Managing Uncertainty as a Physician

Uncertainty is a fact of life if you are a physician. Patients don’t always get better, there is not always one best choice or right answer, and sometimes our decisions are affected by factors that are completely out of our control.

Managing uncertainty is a skill set that doesn’t come easy for many of us. Perfectionism is likely a way of life, and to be truthful, that’s not always a bad thing. We want to do the best for our patients, we want excellent outcomes, and we want to be acknowledged for the care we provide. But when we set unrealistic standards, it can actually be a barrier to optimal care and to our own well-being.

A recent study examined the connection between tolerance for uncertainty and burnout in 2000 faculty physicians. Not surprisingly, intolerance for uncertainty was associated with a three-fold increased likelihood of burnout.

As you might expect, those who struggled with uncertainty were much less likely to be satisfied with their career, and tended to be less engaged at work. Factors that correlated with a greater intolerance of uncertainty were

• Female gender

• Primary care

• Earlier stage of practice

• Lack of a trusted advisor.

Although these were important risk factors, many men, specialists, and later stage physicians were also burdened by intolerance of uncertainty.

Burnout and physician unhappiness are crucial pain points in our current healthcare environment. Not surprisingly, stress from uncertainty correlates with depression and low levels of resilience. Intolerance of uncertainty has been linked to poorer outcomes and even to increased healthcare costs. And burned out physicians are more likely to leave the practice of medicine.

Our innate perfectionism combined with the prevailing medical culture of stoicism means that physicians may be reluctant to admit that they are dealing with uncertainty. This makes it all the more important for more senior colleagues and mentors to acknowledge that despite all we know and no matter how hard we try, uncertainty will always be a part of the life of a physician. Simply sharing that insight can make it a little easier to come to terms with the fact that we cannot control everything.

Although becoming comfortable with uncertainty may always be a challenge, managing your response to uncertainty can open up opportunities to react to life’s curve balls in ways that are both positive and beneficial to all involved.

In their thorough analysis of the issue, Samuel Reis-Dennis and colleagues describe “three corrective virtues” that might help physicians navigate the challenges that uncertainty creates. These include:

• Courage: avoiding the tendency to run away from threats by developing strategies to cope with new challenges

• Diligence: seeking guidance from trusted colleagues and staying current on the medical literature

• Curiosity: addressing uncertainty by viewing it as an opportunity to learn and grow

It’s not an easy task to recognize the factors that may be holding you back. And it’s even more difficult to be objective and to find your own way while living the unpredictable and demanding life of a physician. Medical schools are increasingly understanding the importance of teaching these skills, but it’s not always enough once you hit the real world. Working with a coach or trusted advisor may help to get you on track, discovering the solutions and opportunities that best fit your needs.

An earlier version of this article originally appeared on this site in July 2022.

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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

Allison, J. J., Kiefe, C. I., Cook, E. F., Gerrity, M. S., Orav, E. J., & Centor, R. (1998). The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO. Medical decision making : an international journal of the Society for Medical Decision Making

Begin, A. S., Hidrue, M., Lehrhoff, S., Del Carmen, M. G., Armstrong, K., & Wasfy, J. H. (2022). Factors associated with physician tolerance of uncertainty: an observational study. Journal of general internal medicine

Berg, S. (2020). Feeling burned out? Try picking up the phone to call your coach. American Medical Association

Cook, J. (2022). Forget resilience, improve your uncertainty tolerance. Forbes

Iannello, P., Mottini, A., Tirelli, S., Riva, S., & Antonietti, A. (2017). Ambiguity and uncertainty tolerance, need for cognition, and their association with stress. A study among Italian practicing physicians. Medical education online

Reis-Dennis, S., Gerrity, M. S., & Geller, G. (2021). Tolerance for uncertainty and professional development: a normative analysis. Journal of general internal medicine

Simpkin, A. L., Khan, A., West, D. C., Garcia, B. M., Sectish, T. C., Spector, N. D., & Landrigan, C. P. (2018). Stress from uncertainty and resilience among depressed and burned out residents: a cross-sectional study. Academic pediatrics

Sinsky, C. A., Brown, R.L., Stillman, M. J., & Linzer, M. (2021) COVID-related stress and work intentions is a sample of US health care workers. Mayo Clinic proceedings

My Podcast Appearance with Kevin MD on Meditation and Mindfulness

I enjoyed my recent conversation with Kevin Pho, M.D. We discussed how mindfulness can have far-reaching effects not only for yourself, but for those you care for. We also discussed the best times for meditation, when you might want to avoid it, and how a brief meditation can impact your sense of well-being.

