Alison Escalante, MD is a practicing pediatrician who has developed a way of thinking and breathing through what she calls, “The Shouldstorm.”  As physicians, we face similar storms with our patients, colleagues, administrators, and ourselves.  She walks us through the ideas she presented in a TEDx talk and applies it to doctoring.     She can be found at  shouldstorm.com  And her TEDx talk can be found at  youtube.com/watch?v=mYT7EDi_nOs&t=387s   She did her undergrad at Princeton, studying Medieval Renaissance History, went to med school at Rutgers University-Robert Wood Johnson and pediatric residency at Duke and University of Chicago.  She is a former clinical instructor of pediatrics at Northwestern Feinberg School of Medicine and is now a pediatrician at DuPage medical group in Naperville, Illinois.  She practices what she preaches as the mother of two fun, friendly, rambunctious and startlingly wise boys.

 

EPISODE TRANSCRIPT

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Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians, Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing the Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of our respective employers.
Unknown Speaker  0:26
Allison Escalante is a pediatrician in Naperville, Illinois, who’s made it her goal to lift some of the burden off of parents shoulders, that’s inflicted by what she calls the shitstorm. She gave a TEDx talk called the parenting shouldn’t storm. So we discussed her three step method for weathering that storm and how we can apply it to both parenting and doctoring in terms of our patient interactions and our careers.
Unknown Speaker  0:56
Welcome back to the physicians guide to doctoring On today’s episode. We have Dr. Allison Escalante, a pediatrician in Naperville, Illinois. She did her undergrad at Princeton, which having gone to undergrad at Penn, we were frequently taunted with your safety school. So thank you Princeton graduate. I went she went to medical school at Robert Wood Johnson, and did her pediatric residency at Duke and then University of Chicago. So I guess she preferred Illinois to New Jersey, after Princeton and Robert Wood Johnson, because that’s where she’s chosen to stay. And she wasn’t give a TEDx talk called the parenting should school should storm. I have to say that very carefully. And we have another interview coming up with Lynn Marie morskie. And she has a podcast called quit happens, which I also need to say very carefully because they both share that double entendre. There’s a strong similarity there. Dr. Escalante is also an avid blogger at should storm calm. So Allison, thanks a lot for taking the time. be here today.
Unknown Speaker  2:01
Well, hi, Brad. But you know, I’m actually a New Jersey native and my family’s been there for generations. So we can’t knock the jersey. But yes, I have been in Illinois since I finished my training. And we are raising our kids out here. And it’s it’s a good place.
Unknown Speaker  2:18
Great. Great. And yeah, your your TED talk was TEDx Naperville, which is where you’re located. So before we start talking about the subject matter, subject matter, the shitstorm, how did you end up giving a TED talk?
Unknown Speaker  2:33
Well, that was very interesting. You know, the The first time I saw a TED talk, my husband showed me one and said, Oh, I think you’ll find that really interesting. And I watched it. And first of all, I loved the idea. But secondly, I thought, Oh, my goodness, I want to do one of those. That is so cool. And then, um, you know, I’ve been working on my project and what I was researching for several years, but once I had that idea of doing one, it sort of sat for a while. And then one day I decided to go to TEDx Naperville and and see if I could go about giving one myself. So I went to the conference and it was so much fun. Those are great conferences I recommend everybody goes. It’s full of really interesting curious people that are interested in lots of different subjects. And I just stayed late talking with various people, including the improv group that had done a joke session making fun of all the talks. And I ended up running into Arthur, who runs TEDx Naperville. And I said, Hey, how you doing? You know, I see you’re busy, but I have an idea. And I’d like to apply to talk next year. And he said, Well, give me your 60 seconds. So I gave him my 62nd idea. And his eyebrows went up and he grinned. And he asked me a question and I thought, This is great. And so we ended up getting in touch a couple months later and sat down and talked for probably two hours at Starbucks.
Unknown Speaker  4:08
And he said, Great, you’ve got to talk.
