Rediscovering Your Why: A Road Map for Physicians

If you’re questioning whether you’ve chosen the right job, the right specialty, or even the right profession, you’re not alone.

Most physicians go through cycles of doubt, revisiting old decisions when things aren’t going well. That can be very normal, and over time the chances are good that these periods will become less frequent.

Dissatisfaction today doesn’t always mean that you need to make a drastic change tomorrow. Sometimes short-term pain and sacrifices are necessary to get you where you want to go.

But if this seems like a theme song that just won’t stop playing, then it might be time to rediscover your why.

Often when you feel unfulfilled or frustrated at work or in your personal life, it’s because you are not living a life that feels authentic to you.

• Perhaps you are trying to live up to someone else’s ideal

• Maybe your life has moved in a different direction since you first chose your current path

• It could be the job itself that has changed or not lived up to your expectations

• Perhaps you simply need to rediscover the reason that you chose to become a physician so many years ago

"Finding your why" is the process of discovering and understanding the deeper purpose or meaning behind your actions, goals, and choices. It's about identifying the core values and beliefs that drive you and give your life a sense of meaning and fulfillment.

This concept is often associated with personal development and leadership, and it's a key element in the philosophy of Simon Sinek, an author who has been hugely influential in the business world. Sinek argues that successful individuals and organizations are those who are able to articulate and align their actions with a clear sense of purpose or "why." In fact, one of Sinek’s most popular books is called Find Your Why.

The idea is that when you have a clear understanding of why you do what you do, it can serve as a powerful motivator and guide for decision-making. It can help you stay focused, overcome challenges, and find a greater sense of satisfaction at work and in your personal life as well.

As Sinek puts it

• Your why is your driving force

• Your how is the actions that you take to bring your why to life

• Your what is the manifestation of your why—the actual work that you do

Once you understand your why, everything else starts to make sense. Your decisions will become clearer and your actions more purposeful and meaningful.

Knowing your why is so integral to being a physician that it’s surprising this concept is not routinely taught in medical schools. Discovering your why is not a “one and done”, check-it-off-the-list sort of thing, but it’s logical and easy to understand.

The process involves introspection and reflection on your values, passions, and the impact you want to make on the world. It means going beyond your surface-level goals and digging deeper into the fundamental reasons that drive your choices and actions.

To help you find your why, get a piece of paper or a journal and start writing. You could do this on your computer or your tablet, but writing by hand tends to engage the brain more fully than typing on a keyboard, encouraging a deeper connection with the words and ideas and improving later recall. Most importantly, choose a method and a time that works for you.

Consider taking a few minutes every morning or evening to discover the patterns and thoughts that arise. Here are some questions to get you started:

• What do I find fulfilling about my current job?

• What do I not like about my current job?

• What values do I seek to honor in my work and in my life?

• What other goals and aspirations, professional and personal, do I have?

• What are my strengths, my natural talents, my soft skills?

• What strengths and talents would I like to develop further?

• What are the common ideas and threads that run through my life over the years?

• What makes me happy at work, at home, and in my private life?

• What do people thank me for?

• What do I enjoy teaching?

• What do I enjoy learning?

• What keeps me up at night?

• What moves me to take action?

• What is my ideal day?

After spending a few weeks letting these ideas gain traction, create a mission statement that will encapsulate your why in a single sentence. To get started, ask yourself what contribution you wish to make, and what impact you hope to have. It doesn’t have to be perfect, and it doesn’t have to answer to anyone else’s expectations. Your statement can be a work in progress, but it’s a great way to begin to align your goals with a purpose that is genuine and fulfilling. Over time, knowing your why can become a transformative force.  

 P.S. If you want to learn more about defining your values, click here to sign up for my free Values Workbook.

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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 introductory meeting with me, click the link below.

My Podcast Interview with Phage Therapy Research Scientist Dr. Jennifer Sacher

It was such a pleasure to interview Dr. Jessica Sacher for the Techlink Health Podcast.

We discussed her fascinating work using phage therapy to defeat superbugs, and how she got started in the field.

We also had a great conversation about the personal aspects of this work, and how she has adapted her laboratory process to meet the growing need for phage therapy.

This interview is a great reminder of all the people whose work contributes to saving lives and furthering the progress of medical science.

Jessica’s passion for her work shines through in this interview. I hope you enjoy it!

