Thriving Amidst Chaos: Prioritizing Health, Self-Care, and Mindfulness

An earlier version of this article appeared on this website in October 2023

When your days are busy and your evenings are full, making time for your own well-being can sometimes feel like just another thing to check off your endless to-do list. If you’re like many physicians, self-care often falls by the wayside.

The truth is that you need to recharge and refresh in order to be the best version of yourself. And, as important as it is to care for your own health and happiness, it’s not just about you. When you care for yourself, you’ll be better equipped to care for those who depend on you.

In this article, we’ll explore why self-care matters, including the impact of self-care on stress management. Next, I’ll give you some simple steps that will help you to put these ideas into motion. By caring for yourself, you’ll be empowered to thrive amidst the daily storm of medical practice.

The Impact of Stress on Burnout

It’s common to think of stress as harmful and something to be avoided. But stress can affect your health positively as well as negatively.

Positive stress (or eustress) happens when you face a challenge or a deadline that you know you are capable of meeting. It might be a stretch, but you know it’s possible. And importantly, there is a reward waiting on the other side.

While positive stress can propel you towards your goals, negative stress (sometimes called distress) can lead to frustration and burnout. Negative stressors are those forms of stress over which you have no control. A boss (or spouse) who is never happy, a job for which you are never rewarded or thanked, and escalating demands at work without adequate time off to rest and reset are all forms of negative stress.

Constant and unrelenting stress can lead to burnout. The World Health Organization defines burnout as an “occupational phenomenon.” Burnout is characterized by

• Exhaustion and loss of motivation

• Cynicism and negativity

• Inefficiency

Given the current state of healthcare, it’s no surprise that nearly half of physicians reported at least one manifestation of burnout in 2024.

It’s important to remember that burnout is not your fault. By definition, it is a symptom of a dysfunctional system or workplace. Perfectionists, people-pleasers, and so-called workaholics seem to be more susceptible. Not surprisingly, these personality types are common for physicians. But developing some tools to help you get through tough times can lessen the impact and improve your overall happiness and wellbeing.

Self Care and its Benefits

Self-care is not just about pampering yourself. It's about taking care of your mental, emotional, and physical well-being.

Committing to self-care can enhance your focus, improve relationships, lower stress, and mitigate burnout. Acknowledging the mind-body connection is often the first step towards effective self- care.

Nutritional Psychiatry and Stress Management

The new field of Nutritional Psychiatry focuses on the growing body of research that strongly connects what you eat to how you feel. Without a doubt, mental health is complex and multifaceted. Diet is only one part of the big picture.

But when you’re famished and pressed for time, the quickest options can undermine you, sabotaging your best intentions and sapping your energy.

As it turns out, those ultra-processed foods that often pass for nutrition in the doctor’s lounge or office snack machine can raise your risk of anxiety, sleep disturbance, depression, food addiction, alcohol use disorder, and increased inflammation. Artificial sweeteners in particular have been linked to a greater risk for depression.

Instead, consider switching in simple elements of the Mediterranean diet like fruits, nuts, whole grains, olive oil and fish. You probably know that the Mediterranean diet supports heart health and may reduce the risk for certain cancers. But this diet is also linked to improved symptoms of depression and better mental health and well-being. There’s also emerging evidence that a Mediterranean diet can improve perceptual performance.

It might take a little planning, but going Mediterranean doesn’t have to be complicated. Simply packing a nourishing lunch or advocating for healthier options at work can make a difference.

Exercise and Health

You already know that regular exercise will lower your risk for heart disease, cancer, bone disease, and dementia, among other dreaded conditions.

But research has also shown that exercise can reduce anxiety, improve sleep, and improve immune function. It doesn’t take a lot of exercise to reap the benefits. A brisk 15 minute walk a few days a week is a great way to get started.

Mindfulness and Self-Care

"Mindfulness is the awareness that arises when we nonjudgmentally pay attention in the present moment.” These are the words of Jon Kabat-Zinn, PhD., Professor of Medicine Emeritus at the University of Massachusetts Medical School, and the godfather of mindfulness in healthcare.

Put even more simply, mindfulness is undistracted attention.

Practicing mindfulness has a wealth of benefits, some of which you might not anticipate, including

• Healthier lifestyle choices

• Less stress and anxiety

• Greater parasympathetic tone

• Better cardiovascular health

• Improved immunity.

