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Monday Aug 24, 2020

How Gardening Made Me A Better Doctor

I haven't always had a green thumb. When I was in medical school and residency, I could barely keep a cactus alive. I knew the basics, namely that plants need water, soil and sunlight. During those hectic phases of my life, I seemed to always fail in providing one of those key elements.

[Luis Garcia, M.D., with peach]

Luis Garcia, M.D.

After residency, we purchased a new home on half an acre of land and the previous owners left a small garden behind. The vegetables were just starting to emerge when we moved in, and my wife and I delighted in discovering what we would find there. Having never done any gardening, though, we had a lot to learn and many questions: Was this growing thing a pesky weed or a desired plant? How often did we need to water, fertilize or add compost? Did we need to till the soil? How could we keep out birds and rodents?

Much like anything else, the answers to these questions came with time, trial and error. We're now in our fifth year of gardening, and although we are still learning, we've come a long way from our first small plot of vegetables. We now have a small orchard with several fruit trees and dozens of berry plants. We've expanded the space for the vegetable garden, and we made adjustments to optimize our soil and keep everything organic. We've been able to produce enough fruit to freeze supplies that last us through most of the winter and to share with friends, family and coworkers.

This success led me to reflect on what I did to help these plants thrive and improve each new year. Though many factors are out of my control, adding the right nutrients at the right time or adjusting the pH of the soil slightly can make a big difference. In this process of reflection, I've realized that much of this hobby has had parallels to my first five years of practicing medicine. Both have required continuous learning, creating the right environment for success and having a lot of patience. Without realizing it, as I grew in these skills in my practice of medicine, I was exhibiting them in my gardening as well. As a result, gardening has served as a proving ground of testing and growing in the skills and virtues needed to be a better doctor.

Creating the Right Environment

Retired U.S. Army Gen. Stanley McChrystal has a philosophy that success as a leader is best achieved when one creates the right environment for others to succeed, and he draws this from his own practice of gardening.(www.forbes.com) Great leaders, he says, are more like master gardeners who can influence the ecosystem for the plants to grow. My plants need the right amount of sunlight, but some need more than others, and this determines where I plant them. They need to be watered, but too much or too little could cause harm. And they need the right soil with the right balance of organic compounds and minerals to thrive.

My patients, likewise, need the right environment to achieve lasting health. They need opportunities for exercise and healthy food. The medicines I prescribe them can help, but much of their environment is outside of my control. Working in a federally qualified health center, I've learned how the social determinants of health can affect up to 80% of a person's health outcomes.(nam.edu)

Similarly, I have little control over what bugs, pests and diseases enter my garden. But with the help of YouTube and some ingenuity, I've been able to fend off rabbits, squirrels, birds and many other undesired pests using things like packing tape, vinegar and netting.

The challenge of improving the environments that influence the health of our patients is a monumental task, much more complex than protecting plants. There are creative ways my FQHC has begun to address some of the social determinants of health by utilizing community health workers and care coordinators to help break down the barriers surrounding access to care and health education. Although there is little I can do from an exam room to affect that social environment, I can make it a place of listening and healing. This is at the core of being a family doctor: creating an environment of trust that allows us to help patients get to the root of their health needs. Fostering those relationships takes time, but above all, it requires patience.

Patience

Plants take patience, and patience takes practice. It took four years for my peach tree to bear a substantial amount of fruit. Though they were planted years ago, my apple, plum and pear trees still need time to reach full production.

My medical director frequently reminds me that family medicine is a marathon, not a sprint. It took at least two years of practicing medicine after residency to finally feel like my relationships with patients were solidifying. Now I have seen substantial improvements in areas such as smoking cessation, lower A1c levels and maintaining blood pressure at goal. This all takes patience, and for me it has been accomplished by utilizing the seeds of motivational interviewing. Asking the right questions, and sometimes repeating them over the course of years, has helped patients make lasting change.

Success with plants doesn't happen overnight either, and in many cases it takes years of dedication and nurturing. Further, just like with our patients, setbacks can happen. It's always disappointing to plant something, watch it grow and see the hard work lost to infestation or infections. These are some of the most critical moments to practice patience. When everything goes as planned, patience can be easy. But when those plans are challenged and disrupted, that's when patience can truly be tested. How many of us have felt disappointment when a patient's diabetes suddenly gets worse, or when a patient who had been sober for years relapses?