The Power of the Pause: Creating Engagement and Presence

If you do surgery or procedures, you’re probably familiar with the idea of taking a timeout. This is a mandated hard stop in the operating room or procedure lab. It’s a moment for everyone involved to verify that they are on the same page and that all necessary preparations have been made.

What if you took the concept of taking a pause out of the OR and into the other demanding parts of your day? It makes sense that taking a brief pause between meetings, procedures, or complex patient care might be helpful. But my guess is that very few of us actually do this.

New research from Microsoft's Human Factors Lab supports the idea that taking a personal pause can not only help you to reset but may even improve your engagement with your next patient or procedure.

Since this was Microsoft, the study looked at the way people engaged in meetings. The 14 subjects were tasked with wearing an EEG while participating in video meetings. Each meeting lasted 30 minutes.

On one day, they took part in four back-to-back meetings, without a break. On the other, each meeting was followed by a 10-minute pause. Instead of simply checking their phones, the participants meditated with the Headspace app.

The results were pretty interesting. Analysis of brain waves showed that taking a pause for a brief meditation created greater engagement during the following meeting.

Conversely, with no pause, there was EEG evidence of greater stress during the next meeting.

Productivity is often measured by the amount of time spent working. But this study and others suggest that engagement is a more important (and healthier) metric.

Bringing these ideas into healthcare can be challenging when there is no end to the pressures of the inbox and adding one more procedure or working in one more patient (with fewer members of the support staff) is the norm.

How can you begin to practice taking a pause? It’s not always practical to take a 10-minute break for meditation in the middle of a busy day. But even a few mindful moments can help. Here are a few practical tips that can help you to create a little breathing space for yourself and to be more present for your patients:

• Breathe Mindfully:

Take a few deep, intentional breaths before going in to see a difficult or complex patient. Focus on the sensation of the breath entering and leaving your body. This simple act can help anchor your awareness to the present moment.

• Body Scan:

Conduct a quick body scan to release tension. Start from the top of your head and gradually move down to your toes, paying attention to any areas of tightness or discomfort. Allow these areas to relax, even if it’s just a little.

• Mindful Observation:

Take a moment to observe your surroundings without judgment or reactivity. Notice the colors, textures, and sounds in your environment. This brief shift in attention can provide a mental break and promote a sense of calm.

Taking mindful pauses between patients is not just a momentary break from a hectic schedule. It's an investment in your well-being and a way to engage more deeply with your patients. It can be a quick way to reboot your energy. By incorporating mindfulness into your routine, you can cultivate a sense of balance, focus, and empathy that positively impacts both you and those who depend on you.

It's time that healthcare leaders begin to learn the lessons that Microsoft and other leading companies already know. By supporting and empowering physicians and the healthcare team, healthcare systems will not only improve engagement and work satisfaction but will likely improve patient outcomes and physician and staff retention.

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.

“Doctor, You Just Don’t Have Time for Me Anymore”

This article originally appeared on Doximity.com, where I was an Op-Med Fellow from 2022-2023.

“Doctor, I feel like you just don’t have time for me anymore.”

My 92-year-old patient Mr. Gray peered at me through his thick glasses, his bushy eyebrows knitted together. I felt my breath catch in my chest.

Mr. Gray was right. As the constraints of medical practice had tightened over recent years, time had become a limited commodity — and something I had lost control over. I did my best to make the brief encounters that now passed for office visits feel like something more, but a threshold had clearly been crossed.

It had not always been this way. Over the 20 years that I had cared for Mr. Gray, my medical practice had changed almost unimaginably.

We had gone through three iterations of the EHR, each more onerous than the last. Like many other groups faced with the economics of 21st century health care, my large cardiology practice had been acquired by a health care system several years prior. Over that time, we had gradually ceded control.

Several more patient slots had been added to the morning and afternoon schedules, meaning less flexibility for those who needed a little more time. And our scheduling department was in the process of being moved out of our office and into the larger system for the sake of efficiency.

Following our very first encounter when he was hospitalized with a cardiac illness, Mr. Gray had become a regular in my clinic. I was always happy to see him on my schedule. He might have been a little cantankerous, but he was never afraid to speak his mind. And I felt that we had achieved a great partnership.

Despite his age and long list of health issues, his mind was bright. He always asked great questions, and he loved to challenge me, but he was usually willing to accept my recommendations after we had talked things through.

Reeling from the sting of his accusation, I promised Mr. Gray that I would make the time for him. I assured him that he was important to me, and I apologized deeply.

