Jennifer Frank, MD: Vulnerable to stress?

I recently took an online quiz to assess my vulnerability to stress. I was anxious to identify those areas that I needed to improve in order to lower my cortisol-induced stress haze.

I scored a perfect score of invulnerability. Seriously – I didn’t even fudge any of the answers. The questions were things like “Do you get regular dental care?” and “Do you get seven to eight hours of sleep at least four nights per week?” It didn’t even ask if I have kids! Needless to say, I don’t believe that quiz. I am vulnerable to stress, and I feel it on a fairly frequent basis.

These are my stress triggers:

1) Over-commitment. It is my modus operandi to say “yes” too frequently. As a result, I get stressed by competing appointments and demands.

2) No breaks. In medical school, you were better and tougher if you didn’t need to sleep, eat, or use the bathroom during a call shift. This has translated into marathon workdays in which I down a Power Bar on my way to the bathroom in a twisted unhealthy multi-tasking spree. Don’t even get me started on how the mother of four small kids is supposed to take a shower.

3) Perfectionism. Doctors are expected to know everything, do everything, be everything. Actually I think this is just what we expect of ourselves. During those (too frequent) times I have had to confess an error or mistake to a patient, they are much more forgiving of me than I am of myself.
Read more
In looking at my quiz results, I realized there are a number of stress insulators – things that protect me from stress. Probably would be a good idea to maximize these areas. According to the authoritative stress vulnerability profile, this is what I have going for me to keep my stress to a minimum:

1) Healthy lifestyle habits. Okay, I admit to eating half of an apple streudel dessert and a handful of barbeque flavor rice chips for breakfast occasionally, but in general, I eat healthy, exercise, and get as much sleep as my children allow.

2) Friends and family. I do have a “four o’clock in the morning” friend (you know, the person you can call at 4 a.m. with any concern minor or serious) and am fortunate to have family close by.

3) Comfortable lifestyle. Physicians (even primary-care physicians) make a great salary. This enables me to afford all kinds of stress minimizers like dental care, babysitters for date night, and even a cleaning service for our house.

4) A strong marriage. A poem that hangs on the wall of our bedroom describes it perfectly: “You are the strong embrace in my challenge.”

5) Finally, spiritual grounding to give it all meaning.

You probably have your own list of stress inducers and stress deflectors. It is crucial to avoid those things that cause stress while soaking in the wonderful parts of life that reduce stress.

Jennifer Frank, MD: Crazy busy

I am sure you can relate to the sense of being crazy busy – not just rushing from this thing to that but feeling completely overwhelmed with the multiple professional and personal commitments that line up, seemingly endlessly, before you. I am living this, and it’s not a comfortable place to be.

About six months ago, I was invited to speak at a conference occurring this past weekend. I enthusiastically accepted. It was a great opportunity which I thought would be personally enjoyable and professionally enriching. As the date got closer, the stress of actually preparing for and getting to the event outweighed my excitement. It didn’t help that I was flying out on my husband’s birthday or would be missing my daughter’s dance recital.
Read more
My mixed feelings about making these personal sacrifices for a professional honor showed up in a late departure for the airport, poor concentration for the task at hand necessitating a U-turn to head back home to retrieve my forgotten thumb drive, and a series of mix-ups, hold-ups, and circumstances that had me arriving at the conference about 30 minutes prior to my talk (causing a minor panic attack for the poor woman organizing the conference).

After the talk (which went well despite the inauspicious events leading to my arrival at the conference center), I had time to reflect on my “balance” which was feeling quite out of whack. As I enjoyed the absolutely gorgeous scenery that spread out before, I had time to do something I rarely do – breathe deeply and ponder deep thoughts. I came back to something that has occurred to me on previous occasions when I find myself overwhelmed and underfocused: I am trying to do too much.

I was well prepared for the talk and excited to give it. I had allowed some wiggle room in my schedule, which I did have to use. However, I still arrived with (some) time to spare. My husband, left in charge of kids, house, and pets for the weekend, was supportive of my going, even on his birthday weekend. I was, however, trying to balance my professional role with the guilt of choosing to be away from my family during a time we would normally have spent together (our weekend).

Instead of accepting this as the necessary cost of pursuing a professional opportunity, I was going back and forth in my mind between my role as a physician and my role as a wife and mother, feeling unprepared for one role and guilty about not doing the other well.

In reality, I was upset that I couldn’t have it all – you know, being the star speaker of the conference while also being a perfect wife (home for her husband’s birthday) and mother (clapping enthusiastically in the front row at the recital). In the future, I will need to do a better job accepting that choosing one thing (a speaking engagement or staying home to attend a family event) is often choosing not to do something else. That is the cost of the choice, and consciously deciding to pay that price (or not) will hopefully prevent some of the guilt and a sense of imbalance that can accompany crazy busy weeks.

Jennifer Frank, MD: A reflection on me

I recently had to readmit a patient to the hospital for pneumonia. A lovely and delightful woman, she happens to have severe COPD exacerbated by continued smoking. She knows she shouldn’t smoke. I know she shouldn’t smoke. I know that she knows that she shouldn’t smoke. We have been over this countless times.

Speaking to the pulmonologist about her care, I was informed that she needs to quit smoking. I became embarrassed that my patient was still smoking, as if I was somehow responsible for this behavior. I have been scolded by consultants on other occasions when my patient was rude to the nurse in the hospital or didn’t keep a follow up appointment. Sometimes the consultant catches herself before continuing the tirade, and sometimes my therapeutic relationship is perceived to be so close with my patient that the patient’s behavior becomes one with my own.

Really it boils down to a blow to my professional pride.
Read more
I cringe to call a specialist on those patients who continue to abuse their own bodies, eschewing medical care until they are practically in extremis. As a primary-care physician, I pride myself on the close relationships I establish over months and years with my patients. However, sometimes my role as the family doctor seems to carry the responsibility for my patients’ actions along with it.

