Physician Stress and Burnout: How Mindful Coaching Can Help

Physician burnout is not a new phenomenon, but over the past several years, it has become a true epidemic. In 2021, 930 academic papers were published on the topic, compared to 129 in 2011. In 1984, the year I started medical school, a total of 4 articles can be found in the PubMed archives.

Today burnout is out in the open. But the tools to manage and prevent burnout remain elusive.

The term “burnout” itself may sound a little nebulous, but there are methods to measure and define it. The Maslach Burnout Inventory defines burnout as “a psychological syndrome” that “occurs among individuals who work with other people”, with symptoms including:

• Emotional exhaustion, feeling unable to give more of yourself

• Depersonalization, resulting in negative or cynical attitudes towards patients

• Reduced sense of personal accomplishment, meaning a tendency towards negativity towards your own accomplishment.

It’s important to understand that burnout is not a psychiatric disorder, but rather it is “ a normal response to a chaotic and stressful environment”.

Many of us have experienced these feelings from time to time, and that’s completely normal. But when these feelings are persistent and overwhelming, then it’s likely that you’re dealing with burnout.

In a 2022 survey, Medscape found that 47% of physicians reported burnout, up from 42% in 2021. Not surprisingly, Emergency Medicine and Critical Care reported the greatest burnout (60% and 56% respectively), but Ob-Gyn (53%), Infectious Disease (51%) and Family Medicine (51%) were close behind.

Women reported more burnout (51%), perhaps due to competing responsibilities at home which were aggravated by the pandemic. But more than a third of men were also affected.

The contributors to burnout reported in the survey are not surprising to anyone in healthcare. Topping the list:

• Bureaucratic tasks

• Lack of respect

• Long hours

• Lack of autonomy

These features are nearly identical to the six factors associated with workplace stress that were identified by the British workplace health and safety regulatory agency:

• High work demands

• Low control over workload and process

• Inadequate support from management and colleagues

• Poor workplace relationships

• Lack of clarity regarding professional role and responsibilities

• Poor management of change within the organization

Beyond making you miserable, stress and burnout affect your quality of life, your self-confidence, your relationships at work and at home, and perhaps even your patient care.

Sometimes it feels as if everyone is talking about stress and burnout, but nothing is being done about it.

Although mindfulness has been shown to be effective in mitigating the symptoms of stress and burnout, it feels disingenuous to tell physicians to get a grip by practicing yoga and meditating.

Clearly, we are not going to yoga our way out of this mess. And hospitals and healthcare systems need to do more than offer lip service. But in the meantime, a little mindfulness may help. Here’s how:

First let’s start with a simple definition of mindfulness. As a certified Mindfulness Meditation Teacher, I’ve been fortunate to learn from Sean Fargo, a former Buddhist monk and gifted teacher. Sean defines mindfulness as “paying attention to the present moment with curiosity and non-judgment”. In other words, simply being present.

This sounds nice, but how can it possibly help you overcome the powerful forces that lead to stress and burnout?

As it turns out, there have been a number of studies in recent years that were designed to answer just this question. A meta-analysis of six high quality randomized controlled studies of mindfulness interventions for medical students, published in 2020, reported substantially lower stress indices in students who participated in the programs.

These programs incorporated interventions that included

• Body scanning

• Awareness of thoughts and emotions

• Breathing exercise

• Walking meditation

• Sitting meditation

• Coping with stress

Most programs were once weekly group sessions, while one used a mobile app.

Not only did stress scores improve in the short term, compared to controls, but studies that reported six-month follow-ups found that the benefits of mindfulness teaching persisted.

Coaching is another effective strategy for physicians at all stages of professional life. Although it is no substitute for system-wide change and mitigation of the issues that lead to burnout in the first place, coaching can help physicians gain traction and make decisions that help them to reclaim their connection to the profession.

That can range from important changes that create a better work-life balance in the current setting to a move to a new position or workplace. In some cases, a coach may work with a physician who decides to leave the profession altogether.

Research supports the role of coaching as a powerful tool for physicians at all stages. A small study from Duke University included primary and specialty care physicians ranging from first year residents to more senior physicians with leadership roles. The program focused on coaching for physician well-being, and reported improvements in coping strategies, resilience and stress.

Regardless of the specific modality or focus, physician coaching as an intervention has clearly been linked to improvement in well-being and resilience. A 2019 randomized controlled trial of primary care physicians in the Mayo Clinic system looked at the effects of 6 telephone coaching sessions on

• Burnout

• Quality of life

• Resilience

• Job satisfaction

• Engagement

• Meaning at work  

After 6 professional coaching sessions by credentialed coaches, the rate of burnout decreased by over 17% in the coached group but increased by nearly 5% in the control group. And absolute rates of emotional exhaustion dropped by nearly 20% in the coached physicians but increased about 10% in controls.