Although I had not created this situation, I was determined to make sure that I repaired it to the best of my ability.

Mr. Gray was not the only one who had noticed this constriction of time, and ultimately he wasn’t the only patient for whom I surreptitiously bent the rules.

But his age and his medical complexity made the idea of what essentially boiled down to far less than 10 minutes face-time patently absurd.

Mr. Gray had the audacity to remind me of my Hippocratic oath. Faced with his rebuke, I felt compelled to go beyond helpless banalities about “the system” and “the computer.”

The current health care system often rewards those who see more patients, spend less time, and generate higher RVUs. A 92-year-old man’s request for physician time might seem inefficient and irrelevant by those standards.

Yet Mr. Gray reminded me of the importance of living up to the principles that had inspired me as a younger and more idealistic physician.

I contacted our scheduling department and cajoled them into placing an alert on Mr. Gray’s chart, noting that two patient slots would be required for his visits. This was not standard procedure, and I knew that it might be considered an inappropriate use of limited office time by the number crunchers in management. On the other hand, as a senior cardiologist, I had worked with the in-house office staff for many years, and my unusual request was granted without question. Mr. Gray understood that I was going to bat for him, and he appreciated the effort.

From that point on, every visit with him was a reminder of why I became a physician in the first place. Mr. Gray and I were able to discuss his complex health concerns in detail, review the options, and ensure his understanding.

Over this time, I got to know Mr. Gray on a more personal level. An artist since his late 70s, he often brought in paintings that he had made, setting up the examining room as a small gallery. His art would be propped up on the examining table and the desk would be carefully arranged when I walked in. Birds, animals, buildings, historical events — all were subjects that caught his fancy. But he wasn’t only a painter.

Mr. Gray delighted in showing me photos of his raised-bed garden on his smartphone. And over time I learned more about his years in the military and later life as a farmer on the Great Plains. I believe that the trust this relationship created contributed to his longevity.

When Mr. Gray was 95, I decided to retire from my cardiology practice and return to school to study for a fine arts degree in hopes of eventually teaching in the medical humanities. I dreaded having to tell him goodbye.

I checked and rechecked his upcoming appointment, booked for my last month of practice. A few weeks ahead, I saw that a scheduler had moved the appointment to the schedule of one of our practice’s PAs. Although technically this was in line with the practice’s standards, and the PA was very kind and competent, it was not what I had promised Mr. Gray.

By that time, the scheduling department had been centralized and merged with a larger call center serving many different practices. Despite my calls and messages to the scheduling center, the appointment was never moved back to my schedule. Apparently the 30 minutes Mr. Gray required was no longer recognized as a physician appointment by the system.

Nevertheless, I managed to get hold of Mr. Gray that evening by phone. I will always be grateful for that. During our call, I let him know that I would leave him in good hands with one of the other physicians in the practice, and I thanked him for inspiring me.

About six months later, I learned that Mr. Gray had passed away. I was notified when his daughter, whom I had never met, brought one of his paintings to the office as a gift for me.

There may be those who believe this type of care is anachronistic or idealistic. It certainly didn’t optimize revenue, if we look at these longer visits purely from the standpoint of office throughput and RVUs.

But I believe that Mr. Gray’s story is a cautionary tale for these times of metrics and corporate management. When efficiency and productivity take precedence over years of connection and trust-building, we may lose something beautiful and ineffably human. And in the end, the care we provide may itself suffer.

Offering two blocks of time for complex patients is not always feasible, depending on the constraints of the system. Most doctors no longer own their practices, and they may have little say in the way their schedules are configured.

Fueled by lower reimbursements and a drive for greater profitability, many health care systems demand greater productivity with fewer resources. Meanwhile, the EHR requirements become ever more onerous.

It’s up to physicians to lead the way toward making the patient the priority again. No one else shares our unique vantage point, nor our personal investment in the care of our patients. The time we spend with our patients is more than simply interaction and social connection, valuable as that may be.

The doctor-patient relationship is by its nature collaborative. There are tangible benefits to establishing trust. We may unwittingly break those bonds when we are perceived as rushed or pressured.

Patients may not understand the forces that have created these conditions. Instead, they may understandably interpret these experiences as impersonal and incomplete, a failure of the physician to care.

Especially when dealing with patients with complex and overlapping medical conditions, those who may be reticent to complain, or those who may be wary or uncomfortable asking questions, this trusting connection can be a lifeline.