I liken this to what happens when one of my kids goes to school with a stain on his shirt or her hair uncombed. This doesn’t happen most mornings, but occasionally, the juice spills on the shirt at breakfast and I don’t notice the stain until dinnertime. Or, in the mad rush to get out of the house I assume my husband will brush the girls’ hair and he assumes I will and then the bus is there and the opportunity is gone. When this does happen, I wonder if the kindergarten teacher or classroom parent thinks I am careless. I am already suspect as a working mother, so maybe this adds fuel to the fire of speculation about my commitment to my family.

There is an understandable element of pride in how our children behave, appear, and are regarded. We all want to have the most beautiful, talented, polite, and exceptionally bright kids. When our children make the inevitable mistakes or fail to practice the basic elements of personal hygiene, it is challenging as a parent to not inwardly wince at what this says about us.

It is similar being a primary-care doctor. I take pride (or not) in my patients’ performance – if their A1Cs are below 7, this not only reflects what “good” patients they are, but also what a “good” doctor I am. But just like we can’t pick our kids, we can’t pick our patients. So, I must deny the pull of professional (or parental) pride and accept my patients just as I accept my own children – as imperfect people who look to me for help and often for approval as well.

Jennifer Frank, MD: Discipline

While swimming this morning, I entertained self-congratulatory thoughts about my dedications and discipline. I got up this morning early to go to the pool before work. Okay, in all honesty, I slept through my alarm and was awoken by my youngest one’s cry to be rescued from his crib. Because I didn’t go back to bed like I wanted to, I count this as a plus in the discipline column.

I thought further about how I am trying to follow a workout routine (parts of which I really don’t like) in order to prepare for the triathlon. I have a workout schedule that I follow pretty faithfully. Having it written down in black and white seems more inviolable than just having an idea of what I planned to do in my head. I could continue with this illustration – swimming is methodical repetition of the same thing over and over again and involves “staying in your lane” while doing it. Both of these ideas have application for parenting and being a physician.

I recently received a rather strongly worded e-mail from the Wisconsin Medical Licensing Board stating that I (and all other licensed physicians) should read the quarterly newsletter to find out about new information that applied to our licensing. I ignored the first e-mail but did take a few minutes to read it after the second e-mail arrived.
Read more
I never found the new information but I read with morbid curiosity about all the board actions against physicians occurring over the last few months. Truly shocking and surprising in both quality and quantity. Having sex with patients, dispensing vast amounts of controlled substances to patients or yourself, gross negligence.

Reading through this newsletter of shame, I realized why professionals need to have specific guidelines (you have to wait two years after termination of the patient-physician relationship before initiating a romantic relationship with a former patient, you cannot prescribe yourself or a close family member narcotics). These both seem pretty obvious, but I think it is easy to fudge the lines slowly, gradually, and unintentionally over time, so that you are no longer “swimming in the right lane.”

Just like the difficulty in getting up super early to immerse yourself in cold water, it can be difficult to adhere to standards when a questionable case is before you or when your own “needs” seem to be so compelling.

As a parent, self-control and discipline are important as well – not only to teach to your kids, but also to demonstrate yourself. It can be so hard to be consistent when you are tired, overwhelmed, or just at the end of your rope. It often seems easier to give in to their demands than to take the more challenging role of parent – in control and the same today as yesterday.

In all my roles – as fledgling triathlete, family physician, and mom – it is essential that I not only practice self-discipline but also recognize my own natural tendencies to fudge the lines when it is convenient to do so.

Jennifer Frank, MD: An "oops" of epic proportions

An acquaintance recently reminded me of a painful episode in my parenting history. “I was telling someone about you yesterday,” she started. “My friend was giving me grief for not bringing our daughter to the doctor right away when she had a wrist fracture. I told them that you missed your son’s clavicular fracture and you’re a doctor.” Ouch.

Two summers ago, our oldest son was playing with a friend while we were attending a minor league baseball game. His friend swung him around and let go. Our son landed on his outstretched arm and started crying.

My husband brought him back to where I was sitting with our daughters. He seemed like he was in a lot of pain, but it was hard to tell if he had fractured something. I palpated along his humerus, rotated his hand back and forth, looked for swelling. He could move his arm but said his shoulder hurt. It wasn’t dislocated and I couldn’t find anything specifically wrong. So, we comforted him with cotton candy, stayed for another 30 minutes to watch the end-of-game fireworks and headed home.
Read more
Our son alternately appeared totally fine and then would start crying and complaining about his arm hurting. On the drive home, my husband and I debated the necessity of a trip to the ER. I did a more careful exam in our kitchen once we arrived home. He was guarding his arm a bit but told us that it felt better. It was late and we were all tired. I imagined how we would be triaged on a busy Saturday night in the ER and pictured waiting with a sleepy, cranky kid for hours. We gave him some ibuprofen and put him to bed, planning to take him in the next morning if it was still hurting him.

By the next morning, he seemed better. He was playing happily in his room. Every once in awhile he would complain of his arm hurting, but as he tends to be overly dramatic at times, we weren’t sure how much he was actually bothered by his arm. I would spy on him as he played Legos to see if he was using that arm or not. He seemed to hold it close to his side but would use it if needed. I still wasn’t sure. We decided to keep observing him.

By Tuesday morning when he was still complaining of arm pain, we took him to his family doctor. Unfortunately, he had suffered a clavicular fracture. Fortunately, he had self treated it by holding it flexed and close to his body. He was fitted with a cool-looking arm sling that offered a little bit more protection until the bone healed itself.

Of course, my husband and I both felt terrible, and still do, that we – two physicians – missed this in our own child. However, it helps me to comfort my patients’ parents when they too miss something and serves as a good reminder why I don’t doctor my own kids.

