A physician embraces the power of the word, “and” [PODCAST]

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“I struggle for words to describe life in the season of COVID-19. Depending on the day, I need at least a few adjectives: ‘peculiar,’ ‘fine, all things considered,’ ‘terrifying.’ ‘Joyous’ and ‘anxious’ certainly make odd bedfellows in my brain.

As a mother and physician living this new reality, I’ve been extra thankful for Irene, who taught me the power of “and.” Irene is a clinical psychologist who was tasked with helping my family medicine residency classmates and me build skills for self-care and counseling.  She taught me to replace ‘but with ‘and’ in conversation.  This subtle verbal acknowledgement can reconcile what would typically be perceived as conflicting emotions or realities–like mental yoga.  The shift has served me well in my medical career and in personal relationships.  Imagine how different it feels to hear someone say, ‘You’re doing the best you can, but you can do better’ versus ‘You’re doing the best you can, and you can do better.'”

Rachel E. Hines is a family physician.

She shares her story and discusses her KevinMD article, “A physician mother embraces the power of ‘and’ during the pandemic.”

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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 Rachel Hines. She’s a family physician, and she wrote the KevinMD article “A physician mother embraces the power of ‘and’ during the pandemic.” Rachel, welcome to the show.

Rachel E. Hines: Thank you. Thanks for having me.

Kevin Pho: So we’ll get into the article in a bit, but first off, tell me your story and your journey to where you are today.

Rachel E. Hines: Yeah. So my route was maybe a little bit more circuitous than some. I always wanted to be a physician, ever since middle school, I think, and then I ended up actually taking some time between undergrad and medical school to teach high school biology, which I also loved. That was in eastern North Carolina, so that was also my first introduction to the state that I still live in. And then I decided that while I loved the classroom, I felt like I could teach in medicine but also really go to other levels, as far as understanding the science behind what I was teaching my students, and empower people about their health in other ways.

So I went to medical school, stayed at UNC for all my training, and then recently, a couple of years ago, I made a move out to Asheville, North Carolina, to join a medical school classmate in practice out here in a direct primary care practice, which is a different model of primary care that’s based on a membership instead of traditional fee-for-service insurance billing.

Kevin Pho: And for those of my audience who are not familiar with a direct primary care practice, can you tell me a little bit more about the practice itself and why you decided to go that route versus a traditional practice?

Rachel E. Hines: Yeah. Our practice is called Lantern Health, and really, the name tries to conjure being kind of a beacon, or like a new path forward in health care. My physician partner and I both came from traditional practices and were feeling really burdened with the volume of patients on our schedule, and feeling like we couldn’t make meaningful connections in such a short amount of time. That time really only left us the ability to write a referral or write a prescription without getting at the root cause of what was going on in people’s lives.

So direct primary care, because it just changes the whole payment model and really blows open the opportunities to engage with people in a variety of ways and with really flexible amounts of time, has just totally changed that, and it has been really rewarding. So we spend 30 to 60 minutes with every patient instead of 10 to 15, and they can text us or call us in much more nimble ways, which, of course, especially since COVID, has been particularly useful.

Kevin Pho: And how has the pandemic affected you and your practice?

Rachel E. Hines: You know, the biggest change, because, like I was saying, virtual care was actually part and parcel of our practice well before the pandemic, so we felt really well equipped to pivot to all virtual care temporarily when things were pretty uncertain. What has been more dramatic for us in Asheville is that a lot of our patients come to us via their employers. Their employer pays the membership on their behalf, and so many people got laid off, particularly in the service industry, which is really the heart and soul of Asheville. We have a really robust arts, restaurant, and tourism industry. We live in the North Carolina mountains.

That was really challenging, because in losing their employment, a lot of people also, at least temporarily, lost access to health care. So we’ve been trying to navigate how to continue to support people during the time when their incomes and benefits are in flux.

Kevin Pho: All right, I want to go and talk about your KevinMD article, “A physician mother embraces the power of ‘and’ during the pandemic.” Can you walk my audience through that article and explain why you decided to write it?

Rachel E. Hines: Yeah, sure. The reflections started coming to me, I think, as I was interacting with people in my personal life and also in my professional life, and talking about just a simple question like, “How are you?” It just felt like such a complicated answer all of a sudden. In one day, I would be feeling so overwhelmed with anxiety about the state of the world, and then my personal reality actually felt really joyful at times. My kids were out of school, we were hiking and spending more time together, and the weather was turning really beautiful here. That’s a magical time of year in the mountains; things were blooming. It just felt like this really stark contrast, and I found myself needing, for my own sake, to sort of accept that ambivalence about reality.

