Dear Dr. Horton

The new season of "Dear Dr. Horton” is here! Send the anonymous questions that keep you up at night to a real former Associate Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!



Dear Dr. Horton,

How do you address concerns with friends over questionable coping methods, when they are highly educated nearly-doctors too? My roommate has always had body image issues, but I did not know how deep they were rooted. In fact, after a recent psych block, I am pretty sure she has an eating disorder. I'm just not sure how to address it.  Nothing seems to be falling apart in her life.  Any tips on how to address uncomfortable suspicions that are unconfirmed?  Without offending my friend?

Signed,

Tip Toeing

*

Dear Tip Toeing,

Have you ever heard of the invisible gorilla?

In a famous psychology experiment, participants are asked to watch a video clip of two basketball teams and count the number of successful passes. (1)  Most people get the right number of passes.  But they miss the person in the Gorilla suit who literally moonwalks through the game.  Why?  Because they’re not looking for a gorilla.  And we have a hard time seeing what we are not expecting.

My colleague Ron Epstein uses this concept to help physicians go off autopilot and become more observant (2).  It’s a helpful construct for understanding cognitive error as well.  But I think it has another, more personal application.  When it comes to physician suffering, I think there are a lot of invisible gorillas in the room.

The first thing I want to commend you for is noticing.  Too often in medicine, we’re blind to the suffering of our peers. Sometimes this is because we are struggling to contain or manage our own suffering.  Sometimes it’s because we assume that nobody struggles the way we struggle.  And sometimes we assume our colleagues are “smart” enough to be able to identify when they are in over their heads, and we share the fallacy until things have spiralled totally out of control, or worse, until it’s too late.

This is a fundamental paradox of life in medicine...that being a doctor means you always have insight into your own health.  It’s true that being a doctor can be helpful if you are trying to decide if you have a virus.  But there’s no reason to think it’s particularly helpful if you are trying to decide if you have an illness that is characterized by cognitive distortion.  Meanwhile, the people around you may mistake your intellect for insight…words that are not synonyms.  And before you know it, the invisible gorilla has pulled a Godzilla and torn up not just the basketball court but pretty much everything else in your life.

I had some very hard times in my residency, times when a gorilla followed me into every room.  For years afterwards I used to wonder: didn’t my friends know I was in over my head?  Didn’t they see my suffering?  Wasn’t I worth the discomfort of saying something?  I grieved this abandonment; it was a sadness that stayed with me for at least a decade.  But then, in the years that followed, I missed these same signs in my own friends, and sometimes in my residents and students, and I wondered how I could have been so blind.

Life has taught me that my friends didn’t abandon me.  In fact, they were often watching me closely…closely enough to know I never missed a pass, that I always kept catching the ball.  They thought performance was the metric that would measure whether I was alright.   That’s how they missed the gorilla.

It doesn’t absolve them, or me, or any of us of the responsibility for taking better care of each other.  But it helps give us a framework for how we have failed so miserably as a profession when it comes to judging the wellbeing of people around us.  We have to start looking for gorillas.

Tip toeing, you’ve noticed something amiss.  There’s a moonwalking gorilla in your rented apartment.  Maybe you’ve talked to it a few times and it laughs and tells you it’s not a gorilla, it’s a seahorse.  Or maybe it’s barked like a dog, in the hopes of throwing you off its trail.

You have a choice.  You can pretend it is a seahorse, or a chihuahua, and you can become party to the cognitive distortion.

Or you can sit your roommate down.  You can show her this post.  You can tell her you wrote this letter, because you’re worried sick about her.

Be prepared for anything.  Gorillas are unpredictable.  Enlist the help of friends, family, trusted faculty, and school resources, to help get through to her.   Will that make the gorilla angry?  It might.  But my experience is that in processes that don’t preclude a degree of insight, most people welcome true expressions of caring and concern.  Some people have been wrestling the gorilla on their own for so long that it is a relief to know that backup has finally arrived.

Even if things go the other way, would you rather have an angry friend or a dead friend?  And what would any of us want or expect our friends, family and teachers to do if we had an illness that could impair our judgment, insight, willingness, and ability to seek help?

I think we would want them to be brave, to step up, to help us send that gorilla packing, so we could get on with our lives.

Yours,

Dr. Horton

 

References:

  1. http://www.theinvisiblegorilla.com/gorilla_experiment.html
  2. Epstein, R.M. Attending. Scribner, 2017.  P 17

Dr. Jillian Horton is a general internist in Winnipeg, Manitoba. She was the Associate Dean of Undergraduate Student Affairs at the University of Manitoba from 2014–2018 and now directs programs in wellness and medical humanities at the Max Rady College of Medicine.

