of support for poor children after discharge from 17 public hospitals.  According to David Bornstein, author of How to Change the World, Dr. Cordeiro's organization, Renascer, helped bring the percentage of "at risk" children from 42 percent to 10 percent, while increasing family monthly incomes by 58 percent.

So my frustration with our health care system and with the revolving door of our hospital for our most vulnerable citizens is serving its purpose: motivation.  I need motivation to seek out alternatives, to question the status quo, and to research solutions.

I have spoken to Rachel Friedman, a fellow intern, about starting a think tank.  We planned to meet over tacos and salsa to talk about our vision for social change.   About a month ago, our think tank of residents met. Twenty or so idealistic residents showed up to talk and hash out ideas to change their community for the better.  The more I get frustrated, the more I want to do something about it.  This think tank is a start. It is a beginning.

Posted Oct. 2

It's hard not to think about family when you are a family physician. Having been on OB and then on pediatrics, I see a lot of families: newborns wiggling themselves out to a world of loving family members, children accompanied by their protective siblings, new fathers hesitantly pacing the corridors for the "It's time" look, and mothers who hold their breath as you examine their sick babies. I like observing the family dynamics just as much as I like to interact with my patient - the focal point of my 15 minutes in the room.  Some of my most memorable experiences are when I get to witness another family member console, encourage, advise and entertain the patient they've brought me to see.  For them, it's an intimate moment. For me, it's a privilege.

As interns, we get together once a week to check in with each other, to share these intimate moments that have made a significant impression on us. Sometimes the experience of being a young doctor is crushing and overwhelming, sometimes it is glorious, other times it is overshadowed by the events of our own personal lives. Every Thursday, after each of us has had our turn to check in, I always leave the hour feeling awed - humbly awed. These feelings are so raw and yet my fellow residents have somehow individually processed it enough to be coherent and powerful for the rest for us. There is no reason why this opportunity would be unique to doctoring. I think anyone - artist, writers, performers, teachers, social workers - anyone invested in interpreting the human experience gets this connection as well.

When you are observing families, it's hard not to also step back and look at your own family life. How are your personal connections working out? Is there someone, or something, that you take care of at home? Or is there someone who takes care of you?  Residents have told me - and I can attest to the same - many days you come home and you just want to collapse into a funky daze. After a long day of taking care of others, you're simply wiped out. But when the clouds clear, there are plants that need watering, meals to prepare, laundry to be folded and our own health to manage. 

I've thought about starting a family. People in medicine say there is never a good time to start having children because every stage of the career has its own trials and tribulations. As residents, most of us have put our personal plans on hold, waiting and exhaling, watching our patients' lives progress through stages of their own family life, while our own lives patiently wait at the bus stop for the two o'clock bus that never arrives. After a 30-hour call, nothing could posses me to have kids, not even the thought of seeing my favorite weekday baby, my fellow intern's seven-month-old who comes to join our didactics every Thursday. 

For the time being, I have a husband at home whom I can sit side by side with at that bus stop. He is wonderfully silly and charms my meandering thoughts away from medicine and back towards the present moment: my family of two.

 from 8.29.08

The alarm on my $10 powder blue digital wristwatch wakes me up, without fail, each morning at 5:30 am. 

"Get up, you've got 15 minutes to get ready," I pledge to myself, lying there not moving. It is more like 30 minutes before I actually get out the door. If I'm lucky, I will be on a rotation that doesn't require my presence until 8 am so that I can go for my morning swim and get that good start for the rest of my day. I have a long commute to work where I can either quietly collect my thoughts, listen to medical Spanish or thumb through various radio stations. Today, I decided to collect my thoughts.

I spent my entire morning commute thinking about how I could take this energy bubbling inside of me to some good use. I'm in search mode, looking around for direction and purpose outside of my known roles professionally and personally. I've been here before, this search mode. It feels familiar and therefore I know it is a good feeling to have. Last night was the 45th anniversary of Martin Luther King Jr.'s "I Have a Dream" speech as well as the finale of the Democratic National Convention. Each year, I listen to Dr. King's speech and it stirs my spirit. What, I asked myself, can I do to engage myself and others in community advocacy? What are the issues that matter to me and my community the most? Where do I start? How can I help organize the framework for social change? What would the projects look like? And lastly, what would be the endpoint?

