JUN
14

The Medic Minimalist

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The minimalist lifestyle has a stereotype of either some hippy world traveler to a one-upping hipster bragging about how they live on only pour over coffee. That’s not usually the picture most people have of the average medic. Probably because they’re too overworked and can barely afford the free coffee from Dunkin’. 

But what’s your picture of a healthy medic? 

The medic that has everything together mentally and physically. They’re so subtle that you barely notice them until that one moment when everything is going to $hit and they exude comfort.

Comfort in the chaos.

Further examination into how this person operates is surprisingly unimpressive. Yet, their demeanor will often peek further curiosity into what they do; leading to why they do it. Doing a deep dive into their mindset you would likely find that they are very intentional, are insatiably curious, and provide eloquent value. They are a Medic Minimalist.

A Medic Minimalist is an out of hospital provider who intentionally develops tools, habits, and systems that reduce excess in favor of value- so that they can find happiness, fulfillment, and provide healing to others.

The principles of being a Medic Minimalist are versatile yet tenacious.   

The Medic Minimalist1.002

Principle 1: Clutter and consumption are costly

Cognitive pressure is amplified by decision making, environmental factors, and interpersonal emotions. Excess creates noise to the rock concert of stimulus during a resuscitation. This stimulus continues to add weight to our lives like a pile we carry in the backpack called life. We carry that heavy backpack home with us only to drown it out in the quick dopamine hits of Facebook/Instagram or the emptiness of a bottle. We try to get our lives back together by getting more involved or listening to 10 podcast on ketamine (boy those were the days) only to keep feeling like we’re missing out. That backpack keeps getting heavier.

The amount of information, content, and education is so enormous that you would have to read almost 200 books an hour 24 hours a day, 365 days a year just to keep up. That doesn’t include any news articles, podcast, Facebook post, emails, or FOAMFrat blogs. 

Nobody can maintain that pace for a sustained period of time and everyone is missing out on something. 

Having a fear about missing out on a crazy call, party or moment fuels the fire of anxiety that smolders until its out of control. The clutter and consumption of the professional and personal lives cost us the most important thing in our lives; it cost us our self.

The Medic Minimalist is comfortable not being the smartest person in the room because they’ve consumed content that makes them better leaders and resuscitationist. They’ve consumed the right content in a better way. They’re just not consuming everything.

Principle 2: Optimization improves outcomes

The intention of a Medic Minimalist is captured by how they optimize their systems to improve outcomes related to both self and patients. When optimizing, the Medic Minimalist blends human factors and metacognition to provide critical examination of inefficiencies and obstacles that inhibit their ability to provide high quality resuscitation. Although improved resuscitation is the outcome it is not what their mind focuses on.

Critical examination is the focus of the Medic Minimalist following the intentional process of decluttering and cultivation of their physical and mental space. This examination leads to optimization in multiple parts of their life that allows them the capacity to handle stress and the cognitive load needed to effectively run the resuscitation. This optimization though starts with self.

Principle 3: Strength builds compassion and resiliency

The goal isn’t to be the best paramedic. Shouldering the responsibility of the community and world on your solo performance will build resentment and contempt within you. Resentment and contempt rip you apart causing a wake of destruction and pain. The pain of resentment is like a corkscrew churning in your chest. Everyday asking the world to stop turning the corkscrew. Yet there is no relief; until you look in the mirror to find out you’re the one ripping yourself apart.

Paramedic school taught that being the best and the brightest was the way to succeed and rewards that performance. In school, strength was taught to mean right answers, task performance, and beating the clock; yet that definition of strength made you weak when your partner confided that her marriage was broken and didn’t know how to save it. 

Medic Minimalism rebukes superiority and condemnation by offering compassion and strength through gracious words and action. The Medic Minimalist offers compassion that meets individuals at their current situation in life and empathizes with them. They are beacons of resilience and compassion built upon unshakable core values. 

Having true mental strength allows psychologically safe environments where hard conversations about life and medicine can be discussed without harsh wit and cutting words. Instead, these conversations can focuse on serving the other person and building people up.

Only the strong can help the weak.

This is not only mental strength but also physical strength. Medic Minimalist recognizes life is made of uncomfortable events and that a resuscitation is extremely uncomfortable event. Being physically unwell makes those events even more uncomfortable. The Medic Minimalist curates the proper nutrition and exercise to allow them to be compassionate and resilient in the the face of choas. They choose to be a better person by cultivating a life of discomfort becoming comfortable in the chaos.

The Medic Minimalist is in the development stages and would love to hear how you are a Medic Minimalist. Tag me on Twitter, @vamedic

PS. I’ve wrestled writing this blog trying to capture the enormity of wellness, organization and minimalism. Ultimately that failed and will always fail. The nuances are numerous and the possibilities endless for one post to capture. Further analysis and thoughts needed to support this topic.