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.

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

In the constant press of your daily life, prioritizing health, self-care, and mindfulness often takes a backseat. But when you make the time to 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, and I’ll give you some simple steps that will help you to thrive amidst the daily storm of clinical 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 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 on the other side.

While positive stress can propel you towards your goals, negative stress can lead to frustration and burnout. Negative stress is defined as 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 recharge 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 over 60 percent of physicians reported at least one manifestation of burnout in 2021.

It’s important to remember that burnout is not your fault. It is a symptom of a dysfunctional system or workplace. 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 enhances focus, improves relationships, reduces stress, and leads to less 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 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 incorporating 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 the risk of heart disease, cancer, bone disease, and dementia.

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 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 can lead to

• Healthier lifestyle choices

• Less stress and anxiety

• Greater parasympathetic tone

• Better cardiovascular health

• Improved immunity.

Mindfulness doesn’t have to be about doing yoga or meditating. Instead, it’s about being undistracted, nonreactive, and fully present in the moment.

Getting started with mindfulness isn’t complicated. You don’t need a special cushion or a meditation app, although those can be nice. 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 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.

Enlisting a partner or friend with whom you can share accountability can 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’ll develop 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.

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.

When Physicians are Disrespected: My Guest Appearance on the Podcast by KevinMD

If you’re a physician, or anyone active in healthcare today, you have probably heard of Dr. Kevin Pho and his KevinMD podcast and website.

Dr. Pho posts interviews and articles daily, and I was honored to be invited back as a guest on his podcast.

In this episode, we talk about the epidemic of disrespect faced by physicians today, and steps you can take to advocate for yourself and reclaim your dignity.

When physicians and others in healthcare are treated respectfully, the practice of medicine becomes more sustainable and more inclusive.

This is a topic I wrote about in an earlier article, Preventing Physician Burnout: Reclaiming Your Dignity. A version of the article also appeared on the KevinMD website.

My podcast appearance discussing disrespect on the Podcast by Kevin MD.

Bike Shedding for Physicians: Avoiding Trivial Time Wasters

Your time is precious. You have a demanding and consuming professional life. In all likelihood, you're juggling multiple priorities at any given time. Sometimes it’s the most trivial issues that seem to claim the most attention. But as a physician, it's important to be able to focus on the things that really matter, and to avoid getting dragged down into the weeds.

It’s useful to consider the phenomenon known as bike shedding. The term was coined by C. Northcote Parkinson, a British management expert and naval historian, in the 1950s. In introducing the idea of bike shedding, he described a committee meeting that is called to discuss a specific financial agenda. On the agenda is:

• a nuclear power plant costing tens of millions of dollars

• a bike shed for the plant costing a few hundred dollars

• a coffee budget amounting to about twenty-five bucks

The nuclear power plant is way out of anyone’s comfort zone, and no one wants to look ignorant or ask too many questions. So they quickly approve the budget and proceed to focus on the more familiar topic of the bike shed. After extensive discussion, argument, and finally compromise and agreement, they complete the deliberations over the bike shed with a feeling of satisfaction. They round out the meeting with an hour-long debate over the coffee budget, a topic on which they all have a strong opinion.

In a nutshell, bike shedding is a term used to describe the tendency to spend disproportionate amounts of time and energy on relatively minor issues, while neglecting more important but complex concerns. If you’ve spent any time in committee meetings, you can probably relate to this phenomenon. Issues such as EHR functionality and staff management can sometimes also fall into this category.

But bike shedding can also happen in your personal life. For example, you might spend hours researching the perfect running shoes, instead of focusing on your training plan. Or you might spend days agonizing over the color scheme of your living room, while putting aside more important but troublesome family issues at home.

It’s natural to want to escape from stressful decisions by focusing on things that don’t really matter. And the importance of taking time to rest and refresh cannot be overstated. But spending that precious time perseverating over things that are not meaningful can be counterproductive. The bigger problems are still looming. What’s worse, these are the issues that tend to build up steam the longer they are ignored. Eventually you may find that you are compelled to take action, whether you feel ready or not.

Here are a few tips for avoiding bike shedding in your personal and professional lives:

• Identify your priorities. What's most important to you? Once you know your priorities, you can make decisions more easily and avoid getting bogged down in trivial matters and unnecessary conflicts.

• Delegate. If you can delegate tasks, do it. Delegation is important both at home and at work. This will free up your time so you can focus on the things that matter most.