I've decided that residency is a good time to revisit these questions. Daily lecture begins at 8 am. We talk medicine. I love juxtaposing the reality of my interactions with patients to the evidence-based recommendations we discuss, getting my noggin to think hard so early in the morning. Every topic hits a cord more so now than ever before because as family physicians, we see peds, we see adults, sports med, ob-gyn, surgery, emergencies - we are involved in the entire life cycle of the human experience. My learning curve has exponentially steepened because of built-in academic didactics - and I love it! The sole agenda of a residency is to produce good doctors so, and in turn, help people live healthier lives. I like that agenda. Even more so, I like the agenda of building healthier communities, not just improving physical health, but mind and spirit as well for total well-being. That, to me, is what separates a great residency from good residencies.

Now, to push the envelope further, what if residencies not only created leaders to build healthier communities, but facilitated the development of civic responsibility and engagement of the patients as well as the residents? What if these developments crossed and integrated other disciplines, producing advocators of advocates, empowering citizens with the leadership skills as the common thread that ties so many social issues? Wouldn't this improve the critical thinking education of our minds, bodies and spirits? Wouldn't these skills tackle fundamental issues and chronic barriers? WHOA there, you may say. This is WAY out of the scope of practice and way out of the scope of medicine at large. This may even be out of the scope of the most idealistic of family physicians.

If you look at your daily life and the breakdown of your day spent toward work, family, entertainment and personal organization, the skills and efforts of each of these aspects are often segregated. However, in reality, we negotiate between these efforts all the time, trying to balance each within the time constraints of a day. This is what makes balance so difficult. Instead of wearing so many hats, I challenge each of us and every organization to recognize people as wearers of one hat that encompasses them all: Citizens. Our personal lives are tied to one another. Our well-being is often defined by the sensation of perfecting a balancing act. How we develop and utilize our skills as employees, students, partners, sons and daughters, parent, consumers of media and citizens of our communities are affected by the affairs of our institutions, the actions of our leaders, the politics of history. They are affected by our daily interactions at work, at home, at school, on the web and in public. How can we better engage the lock, turn the key, and open the door?

I have a dream, too. I have a dream that individuals, institutions and all the layers of organization that govern our daily lives acknowledge the interconnected responsibility we aim to balance by creating long-term bridges for living healthier lives in healthier communities.            

I want to live my best life and I want to make it easier for everyone to live their best life too.

 from 8.18.08

As I gear up for my 30s, I think fondly about leaving my 20s. The memories of my 20s are now lovingly characterized as a younger self that my 30-year-old self appreciates greatly.

Zoooom! What an exhilarating ride it's been - the cities, the smells, the weather, the relationships, the streets, the soundtracks - all of which make this life full of texture; everything falling into its right place. There I was, like it was yesterday, hoping that my ticket for this journey would begin as a college pre-med student. I spent countless nights laying in bed wondering what I'd grow up to become. Between all the schooling, I promised myself that I'd never let life pass me by. Each week would carry a good mix of work, play and dreaming. Potluck dinner parties, BBQs by the pool, late night bowls of wonton soup, lindy hopping, performing on stage, rafting the American River, lounging in front of Jamba Juice, meeting up at the Memorial Union, road trips up and down Highway 5, and, of course, lots of hours holding my head up studying. After college, I was ready to meet the rest of the world. 

The 20s, for me, were about trying dreams out, giving them a chance, taking a risk, not limiting myself to my own preconceived notions of the way things were supposed to work. If Peace Corps didn't work out, there was always New York City, and if Dream Job No. 1 didn't come through, there was always temping until I landed an even better dream job. Being boxed in was not an option; I was in my 20s, I could make nothing turn into something.

Sure, there were moments where I felt stuck. Should I give up my fantastic career in public health to pursue medicine? Did I really want to continue medicine after the first semester of med school? Colors started fading as control of my time dwindled. Gone were the days of museums, designing clothes, subway riding, painting walls and reading for pleasure. 

