How “Mattering” Matters

 From the 1/22/2021 newsletter

Perspective

 

 

How “Mattering” Matters

 

 

Karen Marcdante, MD

 

 

Dr. Marcdante writes about the important and emerging concept of “mattering” in medical education and patient care …

It had been quite a week in the Pediatric ICU, lots of patients with complex issues and a few sad stories.  One such story involved a young girl who had been injured in a car accident.  We had just confirmed that she was now brain dead.  I sat down with her mother to explain the findings.  We spent some time talking about her daughter, who she was as a person, her joys and some of her challenges.  As we walked down the hall, back to her daughter’s room, the mother reached out to hold my hand.  We entered the room and shared a few tears as we knew what was to happen soon.  

 

This day, while encompassing the hardest part of my job, stays with me.  Why?  I left that day, knowing that I had mattered, knowing that, despite this being one of the worst days of that family’s life, I had made a difference.  

 

My forty-year career as a physician is, fortunately, full of such moments, little things that remind us of the value we bring and reaffirming our perception that we have something to contribute.   Those moments play a role in my love of my job and keeping burnout at bay.  There are also moments when I felt I didn’t matter – like when I am ignored or made to feel out of place, when my voice isn’t heard or when someone tries to micromanage (what is the point, if they are just going to redo whatever I did?).  As I look to yet another transition in my career, I have looked closely at the idea of mattering.

 

 

Mattering, in fact, is a psychological concept that involves relationships.  It is the perception that others are aware of my presence and strengths, that they rely on me and that they see me as important to them, the team, or even to society.  While it is something I perceive, it really is about relationships – as we all have a need to feel that we matter to others.  It is, in many ways, transactional as mattering is about an exchange between people where “the others’” words, actions and behaviors lead me to perceive that I matter (or don’t).  It is also reciprocal, as my words, actions and behaviors help others perceive they matter.  First described by Rosenberg and McCullough in 1981, more recent studies have demonstrated that when people feel they matter they experience a greater sense of well-being and belonging, more self-esteem and self-efficacy, and even learn better.  People who feel that they matter experience less burnout and depression.  Organizations where people feel they matter are more productive with less personnel turnover.  

 

 

Three components of Mattering

 

So, as I think about how I can still be of value and contribute, I also have been realizing just how important making people feel that they matter can be.  And it doesn’t take a lot of resources, especially to address the interpersonal mattering.  Let’s look at the three major components of mattering to identify what we can do.  

 

 

Awareness is the first component.  Recent interviews with medical students reveal that one way to make them matter is to learn (and call them by) their names.  It can be that simple.  Asking a few questions to learn more about each other is another way – one you likely already do but that you may skip if you are busy or if the other person is not likely to spend much time with you.  Saying hi in the hallway or asking, kindly, about an absence are other ways to make people feel they matter. 

 

Importance, as a component of mattering, means that someone expresses concern for you.  Again, simple things may help.  One of the simplest – but not always easiest – is investing time in people.  I recently spoke with one of our colleagues who focuses on his role as advisor by talking with students for several hours over time (not just in a single session, reaching out as they prepare for and go to their interview.  The students must feel that they matter (and, hopefully,  so does the faculty member when he sees the students’ successes!).  Advocating for others is another way to make them feel that they matter.  So is providing appropriate emotional support – often just listening to them during challenging times.   Others know they are important when you provide growth-directed feedback, especially when they need to improve performance.    

 

The third component of mattering is reliance – how others look to you for your help and skills (your contributions).  You know you matter when others rely on you to “be there,” complete tasks, or seek your advice.   A simple way to make people realize that you rely on them is to seek their input on decisions that impact them.  Acknowledging that you missed someone (not just because work didn’t get done) is perceived as a form of reliance.    Granting learners autonomy, especially if it pushes them a little out of their comfort zone, is one way to let them know you are relying on them.  

 

 

Building relationships

 

As you can see, much of interpersonal mattering is about building a trusting and reciprocal relationship.  You also want to matter to your organization.  For this, organizations need to have effective ways to demonstrate awareness (recognition, whether a supervisor’s thank you or an institutional award for a sustained contribution); importance (seeking your input, positively addressing inclusion, diversity and equity, or listening and responding to employee concerns); and reliance (making expectations clear with appropriate accountability, allowing you to use your strengths).   Organizational mattering is about building systems that support and enhance the relationship between you and the organization.  It may be harder in some ways and require more resources but being explicitly aware of how people feel they matter and incorporating ideas that help them perceive mattering more regularly can improve the work environment.