• Remember the big picture. When you're feeling overwhelmed, take a step back. What are your long-term professional goals? What do you want to achieve in your personal life? How can you break that down into achievable steps? Keeping your goals in mind will help you to stay focused on the important things.

• Set boundaries. It's important to set boundaries so that you spend your time purposefully. This could mean saying no to extra work commitments with little upside so that you can make time for yourself and your loved ones. Or it could mean giving up your spot on the neighborhood committee that causes you stress and lost sleep, when you’d really rather be gardening.

It’s natural to default to bike shedding. It’s a way of avoiding stress and putting off difficult questions. But it's something that you can learn to recognize, navigate, and redirect. If you find yourself getting caught up in bike shedding, try to take a step back and ask yourself if it's really worth your time and energy. If not, let it go and move on.

By following the tips above and then building your own strategies, you will protect your time and energy and focus on the things that matter most.

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.

My Podcast Interview with Dr. Keith Matheny, Medical Entrepreneur

It was a real treat to have the opportunity to interview Dr. Keith Matheny for the TechLink Health podcast. As a colleague and fellow Vanderbilt alumni, I was especially interested to hear his story and discover how he designed an innovative and physician-driven approach to challenges in the Ear Nose and Throat specialty.

Keith is a fantastic clinician and an inspiring entrepreneur, and I think you’ll enjoy our conversation.

Check out the podcast here, or you can listen on Apple Podcast, Spotify, or on the TechLink Health website or app.

Navigating Burnout: My Podcast Appearance on KevinMD

If you’re a physician, or anyone active in healthcare today, you have probably heard of Dr. Kevin Pho and his KevinMD podcast and website.

Kevin posts interviews and articles daily, and I was thrilled to be a recent guest. In the episode, we discussed the burnout epidemic, and why it’s not the same as compassion fatigue.

Burnout is a symptom of a system that is not working for you. In many ways, it’s a form of grief. It’s not your fault. But that doesn’t mean there’s no way out. In the interview, I went over actionable steps you can take to improve your life as a physician and to combat the effects of today’s stressful environment.

My August interview with Dr. Kevin Pho on the KevinMD podcast.

Using the Language of Art to Create Work-Life Balance

This article was published in a slightly different format on KevinMD.com

Most physicians cite work-life balance as a top priority. Yet there is little clarity on what exactly work-life balance means.

Some prefer the term work-life integration, as if your work and your so-called personal life should be intertwined. Work-life integration is a common buzzword in managerial circles. For most physicians, however, this way of life is already a reality. Taking call, working late, and keeping up with CME and recertification already mean that much of what might be considered personal time is already filled with work commitments. And so what “work-life integration” often means is that there is really no distinction between the two.

Under this construct, work may be expected to run freely into family and personal time without boundaries. Yet in most cases, the river only flows one way. Bringing your home and personal responsibilities to work may be neither practical nor desirable.

For these reasons, I believe that work-life balance (WLB) is a better goal for physicians. But what does balance even mean?  You might be surprised to learn that art theory holds the answer.

Most people think about balance as a seesaw or a set of scales, with each element balancing the other to achieve a perfect equilibrium. This cliché is virtually impossible to achieve and may not even be desirable. Instead, there’s another more nuanced way to look at balance that I believe can help better inform your personal choices.

Before we go any further, it’s valuable to think about WLB 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 just not going to happen.

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

In art, balance can be

• Symmetric

• Asymmetric

• Radial

• Crystallographic (Mosaic)

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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

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For 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. 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 chord and create different relationships between the pieces.

When thinking about your own WLB, asymmetric balance may be a good starting point to consider.  As your priorities shift over time, your vision of balance may also change. The asymmetric model is a way to conceptualize a personal definition of balance that works for you.

If you’re looking for practical tips to help you take action on WLB check out my recent article, which also appeared on Doximity. In the article I include nine actionable steps to get you started.

How do you begin to define your own WLB? Sitting down with pen and paper and sketching it out in words or pictures is a great way to get clarity on your own ideas and to 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.

My Podcast Interview With Dr. Cliff Han of AllerPops

I recently had the opportunity to interview Dr. Cliff Shunsheng Han for the Techlink Health podcast. Dr. Han is a physician, a medical researcher with the Human Genome Project, and the creator of AllerPops, an innovative product designed to help fight the seasonal allergies that plague so many of us.

