Growth Hurts

I’m sitting here in a comfortable position on the couch avoiding getting up for an inevitable trip to the bathroom. Why? Because of delayed onset muscle soreness, that’s why.

If you read yesterday’s post you will be aware that I have recently reinitiated my running career. Only, my body hasn’t quite caught up with my aspirations yet.

Growth is good for us, but it can hurt. And that’s ok. Discomfort doesn’t have to be avoided, it can lead to something good.

Getting un-stuck

This time last year there was no way that I could run 5km without stopping. Maybe it was just a change in heart, maybe it was because I’m coming up to turning 40, but I made the decision to do the couch to 5k program and pretty soon I was running 5km multiple times a week. I got up to doing a 10km run which I felt pretty good about. But I only did it once. I got complacent, quick.

I could make excuses about hayfever season and stuff like that, but honestly, this is classic behaviour for me. Throw myself into something to learn enough about it so that I can prove I can do it, and then let it wither over time or abandon it altogether. I get into ruts pretty quickly with things. I wouldn’t say I’m getting any better at avoiding them, but I am getting better at noticing that I’m in one and building some sort of structure to get myself out. If I want to of course. For some things, like cold process soap making, doing it a couple of times in my life time is quite ok with me.

But running is different. I really do enjoy it as a form of exercise and processing my thoughts. I never stopped doing it completely, but I have felt myself getting lazier and avoiding it more in recent times. So a re-jig was in order. Enter the Garmin training plan. I’ve got myself a virtual running coach. And it’s kind of fun, it’s changed things up a bit. I can still be lazy, of course, but there’s some level of accountability and challenge to do better. I like that. I know there are other options, like running groups and stuff like that, but running is a solo practice for me. So coaching it is.

As I think about this, I reflect on my post yesterday, about missing the professional development structure of the hospital environment. The healthy competitive environment where accountability and challenge are ever present. It was hard to stay in a rut when I was working in the hospital. There was always someone who was prodding me to do better, or a new challenge or opportunity opening up or job to apply for. But this isn’t how it is in the community-care sector. It’s so self-directed. So isolated. It takes some serious effort and self-reflection to keep growing professionally when no one’s really looking.

Take HMR/RMMR pharmacists for example. Everyone gets paid the same base rate, so long as you continue to get referrals and get through them at a rate that pays you a reliable wage then you’re doing ok. If the purpose of your work is to pay the mortgage then you’ll be fine with that. But if you’re looking for greater fulfilment in your work (e.g. have a more collaborative approach with GPs, take on more challenging cases, get involved in projects or teaching) or want to grow your business then you need to actively change things up. It’s not going to get gifted to you, you have to make it happen. You have to differentiate yourself by acquiring and developing skills and professional attributes. And it might not be that obvious how to do that if it’s sitting in your blindspot.

So what’s out there to help these people? From my personal experience and interactions with colleagues, I don’t think there’s anything that’s meeting these needs for the broader workforce. CPD points to meet registration criteria, sure, there’s tonnes of that. Support for early career development, there are many programs steered toward their needs. But we’re not all early career and we still need help with career development, and that’s totally ok.

I don’t know why it is this way that the focus seems to be so much on early career. Perhaps because it’s easier to get newbies ‘on the right path’ than it is to deal with disgruntled realists who are bordering on cynical. Well, bugger that. I mean, I’m obviously biased but I think us disgruntled realists have a lot to offer. We just haven’t got the right venue. Lets not wait for someone to gift this to us, lets build it ourselves.

Lets build somewhere that provides meaningful engagement with our peers where we can safely share our practice. Somewhere that values our contribution simply because we care about doing good work. Somewhere that offers a range of opportunities to challenge us to meet our goals and achieve greater fulfilment in our work.


Things I Miss About Hospitals…

It’s been just over six years since I worked in a hospital, and nine since working in a hospital pharmacy department. There are some things that I’m happy to be rid of (office politics, anyone?) but there are a few things that I really miss about that hospital work environment.

  1. Being part of a multidisciplinary team. One where there is an understanding of each others role in the team, their value and contribution. One where you treat each other as colleagues, regardless of your professional background.
  2. The ability to ask “what do you think about this…” to any number of readily available colleagues who you trust will provide some sound intellectual input. Not only can this validate your thoughts/give you confidence, but it also illuminates your blindspots. Both are good. Both make you a better professional.
  3. Learning from observing other people’s practice. Other pharmacists, doctors, nurses, allied health. You have so much opportunity within the hospital environment to understand other peoples roles and how they approach clinical decision making and patient care. Observe and appreciate differences. It provides such a deep learning experience if you’re open to it.
  4. Ease of communication. It’s pretty easy to get in touch with the people you want to talk with in a hospital. You can often even talk with them face to face. There’s a shared clinical record, network drives, staff directory, pagers…so many functional communication channels to take for granted.
  5. Professional development opportunities. I can’t say that I highly valued the concept of line management and annual reviews when I was working within the hospital system, but now that I’m out of it my opinion has changed. Having some guide rails and accountability can provide you with a lot of opportunity for growth and ultimately enable you to produce better work if you’re open to it, especially early on in your career.