Jennifer Frank, MD: Consequences

Sometimes being a doctor is like being a parent. You worry about your patients, you lecture, you cajole, you warn. Sometimes your patients act like children (and sometimes your patients are children). They do what you tell them not to do (“I told you not to drink while taking the Flagyl.”). They don’t really believe you when you tell them that if they don’t get their diabetes under better control, they will be starting dialysis. They often look up to you, respect you, and see you as an authority.

As a parent, I maintain a careful balance between preventing and allowing consequences. My kids are young, so I still have this power. “If you miss the bus, you will not get dessert tonight.” Action leads to consequence. I can also intervene to prevent the consequence. “Okay, you forgot your lunch, I will drop it off at school on my way to work.” I realize that as my children get older I will be less able to protect them from the consequences of their actions. This is one of the hard parts about being a parent.

As a doctor, I have less control over consequences. My interactions with patients are, in the grand scheme of things, relatively brief. I also am paid and duty-bound to prevent consequences – I don’t allow a person to get lung cancer to prove that smoking is actually bad for you. I do everything I can to prevent lessons from being learned the hard way.
Read more
Despite my best efforts, consequences often find my patients. The years of overeating and lack of physical activity eventually lead to diabetes. Forgoing the statin and continuing to smoke leads to a second heart attack.

During a recent discussion with one of the senior residents, she revealed the struggle she is experiencing with seeing a patient suffer the consequences of a poor choice. The resident did everything right for her young teenage patient. She counseled her on safe sexual practices, the value of delaying sexual activity since she was so young, the need for contraception and barrier protection should she make the decision to have intercourse, and the importance of being prepared for “heat of the moment” decisions.

Despite a close therapeutic bond, despite a parent who was accepting and supportive of her daughter’s decisions, despite a prescription for contraception, this young girl is pregnant. The resident did everything right but could not save her patient from the consequences.

This can be heartbreaking as a doctor (or a parent). You wonder where you went wrong, what you could have said differently, if you missed something that could have prevented this from occurring. The sad fact is that our control (as doctors and as parents) is uncertain and often almost completely absent. We have influence but little actual power. Where we do have power is in our presence – walking beside our child or patient (or friend, sibling, spouse, or parent) as they face a consequence. As a family physician, this is a role I gladly and willingly take.

Jennifer Frank, MD: Breastfeeding... at work

I have breastfed all four of my kids. I strongly believe the research – breast is best. It is the healthiest nutrition for babies and provides long term health benefits. It is healthier for mom allowing the average mom to consume an extra 500 calories a day. A definite fringe benefit!

Returning to work at six to 12 weeks after the birth of each child, I have pumped at work, on call, while traveling, and even on the road one very chaotic day. Both personally and professionally challenging, it causes me to appreciate why so many of my patients give up breastfeeding shortly after returning to work.

I breastfed my first child until he was five months, having to wean him rather quickly in anticipation of a deployment to Afghanistan that fortunately never occurred. My second child “fired me” after eight months. She was and remains a daddy’s girl and I secretly think she preferred a bottle from dad to milk from mom. My third child was 14 months old when we gave it up by mutual agreement. Number Four is a tenacious breastfeeder, continuing to almost exclusively breastfeed at eight months, despite our daily attempts to convince him of the benefit of eating cheerios, squash, or oatmeal.

After doing this four times, I have learned two important things.
Read more
You must allow time to breastfeed or pump. This means getting up a little early (if my husband is reading this, he is probably snorting with laughter as he usually gets up over an hour before I do and brings me coffee in bed), carving out time in your clinic schedule to pump, and taking frequent breaks no matter what you are doing to breastfeed or pump – whether you are teaching at a conference, in the airport, or at a restaurant.

I have found it helpful to make a 15-minute appointment with myself in each half-day of clinic to allow me time to pump. This gives me enough breathing room to actually get it done, despite a hectic schedule. Sometimes I have to leave a meeting early or arrive late so that I can take care of what needs to be done.

One thing I struggled with was how to inform colleagues, staff, and residents what I was doing without making them uncomfortable. I heard about one woman who had a picture of a cow she would hang on her office door whenever she was pumping to let everyone know she was occupied. That seemed a little too strange and self-deprecating to me (what new mom wants to be compared to a cow?!?). I made a laminated sign that informs people of what I am doing and how long I will be gone that I put on my chair in clinic when I head off to my office to pump.

It is not easy to continue to breastfeed once you return to work. Like every other aspect of combining the personal and professional gracefully, it requires patience, planning, persistence, and practice.

Jennifer Frank, MD: Making friends, Part 3

I have previously written about the struggles I face as a busy, working mom to establish close friendships, or let’s face it, even loose friendships with other moms like me – moms who spend most of their time away from the people that are closest to their hearts.

I joined a meetup.com group to meet other working (outside the home) moms and have been pleasantly surprised by the result. No bosom buddies yet, but I have enjoyed the few activities I have attended. I am even hosting my first event this weekend – a movie afternoon at our house. Friday night will find me madly cleaning the toy room in order to create the illusion that in addition to working full time and parenting four young kids, my house is always immaculately clean.

Last night, I had the opportunity to do something I normally avoid like the plague (or agree to attend and then spend the days leading up to the event inventing ever more fabulous excuses for canceling). There is a new surgeon in town and she is a girl. She hosted a meet and greet for other female physicians at a local restaurant.
Read more
I get a fair number of invites to meet new physicians or see new office space or hear about new services. Usually, I am not even remotely tempted to give up time with my family to attend. However, when I received Dr. Collette’s invitation in the mail, I decided to go. Maybe it was the hot pink lettering and zebra print background on the invite. It might have been the informality of combining the “Doctor” title with her first name – not since I lived in the south have I been “Dr. Jen.”