 

What I have learned as I have studied mattering is that it seems to be one of the foundational concepts, one we may take for granted or not pay attention to as we deal with all the changes and stresses of both the typical and the post-COVID-19 work environment.  I have committed to being more explicit in making people feel they matter and hope that we can find some systemic solutions that allow us all to do the same.  I wonder what would happen if we thought each day about how to make those we will interact with feel they matter – whether it is your patients, your coworkers, or your family.  Research suggests that the work environment will feel safer, and that we will be more creative, happier, and more productive.  I say, let’s try!

 

 

 

Karen Marcdante, MD is a Professor in the Department of Pediatrics (Critical Care) at MCW. She is Director of the Human Centered Design Laboratory,  a member of the Faculty Pillar and serves on the steering committees of the KINETIC³Teaching Academy and Philosophy of Medical Education Transformation Laboratory, all of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

 

 

Three Questions for Dr. Mary Horowitz about Mentoring

From the 1/22/2021 newsletter

‘Take 3’ 

Three Questions for Dr. Mary Horowitz about Mentoring

Dr. Mary Horowitz, long-time MCW Faculty Member, Professor and Chief Scientific Director of the Center for International Blood &Marrow Transplant Research (CIBMTR) shares candid thoughts about her experience with mentoring.  Dr. Horowitz has clinical and research interests in quality of life for transplant recipients and graft vs host disease, and has led incredible efforts in data sharing across bone marrow transplant centers nationally and internationally.  She has been the recipient of the MCW Distinguished Service Award, the American Society of Hematology’s Mentor Award for Clinical Science and a Lifetime Achievement Award from the American Society of Blood and Marrow Transplantation.  

What has surprised you most, personally, in your many years of dedicated mentoring? 

The joy I felt at my mentees’ accomplishments! I, of course, wanted them to be successful and expected to be pleased – but the degree to which their success made me happy was unexpected.

What are some common mistakes to avoid for our junior faculty who are more novice in their mentoring skills?

Don’t try to solve all of your mentee’s problems for them – and be willing to accept solutions that might not necessarily be the way you would do it. There is usually more than one good way to attack a problem. On the other hand, don’t be afraid to get granular when necessary – for example, if you see a mentee is spending too much time on committees and other service responsibilities and not enough on academic advancement, don’t just say “you are over-committed” – go through their lists of activities with them and have them decide which ones should be dropped.

Can you share a story of a successful mentoring relationship you have had, and what made it work

I have several long-term mentoring relationships that have evolved into friendships – and are now relationships where the mentoring is bidirectional. The key, I think, is to really care.  It has always been really important to me that my mentees be successful – and not only in their professional life. You cannot ignore the signs that personal issues are affecting professional responsibilities – and you shouldn’t be afraid to ask. Doesn’t mean you should pry – some people are very private – but acknowledging that our lives include more than work and that everyone sometimes has to divert their attention to things outside the workplace can relieve some of the stress and actually lead to more productivity. A little organization helps also. I started many years ago asking mentees to make a list of things to discuss during our meetings – it made the meetings much more productive and made sure that we focused on the things that mattered to them. And, as the mentee and the relationship matures, I started asking their advice on things. 

 

Discussing the Grandkids: If RBG and Antonin Scalia can Find Common Ground, Then so can We

From the 1/22/2021 newsletter 

Director’s Corner

 

 

Discussing the Grandkids: If RBG and Antonin Scalia can Find Common Ground, Then so can We 

 

 

By Adina Kalet, MD MPH and Kathlyn Fletcher, MD MA

 

 

This week Drs. Fletcher and Kalet team up to argue that there are ways in which nurturing a patient-physician relationship resembles the healing our society needs today …

 

 

As clinicians, we learn to build rapport quickly. Most of the time this is easy. After all, people come to physicians and other health professionals seeking help or advice and are predisposed to trust us. Under most circumstances, we use our verbal and nonverbal skills to put the individual at ease and make an opening invitation, something along the lines of, “Tell me, what is going on?” or, “How can I help?” to get the patient telling their story. Evidence suggests that establishing a narrative thread, by encouraging the patient to speak uninterrupted and actively listenining  is the most efficient way to get to the “heart of the matter.” It provides information  for clinical reasoning and also establishes the therapeutic alliance needed to ensure shared decision making and a workable plan to address the issues that need tending to. And it usually takes under two minutes for the patient to come to the end of their story.  