Now I’m not saying that these things are entirely absent in community-based care settings, but they’re a lot harder to come by. Sure, we each have colleagues we can get in touch with to run stuff by, but it requires more effort and your network of peer support is more limited. Professional development rests heavily on the self-direction of the individual. Again, this can be ok when things are going well and you’re being challenged, but more difficult if you feel like you’re in a rut, having difficulties in your personal life or you’re simply not self-reflective. As for communication? Well, it’s just bloody hard work. So inefficient. So much time wasted. I mean faxes…do I need to say anything more than that?

I think there’s a pretty obvious opportunity to improve on where things are currently. And I don’t think I’m being idealistic in saying so.


Shipping It

It’s all well and good to know all the theory about the 80/20 effort and all that stuff. It’s another thing to actually put it into practice and accept that oftentimes, shipping something that is good at the right time is much better than shipping something that’s near perfect at the wrong time.

Yesterday I decided to start shipping. I’ve been working on this interdisciplinary online community for strengthening community based care for months now. I’ve talked to people about it and listened to their perspectives. I’ve engaged in other online communities. I’ve learned about business stuff. I’ve written copy for the site, set it up, started using it with a couple of colleagues. I know it’s not perfect, but it’s good enough to start. And I know I’ll never really know what works and what doesn’t unless I put it in front of people. Unless I risk failing and feeling embarrassed and uncomfortable.

So I shipped. I started inviting founding members. I will jump off the cliff and build the aeroplane on the way down.

And with that, Traversity has been born. Will it survive and grow to maturity? We shall have to wait and see how good I am at building aeroplanes!

What Ifs

Sometimes I come across children’s stories that make me think they were written for the parents. Arthur and the What Ifs is one of those stories.

A little guy named Arthur is filled with music but psychs himself out by thinking about the what ifs. What if he’s not good enough. What if people laugh at him. You get the idea. But the music is still inside him, it doesn’t go away.

One day Arthur gets a flyer for an open jam session and he again starts to think about the what ifs. But this time, for the first time ever they are good what ifs. What if it’s fun? What if he’s actually good?

This shift in mindset doesn’t solve all of his issues (this is a children’s story, not a fairytale) but it gives him enough confidence to fashion himself a disguise and join the jam session. He joins in and gets so consumed by the music that he doesn’t realise he is no longer in disguise and playing music out in the open where everyone can see him. And enjoying it. This leads to his new life of playing in the band, Arthur and the What Ifs.

How we talk to ourselves is so powerful and so hard to get past. Reframing sounds like such a load of jargonny bullshit. But what if it leads to something great? Isn’t it worth the experiment? I tend to think yes, it is.

Being Judgemental

I have a strong tendency to be a bit too judgemental and intolerant of others. Ive written about it before. Its something I’m consciously trying to improve. But I feel like there are some circumstances where it is still acceptable.

Take small children riding a scooter at speed on a footpath for instance. Make your kid wear a helmet for God’s sake! Didn’t you learn about the impact of heads hitting concrete curbs when Patrick died on Offspring?

And for a work related one, how about oxybutynin and donepezil all packed together nicely in a dose administration aid? Not good enough I think. We need to do better.

Knowing When to Quit

How do you know when it’s the right time to quit something instead of just relentlessly pushing through? I’m not sure. But it’s something I’ve had to face up to this week.

I’ve written before about my frustration with receiving anonymous feedback. I’ve had some pretty bad experiences. Well actually, when I think about it, the bad experiences have all been anonymous reviews conducted by pharmacists. I think it’s because most pharmacists like to distil the world down to black and white. They like to be right. And that’s just not the way I see things, so it creates some pretty strong dissonance.

A while ago I decided that if I was going to be studying and writing about the HMR process then I should really get accredited by the AACP. I figured it would help me in understanding the position of the accredited pharmacists. Improve my capacity to empathise. Get to know the community of practitioners.

It’s not so much that I want to actually pursue a career of providing HMRs. In fact, I used to be accredited with the SHPA and never did a single one so I let it lapse. Back then, I was doing medication reviews for the community palliative care team. I thought if I was going to do them I should at least make sure I met the standard, so I sat the CGP exam, filled out my paperwork and paid my fee. Easy.

If only I could say the same ease existed with the AACP process. I can’t. I definitely can’t. In fact, I’ve found it so anxiety-provoking that I have just sent an email saying that I’m not going to pursue accreditation. Yes, I am quitting.

It’s not because I got negative feedback. I got negative feedback the first submission, I had my little rant, then I sat down and revised it and did it properly. Dare I say that I actually quite enjoyed it and learned a few things. I was almost looking forward to the next case. But then I got the feedback telling me I was still not yet competent. That they could see I’d improved so I was lucky enough to get to submit to the same reviewer for a third time. And I could pay another $70 for that privilege.