Unknown Speaker  4:11
Wow. So I think that brings up a point that we’re going to be talking about, again, later, that you had mentioned in our pre interview discussion about knowing your worth. And as physicians, sometimes we take for granted our expertise, right, you have all these researchers and big names that give these TED Talks. But what we need to recognize as physicians, as we’re physicians, we have expertise. So if you have an idea, it might be as simple. Your pitch might be as simple as just telling someone your great idea in the right situation. And now all of a sudden, you’re you’ve been invited to give it to give a TED talk.
Unknown Speaker  4:53
Well, that’s right. And I think most TEDx events have their own process and some of them you need You do apply through their website. Some of them it seems like you need to network TEDx Naperville is generally done through submitting a video. But what I’ve learned is that if you can’t share your idea in 30 to 60 seconds, then people are not going to keep listening. And I think it’s physicians were used to giving like, a morning report or a grand rounds with our research, and we’re used to qualifying what we say, to increase our authenticity. But that’s that’s just not how you’re going to want to talk to someone who’s interested in a TEDx because they want to know that you can communicate your idea briefly and clearly.
Unknown Speaker  5:42
So did you have your elevator pitch ready already had you honed it and given it before or you just let it happen?
Unknown Speaker  5:51
You know, I did actually prepare it but when he first Okay, here’s the truth. When he told me to give it to him, I I started to talk and I froze. And I giggled and I said, I’m sorry, I’m nervous. And I thought it was over. Right. But he, he just kind of like, shrugged his shoulders inside a little bit and let me go because he probably gets approached by a lot of people. But I went for it and I gave it again. And at that point, that’s when I got his. That’s when he connected with the idea.
Unknown Speaker  6:22
Fantastic. So, so what is the idea? Let’s talk about that.
Unknown Speaker  6:26
You know, parents love their kids more than anybody and so many people will describe parenting as living with your heart outside your body because it resides with your kids. I don’t know if you’ve ever felt that way. Brad.
Unknown Speaker  6:40
Absolutely. It’s currently outside my bed, my body two rooms down, and hopefully not making too much noise.
Unknown Speaker  6:47
nap time. But, um, as we’ve had a generational shift from the type of parenting that many people my age grew up with to parenting that’s really aware that we know so much about child development, and that things have changed. And maybe what our parents did isn’t the right way. Parents are bombarded by information and criticism and a culture that sends a message that if you’re not constantly doing for your kids, constantly worrying about your kids, and constantly optimizing yourself and your kids, you’re failing as a parent, and that is the parenting should storm.
Unknown Speaker  7:31
Yeah, I remember when we were sleep training, my first one, there was a New York Times article, and it it had discussed all of the different methods that were out there, and it didn’t say, this is the right one. This is the wrong one. It just said, these are the different options. These are the things that we can talk about. And you have to just find the one that’s right for you or don’t and the comments section had such vitriol about you’re doing permanent damage to your kids? How could you do that they’re going to have problems with it. Like it was, it was terrifying to read. And you could see a parent who is already sleep deprived and frayed at the edges, reading something like that and coming away thinking that they’re terrible person. So yeah, I completely understand that.
Unknown Speaker  8:23
It happens online. It happens in our Facebook groups. It happens with our friends and families. I recently did a survey on an online mom group to ask how many women had been a head experience mom shaming, and the number of women who checked off all of the above which included random strangers, neighbors, teachers, principals, relatives and friends. was astonishing.