If it all sounds a little woo, know that mindfulness doesn’t have to be about practicing yoga or meditating. You don’t need a special cushion or a meditation app, although those can be nice. Instead, it’s about being undistracted, nonreactive, and fully present in the moment.

Getting started with mindfulness isn’t complicated. Simply set aside 3-10 minutes of quiet time each day to observe the present moment. Notice your thoughts and let them go, returning to the present when your mind wanders.

It is this practice of continually returning to the present moment that develops the “mindfulness muscle.”

When you practice mindfulness, you may find that your presence, and hence communication, with patients and colleagues becomes easier and more engaged.

Create an Action Plan

Creating an action plan will help you to set realistic goals and track your progress. Write out the steps that you need to take to commit to your self-care. And develop a plan that is realistic and actionable.

Consider enlisting a partner or friend with whom you can share accountability to help you to stay committed. Something as simple as a daily reminder on your phone may also keep you on track.

The ripple effect of taking your own self-care to heart will show up in your energy level, creativity, and relationships. You may notice a greater sense of self-compassion and equanimity. And in time, your path forward toward the goals that matter will become more clear.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Adan, R. A. H. et al. (2019). Nutritional psychiatry: Towards improving mental health by what you eat. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 29(12), 1321–1332.

American Medical Association & American Medical Association. (2024, July 2). Physician burnout rate drops below 50% for first time in 4 years. American Medical Association. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-rate-drops-below-50-first-time-4-years

APA Dictionary of Psychology. (n.d.). https://dictionary.apa.org/eustress

Brulé, G., & Morgan, R. (2018). Editorial Working with stress: can we turn distress into eustress? ResearchGate. https://www.researchgate.net/publication/324531212_Editorial_Working_with_stress_can_we_turn_distress_into_eustress

Davidson, R. J. et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine, 65(4), 564–570.

Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, et al. (2022). Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose–response meta-analysis of data from 1 853 610 adults. British Journal of Sports Medicine 56:1188-1193.

Gilbert, D., & Waltz, J. (2010). Mindfulness and health behaviors. Mindfulness, 1(4), 227–234

Lane, M. M. et al. (2022). Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients, 14(13), 2568.

Loucks, E. B.et al. (2015). Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework. Current cardiology reports, 17(12), 112.

Martinez-Gonzalez, M. et al. (2019). The Mediterranean Diet and Cardiovascular Health: A Critical Review. Circulation Research 124:779-787

Munoz, M.A. et al. (2009). Adherence to the Mediterranean diet is associated with better mental and physical health. British Journal of Nutrition. 101 (1821-1827),

Samuthpongtorn C et al. (2023). Consumption of Ultraprocessed Food and Risk of Depression. JAMA Netw Open. 2023;6(9):e2334770. doi:10.1001/jamanetworkopen.2023.34770

Shanafelt, Tait D. et al. (2022). Changes in Burnout and Satisfaction With Work-Life Integration in Physicians During the First 2 Years of the COVID-19 Pandemic. Mayo Clinic Proceedings, Volume 97, Issue 12, 2248 - 2258

Stubbs, B. et al. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry research, 249, 102–108.

World Health Organization: WHO. “Burn-out an ‘Occupational Phenomenon’: International Classification of Diseases.” World Health Organization, 28 May 2019, www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases.

Yin, W. et al. (2021). Mediterranean Diet and Depression: A Population-based Cohort Study. International Journal of Behavioral Nutrition and Physical Activity, 18(1). https://doi.org/10.1186/s12966-021-01227-3

Young, H. A. et al. (2022). Mediterranean diet, interoception and mental health: Is it time to look beyond the ‘Gut-brain axis’? Physiology & Behavior, Volume 257.

Using the Language of Art to Create Work-Life Balance

An earlier version of this article was published on KevinMD.com in 2023

For most physicians, achieving work-life balance is a top priority. But what does balance mean? And is it even possible?

In this article, I propose that there is more than one way to conceptualize balance. Before we explore these new perspectives, it’s important to address a common alternative: the concept of work-life integration.

Because the concept of balance often feels unattainable, and perhaps even undesirable, some argue that “work-life integration” is the better term. This popular terminology implies that somehow work and personal life should seamlessly intertwine, one gently flowing into the other.

It’s a trendy buzzword in managerial circles, but for physicians, work-life integration is often not a choice—it’s a given. And between taking call, attending after hours committee meetings, slogging through the EHR, and making time for CME and recertification, what’s labeled as “personal time” often gets consumed by work-related demands.