An allergy sufferer himself, when medications failed to get his problem under control, Dr. Han decided to look beyond the traditional factors that contribute to allergies. he was also motivated by the allergies suffered by his young son. That led him to explore the idea of prebiotics and the importance of a healthy oral microbiome.

Dr. Han is a wonderful example of a physician who followed a nontraditional pathway. Although he trained and practiced as a doctor in China, he has worked as a research scientist since coming to the US over 20 years ago. He shares more about his story on the podcast and in his book, Nothing to Sneeze At.

But once a physician, always a physician. Through his curiosity and resilience, Dr. Han has created something completely new with AllerPops. The science is still in the early stages, but the testimonials on his website are inspiring.

As a disclosure, I will note that Dr. Han has kindly offered to supply me with a sample kit of Allerpops. As a nearly year-round allergy sufferer, I am really looking forward to giving them a try.

Listen to my podcast interview with Dr. Cliff Han, co-hosted with David Sanchez, RN.

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.

This post contains Amazon affiliate links. I may earn a small commission when you click on the links, at no additional cost to you. These commissions help to support the website.

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As a physician coach, I can work with you to explore what’s possible and create a plan that aligns with your personal values and aspirations. Schedule your exploratory conversation with me by clicking the button below.

My Podcast Interview with Dr. Vicki Rackner: Surgeon, Entrepreneur, and Financial Coach

I thoroughly enjoyed meeting Vicki Rackner MD on the TechLink Health podcast and learning about her work in the field of physician financial well-being.

It was a fascinating conversation, and her story is inspiring! Through personal adversity and challenge, Dr. Rackner created a business helping physicians discover financial freedom.

While she is not a financial advisor, Dr. Rackner works with physicians to help them leverage their medical expertise, generate multiple income streams, and develop critical business and marketing skills. She has authored three books on the subject, with another one on the way.

Take a listen on Spotify or wherever you listen to podcasts.

My podcast interview on Techlink Health with Dr. Vicki Rackner.

Combating Neurophobia: My Podcast Interview with Dr. Michael Kentris

I recently co-hosted an episode of the TechLink Health podcast featuring neurologist Michael Kentris, D.O.

In a wide-ranging discussion, my co-host David Sanchez, RN and I learned about Dr. Kentris' cutting edge work as a neurologist and as a physician educator. As a podcaster himself, Dr. Kentris combats "neurophobia" by breaking down complicated topics in neurology for clinicians across a broad range of specialties. Look for his entertaining and enlightening podcast "The Neurotransmitters" on Apple or Spotify.

I was also excited to learn that Dr. Kentris and I both studied at Vanderbilt University School of Medicine. I graduated from medical school at VUSM in 1988, and he complete his clinical neurophysiology fellowship there in 2018.

My TechLink Health Podcast interview with Dr. Michael Kentris.

Defeating Superbugs: My Podcast Interview with Dr. Steffanie Strathdee

As a podcast host for TechLink Health, it was a privilege to interview Dr. Steffanie Strathdee, an epidemiologist and Distinguished Professor at UC San Diego.

Dr. Strathdee literally saved her husband's life when he suffered a catastrophic antibiotic-resistant superbug infection.

Through her investigations, Dr. Strathdee uncovered the possibility of phage therapy. Considered a risky and largely unproven treatment modality at the time, it was a last-ditch effort -- and it worked!

Dr. Strathdee is now the Co-Director of the Center for Innovative Phage Applications and Therapeutics at UC San Diego. You can find her book, The Perfect Predator, on Amazon. There’s an audiobook version as well, which I highly recommend.

DISCLAIMER: As an Amazon Associate I may earn from qualifying purchases, which means that if you click on one of the product links, I’ll receive a small commission. This helps support the website, for which I am grateful! Please do your own research before making any important decisions.

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.

My Podcast Interview with NeuralPositive’s Dr. Yasmine van Wilt

Recently I was fortunate to have the opportunity to interview Dr. Yasmine van Wilt for the TechLink Health Podcast. Dr. van Wilt has a fascinating story in the field of medical-grade music. She is a founder of Neuralpositive, a company that is on the forefront of medical music innovation. Dr. van Wilt has partnered with Cornell Tech, Columbia University, and Stanford University, among others.

As we work to integrate evidence-based mindfulness and other non-pharmaceutical practices into healthcare, there is a powerful need for well designed research backed up by academic commitment. I’m excited to share this interview with you, and would love to hear your feedback.