Coaching is a powerful tool. Mindful coaching may help physicians manage and overcome the effects of the sometimes-overwhelming forces that impact them and, indirectly, their patients on a daily basis.

But most importantly, addressing and repairing the underlying sources of burnout and stress is paramount. This is a commitment that needs to come from the highest levels of our healthcare systems.

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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.

References

Berg, S. (2021). Q&A: Clearing up confusion on physician burnout and depression. American Medical Association

Christensen, A. J. et al. (2023). Addressing Burnout in the Primary Care Setting: The Impact of an Evidence-Based Mindfulness Toolkit. Military medicine, 189(Suppl 1), 64–70. https://doi.org/10.1093/milmed/usad277

Drybye, L.N. et al. (2019). Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. Journal of the American Medical Association Internal Medicine

Garcia, C. L. et al. (2019). Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina

Hathaisaard, C. et al. (2022). Mindfulness-based interventions reducing and preventing stress and burnout in medical students: a systematic review and meta-analysis. Asian Journal of Psychiatry

Health and Safety Executive. (2019). Tackling work-related stress using the management standards approach

Kane, L. (2022). Physician burnout and depression report 2022: stress, anxiety, and anger. Medscape

Maslach, C. et al. (1997). The Maslach Burnout Inventory Manual

Schneider, S. et al. (2014). Physician coaching to enhance well-being: a qualitative analysis of a pilot intervention. Explore

Maximize Your Time: Essential Toolkit for Physician Time Management

Being a physician often means that you are expected to be a wizard with time, creating minutes and hours out of thin air. It’s not your imagination. A recent study found that in order for a primary care physician to provide guideline-recommended care and communication, they would have to work nearly 27 hours every single day.

With burnout impacting more than half of US physicians, some healthcare systems and many medical associations are beginning to take note. The problem is multifactorial, but administrative burdens are an important issue for many physicians. System-wide commitments to streamline tasks and automate simple processes are beginning to take hold. But true reform is likely to be several years away.

Meanwhile, when every second of your day seems to belong to someone else, managing your personal time isn’t just an option, it’s a necessity. But despite the ever-growing demands of the profession, the skills of time management are rarely taught in our training years.

As a cardiologist in a busy practice for many years, I developed a keen interest in productivity, educating myself by studying some of the masters in the field. The skills I learned allowed me to practice more efficiently. And equally important, I found meaningful ways to nurture my interests outside of medicine, and to create more time and energy for my friends and family.

As a physician coach, I enjoy sharing these simple techniques and insights with my clients. For some, they can be transformative. By optimizing your personal time, you may find that the more rigid pressures of work feel like less of a burden.

You can pick and choose what works best for you, but the important thing is to commit to making at least one change. When you invest a little time and energy to get started, you may be surprised by how much you get back.

Bullet Journal

A bullet journal is more than just an old-school planner. It's a customizable, hand-written system that combines planning, organizing, goal setting, and reflection.  Here’s why it’s beneficial:

• Customizable Layout: Tailor it to your specific needs, whether it’s daily to-dos, long-term goals, or reflective journaling. Don’t worry about making it look pretty. I use a very simple to-do checklist, and scribble notes as they pop into my head during the day.

• Mindfulness Practice: The act of writing by hand encourages memory retention and mindfulness and will help you to prioritize tasks. I like to take 10 minutes every evening to set up my plans for the next day. Even if I don’t meet all of my goals for the day, simply writing them down creates an intention and makes it more likely that they will be completed in the future.

If you want a deeper dive into bullet journaling, check out The Bullet Journal Method, written by Ryder Carroll. There’s no rush to get through it. Commit to reading just 10 minutes each evening (or morning), and over time you’re likely to create serious momentum.

Colored Pens

Never underestimate the power of colors for organization. When you use your colored pens for your Bullet Journal or to take notes while studying for boards, talks, or other commitments, you will:

• Enhance Organization: Assigning different colors to various tasks or appointments helps create quick visual categorization.

• Boost Memory Retention: Color coding  will help you to remember important ideas, tasks and deadlines.

Audiobooks

In general, multitasking is overrated. That’s because most people tend to do both things halfway. And multitasking can make you more vulnerable to distractions. But listening to a good podcast or audiobook on your commute or while exercising can be a great way to safely and efficiently feed two birds at the same time. That could be CME, a good story, or personal development.