That’s why the work-life integration construct for physicians often means no real boundaries at all.

In this model, work doesn’t just blend into your personal life—it takes over. And yet, the reverse is rarely possible. There may be no space in the work day for your own needs.

Let’s be honest: it’s rare that you can realistically bring family or personal responsibilities into the hospital or clinic. For most physicians, that’s neither practical nor desirable.

So where does that leave us? I believe that work-life balance—not integration—is still the better goal. But the way we think about balance is often flawed.

When we picture balance, most people imagine a seesaw or a perfectly balanced scale, where equal weight on both sides creates harmony. It’s a tidy image but one that’s unrealistic for most lives, especially for physicians.

Instead, there’s a deeper, more creative way to think about balance—one that borrows from the language of art. By embracing this alternative perspective, you will discover a dynamic and fulfilling concept of balance that can help you to create a more sustainable and happy life.

Before we go any further, it’s valuable to think about work-life balance as more than simply “work” and “life”. Work is an important part of life, and perhaps even a defining feature of the life you’ve chosen. But “life” isn’t just what’s left over after work. It can be useful to think about life as a array of different elements. Broadly speaking, these may include

• Family

• Friends

• Leisure

• Self-Care

• Anything else that’s meaningful to you

 Equalizing all of these factors our using traditional concepts of balance is virtually impossible.

But if we borrow the concept of balance from art theory, it all starts to make more sense.

 Concepts of Balance

In art, balance can be

• Symmetric

• Asymmetric

• Radial

• Crystallographic (Mosaic)

Let’s take a little detour into art theory so I can show you what this means.

Symmetric

• Think of the typical balanced scale, or a mirrored pair.

• This is the traditional way that we think of balance.

Thomas Nordwest, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

Asymmetric

• The perception of weight across the composition may be balanced, but each element has a different size or mass.

• This form of balance tends to create more interesting and dynamic images.

Radial balance

• This type of balance uses a central focal point

• Rays, spirals, or ripples radiate outward

Fragment, Peru c. 1000-1476 AD, Kate S. Buckingham Endowment, Art Institute of Chicago

Crystallographic (Mosaic) balance

• A large number of elements share equal weight

• There is no single focal point

Choosing Asymmetry

Any of these constructs may work for you. For many physicians, an asymmetric concept of balance can be especially useful. Think about the way you might create a rock garden. With asymmetric balance, you have wide latitude to play with different scale and elements. There is no exact formula, but you feel it when it’s right.

Compared to the symmetric form of balance, where both sides hold equal weight, asymmetric balance falls apart when the elements are too similar.

In asymmetric balance there is usually a dominant element, with the other components playing a supportive or bridging role. Often two smaller elements work harmoniously to balance a larger one. In an asymmetric painting like Van Gogh’s Starry Night, there may be some tension, but the image still feels complete.

Starry Night, Vincent van Gogh, 1889. Public domain, via Wikimedia Commons

Asymmetric balance can be interesting to play with. Moving one element often means that the others must also be moved in order to maintain a sense of harmony. This new configuration might strike a different, even unexpected, chord and create different relationships between the pieces.

When thinking about creating your own work-life balance, asymmetric balance may be a good starting point to consider.  As your priorities shift over time, your vision of balance may also change. At any time, you can rearrange the elements to make them work for you.

How do you begin to define your own work-life balance? Take another cue from the art world. Sit down with pen and paper and sketch it out in words or pictures. This form of reflection is a great way to get clarity on your own ideas so you can create your vision for the future.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

References

Fallon-O’Leary, D. Work-Life Integration Is the New Work-Life Balance. Is Your Team Ready? CO. July 2021.

McManus, I. Symmetry and asymmetry in aesthetics and the arts. European Review, October 2005.

Meyer, I. Balance in Art – Exploring Different Types of Balance Artworks. Art in Context. August 2023.

Saley, C. Survey Report: Millennial doctors still finding jobs the old-fashioned way. CompHealth Blog. April 2018.

Vincent van Gogh, The Starry Night. MOMA.org , 2019.

Making Peace with Your Inner Critic: A Guide for Physicians

Your inner critic is that harsh internal voice muttering in the shadows of your thoughts, constantly critiquing, second-guessing, and comparing. It may take form as the voice of a family member, a tough or challenging attending from your years in training, or a demanding patient. It might even arrive in the guise of your own voice. It’s not surprising that most physicians have their own version of the inner critic.   