I think, though, it was most likely the little note that accompanied the invitation. It described the benefits of female providers meeting, working with, and supporting other female providers. I like that. I wanted to meet this lady. Most of all, I wanted to reward her outreach effort by accepting the invitation.

So, yesterday evening, I headed out to the reception. I admit that I regretted having accepted as I drove to the restaurant. I would have preferred to head right home even knowing that dinnertime chaos awaited me. But, I reasoned with myself, I accepted and wasn’t sure how many other physicians would take the time to go. I also told myself that there were probably other female physicians in my place – busy with work and home and eager to meet other people with whom they share a common bond.

I took an immediately liking to the new doc in town – approachable and down-to-earth. I also had the chance to meet a half-dozen women doctors. One even brought her 9-month-old son – another bond. It was nice to converse with these fellow physicians and moms and wives and women.

It has inspired me to get together with my practice partners and host our own female physician get together. I will let you know if anyone accepts our invitation.

Jennifer Frank, MD: My voice

I have laryngitis. This is my first bout with the sickness that takes your voice. I can squeak out a few words before I start coughing. I can whisper pretty well for several sentences before I get tired of whispering or my audience gets tired of trying to hear me. However, I am definitely unable to continue my current voice-related duties.

At home this weekend, I had to discipline without my voice. This led to two things. First, I let some things go that normally would have found me yelling either up or down the stairs to “stop chasing each other,” “brush your teeth like I told you to three times already,” or ask “is your room clean yet?”

Second, I got a lot more exercise since I had to physically locate myself in the same room as the kids if I cared enough about their current infraction to reprimand them. That tired me out quickly. So, I found it easier to just hang out wherever they were. This allowed me to watch them more closely which made it less necessary to correct them as my proximity had a disciplining effect.
Read more
The unintended effect was that I spent more quiet time with my kids — my daughter read me a story, I taught my other daughter how to play Connect Four, I explored all of the Lego weapons my son had repurposed into even more powerful weapons, and I got some great belly laughs out of my infant son.

At work on Monday morning, I had to critically evaluate my schedule. Clinic on Monday afternoon would prove challenging for both me and my patients if I had to whisper through questions and instructions. I reviewed my appointments and was able to identify which ones needed primarily my hands or eyeballs and would allow minimal conversation. Not surprisingly, I determined that most actually needed to hear me, so they had to be rescheduled.

I couldn’t pick up the phone for the telephone conference I had planned, that would need to be rescheduled. I had a couple of important meetings to attend — both requiring at least some input from me. I considered writing down my thoughts, but was able to express everything I needed to say with a few well chosen words, thumbs up or down, and a few shakes of my head. At the conclusion of both meetings, I felt that the things that I needed to communicate had, in fact, been communicated. It is both humbling and embarrassing to consider how many more words I would have used had it been easier to do so.

Being quiet today has other benefits. When I did speak, everyone listened. They wouldn’t be able to hear me otherwise. Ironic — I usually raise my voice to be heard better. I also feel more quiet and calm. I am thinking before I speak (a rarity) because I have to save up my words to exert maximum effect. It is evident that this would be a good practice every day.

Jennifer Frank, MD: CME ... with baby

It seemed like a great idea at the time. You know, like a year in advance. I applied to present at the American Academy of Family Physicians Annual Conference. Between the time I applied and the time my presentation was accepted, I discovered (happily) that I was pregnant.

My new baby would be about 3.5 months at the time of the conference. I figured it was doable and set out to make the arrangements to attend (along with my husband and three older kids). As an academic physician, it is important to keep publishing and presenting, even when life is happening.

A few weeks into my maternity leave, I found myself madly putting the finishing touches on my presentation. In between diaper changes and breastfeeding sessions, I did pub med searches, printed up articles, and finessed my PowerPoint presentation. Shortly after returning to work, I practiced my presentation for colleagues, received their feedback and made the necessary changes. I uploaded my “finished” presentation the day before we were to fly to Boston. I was ready for the presentation. I wasn’t so sure, though, about traveling with four kids on a plane, staying in a hotel, and navigating to the conference every day with a baby in tow.
Read more
We arrived in Boston on time and got settled into the hotel. Fortunately, I had realized, in a rare moment of sanity, that once I left work on Monday evening, I would not have a chance to practice my presentation again before I did it live. So, there was no pressure trying to fit in one more practice or rewrite before my session was scheduled. My wonderful husband took all four kids on the day of my presentation so that I could focus.

And, it went great. The room was packed with interested colleagues, my talk went well, and I had the chance to connect with other family physicians who shared my interest. My husband even walked our kids past the room where I was talking so they could see Mommy.

For the rest of the conference, I had a guest attending with me — my 3.5-month-old son. We attended CME lectures together (when he allowed it), strolled the convention center floor in search of gadgets for his sisters and brother, met up for lunch with friends from residency and past jobs, and spent a lot of time waiting for an opening in one of the very few restrooms with a diaper changing station.

I was apprehensive about bringing my little guy with me to a professional activity. As a working mom, I often feel pressure (mostly from myself) to keep personal and professional roles separate. This represented a definite merging of the two. However, it went remarkably well. I received mostly encouraging smiles and comments from my family physician colleagues at the conference. I was grateful for the CME I did manage to attend. I was proud of my husband and I for attempting something so challenging…and succeeding.

Jennifer Frank, MD: What I love

Recently, I have rediscovered two old loves – soccer and ballet. Starting with a somewhat flighty dance instructor when I was three, I took ballet until I was in college. The discipline of the exercises and reassurance of doing things “the right way” is satisfyingly attractive. (Is it any wonder I found my home in medicine?) Soccer was a given in the suburb where I was raised and I dutifully played from elementary school until college.

With my focus on pre-medicine studies and the need for excellent grades to get into medical school, soccer and ballet fell aside as I pursued my ultimate goal of becoming a doctor.