Unknown Speaker  8:53
Yeah, I actually after seeing your TED Talk, it has hopefully definitely changed the way that I interact with my parents, because I’m an EMT. So I see kids and adults. And I’ve had a couple parents recently where they come in for like a tongue tie. And they talk about their experience with breastfeeding their older one. And now said, How, how’s that kid now? Oh, he’s fine. Great. Just please keep that in perspective. They’re fine. Everything is fine. Because Yeah, you just get you just get wrapped up in the minutia. So so you in order to help parents avoid that. You came up with a three step method, and I think we should talk about how that works in terms of parenting. But then I think it segues really well into doctoring. So let’s first talk about your three step method and how you describe that to parents. And then we’ll talk about how physicians can apply that to their one their parenting styles clearly, but their lives as physicians,
Unknown Speaker  9:58
right so it’s it’s wondering Full to get insight into the fact that the reason that we as parents are driven with a sense of anxiety is not because there’s something wrong with us. It’s rather a culture that’s really driving us. And it’s wonderful to recognize that I’ve had so many people interact with the talk or some of my writing, and just have a huge aha moment and a sense of relief. But then everyone’s next question is, what now? What do I do with that? How can I resist this, when everyone around me is doing this? You know, it’s so hard for us when an entire group is behaving and thinking a certain way for us to step out of that and do it differently. Because if I don’t take my kids to kumaon, maybe they won’t get into the good math class. And if they don’t get into the good math class, then maybe they won’t get into the good class in high school, and then they’re not going to go to a good college. Now, of course, that kind of thinking we will as a side note, that’s actually not actually Accurate or rational thinking, but that’s how it works for most of us. So what do you do? Well, every time you feel a should, or you feel that anxiety of being not sure, stop, sigh. And see, I’m sorry, let me say that again. Sigh, see, and start. So when we say it this, you breathe deeply into your body, but you let it out as slowly as possible. And this is a little different than how most of us are taught deep breathing. But it’s actually some really exciting neuroscience that has been found that it’s the slow out breath that actually moves us out of the fighter flight centers and into our common connected centers, which actually are located in the ventral vagus nerve. So that’s the first thing. Have you ever tried that one?
Unknown Speaker  11:59
I’m going to Right now, there we go away from the mic,
Unknown Speaker  12:03
then see, see your child, see the situation, see their body language, see what’s going on, see what’s going on with you. And this is an important part to see how you’re feeling. And then and only then start. And you can start something, you can start nothing, or you can start the wrong thing. And this is my favorite part about sicp. And start is that it’s designed to us our mistakes and our failures to grow us as parents and to grow our kids. So when we get it, right, we learn great, we’ve got something that works for us, but when we get it wrong, we might actually experience this should oh my gosh, I messed up. I should have done it this way. That’s okay. You can immediately sigh see and start again and It really incorporates a sense that mistakes are how we learn. And like a sense that we’re growing all the time. And then we show that to our kids. And I think that’s the coolest part of all.
Unknown Speaker  13:14
This, this reminds me of I think it might have been Freakonomics where they talk about the Chicago busing system where they followed kids over time, you know, you’ve got your wealthier areas, and you’re less economically inclined areas. And so what they do it or I’m not sure if they still do it, but they have a lottery or had a lottery where the the poor neighborhoods were able to enter a lottery to bust their, their kids, the rich neighborhoods, for school, and then they follow those kids over time, and saw how many of them went to graduated high school and four years, went to university how many went to a four year university graduated and those were there. Many metrics for success. And what they found was, it wasn’t winning the lottery or getting to go to the fancier school that dictated their likelihood for those metrics of success, but whether or not their parents entered them into the lottery. So it was intent more than the outcome. If you had parents that were interested enough in their kids outcome in their education, that was what determine their long term, their long term success. So I think it’s the same thing with what you’re saying with sigh, see, start. sigh Take a deep breath, take yourself a little away from this situation. Try and get a longer view of what’s happening with see and then start, but even if you make, what is the, quote, wrong decision. You’re still ultimately doing what you believe is in your child’s Bench BEST interest, which is at the heart of the matter whether it was the right or the wrong decision. As long as you’re not letting this damage your relationship with your child and stress you out and allow you to get worked up, you’re still making progress.
Unknown Speaker  15:12
That’s right. And I think constantly modeling right in front of my kids that up guys, I apologize, mommy made a mistake there, I’m going to try something else is really changing the way that they approach their own behavior. And I’m starting to see this kind of language from them. Oh, I messed up there, but I think I know what I could figure out to do next. And that, you know, I mean, it’s a buzzword, but that’s a growth mindset. And and that’s something that is is fundamental for us in managing our lives and in dealing with the challenges that come up.
Unknown Speaker  15:47
Can you give us an example of sicp and start?
