Doctors are Not Immune From Illness

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

This is a difficult story for me to tell. It is about facing our humanity and our mortality as physicians. And it’s about the truth that despite our desire to view ourselves as insiders with the keys to the hospital doors, the pact that we have made is one-sided.

There is no covenant with the universe, no deal with the devil that if you save others, you yourself will be saved. I saw my physician father fall victim to this implicit belief after he became ill. I witnessed with sorrow his misplaced trust that he would be treated differently, and his difficulty in disengaging from his identity as a physician.

I’ll start by telling you about my father before his illness. He was a brilliant physician and researcher, an immigrant and outsider who worked his way up to the highest position in his specialty. He taught and inspired generations of medical students, residents, and fellows from around the globe. He was described to me years later by one of his former fellows as “a god.” He saved, mended, and assisted in the conception of countless lives through his innovative therapy and research.

My father was a humble man in many ways. But he refused to submit to becoming a patient, and that’s what was ultimately his undoing.

My father’s family history was riddled with heart disease and early death. His mother died of a heart attack at the age of 45. Most of his siblings died young. But he was a vigorous and proud man, and even when he suffered an unexpected and frightening episode of hypertensive heart failure after returning home from a conference, he refused to see a cardiologist.

I will never know what kept him from seeking help, but I believe that he was afraid of what he might learn. That all the years of work and sacrifice might eventually catch up with him. That he needed someone or something else to become physically whole again. That his health, and thus his independence, might be irretrievably changed. That he, like those he cared for and those he loved, was mortal and vulnerable. Truth be told, he refused to even go to the ER for evaluation. Instead, he sent my mother, a physician herself, out to the pharmacy for a dose of furosemide in the middle of the night. It was she who made the diagnosis, with her stethoscope and blood pressure cuff.

To us, his children, this somehow did not appear inappropriate or unusual. Our parents were true medical do-it-yourselfers. They always seemed to have everything under control, so why should this be any different?

Yet I recognized that something was off. At the time I was a medical student out of state, and during my calls home my dad regularly assured me that his blood pressure was a perfect 120/70 on a low dose of medication. I thought he was misleading me, but there was nothing I could do about it but believe him.

It should have come as no surprise that my father suffered a terrible hypertensive stroke several years later. It was severely disabling, and despite appropriate care, there was no hope of recovery. I will never forget finding him in the radiology department of the hospital, a local facility where no one knew him. Slumped in his wheelchair in a faded hospital gown, he was shivering, weeping, and demoralized.

This was the unraveling of the deal that he believed he had made. No longer the professor, the department chief, the innovator, he was simply the stroke in Room 402. He had gone from a man of the world to a random patient, unacknowledged and unremarkable.

Plaintive pleas for water, request for assistance to the bathroom, and upkeep of simple hygiene were addressed by staff with disinterest, although he received timely care. Instead of being acknowledged as a respected and dignified physician, he felt like an outsider, just another task for the busy staff who had no time or reason to think any more of him.

After my father returned home, there was a brief period of hope and even optimism that things might improve, despite the devastation recorded on his imaging studies. But what little recovery he made was unimpressive and ultimately gave him no freedom or chance of independence.

He had been beloved by his patients and revered by his coworkers, but after the first brief flurry of visitors, the world moved on and he was mostly forgotten. He desperately wanted to return to work, to reclaim his identity, to be of service. He was unable to drive himself, so after much anguished pleading, my mother agreed to take him for a visit to his hospital and research lab. He found himself disoriented, lost, and humiliated, subjected to the well-meaning pity of his former staff.

It was clear to everyone that his days as a physician were over. Only a sole colleague regularly came by to see him for the next seven years of progressive decline that preceded his death.

From my father’s devastating story, I learned several hard but ultimately sustaining truths. These lessons have informed my life and my practice of medicine. I believe they have not only made me a better physician but have allowed me greater freedom to explore and discover the world outside of our profession.