In medical school, the work only became harder and the limits on my time and energies more stringent. The second year of medical school closed and I saw the end of heavy-duty “book” studying, but quickly transitioned into all-night call shifts and real-life learning from patients. Completing residency before the 80-hour work week rule, I remember 100+ hour weeks that found me asleep on the desk on L&D.
Read more
During a “light” rotation in residency, I signed up for a four-week pottery class to rediscover a part of me that wasn’t related to medicine. I managed to attend two or three of the sessions, but didn’t have time to go back to get my completed projects. All that is left of my lessons are clay encrusted tools on the back of a garage shelf.

After residency, I suddenly had a lot more time and money…for the two months between graduation and the birth of my first child. Four kids later, residency a fading memory, and a more predictable schedule, I realized that if I don’t reclaim old passions and discover new ones now, I will next be exploring extracurricular options in my assisted living facility.

So, I signed up for a ballet class at the local Y and accepted an invitation to play on an over-30 women’s soccer team.

My ballet classes, open to adults and teens, have been populated solely with young women who have been alive for a shorter amount of time than has elapsed between now and the last time I donned tights. I can only imagine what they think of me as I glide through plies and pirouettes. Despite the limits of my older body, I love it. I look forward to my ballet class with eager anticipation every week. Gone is the need to be the best in the class. I am doing it simply for the love of doing it.

I am similarly enjoying soccer. We are not a great team. We lose every time and rarely score a goal. Once again, there is no pressure. Our team is not striving for a playoff title and no one is trying to shine in order to secure a college scholarship. Sitting on the bench for a few minutes is a privilege not a punishment.

I have finally finished my training and found a job that combines my interests and abilities. I am married with kids. I am terribly busy, but have learned not only the importance, but the absolute joy of reconnecting with a long-forgotten part of me.

Jennifer Frank, MD: My try-athlon

I am pretty physically active. This shouldn’t be confused with being physically fit. I am one of the few Americans who enjoy exercise. In contrast to my husband, I don’t look at my exercise sessions as grueling opportunities to do my best. I consider them more leisurely forays into a combination of “me time” and a healthy behavior that benefits mind, body, and soul.

For the past few summers, my husband competed with a relay team in a local half Iron Man triathlon. I am suitably impressed by anyone who runs a race, personally viewing running as a form of torture perfected by the Army, in which I served.

Nevertheless, I get caught up in the excitement at the finish line and cheer loudly for him as he comes into the home stretch. At these moments, I (briefly) envision that one day, I too will compete in a marathon and picture myself crossing the finish line, thrilled with my mighty accomplishment. Soon, though, I remember that this involves running, which I detest, and the dream floats away.

I am considering being part of my husband’s relay team this summer. He would run, I would swim. Once we find a willing cyclist, our team will be set. Read more
My husband studies me as I make this announcement. “You have to swim in the lake,” he reminds me.

“I know,” I respond, acting offended. One of my faults is that I often leap before I look, later regretting my rashly made decisions to do everything from the aforementioned joining the Army to agreeing to write another journal article. We discuss it more seriously. I think about it as I do my laps at the YMCA. I asked him when I have to make my final decision. “I need to know by March what you’re going to do,” he responds. He already has a lead on a cyclist.

So yesterday, I pushed myself harder at the YMCA. Instead of my usual leisurely, and admittedly short, swimming workout, I vowed to do a mile swim in the shortest time possible. I will have to swim 1.25 miles during the triathlon and want to make sure this is something I can do easily in the pool before I take it out to the open water.

I was successful in swimming my mile. I felt that I could have even gone longer, had I the time to spare before I was ousted from the pool to make way for swimming lessons. I will not advertise my time here – let me practice a bit first before I have to confess that. I proudly bragged to my husband that I accomplished this goal.

“I knew you could swim a mile,” he says bursting my bubble. “You just need to be able to do it faster…and longer.”

My medical training has prepared me well to take up a challenge. As a mom, I would love to set the example for my kids that you can start something new at any age and successfully accomplish your goals. So, we will see if this tired and exhausted, not-quite-stellar athlete, mom, and doctor is up to the challenge. More to come…

Jennifer Frank, MD: Community helpers

Today, my kindergartner is dressing up as a “community helper” for school. Choices are abundant — firefighter, police officer, or teacher. She chose to be a doctor.

This is flattering. I don’t see myself as a community helper most days. Paperwork machine, drug dispenser, lecturer, cajoler — those are my roles. Of course, as a family physician, one of my main objectives is to help not only my patients but the community as a whole.

As my daughter heads off in her long white coat with her Fisher-Price doctor’s kit, I consider how I will feel if she chooses to be a doctor, not just for today, but for all of her days. Many doctors tend to discourage their children from pursuing a career in medicine. Burdens of managed care, reimbursement, and paperwork are onerous. Training is long and difficult. The lifestyle can be grueling. Family life can suffer. You can make more money doing things that don’t require the better part of your 20s and early 30s and exact the same emotional toll.
Read more
I would recommend her to carefully consider a future in medicine. She wants to be a wife and mother one day — and will be quite devoted, judging by the attention she shows to her dolls and stuffed animals. Being a wife and mother is hard work; it is important work. Many physicians start considering marriage and parenthood around the time they are choosing residencies and jobs. At the very moment all of your hard work in medical school is paying off in the form of a top choice residency or a position with a prestigious clinic or medical school department, you need to seriously consider other people’s needs — your spouse, your kids, your family.

Female physicians face unique challenges. Some specialties are still male-dominated and venturing into these arenas may require a thick skin and selective hearing. Even in female-friendly specialties, the physician may be the leader of a care team, a clinic, or a department in which she oversees other women — possibly other physicians, but also mid-level providers, nurses, administrative staff. Women are often unkind to other women and can undermine their success in leadership roles.