Unknown Speaker  15:51
Well, sure. Um, so
Unknown Speaker  15:55
this morning, it’s snowing out here, and we have a really Great local sledding Hill, super steep, super fun. And my husband decided he was going to take the boys sledding and the shoes, the shoes were in the mudroom but some of the boots were missing. And so this was of course a crisis because how are we going to work this out? So basically, when we pointed out that the boots were missing, there was kind of a panic. And some blaming started to get thrown around between the boys about who lost the boots and who might have taken them to school and not brought them home yesterday. And I was finding myself getting really tense. I felt my shoulders up by my ears. My neck was tense. I felt angry. I even noticed my fists were bawling. So I side and I let it out really slow. And then I could see that my kids were getting really angry with each other. But because I had just pulled out of crisis mode. I could also see that what was underneath that was not that they were angry or upset, but that they were just so worried about being disappointed and not getting to go sledding. So, I started and I said, Guys, we’re going to figure this out. And so the boy who didn’t have boots that fit, we got two layers of socks on and we put Ziploc bags on his feet. And I found some, I found some pipe cleaners and I wrapped them around the Ziploc bag so they would stay on and then we push old shoes on and I said, Great, you guys can go sledding, and it’s going to be fabulous. Now he was very doubtful, but this is exactly the kind of thing we would have done when I was kids. And we finally got everybody packed up and out the door. In the end, they found the boots in the car. Got out of the Ziploc bags and got it all got it all figured out. But that’s the kind of crazy zany solution that I never came up with before I started using this technique.
Unknown Speaker  18:00
Because everything had to be perfect, right? Like the worst.
Unknown Speaker  18:04
Yeah, if if if, I mean, if he got frostbite so badly that he would lose a toe, that would have been terrible, but the likelihood that something like that is going to happen for sledding for a little island, he’s climbing up the hill and walking and right, like, that’s not going to happen. So really, everything doesn’t need to be perfect. You know, the other, maybe worrying that the other parents in the neighborhood are going to judge you because your kids got plastic bags on his feet. But he’s not sledding. It’s great.
Unknown Speaker  18:37
Well, and what I think I love so much about the way that sicp and start changes the way you look at things is those thoughts this time around, didn’t even enter my head. Instead, I thought of other far more positive things like wow, if he goes sledding like this, this is going to be this stuff, a family legend and they’re going to be telling this story at Christmas someday to their own kids or Oh, wow, if some family sees them out there, they’re going to think, wow, that mom really solved that problem. Look at those cool Ziploc bags. That was pretty clever. And it just, it changes because I’m not criticizing myself so much, because I’m engaging with my own creativity and leadership. It just, everything becomes so much more positive and so much more doable. And then I start to expect positive responses from the rest of the world. Instead of worrying so much about the random should storms that can happen in the grocery store when someone criticizes your parenting.
Unknown Speaker  19:38
So let’s pivot a little to the doctoring should storm. Right. So I think the the easiest example would be you’re running behind in the office, you’ve patients that have been waiting for a long time. You’re getting frustrated, they’re frustrated, you’re going to have to issue an apology when it’s not even your fault because You’re running behind because the three patients before we’re all late, you know, I think that the size see start can be applied in that situation where you take that deep breath, let it out actually think that look that came up in episode for improving the patient experience where the recommendation was, before you ended that patients room, take a deep breath. But now that deep breath is going to be a little more specific. Take a deep breath, and then slowly let it out. See, I think see in that situation was trying to see things from the patient’s perspective, and then open the door and walk in and try and start that interaction in the best way possible, which is, I’m sorry, you’re waiting, you know, we try to do the best to to keep things on time. But I value your time. And you know, this is important to me. So thank you for waiting something, something along those lines.