She writes a column for CMAJ Blogs called Dear Dr. Horton: cmajblogs.com/category/dear-dr-horton/

This week’s edition of Dear Dr. Horton” is a general response to the many excellent questions that were submitted in response to the CMAJ call-out for the “Med Life with Dr. Horton” podcast. Find it originally here: https://cmajblogs.com/horton-podcast-carms-interviews/


Dear classes of 2019,

Ah, CaRMS…that beloved hybrid of Survivor and The Bachelor.  You want to be the last one standing, but hopefully that doesn’t mean accepting a proposal that will become your new personal definition of hell.

I’ve coached hundreds of students through the CaRMS process over the years. My approach draws on my experiences as a long-time clinical teacher,CaRMS interviewer, Associate Program Director, Associate Dean, Royal College committee member, Royal College exam coach, and my interest and expertise in communication, cognitive error and mindfulness.  One thing I’ve learned: there are wrong ways to answer questions, but there is no universally right way.

Some interviews start with a variant of that dreaded question, “Tell us about yourself.”  Too frequently, students use that precious first impression to regurgitate dry information that is already included in their CV.  That’s a sure-fire way to get lost in the crowd.

I counsel students to spend time considering how they will structure this question.  It’s always helpful to open with what I think of as an editorial statement.  “I’m so pleased to have the opportunity to be here with you today.  When I reflect on this question, I think there are three things that help give you a window into who I am as a person.  The first thing is X.  The second thing is Y.  The third thing is Z.”

How do you settle on the content of X, Y and Z?  I recommend looking for your three best positive anchors.  Perhaps you are from a small town, in which case X might be your deep sense of community.  Maybe you’re a runner, and Y is that you are a person who has a long game philosophy in life.  Maybe you’re a person who grew up in tough socioeconomic conditions, or you have spent a lot of time in volunteer roles, and Z boils down to your personal commitment to social justice.   ...continue reading

Welcome to this week's edition of Dear Dr. Horton. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

I've experienced the death of patients before — but this one feels different. I can’t help but think of small things we spoke about, like their dogs and their season tickets to the theatre. How do you navigate the intersection of professionalism and mourning another human you felt connected to?

Signed,

Mourning in Secret

...continue reading

2 Comments

Welcome to this week's edition of Dear Dr. Horton. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

I am a recently retired physician, and your blog seems like a great idea to me. Support and acceptance are needed at all stages of our careers.

Burnout is a reality in our profession, as is ageism. Because of ageism, it is often difficult to balance limitations with outside expectations and many physicians simply choose to retire. My hope is that will change — our profession will see, acknowledge, and embrace the value of our aging colleagues — but that is simply not true now. How can the profession both assist the transition and get maximum value from its most experienced colleagues?

Signed,

Twilight

...continue reading

Welcome to this week's edition of Dear Dr. Horton. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

Over the past month, much of what is occurring in our political and social climate has been serving as a constant reminder of inappropriate behaviours/sexual harassment I've experienced as both a patient and a medical learner.

Do you have any advice in navigating these feelings?

Signed,

Demoralized

...continue reading

1 Comment

Welcome to this week's edition of Dear Dr. Horton! Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

Looking back, I know there were many reasons I wanted to enter this field — but with the overwhelming and increasingly hectic nature of medical training and residency, it’s sometimes easy to forget what those were.

I don’t want to become jaded so early in the game, but can feel some of my initial idealism ebbing away and cynicism setting in. What are some ways to remind ourselves of our passion for medicine?

Signed,

Burning Out

...continue reading

1 Comment

Welcome to this week's edition of Dear Dr. Horton! Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

It seems everyone is always talking about the importance of having a strong support system around you. While I’ve managed to make casual acquaintances among the pool of colleagues and co-learners I see from time to time, these relationships feel fairly superficial. Yet no one seems to have the time to forge deeper connections...

How do you build your "tribe" in medicine, given how busy everyone is?

Signed,

Lone Wolf

...continue reading

Welcome to this week's edition of Dear Dr. Horton! Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

With CaRMS applications open, the pressure is definitely piling on... yet no matter how much I tell myself I need to get started on preparing personal letters for the different programs I'm applying to, I just keep putting it off.

I know a great letter isn't going to pop into existence the night before applications are due, but I'm also at a loss in terms of where to even start... any advice would be much appreciated.

Signed,

Procrastinator

...continue reading

1 Comment

Ever wish you could ask a wise, kind, approachable Student Affairs Dean something without having to admit the question was yours? Maybe you think it’s cringe-worthy; maybe you feel like you should know the answer already; maybe you think you will be judged; maybe you’re sure you are the only medical trainee on the planet ever to have felt this way, and you need confirmation now.

Enter Dear Dr. Horton, a new feature on the CMAJ Blog. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment (rest assured, though — Student Affairs Deans in Canada are all really great people, and not only have they heard it all, but they take on these decidedly unglamorous, 24-hour call jobs because they really, really care about learners).

Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks! ...continue reading