Here’s a brief list of some of my favorite productivity audiobooks:

• Atomic Habits by James Clear focuses on the development of small, incremental habits to achieve significant life changes. The book emphasizes the compound effects of your small daily decisions and the importance of establishing systems rather than focusing solely on goals.

• Stolen Focus by Johann Hari delves into the modern crisis of attention, exploring how various factors in our environment and daily lives erode our ability to concentrate. Hari argues that the decrease in attention spans is not an individual failing, but rather a systemic issue influenced by technology, diet, sleep patterns, and societal structures. Although Hari advises systemic change, simply being aware of these forces can help you to push back.              

• Deep Work: Rules for Focused Success in a Distracted World by Cal Newport advocates for a practice of deep, focused work as opposed to the more common shallow, multitasking approach. The book offers practical advice on how to cultivate a deep work habit, minimize distractions, and maximize your cognitive capabilities. Although the ideas in the book are not always applicable to the reality of a physician’s practice, you will come away with a greater understanding of the importance of focus and the negative impact of constant distractions.

Online Yoga (or other activities)

Physical and mental well-being is integral to managing time effectively. As a registered yoga teacher, I love the option of online yoga classes. That’s because they offer:

• Flexibility: Yoga apps allow you to practice at your convenience, fitting sessions into a busy schedule. Most yoga apps give you a range of types, levels, and duration. I like DownDog, AloMoves, and YogaWorks. All three also offer options besides yoga, including strength training and meditation. And some offer live options as well.

• Stress Relief: Yoga is a great way to unwind and maintain physical and mental health. So are many other forms of physical activity. If you want to start, but exercise isn’t part of your routine, simply commit to 10 minutes twice weekly, and see where that takes you.

One caveat: if you’re new to yoga, Pilates, weight training, or any other chosen activity, consider taking a few classes or working with a private teacher first. That way you’ll have the basics, get your questions answered, and develop a practice that is safer, more effective, and more enjoyable.

 Time Tracking App 

Understanding where your time goes is the first step to better time management. My favorite easy-to-use option is Toggl. Time tracking apps can help you to:

• Identify Time Drains: When you track your time online, you may pinpoint activities that take up unnecessary time. That doesn’t mean you shouldn’t stay up to date on email or social media, but when you know where your time is going, you may find that you naturally begin to make choices that are more aligned with your priorities and values.

• Create Structured Work Intervals: I especially like the Pomodoro Technique. It goes like this: Work for 25 minutes, then take a 5-minute break. This structured and repeatable process can enhance focus and prevent burnout. You can also use time tracking to break larger projects (as well as tasks like charting) into smaller intervals. That way you’ll maintain your focus and create a more manageable and efficient process.

What time management tricks and tools have you found that keep you organized and on task? Drop me a line. I’d love to hear from you!

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.

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

My Podcast Interview with Grenville Thynne of Neuroflex

I recently had a fascinating conversation with Grenville Thynne for the Techlink Health Podcast. We discussed his work with the trailblazing Neuroflex company. Neuroflex’s portable technology can quickly detect evidence of concussion on site, which makes it especially valuable to athletes of all types.

The technology is also being studied in aging and neurodevelopmental disorders, and has the ability to provide objective measurements of brain function that can be tracked over time.

This was one of my favorite podcasts of the year. I hope you enjoy it.

Overcoming Your Roadblocks: A Physician's Guide to Navigating Change

Not too many years ago, most physicians in the private sector expected to settle into a medical practice straight out of training and to stay put until retirement decades into the future. The idea of moving, changing practices in the same town, or leaving before a ripe old age was almost unheard of. While change has often been part of the career path of academicians, physicians in all sectors are increasingly finding themselves dissatisfied, frustrated, or simply seeking something new.

In fact, a recent Mayo clinic survey reported that one in five physicians plan to leave their practices within the next two years, and one in three expect to reduce work hours. Burnout and perceived lack of appreciation by their organizations were the two primary issues cited in the study.

If you’re considering a move, this change can feel daunting. Physicians are often motivated by loyalty and compassion. But we are also creatures of habit.

For many of us, the roadmap was clearly defined: college, medical school, residency, maybe fellowship. As long as you followed this straight and narrow path, and nothing unexpected knocked you off course, you would make it down the road.

The promise at the end of the trail was a satisfying and gratifying professional life, with a high probability of a happy and fulfilling home life as well.   

Over the past decade, that promise has frayed. Burnout due to lack of autonomy, higher patient demands, a sicker and older population, falling reimbursements, the endless clicks and messages on the EHR: all have contributed. This new perspective means that physicians are more likely to seek change, or at least to consider it.