 

Most of the time, this process works as it should, but occasionally, even seasoned clinicians find themselves struggling to make an initial connection with someone. When that happens, I (KF) pivot to something that I suspect we can connect about.  Given that I practice at the Veterans Affairs Medical Center and that many of my patients are older, my go-to is the grandchildren.  I have found that  when interactions aren’t going well, asking about grandchildren brings a mellowness that descends like magic.  Most people can’t help but smile.  Pretty soon the pictures are out, and we are connecting on a new level, with tenderness, talking about hopes for a better future.  

 

 

Recent events reverberate 

 

We can’t stop thinking about what happened at the US Capitol Building Wednesday, January 6, 2021.  In the days since, we have talked to many colleagues, friends and learners.  We have heard the same words time and again: shock, fear, shame, anger. 

 

Obsessively watching the news and checking newspaper websites has proven unproductive (not surprisingly), although it has been really hard to avoid.  As more details become available, the terrible implications of that day seem to increase, as do our anxiety and sadness.  Talking about the events does not lead to sense-making or understanding, and only reinforces negativity.  As we faced our colleagues and programs, we asked ourselves, How can we move from despondency and anger to action? How can we stop the feeling that we are banging our heads against the wall? 

 

Independent of one’s political views, we suspect that the thought of engaging the “other side” in dialog about the issues seems exhausting and futile.  But what other way is there?  

 

I (KF) found inspiration in an unlikely place, my email inbox! A message from Chad Kessler, National Director for VA Emergency Medicine, provided important advice about talking with  skeptical VA patients reluctant about receiving the COVID-19 vaccine.  He reminded us that, in some cases, providing facts – particularly when so much is still unknown – is not helpful.  For people fearful of the vaccine, trust in their doctors is more important than explaining the results of the randomized controlled clinical trials that led to emergency authorization. So, his advice was to focus on building the trusting relationship rather than trying to convert patients into vaccine believers. Asking about their health beliefs, listening to the answers, letting them know you care about them and their health, understanding their fears and concerns and, well, maybe asking about the grandkids, is time well spent.  

 

Perhaps the way forward isn’t to convince other Americans that they are wrong and that we are right.  Perhaps the way forward is simply expressing caring in different ways, finding ways to hold different views without fracturing relationships, and sharing a commitment to our common future, as embodied in our children and grandchildren. 

 

 

Reaching across

 

The New York Times reported on a nonpartisan project that brought 526 strangers from across the US and  the political spectrum together for a four-day retreat where they talked in small groups  about a wide range of issues that affected their lives.  The description of the project was inspiring.  Participants reported gaining perspective on how political and social policies affect other people’s lives.  It sounds so civil!  What is to stop of us from doing something similar in our own spheres of influence? 

 

 

An unlikely friendship as a beacon of hope

 

On the surface, the famous friendship between Justices Ruth Bader Ginsburg and Antonin Scalia defies comprehension.  And yet, it grew over decades across their tenures at the US Circuit Court of Appeals to the Supreme Court.  These two storied judges certainly did not agree in their work. Scalia regularly attacked the ideas expressed by RBG, but he never attacked her. She regularly and vehemently disagreed with his legal philosophy but had a deep and abiding respect for his, “captivating brilliance, high spirits, and quick wit.” They had a deep, respectful, and caring relationship with each other based on shared loves of  opera, theater and, of course, grandkids, sharing many meals and social outings.   These beautiful relationships which occur despite polarizing differences in politics seem exceedingly rare and precious these days.    

 

 

As physicians, we have the privilege of trustworthiness and the skills needed to find common ground. We routinely must navigate differences in belief systems toward solving a shared common goal. Perhaps we should expand our influence on civic discourse as well.   Asking about the grandkids, actual or only imagined, can focus us on our shared futures.  

 

 

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin

 

Kathlyn E. Fletcher, MD MA is a Professor and Residency Program Director in the Department of Medicine at the Medical College of Wisconsin. She is the co-Director of the Graduate Medical Education Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

 

 

Reimagine: It’s Easy if You Try

From the 1/15/2021 issue of the Transformational Times

Reimagine: It’s Easy if You Try




Balaraman Kalyanaraman, PhD – Professor, MCW Department of Biophysics






Dr. Kalyanaraman takes a spirited look at the process of how we can reimagine many aspects of our lives, as well as our research (including the inspiring story of a COVID-19 researcher to whom we all owe a debt of gratitude), our relationships, and our health …

“Anything you do I can do better, but only if you do it first. That’s because I have no imagination, only a re-imagination.”
–Andrew Keith Walker

Right now, I bet you are telling someone, or have been asked, to reimagine some aspect of your work or life. Or perhaps you are reading about or watching an advertisement focused on reimagining. But what does reimagine mean? According to Merriam-Webster, the first use of the word was in 1825, and it is now among the top 1% of words that are looked up. I don’t know about you, but the word “imagine” makes me happy; hearing it frees up space in my brain. Conversely, the word “reimagine” makes me feel tense and anxious; it sounds task oriented and somewhat contrived! Well, the more I’ve pondered the word “reimagine,” the more I’ve realized I do not have to feel this way!