There are other challenges. Paperwork is time consuming. Medicine is a profession, not a job, and its demands on your time and attention have no limits. As a colleague once stated, “Medicine is a jealous mistress.” Your colleagues are often ambitious perfectionists who can display an amazing array of unhealthy behaviors.

Despite potential disadvantages, I would still encourage my children to consider this most rewarding of careers. The benefits of being a physician are innumerable. There are monetary benefits — physicians still make a great living. Physicians tend to be respected and admired. There is job security and tremendous flexibility in how and where you practice. Most importantly, you make a difference numerous times each day. You are invited into the most wonderful, painful, frightening, joy-filled, and ordinary moments of peoples’ lives. At the end of the day, it is still a privilege to practice medicine.

Jennifer Frank, MD: Paperwork

Of all the things that do dual duty by assaulting me both at home and work, none is as annoying, overwhelming, and constantly present as paperwork. As an academic physician, I manage not only the clinical paperwork that threatens to overtake all physicians, but also grant requests, manuscripts, resident evaluations, medical student applications, faculty schedules, and professional journals.

At home, there are the inevitable bills, catalogs, junk mail, pleas for urgent end-of-year, beginning-of-year, and mid-year contributions to charities both noble and questionable, endless brightly colored announcements about a school roller-skating event, book sale, or popcorn day sent home with frightening regularity from my children’s school, and numerous, precious art projects generated constantly by my prolific kids.
Read more
As I write this, I am in a pretty good place with paper control at home and on my desk at work. This is unusual – manifestations of a pretty quiet weekend at home (clearing off the kitchen table is one thing I can do while holding a baby on one hip) and a Friday afternoon frenzy at work trying to get my desk cleared off so that I wouldn’t come in to chaos on Monday morning.

Most days, my desk is piled high with a random assortment of papers – in reverse order of what I have been working on. The references for my article in progress are on the bottom of the pile, followed by the overdue medical student evaluations, an article on placental abruption, a recipe I requested from a co-worker, notes from the last staff meeting, and a letter from a local health plan. It seems impossible to keep it all under control.

Sitting at our kitchen table eating dinner, I am amazed at how quickly my family members undid my good work of the weekend. Papers have taken over once again. The Wall Street Journal, homework assignments, holiday cards, receipts, random scraps of paper for future art projects, and the grocery list compete with the dishes for space. The paper battle feels endless and hopeless. Paper is generated more quickly than I can recycle it. What to do?

- Toss as you go. It is only four feet from the in-box on my office door to my desk, but if I don’t cull out the job offers, CME brochures, and throw-away journals before I get there, they claim space on my desk and make it less likely that they will be recycled quickly.

- Buy a label-maker. It is so much more inviting to file papers in a colorful, clearly marked file folder.

- Periodically purge. Take some time to get rid of papers that you once needed but no longer use. For some of us, it is the article on hyponatremia our internal medicine attending gave us in 1995. For others it may be the pile of Christmas cards littering the dining room table.

- Use electronic media frequently and comprehensively. With electronic access available nearly everywhere, it is getting easier to store things virtually – perfect, no clutter. (Actually it is possible to clutter up your electronic storage but it is not as unsightly).

Jennifer Frank, MD: Looking out for each other

Last spring, in a state of somewhat over-worked frenzy, our faculty group got together for a “work-life balance” retreat. We hashed out schedules, expectations, demands, priorities, and realities to come up with a mission statement. This statement outlines a respect for a “healthy balance between personal and professional responsibilities,” “healthy limit setting,” and “open and transparent communication.”

We also discussed the different needs that lead one of my colleagues to round at 5 a.m. in order to fit in all of the items she needs to do in a day and leads another colleague to work part-time so that her balance is not upset.

One thing that recently came to mind was the need to help each other achieve this elusive balance.
Read more
This is a foreign concept in medicine, where workaholism, perfectionism, and all other kinds of unhealthy –isms abound. I don’t remember any residents I worked with as a student or any attendings I worked with as a resident tell me that I looked tired and should go home early to rest. In fact, I remember an attending on my pediatric cardiology rotation reminiscing about his intern days, when he took call every other night. He was told (by his attending) that “if you are only on call every other night, you miss 50 percent of your learning.”

I have been blessed with great colleagues who actually do look out for each other. When I returned to work after a three-month maternity leave, they were understanding of the demands of a new baby, offering to help with rounds or other responsibilities if needed. When one of my colleagues is struggling to complete a paper or presentation, I hope that I am responsive and step up to help out. Why is this so unusual in medicine, where health is our supposed goal?

My husband and I also try to look out for each other. We are both going about 100 mph during an average day. It is essential for us to occasionally look at the other to evaluate for signs of near-collapse or exhaustion. At times like these, my husband may encourage me to head out to the gym or I may send him down to the basement to play video games. This is why my obligation to be at home one Wednesday evening a month while my husband goes out for his “guys’ dinner” is sacrosanct.

Very demanding roles — such as physician or mother — rarely are accompanied by other people looking out for your wellbeing. My kids love me but are inherently egocentric, as is the norm when you are young. My patients appreciate me (most of the time) but are appropriately focused on their own myriad needs instead of on their doctor’s. Therefore it is essential that colleagues or partners look out for each other. Check in with each other to see how things are going, protect each other from self-imposed craziness, and help each other to be healthy in the way they fulfill the demands of their roles.

Jennifer Frank, MD: There's no "I" in "team"

Busyness and stress erode a team’s cohesion. My husband is my primary teammate. Together we are raising four children, managing my career, keeping our home running (even smoothly at times), and occasionally even interacting with each other.

At work, my faculty colleagues are my primary team. We support each other during difficult days, cover each others’ patient care responsibilities, and commiserate about the numerous challenges we all face. Moments of true team cohesion feel really good. We get in a groove, work together towards a mutually important outcome, and smile at each other while doing it. Encouragement, support, understanding, and good will are the undercurrents of the team.