What the Failure of the ER Match Says About the State of Health Care

And How Physician Coaches Can Change The Story

When I was in medical school, the cool, smart kids went into ER medicine. It was a hotly competitive residency, and there was no guarantee that you would match. Now things are entirely different. Over 550 residency spots went unfilled by US med school grads in the residency match this month. Some centers had zero applicants match to their programs. Compare this to 2021, when only 14 ER residency spots were not filled.

The reasons? Just about any physician in the US can tell you:

• Disrespect fueled by social media personalities and irresponsible "news" outlets

• Dangerous working conditions

• Overloaded ERs being used as a source of primary care, often because people lack insurance or access

• Corporatization of medicine with a focus on numbers of patients seen and metrics that often don't relate to patient care

• Management of physicians by business people and those with less responsibility and training

• Intrusive, redundant, and burdensome EHR requirements

• Lack of adequate support staff

Some of my best friends are ER physicians. They are some of the hardest working people I know. These are the doctors who will save your life at 2 am, no matter who you are or whether or not you have insurance. And they are also the doctors that are tasked with waking up their colleagues at all hours of the night to request a consult or hospital admission. Most manage their work with grace, strength, and courage.

The steep decline in the desirability of ER residencies is a really scary trend. It’s easy to say that doctors can be replaced with mid-level care providers, but the truth is that the expertise, skill, responsibility and knowledge that an ER physician provides requires years of education, training, and commitment. Mid-levels can reduce some of the burden of less complex patients, but they are no substitute for a physician.

This sudden and shocking shift should be a call to action for hospital directors, ER directors, and the corporations and private equity firms who own and manage many of these practices.

As we wait to see how this recent revelation will impact the decisions and practices that affect ER physicians, it’s important that physicians take steps to stand up for ourselves and our profession. This is a new way of thinking about medical practice, but times have changed irrevocably. By learning how to work within the systems we now have, we can start to make important changes from the inside out. Ultimately, such changes will benefit not only physicians, but also their patients and indeed the very institutions and corporations that currently control our healthcare systems.

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 How can coaching help? Well clearly, coaching will not fix the problem. Coaching means working with one physician at a time, very much like patient care. But coaching will help you clarify your goals, identify your frustrations and obstacles, and give you the tools to create your way forward. Will that be

• Negotiation, understanding your own value?

• Creating a streamlined workflow that will allow you greater efficiency?

• Acquiring new skills to make your time more effective?

• Courage to make a lateral move to a new facility?

• A switch to a different type of practice altogether?

• A change in working hours?

• Reframing conflicts so that you are able to create a more positive working environment?

• Honing interpersonal skills?

• Advocating for change in EHR management?

Regardless of your specialty, the healthcare world is shifting. The work you do matters. By recognizing your own worth and power, and by taking action that is beneficial to both you and your patients, you will be able to create a happier and more sustainable life.

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.

My Podcast Interview with Dr. Naomi Lawrence-Reid

After appearing on a recent segment of TechLink Health’s Podcast, I was invited to interview Dr. Naomi Lawrence-Reid of Doctoring Differently. Dr. Naomi, as she prefers to be called, describes how she pivoted from full-time practice and found new opportunities to use her skills as a physician.

Her story is inspiring and engaging. You can take a listen right here.

How My Experience with Pain Made me a Better Physician

This article originally appeared in Doximity.com, where I am an Op-Med Fellow.

Although I don’t like to admit it, I am a typical Type A cardiologist who takes absolutely everything far too seriously. Like many physicians, this extends well beyond my professional life and reaches into every corner of my existence.

I am also a competitive equestrian. And my big, red, and rather fancy horse really doesn’t care what I do for a living, or how seriously I take myself. In his mind, I am both a reliable source of carrots and a nuisance who sometimes keeps him away from his friends while trying to boss him around. My horse is a source of joy and a beautiful connection to the natural world. He also seems to delight in keeping me humble. But I never expected him to teach me a profound and enduring lesson about the nature of pain, empathy, and mindful compassion.

Several years ago, while training on a cross country jumping course, I suffered a serious fall. One minute I was on top of the world, flying across the open fields with my beloved equine partner, and the next I was on the hard ground, writhing in excruciating pain and unable to walk without assistance. My horse, meanwhile, high-tailed it back to his friends, grateful for the unexpected interruption.