While trying to understand “reimagine,” I came across this anecdote about imagination from the book The Element: How Finding Your Passion Changes Everything by Ken Robinson, PhD:

An elementary school teacher was giving a drawing class to a group of six-year-old children. At the back of the classroom sat a little girl who normally didn’t pay much attention in school. In the drawing class she did. For more than twenty minutes, the girl sat with her arms curled around her paper, totally absorbed in what she was doing. The teacher found this fascinating. Eventually, she asked the girl what she was drawing. Without looking up, the girl said, “I’m drawing a picture of God.”  

Surprised, the teacher said, “But nobody knows what God looks like.”

The girl said, “They will in a minute.”

The girl was making an image of something she could not feel with her senses but could feel in her heart!

Try to reimagine “Imagine” written by John Lennon and inspired by Yoko Ono:

Imagine there’s no heaven

It’s easy if you try

No hell below us

Above us, only sky

Imagine all the people

Living for today

Hmm, the song is not the same when reimagined, right?

Clearly, reimagination requires a lot more imagination with a lot more passion!
In business, people “think outside the box” and reimagine everything from A to Z! (Do you have a novel idea? Sorry! Amazon already claimed it.) I considered synonyms for reimagine: reconceptualize, re-envision, reinvent, rethink, refine, re-create, reevaluate, or reinterpret imaginatively. It seems that “reimagine” is a word meant to inspire us; it captures the essence of what we need to do together or in collaboration that builds upon our strength.

Below, I’ve given my thoughts on reimagining a few aspects of research and life that are personal to me, but I know there are plenty more that you can reimagine. Some of these also could be applicable to other areas, such as workplaces, social systems, communication, teaching, childcare, sports, and recreation.


Reimagining ideas in research

How does one reimagine research ideas? Here are some ways to get started:

• To find one good idea, you ought to begin with several ideas. It’s important, though, to work on only one idea at a time.
• Become obsessed with your idea. Believe in yourself but be prepared to modify your idea.
• Always be ready to talk about your research ideas passionately at different levels depending upon your audience.
• Don’t be afraid to talk to your colleagues about the grant that was not scored or did not score well enough to be funded, even if they are not in your field!
• Rejection happens to everyone, no matter your reputation in your field. Even Nobel laureates experience it. Ideas, new and old, are rejected all the time. What matters is how you respond to criticism and reshape your ideas!
• Even though you may have the most cutting-edge idea, your proposal may lack widespread approval in the study section and require tweaking. Sometimes you have not exactly read between the lines in the summary statement, and you keep resubmitting the same idea while expecting different results. This is when you really need to get out of your comfort zone and reimagine—consider a chemist/biochemist collaborating with an immunologist, a vaccine researcher (perhaps, an extreme example)!

A great example of reimagining - Katalin Karikó, PhD

Katalin Karikó, PhD, a Hungarian-born biochemist, first laid the foundation for the messenger RNA (mRNA) therapeutics that have been used to develop the COVID-19 vaccine. Messenger RNA transfers the information from DNA to ribosomes to make specific proteins in cells. Karikó hypothesized that if a genetically coded synthetic mRNA was injected into mice, the cells in the body would make the specific protein instructed by the synthetic mRNA. In the 1990s, when she was faculty at the University of Pennsylvania, Karikó submitted several grant proposals on this idea. The proposals were repeatedly rejected, as the reviewers’ thought this concept would not work because of the potential degradation of the synthetic mRNA in the body and the potentially dangerous inflammatory immune reaction.

Despite professional setbacks, Karikó believed in her idea and continued the work with little money. Karikó began collaborating with immunologist/mRNA vaccine researcher Drew Weissman, MD; together they came up with the idea to modify the structure of uridine, one of the four nucleosides of the building blocks of RNA. As they predicted, the modified mRNA encapsulated in a lipid nanoparticle was taken up by cells; Karikó and Weissman then extended this technology to deliver the synthetic mRNA in mice.