But the decision to embark on a new professional journey can often feel like traversing uncharted territory.

And the process of choosing a new path can be riddled with mental roadblocks. As a physician coach, I have found that guiding individuals through these challenges can be transformative, bringing new and unexpected possibilities to light.

Getting started can be the hardest part of the process, but once you begin, you’ll notice that the momentum will slowly build. In this article, we will explore actionable steps that can help you to overcome some of the mental barriers that may stand in your way.

1. Self-Reflection

Before embarking on a new professional path, it's essential to engage in deep self-reflection. Journaling for a few minutes every day can really help.

You don’t have to have a clear endpoint in mind to get started, but you do need to know what matters to you, and why. Consider the specific skills, interests, and passions you want to prioritize, and how you want your personal life to look. Take time to identify your values, strengths, passions, and personal goals.

Ask yourself:

• What are my core values and priorities in life?

• What aspects of my current role do I find most fulfilling and unfulfilling?

• What are my unique skills and talents?

• What are my long-term career and life aspirations?

By understanding yourself on this deeper level, you can better align your career choices with your values and objectives. For more prompts and tips to help you with this process, see my recent article about finding your “why”.

  2. Recognize Your Triggers and Limiting Beliefs:

As you work through self-reflection, you might encounter triggers and limiting beliefs that hold you back. If so, don’t be afraid to ask yourself probing questions such as:

• What specific thoughts or patterns arise when considering a new direction?

• Have you or someone else created any self-defeating narratives about your capabilities or limitations that might be influencing your mindset?

• What might these limiting beliefs be trying to protect you from?

• And how might they be proven wrong?

• If there are meaningful limitations that are keeping you from moving forward, how might you close gaps in your knowledge or skills?

When you pinpoint these mental roadblocks, you’ll take the first step towards disarming their power. Often a coach can be helpful when working through this process.

 3. Seek Guidance

Don't hesitate to seek guidance from mentors, career counselors, and trusted colleagues who have gone through similar transitions.

There can be great value in networking and connecting with others who have found fulfillment in their medical practice or who have ventured into alternative career paths. Their insights and experiences can provide valuable perspectives and inspire you to take bold steps in your own professional journey. Of course, you will want to be discerning about who you confide in, especially if you are leaving your current practice.

 4. Set Achievable Goals

Break your career change into smaller, manageable goals. This not only makes the process less intimidating but also allows you to track your progress. Create a timeline with milestones. These might include

• Gaining specific qualifications or licensure

• Attending relevant conferences,

• Researching places you might want to live

• Reaching out to potential employers or colleagues in your desired field.

Setting specific, measurable, attainable, relevant, and time-bound (SMART) goals can provide you with a clear roadmap and motivate you to move forward despite any mental hurdles.

 5. Embrace Setbacks as a Learning Opportunity

Rejection can sting. It's important to acknowledge that setbacks are part of any professional journey. Instead of seeing them as failures, view them as valuable learning experiences.

Approach unexpected challenges as opportunities for personal and professional growth. Be flexible and willing to pivot, if necessary, but don’t lose sight of your values and your “why”. The key is to use these uncomfortable experiences as opportunities to learn, adapt, and refine your approach.

 6. Get Comfortable with the Unknown

Fear of the unknown is a common mental roadblock for anyone making a career change. This may be especially true for physicians, since so much of our life has been neatly defined for us. Counteract this fear by engaging in thorough research into your desired path.

If you’re looking into a nonclinical job, understand the industry, its trends, and the challenges you might face.

And if you’re changing focus or practice, get to know more about the system, individuals, and culture you may be working with. Will you need new skills or certifications? If so, how and when can you achieve them? This knowledge will help you feel more prepared and confident as you take the leap.

 7. Keep an Open Mind

Maintaining an open mind is crucial during a career transition. Your initial path may evolve as you gain more insights and experiences. Embracing change and adaptation opens the door to broader opportunities. There may be something you may not have considered, but which may turn out to be a perfect fit.

Conclusion

Choosing a new professional path as a physician takes courage, contemplation, and perseverance. Know that you almost surely will need to step outside of your comfort zone to get somewhere new and more fulfilling.

By facing your roadblocks head on, you will build the skills and resilience you need to embark on this new journey. Remember that your background as a physician has equipped you with valuable skills, fortitude, and experience that are needed both in clinical medicine and in a wide range of connected fields.

Embrace the opportunities that arise, trust in yourself, and move forward towards a more fulfilling professional future that aligns with your values and your strengths.

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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.

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.

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.

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.

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.

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.

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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.