Unfortunately, the team doesn’t always work well.
Read more
Busyness breeds isolation. I run off to take the kids for a haircut while my husband goes in the opposite direction to get groceries. Isolation can foster delusions of persecution. I’m doing all the work around here. Nobody else is as stressed as I am. Good will evaporates, even as logic demands that everyone is busy and stressed. A lack of communication born of too many fires to put out or too many patients to see or too many little people needing a bath inevitably leads to even less communication and that leads to more isolation. You see where I am going with this.

The less connected I am with my teammates — at home or at work — the less connection I tend to seek as I hunker down into an increasingly selfish spiral of what is bothering me, what is important to me, what I have to do, what is on my to-do list. It gets ugly. I also notice that my team members behave similarly. They are less generous in cutting me slack when I don’t get something done. They are not as quick with a smile or a friendly “good morning.” It gets uglier. Sometimes someone is so frustrated and disconnected that they quit the team.

How can I protect against this? Well, for starters, communication is key to the successful running of a team. (When is it ever the case that communication is not key to success?) I force myself to start a conversation with a colleague I have only breezed by during the week on my way to this task or that task. During our chat I discover that he or she is carrying a heavy load and I understand more, am willing to extend myself more for them, and see my own worries in a new light.

Two other ingredients are important. First, I need a margin around myself — a little extra time, energy, understanding, patience — so that I have it available to a team member who may need it. Second, I need to assume the best, instead of the worst. If my feelings were hurt by the fact that my husband has yet to read any of my blog posts, I remember that he is usually too busy to sit down and when he does, he inevitably falls asleep.

Teamwork is just that — work. However, the times when I look up at work or at home and catch a teammate’s eye and smile, knowing that we are in it together energizes me to continue the work.

Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.

Jennifer Frank, MD: The mom in me

As my husband and I lug four tired kids from the YMCA to our minivan after swimming lessons one bitterly cold evening, I think to myself, “This is hard.” In fact, I frequently have that thought. It is hard getting four kids clean simultaneously. It is hard refereeing the continual arguments and fights that abound in our home. It is hard being a working mom.

But, I often think, it could be so much harder.

I see the difficulty many of my patients have with parenting and raising their children. Often, these are young, single moms trying to raise one, two, or more children on minimum wage salaries while battling their own medical problems or addictions.
Read more
They love their children as fiercely as I love my own, but their struggles are multiple. They can’t easily afford children’s Tylenol. Gas money may be scarce. Trusted childcare can’t be found for the price they can pay. Other family members interfere with their attempts to better themselves and protect their children. They have serious medical problems that physically or psychologically impair their ability to be the type of mom they would like to be.

It is difficult not to judge them for the choices they have made that led them to where they find themselves. When I am tempted to form a critical conclusion, I remind myself that I was raised in a stable home by two loving parents, had numerous educational and extra curricular opportunities, enjoy a healthy marriage, have a supportive spouse, am blessed with four healthy children, and appreciate an exceptional standard of living. If it is hard for me, it must be nearly impossible for someone with more barriers and obstacles.

Too often, I have little to offer to help them in their journey. However, I can try to smooth the way rather than being another obstacle. I can forgive the no-show appointment or showing up 20 minutes late for a 15-minute visit. A few simple words such as “you are doing a great job” can lift spirits. I can fill out that paperwork for the social services agency quickly (even though it was just dropped off). I can try to find an extra bottle of children’s Tylenol and not bristle that they spend needed income on a pack of cigarettes.

In short, I can try to be an advocate for these patients. Taking them where they are, I can try to help them and their children by doing everything in my power to make it less hard for them to be successful. From one mom to another, I can extend a hand and lift them up.

Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.

Jennifer Frank, MD: Intimacy

I am both amazed and humbled by what patients share with me. They volunteer the most intimate details of their lives and allow me to examine the most intimate parts of their bodies. I hear things that no spouse, parent, counselor, or priest hears. Something about the trust patients place in their doctors and a desire to share important information motivates patients to reveal these intimate details.

The knowledge I have about my patients is sacred. Indeed it is so sacred, that I have both taken an oath to protect it and am under strict legal obligation to safeguard it.

I was pondering this recently as I chatted with our housecleaner in my kitchen one morning before I left for work. She enters our lives and our home every other Monday morning. She arrives early, when we are still in our pajamas, and vacuums around us as we eat breakfast, get ready for work and school, and handle the inevitable morning meltdown (usually one of the kids, but occasionally one of the parents). It is hard to hide your true self from someone who vacuums under your refrigerator and cleans your toilet bowl.
Read more
In many ways, the relationship I have with my housecleaner is even more intimate than the one I share with my doctor. I tell my doctor that I eat healthy, but my housecleaner sees me eat a chocolate chip cookie for breakfast. When asked about my stress level, I tell my doctor that I am doing fine. My housecleaner sees the difficulty I have balancing the multiple demands made by four young children. She sees the inner workings of my family, what books are on my bedside table, the food we eat, how tired we are.

I often wonder what she thinks about us. Is she as horrified as I am that it took her seven hours to clean our windows this past spring or is that “normal”? Does she silently judge the way we parent our children? How do we compare to other families in trying to get everyone out of the house in the morning?

My patients must feel similarly. Do they sense that I am perfectly accustomed to the “oh, by the way” symptom of erectile dysfunction offered at the conclusion of a visit? Do they perceive me judging them for failing to take their diabetes medication? Are they concerned that I may discover too much or pick up on secrets they wish to keep hidden? It reminds me of the unique vulnerability patients experience.