As a physician coach, I love sharing this story, because it encapsulates how such a simple and brief practice can have a meaningful impact.

Despite often heavy-handed corporate efforts to the contrary, mindfulness is not a bandaid to fix all that is wrong with healthcare. And it’s not a substitute for the meaningful change that is so desperately needed. Instead, it’s a reminder to be present and engage with what is happening right now, without judgement or reactivity.

Through mindfulness, you are can find a way to take a moment in the middle of the daily storm to re-center and reset. And for physicians, that can go a long way towards building stronger relationships with patients and staff based on trust and respect.

HALT: A Self-Coaching Stress Management Tool for Physicians

As a physician coach specializing in burnout and professional transitions, I've seen firsthand how the current state of healthcare can push even the most resilient doctors to their limits. Unchecked anger, frustration, and passive aggressive behavior can often be symptoms of the times.

By now you probably know that burnout is not your fault. Nor is it a mental health issue. Instead, it’s the consequence of a broken system.

At the moment, this is the system we are living in. While some headway is being made, the forces that are driving the burnout epidemic are not likely to improve overnight. And while it can be tempting to lash out when you’re stressed, it’s likely to make the situation worse, straining your relationships with colleagues, staff, and patients.

Beyond burning your bridges, the effect that an emotional outburst can have on your own well-being is profound. What’s more, healthcare systems are cracking down on behavior that’s deemed inappropriate or unprofessional.  

Although you didn’t cause the problem, it’s important that you remain mindful of the far-reaching implications of your communications and actions, regardless of the high quality of care that you provide.

To get you back on track, the simple acronym "HALT" – Hungry, Angry, Lonely, Tired – can be an important tool for self-awareness and self-care.

HALT was originally developed by David Streem, MD, a psychiatrist and addiction specialist, as a reminder to stop and identify the triggers that might lead to a relapse.  But for physicians, the acronym is also an intuitive tool that can remind you to mindfully take a pause and check in with how you’re feeling, and why, when something or someone triggers a reaction.

By using HALT, you can slow your roll before impulsively acting in ways that might harm your personal and professional relationships.

Here's how HALT works:

Hungry

When you're hungry, or “hangry”, even small problems can feel overwhelming. Hunger can make your patience wear thin and your trash your tolerance for stress and difficult interactions.

If you’re like many physicians, being hungry may be your default mode. Although it shouldn’t be the norm, it’s painfully common for physicians to skip meals or eat irregularly due to hectic and overbooked schedules.

Junk food from the snack machine or physician’s lounge might fill you up, but it can make you feel even worse. One straightforward strategy that can help is to pack simple but healthy food for the next day each evening.

But hunger isn't just about food. It's often about other unmet needs, whether emotional, physical, or intellectual.

Take action on hunger by getting in a 10–15-minute break to reset your mind and body once or twice daily whenever possible.  You’ll probably find that when you fill up the tank, even out your blood sugar and slow down your sympathetic nervous system, you’re able to maintain a more balanced mood and energy level.

In the long run, the few minutes you set aside to care for yourself will pay off in more respectful relationships, improved productivity, and better health.

Angry

Anger is a natural emotion, but how you handle it in the workplace is crucial. Unchecked anger can lead to conflicts with colleagues and unpleasant meetings with administrators. When it carries over to the bedside or operating room, it may impact the doctor-patient relationship, undermine teamwork, and even affect patient care.

Become aware of this emotion, and how it feels in your body. When you find yourself getting angry, take a moment to pause and step back. Give yourself time to process, reflect, and move on.

Deep breathing, a short walk, or even bluntly but respectfully discussing your feelings with a trusted colleague can open up a fresh perspective and prevent words and actions that you’ll regret later.