No one likes the inner critic, but here’s what you might not realize: Despite its harsh and heckling tone, constantly telling you that you’re not good enough, the inner critic may actually believe that it’s on your side. It may be trying to protect you from what it senses as impending harm or shame.

Of course, sometimes the inner critic is intentionally cruel. That’s a voice that needs to be locked in a box and put out with the trash. It does not deserve your attention or respect. If it is especially powerful, therapy can be life changing.

But your inner critic often emerges from an authentic drive for self-improvement and accountability. Although its intentions may be well-meaning, if left unchecked, this inner critic inevitably creates an unhealthy cycle of self-doubt, perfectionism, and burnout.

In this article, you’ll learn how to recognize the inner critic as a voice rather than a truth. And you’ll see how you can harness its intentions, putting it to work to develop a more compassionate self-dialogue that allows you to thrive and grow.

Noticing the Inner Critic

Your inner critic might say things designed to make you question yourself, such as:

• "You should have caught that diagnosis sooner."

• "What if you made a mistake during that procedure?"

• "You’re not smart enough to keep up with your colleagues."

The inner critic thrives on echoing your deepest fears, drawing strength from your attention. The more you engage with it, the more amplified and persistent it becomes. That’s why it’s crucial to recognize its influence and take steps to quiet its power.

You might visualize your inner critic as an annoying and unwelcome distant relation, tagging along for the ride. But instead of sitting quietly like a polite passenger, or offering constructive advice, this protective character goes into overdrive, grabbing the steering wheel and becoming harsh and punitive when it senses danger ahead. It might believe that it is trying to protect you. But instead of helping you discover your own route, the inner critic may actually run you off the road and into a ditch.

To create some distance, it can help to give your inner critic a name. Take away its sting by making it something ridiculous or silly.

No matter how you conceptualize it, keep an eye out for this dangerous character. By tuning in to the patterns and triggers of the inner critic, you can begin the process of disarming it.

Facing Down the Inner Critic

Identify Patterns

When does the inner critic tend to appear? Does it strike at a specific time of day, day of the week, or month? Do you notice it when you are doing certain types of tasks?  Or does it show up when you’re exhausted and unable to block out its annoying chatter?

Understanding the recurring patterns can provide insights into the core issues your inner critic is amplifying.

Voices in Your Head

Delve into the narratives your inner critic spins. Recognize its dramatic and querulous nature. When your inner critic surfaces, pay attention to the specific phrases and statements it uses. These may include self-defeating remarks, doubts about your abilities, or a barrage of negative predictions.

Tap into the self-talk your inner critic stirs up and ask yourself if there might be a different way to see things. For instance, if your inner critic says, “You’ll never get this right,” counter it by recalling times you’ve successfully navigated similar challenges. Reframe its negativity into constructive, empowering thoughts. By turning its drama into dialogue, you’ll regain control.

Emotional Impact

Explore how your inner critic drives your emotions. Does it trigger self-doubt, frustration, or a sense of being overwhelmed? What are the underlying fears it amplifies? Can you seek out the root causes? Perhaps there’s a different way to tackle these issues.

For instance, if fear is present, can you dissect it into its parts? What are you afraid of, and what's the worst-case scenario? What skills and knowledge do you already possess? How might you target areas for improvement in knowledge or skillset that might disarm the fear?

Physical Sensation

Consider the physical manifestations caused by the inner critic. Do you notice increased stress, tension, or even physical discomfort? Recognizing your physiological responses can serve as an early warning sign when the inner critic is near.

This is a perfect time to integrate mindfulness techniques like focused breathing or even a brief walking meditation. Just a minute or two can break the spell. When you feel the inner critic approaching, remind yourself to be present in the here and now, avoiding the temptation to ruminate over the past or over-analyze what’s to come.

Excessive Restraint

Pinpoint the actions your inner critic prevents you from taking.  Evaluate how the inner critic seeps into your decision-making process. Does it hinder your ability to take calculated risks or make decisions with confidence? Is it fear or is there something you need in order to gain confidence? Acknowledge the limitations, if they are real, but then make a plan.

Are these limitations that you want to overcome? Envision them as roadblocks and strategize how you might get over, around, or through. You don’t need to go it alone. Perhaps a coach or a therapist would be valuable, depending on the type of obstacle that you’re facing.