1
JUN
10

Anchoring Heuristics

A few years ago I decided to go back to college to obtain my bachelors degree in psychology. I am often asked why I chose this field of study. "Do you plan on becoming a shrink?"

The answer is.. probably not.

Yet, the study of psychology has helped me tremendously when meditating on certain behaviors and decisions in medicine. 

Medical errors are commonly portrayed as individualistic faults that manifest from either a lack of training or diligence. Application and understanding of cognitive psychology can partially explain the reason smart people make simple mistakes.

If this stuff interests you, I encourage you to check out a 2005 article published in Annals of Internal Medicine titled “ The cognitive psychology of missed diagnosis.” In this paper Donald Redelmeier unpacks the logistics and heuristics of clinical decision making. Contrasting cognitive psychology with other psychological paradigms (e.g. humanistic and psychoanalysis) can provide further insight into clinical error. 

Brain-Lag
When a computer has multiple tabs or programs running at once, there can be a frustrating lag that occurs. Cognitive psychology and anecdotal experience support the fact that the human brain experiences a similar processing lag when choices or stimuli accumulate.

In order to increase cognitive bandwidth, clinicians will develop mental shortcuts known as heuristics. Heuristics are decisions based on familiar patterns we have experienced. Humans repeating actions and mentally recording the effect, was noted by Swiss developmental psychologist Jean Piaget, as “circular reactions."

Illustration by Hugo Lin. © Verywell, 2018.

When studying infants, Piaget noted mental shortcuts that were formed when the infant experienced the cause and effect of actions. When this theory of mental shortcuts is applied to medicine, it allows rapid life-saving interventions to be performed with incredible pace.

Let's try one out! How fast does a differential come to mind when you look at the picture below?

You likely did not hesitate to analyze the complaint/story and patient demographics to produce a suspision of an acute myocardial infarction. Your brain has created shortcuts based on previous experiences or experience of others. Let's try another one!

Don't feel bad if drug use was your first thought! Your brain has seen enough of these that it has attempted to create a mental shortcut. This is called recognition primed decision making (Klein, 1998). While it works a lot of the time, it is not flawless. 

Occasionally clinicians can fall victim to anchoring heuristics and diagnostic momentum. Perhaps a humanistic approach to psychology could explain why this occurs. 

Abraham Maslow, an American psychologist in the 1900’s commonly known for his theory of self-actualization, postulated that humans have specific needs that must be fulfilled before they can reach self-actualization.

For example, consider an EMS provider who is having personal health issues. Pre-existing experience and heuristics may lag in processing information even when providing routine care. Anchoring on a specific diagnosis and tunnel vision is a hallmark symptom of decision fatigue and accumulative stress.

In aviation it’s commonly taught that human error is a symptom of a deeper systemic flaw. Rather than blaming the individual, diligence should be made to evaluate why the error occurred.

Maslow reminds us that sometimes the system issue is internal and/or individualized to basic needs. However, even if all essential needs are satisfied, specific presentations or sensatory stimulation may exacerbate emotion from repressed experiences or memories (Wortham, 2017) . This type of error is harder to detect from pure external observation.

An unconscious emotion manifested by repressed experiences is best described through psychoanalysis, a theory proposed by neurologist, Sigmund Freud (Goodwin, 2015). Freudian resistance was a term developed to describe an individual who avoids specific topics (consciously or unconsciously) due to previous experiences. When contrasted with an EMS provider or healthcare worker - one may defer a specific skill or medication based off poor anecdotal experience.

Surfacing  and vocalizing memories that connect a frightening experience to trepidation was suggested by Freud to be the first step in eliminating repressed emotion. But getting individuals comfortable enough to accurately reflect on an emotionally pivoting experience is cumbersome (Wortham, 2017). 

Sharing vantage-points with various psychological paradigms and theorems allows for an objective and holistic understanding of human factors that lead to predicatble error. By emphasizing that clinical error is typically a symptom of systemic flaw, cognitive dissonance may subside and allow honest reporting of mistakes.

If you have interest in learning more about the online university I decided to go with and pursuing a degree in Psychology, please reach out. This email address is being protected from spambots. You need JavaScript enabled to view it..

References:

Goodwin, C. J. (2015). A history of modern psychology (5th ed.). Hoboken, NJ: Wiley.

Klein, G. A. (1998). Sources of power: How people make decisions. Cambridge, Mass: MIT Press.

Redelmeier, D. A. (2005). The Cognitive Psychology of Missed Diagnoses. Annals of Internal Medicine, 142(2), 115. doi:10.7326/0003-4819-142-2-200501180-00010 

Wortham, S. (2017). Resistance and Psychoanalysis : Impossible Divisions. Edinburgh University Press

 

 

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