I also realize how limited my vision is. Sure, I can ask (and have asked) almost every question imaginable, including some that probably made me blush. But, 15 minutes is hardly a window into someone’s life. How much different it would be if I could get the “housecleaner” view of my patients’ lives. I can ask those probing questions that allow me to visualize what I can’t see. What did you have for breakfast this morning? What time do you go to bed? Who lives in your home? Hopefully, this will fill in the gaps that are not revealed, so that I can get a sense of the whole person and hear beyond their words.

Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.

Jennifer Frank, MD: The balance

This week has been crazy busy at work as each day has turned out much different than my day planner predicted. After a long weekend, Monday was predictably hectic, but as I perused my schedule for the remainder of the week, I was optimistic that it was manageable and would allow me to get everything done that was necessary on my to-do list.

Tuesday morning I was in a meeting (dutifully recorded in my calendar) when I received an urgent page informing me that I was already 45 minutes late to staff the residents in clinic. I quickly glanced at the clinic’s schedule to see that, yes, I was scheduled for staffing duty that morning. A change must have been made that did not make it to my personal calendar. Frustrated, I worked hurriedly to get through the staffing back up while trying to find a time to reschedule the meeting that was abruptly cut short.

Tuesday afternoon’s planned lunch-hour swim at the YMCA never occurred, as I attended another meeting, addressed a number of urgent issues, and made it out the door 20 minutes late to meet my husband for the kids’ swim lessons.
Read more
Wednesday’s schedule was packed full with clinic and staffing duties. Shortly after waking up in the morning, I received sign-out from a colleague (did I mention I was on call too?) with two laboring patients. I quickly showered, ran to clinic to perform a procedure I had scheduled, and worked with colleagues and staff to rearrange my morning before heading over to the labor deck. While supervising the resident managing the two women in labor, I was able to finish resident evaluations and a self-assessment module for my board certification requirements. I am fortunate that my colleagues are understanding of the urgency of OB practice and covered my patient care and staffing duties for me. The second patient delivered at about 8 p.m. and I was able to leave the hospital by 8:30, having missed dinner, bath, and bedtime.

Thursday seemed ideally planned out – a full morning clinic but administrative time in the afternoon allowing me to attend my daughter’s preschool holiday concert and catch up on charts prior to a vacation day planned for Friday. I finished my 11:15 a.m. patient at 1:10 p.m. (having elected to pursue an overly ambitious agenda for this visit) and was walking back to my desk when a resident stopped me in the hallway to tell me that we were scheduled to do a vasectomy together.

There was no way I could do the vasectomy and make it to the concert (I had promised to attend) on time. None of my colleagues were available to help out and I was torn between doing the right thing for the patient and honoring my promise to my daughter. I tried to figure out where the mix up had occurred but quickly abandoned that exercise as both irrelevant and a time waster. The patient, having been poorly prepared for the amount of time the procedure would take actually requested to reschedule, so that part of the problem was solved. However, working with the front desk to reschedule him, soothing the patient’s ruffled feathers, giving instructions to the resident, and explaining the situation to colleagues took up precious minutes, so that I arrived at my daughter’s preschool just as the concert ended.

So frustrating to be extremely busy but fail to meet your obligations. In moments (days and weeks) like this, I rely on the common sense voice in my head which reminds me that all weeks are not like this one. I am thankful for a husband who records those events I miss and appreciative of the opportunity to share cookies and juice with my daughter who is unaware of my absence. Finally, I am reminded that so little of the pressure I feel to perform is real – much of it is my own drive for perfection. It’s okay to be imperfect, which is good because I am.

Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.

Jennifer Frank, MD: The family in family medicine

I open the door, greeting the older couple, patients of mine for the last three years.

“Let’s see the picture,” the husband demands good-naturedly. I know what he means; he wants to see a picture of my new baby. “I don’t have one on me right now,” I admit sheepishly. He looks disappointed and I promise to retrieve one from my office before the visit is over.

Today’s visit focuses on the wife’s slow and inevitable decline. I try to focus on the myriad social, medical, and logistical issues that assault the couple as they progress through their 80s, trying to live together at home. They do their best to sidetrack me.

“Is he sleeping through the night yet?” “What’s his name again?” “Our great-grandson is 3 years old now.” As a family physician I both recognize the value of the details of my patients’ lives and relish the opportunity to share those details with my patients.
Read more
However, I am also trying to determine whether this couple can continue to live at home safely and for how long. I wonder whether my patient is falling more often than she lets on and attempt to discover whether her memory loss is reflective of dementia, depression or both.

“I’m in charge of all the pictures,” the husband interrupts me as I question his wife. He describes how he cropped a digital photograph recently to accompany a friend’s obituary. “I am keeper of all our family photos,” he explains. He has two external hard drives each containing his family’s pictorial history. There is one hard drive for each of his children, “in case something happens to me,” he says.

After repeated attempts at questioning the pair, I come to the conclusion that things are, for the meantime, stably unstable. Not as good, or as safe as they could be, but pretty close to baseline. I adore this older couple and the playful affection they show for each other, especially while bickering. I am saddened by the future I can see for them and realize that there is little I can do to ease the numerous challenges in their normal day.

“Let me go get that picture,” I say. I return with two photos, one of my newborn son, hair standing on end in a post-bath mohawk, the other of my husband holding him during an outing to the park. The husband positions them each on the exam table and whips out his digital camera. He adjusts the pictures under the fluorescent light just so, trying to avoid a glare as he takes a picture of my pictures. I use the opportunity to probe his wife. “How are you sleeping?” “Are you still taking the Celexa?” “When did you notice your memory being a problem?”

“I got a good one,” the husband announces and shows me some remarkably clear pictures of pictures. I imagine they will end up in his family’s photographic archive, leaving his children to wonder which distant relative is pictured. I can’t say a lot was accomplished medically during this visit, but I am flattered that this couple thinks of me and my family as part of their own. I hope this bond will allow me to gently explore how well they are coping as they decline together.

Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.