Unknown Speaker  20:47
Yeah. And I think that’s that’s kind of something I have to do every day because I’m a pediatrician. So it’s rare that I’m actually on time. Because you know, people like to bring in those extra things. So we’ve done our visit and By the way, Dr. Can I ask you about this other thing, and by the way, so you know, so that happens a lot. But I think that what I’ve really noticed about this ice and start is that it’s not just a technique, it’s a model. And it changes the way you feel about things. So that instead of feeling really stressed out and frustrated that this is happening again, and people are going to be mad at me. I just accept that this is the way we are. And this is the way things are because this really is fundamentally a mindfulness technique. And what’s funny is when I see it differently, when I acknowledged myself that, hey, I just did the best I could right there and now I’m going to go do my best again. That is a completely different feeling from saying, Oh my gosh, I need to get this right. I really want to meet everyone’s needs and you know, I need to be on time for them. But I also need to meet all the stuff that they bring up. And oh gosh, but there’s also Press Ganey. And I mean, and then there’s all the phone calls. And and I got to do it right. And when I let that go, and I just say, Here I am right now, this is what I’m doing. I find that I’m so much more positive. And what’s really interesting about that is people seem to be a lot less annoyed with me. Because I just walk in with that acceptance, and then I’m right there for them. So that works well. But I think that the more fundamental thing is once I had my big intuitive pop, with a mom who was really struggling with breastfeeding, and those words initially came out of my mouth that made me realized I had found a method for people. It was only much later that I realized I had been using it as a doctor for quite some time, particularly with difficult diagnostic situations. So whenever I am Dealing with a complex diagnosis where or somebody suddenly just throws out that detail where you realize, whoa, this isn’t just stomach pain, what did you just say? And I found that I have been for years naturally sighing and centering, taking a look at the information, both the patient the situation, but also that intellectual information that I’m gathering in my head and then starting to generate that diagnosis. So I actually think it’s a it’s a really useful technique for being more accurate as a clinician.
Unknown Speaker  23:38
I think you need to be careful about it when you’re doing it in front of your patients, though, because I think a sigh can be miss it very easily misinterpreted, right? If you’re physically sighing in front of your patients, they might think, Oh my god, what does the doctor thinking about me? They’re thinking that they’re getting fed up without a pen. I’m talking so much and they don’t they’re not believing me. So I think It is important if you are using that technique in front of your patients that you somehow maybe even verbally address it.
Unknown Speaker  24:09
Oh, that’s super easy. I just say, Wow, you just said something really important right there. Let me just take a deep breath and really think this through. They love that.
Unknown Speaker  24:18
Yeah. Yeah, that sounds,
Unknown Speaker  24:21
remedies that problem.
Unknown Speaker  24:25
So, how could we also apply this technique outside of the clinical arena when it comes to say, our career aspirations or maybe lack thereof, right? Coming, I came from an EMT program, where all the graduates my year went into private practice. And I remember seeing a picture of a class that was many years before mine, were and they said and now every person in this picture Almost every person in this picture is a chairman. So that’s, that’s a bit of a shitstorm. Because the implication is, that’s what you guys should be aspiring to be. And if you’re not, well, you should be. So I think this this should storm can be applied in that area as well. Would you agree?
Unknown Speaker  25:25
I think so. Um, my class at Duke was the first class where I think half of us went into primary care but in general Duke was known for producing specialists and I remember feeling like less because I decided to take that path. I finished my residency at University Chicago and it was very similar to where most people went into academic medicine and I distinctly remember really a very inspiring talk given to us by someone very high in the department at University of Chicago just talking about how you have this great in education, you’ve been really fortunate to train at a top institution, you need to make an impact, make a difference. And he was really discussing doing research and doing medical research to, you know, cure cancer or make a difference in a disease. And I sat there wanting to just crawl under the couch because by that point, I was close to finishing and I had made my decision. And I was even told on the way out the door by a mentor that I really respected that I was throwing myself away. I think that when we can use a method like this to really connect with who we are and what we really are passionate about, or even that we are not yet passionate about. Anything, it leaves us more free to make an authentic decision. So in a situation like that, if I were back there now, I might be sitting there listening to him secretly doing a very slow out breath. And looking at what I knew about myself what I knew about my goals for a family what I knew about what I really enjoyed with patients, that would be my see step and then and then start by saying, Okay, I’m going to take what he said with a grain of salt, because the deeper meaning that there was, you know, do something good and make an impact. And in the end, I ended up there on my own path, because now I am doing what I’m really passionate about doing which is trying to reach parents and take some of the burden off their shoulders.