Transforming the Inner Critic

Imagine your world without the inner critic. If nothing was holding you back, what are three small actions you'd take immediately in your medical practice or your life? How might that improve your well-being, or your capacity to practice your profession at a level you aspire to?

While it may not be possible to squelch the inner critic completely, there are several important ways that you can disarm it, turning it into an ally instead of a fiend.

Acknowledge Its Intentions

When your inner critic pipes up, pause and ask, “What is this voice trying to protect me from?” Naming the underlying fear—like avoiding a mistake or preserving your reputation—can reduce its intensity while offering a tool for reflection and positive action.

Reframe the Dialogue

Instead of letting the critic dominate, respond with curiosity and self-compassion. For example, “I hear you’re worried I missed something, but I reviewed everything thoroughly.” This turns self-judgment into a productive conversation.

Redirect Its Energy

Channel the inner critic’s vigilance into positive actions. This might include creating a checklist for complex tasks, learning new skills, or seeking feedback from a trusted mentor to grow your expertise.

Balance with Self-Compassion

Remind yourself that mistakes can happen even under the best circumstances. Failure doesn’t always mean that you did something wrong. Learn from less-than-ideal outcomes and move forward. Your patients, family, and community need you.

Why Taming the Inner Critic Matters

What’s your inner critic trying to protect you from? Next time it speaks up, take a moment to listen with curiosity, not judgment. You don’t need to hand over control, but you might be surprised at how much it’s been trying to help.

By recognizing the inner critic as a well-meaning—if sometimes misguided— ally, you can reclaim your confidence, stay motivated to grow, and expertly care for your patients. At the same time, you’ll cultivate the self-compassion you so readily give to others. When needed, a coach or a therapist can be a valuable ally. In the end, taming the inner critic is about becoming the best version of yourself.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery session, click the button below.

Stop Being So Hard on Yourself: Five Reasons To Celebrate Physicians

If you’re like many physicians, it may be easy to lose sight of your value. Healthcare today faces unprecedented challenges and stressors, and it’s sometimes hard not to take it personally.

Physicians in particular are some of the worst at self-flagellation. It’s common to feel frustrated and disappointed when you feel as if you haven’t lived up to your own ideals, or those that are imposed on you. Some days it can seem as if being a doctor is a thankless task. Doctor’s Day comes once a year, but your work is never done. So I’d like to share five reasons that you deserve to be appreciated and celebrated every day.

You Want to Do Good in the World

Medical practice is a field that naturally attracts individuals who are both highly intelligent as well as driven by a desire to impact the world positively. But wanting to do good and actually doing the work are two very different things. You do the work. Although your efforts may not always be acknowledged, your actions, big and small, directly affect the health and well-being of your patients and your community.

You Do Hard Things Every Day

Physicians face an array of challenges daily, from navigating complex medical and social issues to making life-saving decisions under pressure. On top of that, societal, economic, and administrative pressures may add levels of frustration that test your empathy and determination. The work of a physician requires an extraordinary level of resilience and fortitude, especially when, despite your best efforts, things don’t always turn out as you’d hoped or expected. It is no exaggeration to say that this level of commitment and grit far exceeds that of most other professions.

You Are Passionate About Your Work

Passion is the lifeblood of innovation and motivation. Physicians often pursue their profession because of a deep-seated passion for healing and discovery. This enthusiasm is often what spurs you to continually learn, grow, and push the boundaries of what is medically possible. Even on days where you feel less than enthusiastic, your years of focus and commitment drive you to do your best work.

You Come from All Walks of Life

Each physician comes to the profession with a unique array of backgrounds and experiences. Whether you come from a rural town or a large urban community, from a US metroplex or a country thousands of miles away, each physician carries a distinctive set of perspectives and skills. This diversity enhances your ability to connect with and care for a wide range of patients with a rich mix of cultures and viewpoints.

You Are a Change-Maker

Physicians are often at the forefront of change, not only in their clinics or hospitals but also in the broader context. Collectively, you have the power to initiate significant health policy reforms, improve patient care standards, and lead community health initiatives. What you do makes a difference in ways, big and small, that ripple out into the world.

As a doctor, you are not just a healthcare provider or a widget in a faceless system. You are a resilient, passionate, and dedicated professional committed to making the world a better place, one patient at a time. Most importantly, the work you do matters.

If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.