Lonely

If you’re feeling lonely, you may react harshly to stress out of a sense of isolation. Although you’re likely surrounded by people all day, medicine, our profession, ironically, can be a lonely one.

The burdens of responsibility, the fear of making mistakes, the ever-present perception of competition, and the need for confidentiality can all leave physicians feeling isolated.

Acknowledging loneliness is the first step towards seeking connection.  Regular interaction with friends, family, and community, even if brief, can hold back isolation and create a sense of belonging. Finding a hobby that gets you out of the doctor mindset or working out with a group of like-minded people can help as well.

Tired

When you’re tired, everything just feels harder. It’s no surprise that fatigue is a common issue among physicians. Long hours, high stress, and fractured sleep while on call mean that more than 40 percent of doctors surveyed report that their work schedule simply doesn’t allow for adequate sleep.

Chronic tiredness can impair your judgment and your empathy. Although it can be hard to feel compassion for your staff and others though the fog of fatigue, noticing what’s driving your irritation can soften your reaction to stress.

How to Use HALT in Your Daily Practice

• Check In: Before reacting, run through your HALT checklist. This simple pause can reset your frame of reference.

• Be Proactive: Make time for healthy meals, use brief but meaningful stress-relief techniques like mindfulness, get regular exercise, cultivate a life outside of work, and do your best to get restful sleep.

• Seek Support: Don't hesitate to seek professional help if you're struggling with anger, loneliness, or fatigue. Therapy, coaching, and peer support groups can all be helpful, depending on your circumstances.

• Communicate with Colleagues: Foster an environment where it's safe to respectfully express what you’re feeling. This openness can build stronger, more supportive team dynamics.

When you’re feeling reactive, upset, or tempted to lash out, use HALT to take a pause. Are you Hungry, Angry, Lonely, or Tired?

Simply becoming aware of your inner state can help you to defuse a situation and craft a different response. It’s also a great reminder that caring for yourself is neither selfish nor optional if you want to work at your optimum.  

When you take care of your own needs, you’ll find that you will be better equipped to care for those whose lives and well-being depend on you.

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.

Coaching for Physicians: A Guided Journey to Goal Setting, Overcoming Obstacles, and Finding Fulfillment

If you’re curious about physician coaching, and want to know more, this article is for you. As someone who loves getting outdoors, I like to use the metaphor of a hike or journey when describing my coaching process. In this coaching journey, I serve as your experienced companion, providing support, insight, and encouragement, helping you navigate both familiar and new terrain, and celebrating with you as you discover your destination.

1. The Trailhead: Preparation and Goal Setting

 Just like preparing for a hike, the first step in coaching is to understand where you are right now and where you want to go. This involves an in-depth assessment of your current professional and personal landscape, identifying both the peaks (successes) and valleys (challenges) you face. Whether you’re dealing with burnout, challenges with time, professional transitions, or finding the right work-life balance, together we’ll set specific and achievable goals. You can think of this as choosing the right trail that aligns with your current fitness level and hiking experience. Don’t worry if this is all new to you. You may be surprised at the ways your strength and endurance will naturally grow along the way.

 2. Gathering Gear: Equipping for the Journey

After setting the goals, the next step is to equip you with the necessary tools and skills. This includes exploring techniques for time management, stress reduction, and effective communication. Similar to choosing the right gear for a hike, these tools are personalized to fit your unique needs and circumstances, ensuring you are well-prepared for the journey ahead.

3. The Hike Begins: Embarking on the Journey

With goals set and tools in hand, we begin the coaching journey. This phase is about action and moving forward. Regular coaching sessions serve as checkpoints, where we assess progress, celebrate achievements, and address any new challenges. The journey may involve steep climbs and unexpected obstacles, but with guidance and support, you keep moving towards your goals. 

4. Difficult Terrain: Navigating Challenges:

Just as a hiker encounters rough patches along the trail, you may face challenges in your professional journey. Burnout, difficult workplace dynamics, and balancing personal life are common terrains we navigate. Together, we develop strategies to overcome or get around these obstacles, building strength, creativity, and adaptability, much like a seasoned hiker learns to navigate through challenging paths.