Unknown Speaker  27:52
That is, I think that’s great for if there are any pre meds or medical students or resident That are experiencing some insecurity in their choices. There are, you’re a physician, you have plenty of opportunity to make impact. But you just have to do it as as yourself. Don’t let anyone I don’t want to use that buzzword bully but, you know, try and manipulate you into doing things that that that you’re not interested in doing that you’re not passionate about. Certainly, you can’t spend your life doing. You know, absolutely being in love with every single thing that you do. I think that’s a little too pie in the sky. But, but if your passion is academics go for academics. If your passion is private practice, if your passion is research, you know, you’ll you’ll you will be making an impact no matter what you are. And I think the size C and start technique really helps people when they’re in that situation, right. They’re sitting in that audience and they’re being made to feel insecure. They can see them cells for who they are and what they want to do and how they want to how they want to make their mark. So I think that’s very, very pragmatic.
Unknown Speaker  29:08
Well, and I think one of the key features of the shitstorm, whether it’s the shitstorm, and parenting or the shitstorm, and doctoring is that it tends to value some things over other things. So for instance, the stories you and I just shared was valuing a certain type of work or a certain type of career path over other things. But why in the world would we undervalue the clinical relationship and the huge ripple effects of that small impact we make each moment in a room with a patient. I mean, so many people, just the experience of having someone really notice them and care about them and try to help them is the kind of experience that can make a little shift in their life and those things add up. So I’ve always found the shitstorm very interesting in the way it Does that now you know, the shitstorm tends to really value metrics and certain particular measurable metrics in medicine. And I’m not blaming anyone for that, because it’s come about by a vast, complex range of factors, including, you know, requirements from insurance companies and very well intentioned things. But fundamentally, certain things are now overvalued, as opposed to other things that are also very important, but maybe aren’t measurable by a metric. Is there anything else that you think we should be discussing today to help our our physician colleagues to whether the shitstorm I think the biggest thing and I think you and I talked about this in the pre interview, about the shitstorm is the way that it makes us feel unworthy, and so much of what makes us able to really connect with other people and connect with our world in a way that matters. is when we can come from a place of saying, You know what? I’m okay. And I’m going to do my thing here. And that’s what I love about what I see and start has done for me and for many of the people I know who have told me they’ve started using it is that it starts to shift you into a more of a place where you feel acceptable, as opposed to feeling like what you do isn’t important or isn’t enough or doesn’t matter.
Unknown Speaker  31:25
You’ve chosen a career. Do your do your best to look after your patients and, and don’t let the shitstorm get in the way.
Unknown Speaker  31:34
Yeah.
Unknown Speaker  31:36
So where can people find you and where can people find that TEDx talk?
Unknown Speaker  31:40
Sure. So if you go on YouTube, and you search the parenting should storm or you search by my name, it’ll come up. I’ve got a website and probably the easiest place to find that is www dot shitstorm. Calm and that shows my quick two minute videos with little tips at links to my blog. For Psychology Today,
Unknown Speaker  32:02
I even have a fascinating inspiration page.
Unknown Speaker  32:07
We are also on Facebook and we’ve created a group for parents called no more shitstorm. And we’re really having a great time with this group of parents and anyone is welcome to join if they want to enter the should free zone and see what that’s like as a parent.
Unknown Speaker  32:22
I think we should all spend some time in the should free zone. Well, Dr. Allison Escalante, thank you so much for talking to me today. I feel like our listeners will be better parents and better doctors for taking your advice. So I really appreciate it and appreciate the work that you’re doing.
Unknown Speaker  32:38
Well, thank you so much for having me on Bradley. I really appreciate it.
Unknown Speaker  32:47
That was Dr. Bradley Block at the physicians guide to doctoring. We can be found at physicians guide to doctor and calm or wherever you get your podcasts. If you have a question for a previous guest or have an idea for a future episode. Send Comment on the web page. Also be sure to leave a five star review on your preferred podcast platform. Our show is produced by guilt free Studios in New York City. You can find them at guilt free studios calm. Our theme music was written by our show’s producer voice, actor car and guilt free
Transcribed by https://otter.ai