It made me think a lot about a strategy that I was introduced to in residency, which I mentioned in the article, called dialectical behavior therapy, or DBT, which we were trained in a little bit by a clinical psychologist as residents. Her name was Irene, and I give her full credit for introducing that concept. One of the basic tools is using the word “and” instead of “but,” because it really, I think, acknowledges that most of us live in mixed emotions. That’s not something that we have to shy away from, or where we have to pick a side at all times, like, “I have to only be anxious today.” I can be anxious and joyful, or I can be excited and nervous.

You know, I think in this story, I reference being disappointed and rejuvenated by the whole COVID experience, and changing plans, and having to just shift my expectations pretty dramatically. Being able to be OK with that and just sort of sit with it felt like an important thing in this really extraordinary time.

Kevin Pho: So it’s almost like reframing the question to frame it into more of a growth mindset. Can you explain how that subtle change has affected you, both professionally and in your family life?

Rachel E. Hines: Professionally, ever since Irene introduced the concept, I think I’ve really leveraged it quite a bit in talking with people that I interact with, particularly patients who, for example, are working on some kind of lifestyle change, whether it’s a change in nutrition or reducing cigarettes or whatever it may be, because we’re really all, in any moment, doing the best we can, and there are always opportunities to do better. Really giving specific examples of that and acknowledging both of those things, “You are doing the best you can, and you can do better,” not “but you can do better,” because that just totally takes away all the valid efforts that are being put forth, has been a really helpful tool.

And I think in my personal life, I had never really thought about this until I had kids and then also started watching Daniel Tiger. I don’t know if you’re familiar with that show, but there’s a little jingle that they sing that says, “It’s OK to have two feelings at the same time.” So I’ve been trying to really model that with my kids. They’re going to start new classes in August, and we’re talking about how, yeah, it might feel a little scary and exciting to have a new teacher or to get a new student in your class.

Or certainly with the pandemic, when they had to pretty dramatically rearrange things for the school for the kids’ safety, the whole check-in process changed. We talked about how it feels weird, and look how hard everyone is working to keep people healthy. Those two things can coexist. It’s an adjustment. It’s a real thing for everybody’s benefit, and it really reveals something that’s very caring about why we’re having to make those changes, and that can be a good thing. But not just dismissing it, like, “You shouldn’t feel weird, because it’s just to help people,” because if you say “but,” then it just sort of feels like a different experience.

Kevin Pho: Sure. Now, in your article, you talk about your husband, who’s an emergency physician, and you talk about raising two young kids. Now, there are a lot of physicians who are in similar positions. Is there anything that you’ve learned over the past few months during the pandemic that you could share with other physicians who have young kids and who are married to other physicians?

Rachel E. Hines: I’m always quick to acknowledge that we’ve been really privileged here. The pandemic hit here much later. It’s actually kind of escalating right now, but we’re coming to it with a lot more understanding and information than people had, for example, in New York and Seattle, obviously, back in March. So I think the reality for physician couples then especially, not knowing truly if it was going to really jeopardize their well-being and their family, must have just felt so scary, because it felt scary to us even just watching that unfold, even though we knew that things were sort of, at least temporarily, not that bad here.

What we had to really soul-search around, especially for Tyler, knowing that at some point he was going to be in pretty much daily contact with COVID patients, was to what degree we were going to change our family and the way we operate out of fear of him bringing it home. And ultimately, besides a couple of accommodations, like he doesn’t touch any of us until he’s come home, changed clothes, and showered, we decided that for our family, it would be harder and worse to try to separate him than to continue to live together and enjoy our family, with the knowledge that at some point either of us could get sick.

But I think that’s just a really personal decision, and I hope that more people, for better or worse, are figuring out ways to live with COVID. I think about it as, in March, it was like a blaring TV in our faces that we couldn’t ignore, and now it’s sort of in my existence like a TV that’s on in another room. I’m always aware of it, but it’s not necessarily at the forefront of my consciousness, and I have to find ways to make meaning of my day that aren’t related to that. So I think that’s translated into how we live our lives and how we interact with our kids.

Kevin Pho: We’re talking to Rachel Hines. She’s a family physician in North Carolina, and she wrote the KevinMD article “A physician mother embraces the power of ‘and’ during the pandemic.” Rachel, my final question: What is your take-home message that you want to share with the KevinMD audience?

Rachel E. Hines: Yeah. So I think that “and” is just a really powerful concept right now in general, with our country being so polarized around so many things. It’s kind of like we’re all living in this sense of dichotomy, you know, black and white, feeling like we have to be on one team or another around so many issues. I think if we can do the work to acknowledge that we are all complex, we’re all really Venn diagrams that overlap with each other in different ways, we’re not just separate teams, that could really translate in powerful ways to a lot of other issues that we’re facing.

So, yeah, for me, it’s been an important concept to lean on when I’m feeling pulled to have to commit to one way of being. I think the reality is we’re all “ands,” and we’re “and” many things, not even just two things at a time.

Kevin Pho: Well, thank you so much for sharing your insight and your time, and thank you for being on the show.

Rachel E. Hines: Thanks for having me. This is great.

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