 5. Scenic Views and Rest Stops: Reaching Milestones

Along the way, it’s important to recognize and celebrate milestones. These are like the scenic views or rest stops on a hike, offering a pause to appreciate how far you’ve come, recharge, and reflect on the journey. Although it’s tempting to keep pushing forward, these waypoints are crucial for maintaining motivation and perspective.

 6. The Evolving Trail: Continued Growth and Adaptation

The journey doesn’t end at the first summit. Like a trail that changes with the seasons, your professional life will continue to evolve. Ongoing coaching can help you adapt to these changes, develop new goals, and continue growing. The journey is continuous, and as your coach, I am there to guide, support, and celebrate with you every step of the way.

 7. The Lookout Point: Reflection and Forward-Thinking  

As you reach significant milestones, we’ll take time to reflect on the journey. From this vantage point, much like a lookout on a hike, we’ll assess the path taken, lessons learned, and obstacles overcome. From there, we’ll plan for the next phase of your journey. Together we’ll chart out the travels ahead, including strategies for keeping burnout and inertia at bay. As you move into the future, you’ll be empowered and well equipped to stay engaged, inspired, and energized.

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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.

How to Find Your Creative Spark: A Guide for Physicians

As physicians, we learn to practice from an evidence-based standpoint, checking the data, keeping up with the literature, and following carefully researched guidelines. But as crucial to good patient care as this is, providing the best care requires the ability to go deeper, connecting a series of disparate dots, asking probing questions, and creating trust.

Having your own creative practice can stimulate this stronger connection by giving you tools and insights that come from a less rigid view of the world. It’s not suprising that a British study found that people who engaged in creative activities at home were more likely to discover creative solutions to problems at work.

And at the same time, creativity can be a refuge, offering an escape and a form of mindfulness that is often difficult to access in our precision-driven world.  

You don’t have to have talent or special skills to begin a creative practice. It can be something that you do for yourself alone. But once you get started, you may find that your imagination awakens, opening your mind to new techniques and ideas that might never have occurred to you if not for this artistic exploration.

In this article, I’ll discuss how you can awaken and nurture your inner artist.

1. Just Get Started

Do the work. It sounds simple, but overcoming inertia can be the hardest part. You don’t need a grand plan, a fancy camera, or a fully equipped studio. Just begin and set the wheels in motion. Your first step doesn’t have to be perfect; it just has to be taken.

2. Embrace Imperfection

Check your perfectionism at the door. For people immersed in the creative arts, imperfection is not just accepted; it’s often celebrated. Express, explore, and learn. Give yourself the freedom to make mistakes and be messy. This is a crucial part of the creative journey, and it’s how new ideas are generated.

 3. Inspiration Appears While You’re Working

Waiting for inspiration is like waiting for the perfect moment – it rarely comes when you're idle. To borrow a phrase from mindfulness meditation, creativity is about being in the now. As Picasso is famously quoted, “Inspiration exists, but it has to find you working.” The muse, that elusive spark of creativity, is not impressed by your aspirations. She finds you when you’re in the messy midst of creation. 

4. Set Aside Time for Creativity

Schedule your creative time just like you would for any appointment. Whether it’s 30 minutes a day or a few hours once a week, having a dedicated slot for creativity can open windows in your mind and give you room to explore. If it feels overwhelming, commit to simply 10 minutes each week, and see where that takes you.

5. Explore Different Creative Avenues

Creativity means different things to different people. You might enjoy writing, while someone else might find solace in painting, dancing, or playing an instrument. Simply wandering around intentionally with your phone’s camera can be a form of creative play. If you have time, taking a weekend class in pottery or some other art form could be a fun place to start. If you’re not sure how to start, experiment with different forms of creative expression to find what resonates with you.

6. Join a Creative Community

There's something magical about being part of a community that shares your passion. Look for local art classes, writing groups, photography clubs, or online forums. Share your work, get feedback, and enjoy the collective creative energy. These communities can offer support, inspiration, and a sense of belonging. And unlike your practice as a physician, no one will expect you to be perfect or have all the answers.

