Feedback

If you've been in medical or dental training for any length of time, you are likely very familiar with the term "feedback."  If you're an upper-level resident, fellow, or attending, you've probably attended seminars on how to give feedback, with silly examples like "Feedback Fridays" and, my personal favorite, "The Feedback Sandwich", with a little bit of negative surrounded by fluffy positivity to cushion the criticism.  The word feedback itself makes my skin crawl, to be honest.  It implies that I've done something wrong, that something needs to be done differently, usually in the way or to the preference of the one giving the feedback.  Feedback can be positive, but when someone says, "I have some feedback for you," I've realized this is a nice way of saying, "Let's talk about what you did wrong."

Feedback is also a physiologic phenomenon.  Remember the positive and negative feedback loops in physiology class?  How hormones act on organs and the organ sends a signal back to make a change indicating it's received the signal?  How positive feedback increases the target's function and negative feedback inhibits it?  At least that's how I remember it...

And then it comes to the matter of our hearts.  From where do we, as Christians, get spiritual feedback?  There's no such thing as Feedback Fridays (at least in my theology...), but it is a continual, instantaneous process.  The Holy Spirit brings conviction through times of prayer, worship, reading the Bible, and even through other Believers.  That prick in your heart...Was that the right thing to do or say, the right way to react?  Was that conversation necessary?  Why didn't you pray for that patient or coworker?  Let's readjust your focus.  It's--thankfully--not a feedback sandwich--the hope and gentleness offered in our salvation is a long-standing, permanent offer, no fluff or pretense about it, no having to second-guess my position or status or role as a child of God.  We've got God's love in the form of a Savior sacrificed the cross, no matter what.  But we need to stay sensitive to His feedback (as much as I'd prefer a different word such as 'conviction' or 'discipline'), and change our lives accordingly, knowing there may be eternal value (for me and others) as I respond to the Holy Spirit's prompting.

I Timothy 4:8, 15-16: For physical training is of some value, but godliness has value for all things, holding promise for both the present life and the life to come...Be diligent in these matters; give yourself wholly to them, so that everyone may see your progress.  Watch your life and doctrine closely. Persevere in them, because if you do, you will save both yourself and your hearers.

When I Don't Know

CMDA Resident Life Devotional March 29, 2013

Isaiah 48:17--

This is what the Lord says--

your Redeemer, the Holy One of Israel:

"I am the Lord your God, 

who teaches you what is best for you, 

who directs you in the way you should go."

I don't know about you, but life in medicine--especially the training years--is somewhat of a certain, well-defined, generalized trajectory.  Making a decision about where to go for undergrad--even what I'd major in--seems like child's play compared to the decisions before me today.  What am I going to do after residency?!?  The plan to this point has been straightforward:  MCAT, Medical School, COMLEX/USMLE, Step 1, Step 2, Residency, Step 3, finish Residency, take specialty boards, go on vacation.  If you're still alive and vigorous, there's this fork in the road...Fellowship, Missions, Real Doctor Job, Research, Work at Starbucks, Never Return From Vacation.  Some days, the opportunities before me are overwhelming.  After all, this is the rest of my life we're talking about here! 

And then I read the above verse...the Lord is going to teach me what is best for me and direct me in the way I should go.  There is incredible comfort in this verse!  We all have Proverbs 3:5-6 memorized--"Trust in the Lord with all your heart, and lean not on your own understanding.  In all your ways acknowledge him, and he will make your paths straight."  There's a lot that I have to do in those verses...trust, lean not, acknowledge.  And I do try to do those things.  But then I have to remember that I'm not here for my glory/satisfaction/self-discovery, but God's.  So in the end, it has to be the Lord who instructs me in what is best and shows me where I should go, and it's up to me to be willing to follow.  

As you celebrate Resurrection Sunday this weekend, I encourage you to take time to rest in the work that has been completed for you through Jesus.  Christ is Risen Indeed!