I let it sit for a while. I told myself that it’s just one of those things to endure. That I just have to play the game. Don’t take it personally. I thought I would approach it like any other peer review and go through the comments one by one. In peer review you’re not expected to blindly accept all the comments, so surely this was the same.

As I sat down and went through each of the 33 comments, a new reality revealed itself to me. The reality where you either produce work that you think is valid, or you produce work that appeases the reviewer – they are mutually exclusive outcomes. And this reality stressed me out.

I’m not really what I would describe as an anxious person. I can take on multiple responsibilities and manage them pretty well without them keeping me up at night. But this was keeping me awake. Multiple nights, there in my head. And it was making me anxious, and angry, and generally not feeling very good.

So, rightly or wrongly, I decided that paying more money and spending more time on this process for learning sake simply wasn’t worth it. I decided that I shouldn’t let sunk costs influence my future decision making. I decided that there was no way in hell I was amending my report to address some of these ridiculous recommendations. Three of the 33 were kind of reasonable, but the other 30 could not be entertained. I ran it by some colleagues first. I’m not stupid, I needed to know I wasn’t being sensitive. They validated my frustrations.

So I quit. I’m a quitter. And I don’t feel anxious anymore.

Going Analogue

There’s just something about tactile, old school methods that just feels better. Like scribbling notes in a notebook. Or moving post it notes across a board from the ‘to be done’ section over to the ‘in progress’ bit. It brings an element of satisfaction. Its made me feel like I’ve accomplished something today, even if it was just a bit.

The Path Less Pooped

Routine was re-established today. Well, somewhat. It’s the first day back at school and I’m excited. I’m excited because I do much better when there is a routine in place.

So this morning was back to walking to school and exercising. I went on a long-ish walk along the river and it was blissful. As I was walking along one section of the path I noticed a lot of fresh bird poo. Not a pile, it was scattered.

As I dodged the fresh grenades, hoping that one wasn’t going to land on me, I started to question my approach. Is it better to avoid the pooped on areas of the path, or seek them out? Aside from not wanting to get your shoes dirty of course, which approach is going to offer the lowest odds of getting through unscathed?

I suppose it depends on the nature of the high frequency poopage. Does it relate to a comfortable perch? If so, definitely avoid. But, if it relates to a general flock of birds feeding in a large tree and moving around, will the previously pooped on areas be less attractive for further perching/pooping? Are you more likely to get pooped on in the open areas?

You can see I tackle the big issues in my mind as I exercise. You’ll be pleased to know that I made it through cleanly, embracing my initial instinct to avoid the pooped on sections of path. I feel like there’s a lesson in there somewhere, but it’s not coming to me right now. Right now, it’s just a silly anecdote that I felt like writing down. Now onto a productive day!

Playground Justice

One of the best things about having kids is the permission to witness playground justice in action up close.

Yesterday we were at the playground with some friends. One of the girls befriended another little girl and her brother, and a new little gang was formed.

There was another child playing with their sibling at the other end of the playground. This kid was being a bit of a menace, racing around on his balance bike. But he was much younger than the other kids, maybe three years old. Five and six year olds should be able to cope with a three year old, even if he was a menace.

He’d race toward them and they’d all scatter. Then he got off the bike and the foot chase began. “Alexander is coming” one would call out, and they’d all start running away. Then he’d run back to the other end of the playground with at least one kid running after him giving chase. A few moments later that kid would be back, fake crying “that mean kid hit me with his water bottle”. Shortly after, another “Alexander is coming” would start and so the cycle continued.

After a while there was a bunch of five and six year olds cowering behind the swings, claiming to be scared because the “mean” kid would get them.

I spoke to my daughter. It was time for intervention. “He’s not a mean kid, he thinks you’re playing a game. If you want to stop, you have to stop encouraging him. Try telling him to stop and that you don’t like it, or ask him if he’d like to play another game. But you have to stop running after him. You guys are keeping this going as much as him”

She went and played the monkey bars. Game over. Alexander started playing (nicely) with my son. Yes, you can call me the fun ruiner if you want to. But that game wasn’t a good one, so I’m ok with that.

Looking for someone or something to blame is almost an inbuilt response. So often we get caught up in cyclical patterns of behaviours and its natural to feel like life is happening to us. Like someone else is the villain. But oftentimes, if we take a step back, things look very different.

With perspective you can start to see the feedback loops that are perpetuating the problem. You can notice your role within the system. You can start to empathise with the so called villain and consider how they may in fact be being victimised.  You can start to see that the only way to change the system is to take action on the one thing you have control over – your action and your behaviour.

When we move to thinking about the system we shift from reacting to responding. Response allows progress and evolution, reacting keeps us stuck in the status quo. I know which one I prefer.