A true test of our patience with patients is the last-minute statement as we're about to leave the exam room: "Oh, Doc, one more thing …" It's often in that "one more thing" that we can find, if we've created the right environment, the root of what's really going on. But to cordially accept those moments necessitates patience.

Gardening is not always perfect, but with patient persistence, it can lead to beautiful things. The same is true in our practice of medicine.

Pruning

One of the most emotionally difficult tasks in my garden is the annual pruning of fruit trees. Each winter, I must remove up to one-third of the branches, all of which are typically healthy and have the capacity to bear fruit. The trouble is, if I don't prune the branches, the trees could become more susceptible to disease and the size and quantity of fruit won't reach its potential.

I don't think it's a coincidence that around the same time that I prune the trees, I often reflect on my own life to see what can be trimmed. I've learned to pay close attention to how I'm spending my time, and periodically reflect on what "extra branches" of my work and home life can be trimmed. This process of reflection has also led me to cut things out of my life that require too much emotional energy, such as limiting my time on social media. This allows me to focus on the areas of my life that will lead to greater fruit, such as spending quality time with my family. This approach has also helped me narrow my focus in my career. In the initial years after residency, I was presented with opportunities for leadership, advocacy and community committees. Over time I've found my strengths through writing and was appointed chief medical information officer, which would not have occurred had I held on to other roles I had been presented with. In a way, pruning can protect us from burnout by helping us focus our energy on the best fruits we can offer.

Beyond the Parallels

There's something to be said about working with the earth, the soil, that keeps us grounded in reality. This is in contrast to the ways in which we distract ourselves with video games and other forms of digital entertainment that exist to help us escape our reality. By working with the soil and helping create the right environment for my plants, I cultivate something transformative in my mind that can best be described as a stimulus to feeling more human. In fact, it's no coincidence that the world "human" derives from the Latin word "humus," meaning earth or soil. Though gardening is a hobby for me, the practice of getting my hands dirty and working outside has given me an even greater appreciation for many of my patients who work in agriculture or other forms of hard physical labor.

Lastly, and perhaps the most obvious advantage of gardening, is its health benefits. A review of research on the benefits of gardening(pureportal.coventry.ac.uk) found that its practice increases consumption of fruit and vegetables, increases physical activity, improves mental health, reduces stress and much more. These are all things we could use as doctors. An article from The Atlantic(www.theatlantic.com) showed that doctors aren't much better than the general public in terms of exercise and eating produce. Like most Americans, I spent most of my life occasionally eating the same types of vegetables: broccoli, carrots and green beans. Since I've begun growing my own food, our plates are often filled with a rainbow of colors with beets, squash and Brussels sprouts. My children have benefited as well. They enjoy going out and picking berries, carrots and tomatoes, and devouring them as soon as they're cleaned and ready. I must say, there is nothing quite like walking outside and picking a fresh peach, strawberry or blueberry, and eating it seconds after its been harvested.

If we are to practice what we preach as physicians, there's no better way to do this than to grow and eat our own healthy food. It's one thing for us to tell patients "eat more vegetables," and it's another to share in the joy of eating healthy because we've experienced good, rich, healthy food that we've grown ourselves. Our message becomes more genuine when we eat healthy ourselves.

The sad reality is that it's not uncommon for me to preach this message and be met with, "But I don't like vegetables…" by many of my adult patients. I politely encourage them to try different recipes. A go-to recipe that I've memorized to quickly share with patients is this one for roasted broccoli,(www.foodnetwork.com) and so far it's been met with positive reviews.

If you don't already garden, I'd encourage you to consider it. It may seem overwhelming, but with the abundance of resources available online, starting with easy plants such as tomatoes, peppers and herbs can build confidence and give you the desire to grow more. As I've experienced, my hope is that gardening can help us become better doctors by helping us grow in skills and virtues that can enrich our practice as physicians, and also lead us to better health.

Luis Garcia, M.D., is a family physician in York, Pa., working at Family First Health, a federally qualified health center. He focuses on caring for the Spanish-speaking community and spending time with his wife and three daughters. His hobbies include gardening and photography.

Posted at 04:27PM Aug 24, 2020 by Luis Garcia, M.D.

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