They published a paper in 2005 and obtained NIH funding, and this new technology was patented by the University of Pennsylvania. BioNTech, a German company known for developing vaccines, licensed this technology, as did Moderna, a biotech company in Boston.

Karikó is now the senior vice president of BioNTech RNA Pharmaceuticals. The Pfizer-BioNTech partnership developed an mRNA vaccine designed to induce neutralizing antibodies against a portion of the SARS-CoV-2 “spike” protein that the virus uses to gain access into human cells. The antibodies against the “spike” protein recognize and neutralize SARS-CoV-2, thus preventing the infection.

Although Karikó encountered early setbacks in her research, she never gave up and always “imagined how the synthetic mRNA approach could treat so many diseases.”


Reimagining a work-life balance

Ideally, having a good work-life balance would give one satisfaction, fulfillment, a sense of purpose, and empathy.

During this pandemic, a barrier to optimal work-life balance exists for parents (more often mothers), particularly single parents, as they juggle work with childcare and home schooling.

People in the workforce are on different trajectories. Some just starting, some climbing up and trying to reach cruising altitude, some pushing the “reset” button, and some pushing the “rest” button. All too often, people (myself included) are too carried away in their work and give little attention to their life outside of work. Organizations conduct workshops to teach us ways to restructure our lives, which may not seem like rocket science, but it may be nearly as difficult. In what ways can we strike a good work-life balance?

I leave this to the experts to ponder. If we take the time to pause and contemplate it, we will be off to a great start.



Reimagining relationships

Professional advice on improving relationships is available everywhere, in workshops, talk shows, magazine articles. This is all well and good and may work for some people, but often we just need to reimagine the little things that are forgotten. Yes, I understand, “Physician, heal thyself,” and I think it goes well with “better late than never.” In his article, 10 Ways To Reimagine Your Relationship, Barton Goldsmith, PhD, says “doing new things together, and old things in new ways, makes your love stronger.” He proposes a number of ideas to reimagine relationships:

• Let go of the past. Learn to forgive and forget, and focus on the positives. Be grateful for each other and treat each day as a blessing. Write down at least one thing (daily or weekly) that you appreciate about your partner.
• Create your fantasy vacation. Daydreaming about your ideal vacation can be fun! During the pandemic, this may be hard to fathom, but things will get back to normal. And when you are able to take a vacation, you will be ready.
• Take a class together. Or do other activities with your partner: Take a virtual cooking class, learn CPR, learn a new language, take a walk through the park.
• Have lunch together once a week. This will help break the monotony.
• Ask your partner 20 questions. Show curiosity in your partner’s interests. What are some things you’ve always wanted to know about your partner but never took the time to ask?

To this list, I’ll add: Never be afraid to poke fun of yourself. Self-deprecating humor can ease those tense moments.

I am sure you can find many more fun things to add to this list.

Reimagining stress reduction through mindfulness

Emerging science convincingly shows that routine exercise, yoga, meditation, and mindful meditation can alleviate stress, anxiety, and depression. Herbert Benson, MD (Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital) pioneered the beneficial effects of meditation (e.g., lowering blood pressure and heart rate, and increasing brain activity). Functional MRI studies support the beneficial aspects of meditation to combat depression and anxiety.

Suzanne Westbrook, MD, a retired doctor of internal medicine, says, “our mind wanders all the time, either reviewing the past or planning for the future.” Mindfulness teaches the skill of paying attention to the present, and that life is in the moment. Mindfulness is not about trying to empty the mind; rather, it is about remaining present. It is a practice designed to improve brain health. Taking a slow deep breath through the nostrils (i.e., inhaling) and then slowly breathing out through the mouth (i.e., exhaling) will help you relax, reenergize, and reconnect. Repeat this inhalation/exhalation technique about 10 times. Use it as a “balance break” as needed during tense times (e.g., grant preparation). Mindfulness will improve your focus on the task at hand and face challenges with a healthy attitude, reduced stress, and increased energy. Mindfulness could be incorporated into many things—eating, conversation, listening. Some people practice 20–30 minutes of meditation that involves “mindful body scan,” during which one notices the sensations one is feeling without judgement. Indeed, mindfulness is presently at the top of the wellness universe as a stress reduction technique!


Let us imagine and then reimagine 2021! But not without first learning from 2020. Yes, hindsight is 20/20.



Balaraman Kalyanaraman, PhD, is Professor and former Chair of the Department of Biophysics at MCW.