Turning 30, I'm standing here: A Doctor. I can speak the secret language of medical jargon with a thick lay person accent. Though proud of my new role, I have discovered that the greatest joy of all is knowing that I have a toolbox full of tools to affect change and that maybe I had these tools all along

From 8.6.08

Part of the lure of family medicine for me is the broad scope mentality: think BIG, be INNOVATIVE and put your ideas into ACTION. Many people, it seems, come into family medicine with a public health/holistic perspective and define health as a state of well being: mind, body and spirit. So how does this translate into practical day-to-day work? In residency, we are mainly spending one-on-one time with patients as well as participating in team activities, but family medicine residencies generally have set blocks of time to work on a community health project, which encourages working with the communities at large. The faculty has encouraged me to read books like "How to Change the World," "Innovative Nation" and "The Omnivore's Dilemma" - all of which are shaping my thought process to challenge the status quo and bring about a health revolution. Growing up, I've always wanted a career that would support idealistic goals and provide me with the tools to reach them. Family medicine, for sure, isn't the only path to social change, but in the medical world, I think it is the closest one to where I want to go.

One of my fellow interns and I toyed with the idea of starting a think tank for tackling some of society's largest social issues, as they relate to health or even larger fundamental causes of morbidity. The challenge to bridge disciplines and pull together innovators with common goals is truly an electrifying prospect. I'm in the process of putting together some ideas for my project, which combines urban planning, environmentalism, public health and chronic disease prevention/management, and community activism together. It's early yet...too early to go into details, but the ideas are floating within reach. 

From 7.31.2008

Today was my first day of OB call. If it weren't for the amazing R3s that helped me get through the day with eclampsia, placental delivery s/p home birth, inductions and the parade of forms to fill out, I might have not been able to say "Wow! That was so awesome - I made it!" More importantly, these senior residents taught me the secrets to OB success: good habits that they have developed along the way such as when to eat, call a loved one, sleep, wake, shower, plan for the worst, prep for the discharge, and call nurses for help. YIKES! These are the REAL survival tips. 

To survive, I've learned that all the little things matter:

A cup of hot green tea matcha
A hand on the shoulder
A run to the cafeteria Q 6 hours
A hot shower with lovely toiletries
A moment with the sun
A pager on vibrate

I could go on and on...

Let this be known: support is so important. Besides my R3s, we residents have access to a lifestyle coach at our hospital to guide us through life's ups and downs. My coach helped me realize that I need to 1) stop prejudging a situation before experiencing them myself, and 2) redefine what a 10 out of 10 in Well-Being means.

At first I was struggling with the anticipatory imbalances of being on OB as an intern (sleep deprivation, lack of time to exercise, spend quality time with family/friends, etc.), but with the help of my lifestyle coach, I'm rethinking how this experience affects my life. What a relief! I now feel more excited, liberated and grateful to be able to experience life as new doc establishing care with people. What I know for sure is that if I can be emotionally ready for these experiences, I can feel better equipped physically and mindfully to handle them as well. YAY for that!

From 6.27.08

Today was the last day of a two-week orientation for the new intern class of 2011. It's so hard to believe that I am a DOCTOR and that so many of my dreams are now my achievements. I've been waiting for a precious moment to reflect on everything. Simply said, I am sure this journey will be a glorious one. 

There are twelve new interns with very similar ambitions, personalities, values and achievements in my class. I am so happy to be in the company of so many great people. Together, we can be the change we want to see and with all the talent and humility this bunch brings together, it seems as if we can make MAGIC happen!

I feel proud to have made it through med school; however destructive it was to my soul, it made me tougher and more efficient. I hope that everything I believe about becoming a healer will come to fruition during residency. People at this residency seem to care so much about each other, about their patients and about their personal growth that I have to pinch myself for feeling like I landed in some utopian world. (Hold on) Yes, I have landed in a utopian world.

During these past few weeks in orientation, we interns have had faculty and staff encourage team bonding, balance, wellness and integrative medicine. These activities have really set the stage for wonderful things to happen.

Posted 8.12.08
My name is Sharon Lin and I have just started my first year of residency at Santa Rosa Family Medicine Residency in Sonoma County, California. I have been involved with the California Academy of Family Physicians (CAFP) since my third year of osteopathic medical school at Touro University in California and have been toying with the idea of starting a blog about my experiences and ideas as a new resident. 
 

Whether you are a student, resident, physician or none of the above, I welcome you to join me on this new adventure. There are so many topics I would like to write about swirling through my mind and I hope that this blog will be a vehicle for social change - or at least a safe place to collect my thoughts so that I may inspire and be inspired. Please feel free to share your comments on my posts as well.