Be Strong & Courageous

CMDA Resident Life Facebook Posting, February 16, 2013:

Yesterday in clinic I had that moment when I thought, "Wait, that's just not right."  I'm halfway through year two of residency, and I'm starting to pick up on that sick/not sick feeling.  In the US, I have a lot of options...tests to run, specialists to call, attendings to consult if I have questions, concerns, etc.  But I'm not in the US this month--I'm in Honduras on a one month international elective.  The 9-month old boy sitting in front of me weighs 5.5kg (11 pounds) and the mom isn't concerned about his weight.  He's always been small.  What brought him in today--his first doctor visit ever--was that he's

started turning purple and passing out when he gets angry.  I spent a long time--with an interpreter--clarifying the story.  Clarifying what he eats and drinks.  Trying to figure out why a 9 month old can't even sit up on his own.

Thankfully here, I'm not alone (of course...the ACGME RRC wouldn't like that!).  I'm here with my chief resident from last year who is serving for 2 years with World Medical Mission.  Together we're reading a ton and emailing specialists in the US our pictures and EKGs and 'heart ultrasound' pictures (not exactly a formal ECHO because we don't know how to do those).  We have limited labs available, but the ones we have available we've done, just to rule out as much as we can.  Bottom line, this kiddo needs a specialist!  The cool thing is that we are that specialist here.  We're following & monitoring him and will refer him to the right people in the big cities when we figure out who that is.

Deuteronomy 31 chronicles some of Moses' last words before Joshua began leading the Hebrews.  They hadn't yet reached the promised land. Verse 6 says, "Be strong and courageous. Do not be afraid or terrified..., for the Lord your God goes with you; he will never leave you nor forsake you.”

Wherever we are, we aren't alone.  I love Psalm 139:7-10: "Where can I go from your Spirit?  Where can I flee from your presence? If I go up to the heavens, you are there; if I make my bed in the depths, you are there. If I rise on the wings of the dawn, if I settle on the far side of the sea, even there your hand will guide me, your right hand will hold me fast."  No matter what you're facing today--be it a puzzling

patient, a difficult family situation, or just struggling to make it through the week, remember Who calls you also walks beside you.

I Bet God is Laughing Too...

CMDA Resident Life Facebook Posting, January 2, 2013:

Matthew 6:25-26--Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear.  Is not life more important than food, and the body more important than clothes?  Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them.  Are you not much more valuable than they?

Happy New Year!!  I hope it’s been a good start so far!  A funny thing happened to me this week.  God provided something that was little.  Something He really didn’t have to.  Contacts.  Like the kind I wear in my eyes.  Let me explain.  

A few weeks ago, I realized I was running low on contacts and would need a new prescription before ordering more.  I had just signed up for the Vision plan on my insurance during open enrollment this fall, specifically to get the contacts covered as a benefit.  I made an appointment, went to the optometrist, and left with a prescription.  For glasses.  They couldn’t fit me for contacts because my plan didn’t kick in until January 1.  And I had one pair of contacts left!!  So naturally, I panicked, thinking, “I better not have to wear my glasses...”  (which I rarely ever wear!).  I had a little bit of a tantrum, never even thinking to ask God to provide them for me.  I figured I could stretch my new pair to the new year, had an appointment set up, and thought I was good to go.  But if they had to order them...if I couldn’t get them before I leave for a month-long overseas elective...I’d have to resort to glasses.  And I didn’t like that option!

I came home halfway across the US for holiday vacation, opened my bathroom cabinet, and found two boxes of contacts just sitting there, waiting for me to be surprised by them.  Immediately I laughed and thought God must be laughing too.  Somehow, in His sovereignty, He had me keep two whole boxes--a 3 month supply of contacts--at home.  I put them there--more than a year ago--and had forgotten all about them, but my God hadn’t!!  It was such a little lesson to me that God cares for the small stuff I forget to pray about because, well, it’s small stuff.  And how much more will he take care of the BIG stuff--relationships, fellowship applications/interviewing/matching, family, hopes/questions/fears/doubts about the future, etc.  

As we face a new calendar year, I hope you’ll remember with me that our Father loves us, will provide and take care of us, and He can be trusted with all our worries.  No matter how big or small they may be!

Philippians 4:19--And my God will meet all your needs according to his glorious riches in Christ Jesus. 

Insight from Sarah Coors, National Resident Council Leader