7. Pause, Reflect and Adjust

Every now and then, take a step back and reflect on your creative journey. Stay curious. What have you learned? What do you enjoy the most? Where has your creativity taken you? You might choose to keep a creative journal to celebrate your milestones, explore the unexpected detours, and maybe even recalibrate your goals.

Integrating creativity into your life isn’t just about producing something; it’s about the process, the joy, and the journey of self-discovery it brings. It can be a form of meditative practice, and an escape hatch from the rigidity of a schedule and a task list.

As a physician, you have a unique perspective of the world, shaped by your experiences and the people whose lives you’ve touched. Infusing this perspective into your creative endeavors can lead to something unexpected, tangible, and uniquely yours. By exploring your creativity without self-judgment, you may find that the insights you discover enrich and deepen your relationships with others, including your loved ones, patients, and colleagues.

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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.

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.

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.

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

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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.

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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.

Taking Action Creates Clarity

Do you ever feel like you’re standing on the edge of a cliff, knowing that you can’t turn back, but wondering how you’re ever going to make it down?

Or maybe you envision yourself at the top of a steep ski slope. You want to glide down the mountain and into the cozy hotel restaurant, but it just feels daunting and undoable.

As my hot-shot skier friend Erica once yelled to me “Just point your skis down the mountain and go!” That’s easier said than done, and in truth it didn’t exactly work out the way I had hoped.

But in taking the first action, making the first move, I began to devise a way to get to my goal. I began to understand the pitch of the slope and the feel of the snow, and I was able to strategically navigate my way down.

Let’s forget the possibility of bodily harm, and just make this about making your way. The same process can happen when you’re contemplating a career move or a life change. How are you going to do it? Or more to the point, how do you get started?

When you’re on the ski slope and it’s 10 degrees Fahrenheit and other skiers are whipping past you, you really have no choice but to take action.

But if you’re unsatisfied or unfulfilled where you are, and contemplating your professional or personal options, making any kind of move can feel daunting.

It’s so easy to figuratively freeze and simply not move forward.

That’s why plotting out your steps in tiny, low-risk increments can often be the best way to get a little momentum going.

And this small step may also ease the stress and anxiety that often accompanies unfulfilled goals.

So how do you get yourself unstuck? I’ve got five steps that can help you jump start the process.

Step One: Get it out of your head and onto a page.

Although there are a lot of great apps for note taking, mind-mapping, and the like, research shows that putting something on paper is often more meaningful and memorable.  Simply pick up a notebook and write out what it is you hope to accomplish: that is, your goal.

Step Two: Next, take a realistic look at this goal and run it through the SMART acronym.

Be sure to write your responses to these questions in your notebook. Is it:

• Specific?

• Meaningful?

• Achievable?

• Realistic?

• Time-bound?

Step Three: Now it’s time to write out your action steps.

What is the smallest possible increment you can take to get you closer to your goal? Each step allows you to move on to the next. There may be 5 steps, or there may be 50. It doesn’t matter. Just write it all out.

Step Four:  Schedule your steps in your calendar.

This is where it may help to use an app like Todoist that will remind you to complete your task. You’ll be rewarded with a satisfying little “pop” every time you click the “complete” box. But this only works if you commit to it. Keep a running list in your notebook as well, so you don’t lose track.

Step Five: Celebrate your wins.

After you’ve completed an important step, or perhaps a series of 5 steps, reward yourself with something meaningful. A fun activity, a cookie, an hour with a good book or anything else that makes you happy. And if you want to enlist an accountability partner, planning to celebrate together may give you both a little extra incentive.

In taking action, you may find that your goals change over time. There’s nothing wrong with that. In fact, it can be an exciting part of the process.

It’s also important to understand that while you have control over your actions, the outcome may not always be under your direct control. That’s also normal.

Ultimately, each purposeful step you take will get you closer to a life that is personally authentic, sustainable, and meaningful. 

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:

Masicampo, E. J., & Baumeister, R. F. (2011). Consider it done! Plan making can eliminate the cognitive effects of unfulfilled goals. Journal of Personality and Social Psychology, 101(4), 667–683.

Umejima, K. et al. (2021). Paper notebooks vs mobile devices: Brain activation differences during memory retrieval. Front. Behav. Neurosci., 15. 1-11.

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.