While I fortunately had no broken bones, it turned out I had sustained a severe injury to my right psoas and my left piriformis muscles. I returned to work soon after, hobbling on crutches for support and trying to shrug off my injury as a minor nuisance. However, I quickly became intimately familiar with the anatomy of my lower musculoskeletal system. Initially, it was the psoas muscle that I noticed, since it kept me from walking. But within a few days, the piriformis injury became the center of my existence, as it cruelly squeezed my sciatic nerve. The pain was truly mind-blowing and would sometimes escalate without warning. Because I was back at work, my options for medications were limited.

I am by nature a quiet person, but during this time one of the only ways I could deal with this monstrously searing pain was to scream my head off. This was only possible when I was safely out of earshot of my patients, partners, or any other human beings. I don’t know if it was the endorphins or the temporary distraction, but it was remarkable how well screaming helped, if only for a few minutes.

After more than a week of unrelenting agony, I began Googling similar injuries (because, of course, you Google). I realized with dread that there was no promise that my pain would ever completely go away. Thankfully I had an excellent orthopaedic team. And, as a physician, my pain was always taken seriously. Sadly, I knew this was not the case for many of my patients. 

Although I don’t treat pain, my cardiology patients are among the estimated 8% of Americans who live with what is termed “high-impact chronic pain.” Like a light switch turning on, after my accident I began to recognize the manifestations of pain and misery in their faces. The anxiety of being asked to change positions on the exam table, the fear of having their medications taken away, and the frustration of feeling dismissed and disrespected. I understood deeply that pain could not always be measured, proven, or relieved. 

I found myself engaging more empathetically with these patients, acknowledging their fear and our shared humanity. The 55-year-old woman with chronic back pain who always remained standing during our visits, shifting back and forth, who used to perplex me? Now I realized just how difficult sitting could be. The anxious 45-year-old man with the perpetually furrowed brow and litany of complaints about his medical team whom I had previously written off as a chronic malcontent? With my newly informed awareness, he now came into sharper focus as a suffering human being. And the 70-year-old woman with severe arthritis and scoliosis, who was nonetheless always ready with a smile and a thank you? She became a messenger of grace — someone who showed me that it was possible to rediscover an innate good nature, despite the difficulties life presented. In acknowledging my patients’ pain, and accepting their well wishes for me, our sense of mutual trust and connection deepened.

As physicians, we learn early on to create healthy boundaries between ourselves and our patients. Hard-earned experience teaches us that we can’t always take everyone at their word, and that in some cases patients will exploit their doctors’ compassion for personal gain. For instance, most medical and surgical interns will eventually encounter characters who seek pain medications for what sound like legitimate reasons, but are eventually discovered to have visited multiple doctors and ERs with similar stories. Often a call from an astute pharmacist uncovers the ruse. Consequently, by the end of residency, it’s common to have developed at least a little cynicism. And indeed, we learn quickly that objectivity is critical not only to our decision-making but also to our ability to leave our work behind at the end of the day. 

My practice, as I mentioned, does not include treating pain or prescribing pain medications, and I have not lost my natural sense of vigilance. Yet my intensely personal experience has opened a window of understanding and taught me a new way of relating to my patients without judgment. This shared experience of pain was something I could acknowledge and be a witness to, without the expectation of a solution. In fact, I found that simply recognizing a patient’s pain often created greater trust and made it easier for them to accept my medical advice. On a practical level, our encounters became more efficient and resulted in fewer after-visit phone calls and cancellations. And as a result, I felt that I was able to offer a higher quality of care, with greater satisfaction from all standpoints, despite being powerless to impact their unremitting pain. 

In my case, I was fortunate: after a combination of several rounds of steroids, high quality physical therapy, a mindfulness practice, and time and patience (plus bedtime narcotics on non-call nights), my symptoms subsided and I was granted a near complete recovery. Still, this is not guaranteed for all pain patients — and I know that not everyone has the resources, good fortune, or support to come out mended on the other side. I was also lucky to have friends and family who tolerated my pain-fueled bouts of insolence and short temper. But many people with chronic pain understandably become so focused on their misery that they drive away loved ones and others who offer help or kindness.

Although I would not wish my experience on anyone, I cannot deny that it has taught me so much. Today, I recognize how chronic pain affects everything — it changes our sense of self, and can make even kind and gentle people become mean, angry, and impatient. As a physician and as a patient, I am tremendously grateful for the unexpected pearls of wisdom and empathy that emerged from beneath the layers of pain.