Although I’d like to believe otherwise, the crucial lesson I learned was that being a physician does not provide us with a teflon shield. As physicians, we spend tens of thousands of hours learning our profession, honing our skills, giving up much of our 20s and 30s in service to our calling. Most of the time, we offer this sacrifice willingly, knowing that by doing so we will be worthy of our patients’ and colleagues’ trust. Even after training, the climb never ends. We may lose untold hours of sleep, delay time with family, forgo relationships and other passions. We take on the weight of our patients’ illness, fear, even their anger at the whims of fate.

Surely the scales must somehow balance out for us in the end, a karmic destiny in this life. That is the deal that I believe my father made.

The truth is that physicians are human, no matter how invincible we may feel. My father’s sad journey taught me that. But if we need any further proof, COVID-19 has shown us that nobody is beyond the reach of sickness and death. I believe that it’s important to live life with that understanding.

To that end, I have made it my mission as a cardiologist to focus on preventive care. Paying attention to our own personal preventive health care is a simple matter of routine checkups and necessary procedures, along with a healthy diet and regular exercise. Addressing the sources of stress and dysfunction in our lives is equally important.

The time to act is now. Even with the best preventive practices, there are no guarantees, but these straightforward measures have the power to extend and improve the quality of the life we have. Waiting until retirement to take preventive care seriously may mean waiting too late. Through my father’s suffering, I was able to appreciate the importance of taking the earliest risk factors seriously. My patients valued my drive and care, even when they didn’t share my concern.

My father’s story also taught me that eventually, most of us will leave the fraternity of medical practice, whether we do so willingly or not. We must take the reins and be the driver of our own lives; otherwise we will one day find ourselves separated and bewildered, without a North Star to follow.

This guiding principle has led me to pursue interests and passions outside of the medical world that have enriched and opened up my life; among other things, I teach yoga and compete as an equestrian athlete. I believe the perspective I gained from my father’s experience also made me a better doctor. For this I am eternally grateful.

I retired from my cardiology practice in 2022 after nearly 35 years in the medical profession. I hope that when I need them, my former colleagues will be there to keep me well and care for me. But nothing is promised. And there is no time to waste.

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As a physician coach, I will 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 Peter Adams for Vielight Inc.

As a podcast host for TechLink Health, I had the opportunity to interview Peter Adams with Vielight Inc. This is a fascinating new technology integrating photobiomodulation for brain health.

The device is already being used by athletes, including former NFL players, for brain recovery protocols. Leading medical centers including UCSF and Harvard, have published research on Vielight, as has the Veterans Administration.

I thoroughly enjoyed our conversation, which you can find anywhere you listen to podcasts, or through the Spotify link below.

Dealing with Regret: Discovering Growth and Self Compassion

High-stakes decisions with no easy solution, challenging interactions with patients and family, and outcomes that don’t always go as planned: these are unavoidable facts of life for most physicians.  

The lost opportunities or unanticipated consequences may lead to feelings of regret that can haunt you when you least expect it. Although this is completely normal, coming to terms with regret can be difficult. This aspect of professional life is rarely discussed out in the open, making the journey forward all the more arduous.

In this article, we’ll talk about regret, what it can teach you, and how it might help you to become an even more effective physician.

Regret Is Normal, and It’s a Sign of Compassion

Although it can feel crushing in the moment, regret is not a weakness or a marker of failure. Instead, it can help to reframe regret as evidence that you are compassionate and invested in the outcome of your decisions. Whether that’s the well-being of your patients, the strength of your relationships, or the integrity of your work, you wouldn't feel regret if you didn’t care deeply.

Learning from Regret

When you recognize regret in this way, you can break the cycle of rumination and open yourself up to the multitude of lessons it holds, including opportunities for reflection and growth.

Perhaps the lesson is learning to slow down, to listen more closely to your patient, to take an extra breath before responding to a difficult conversation. Maybe it’s committing to take a more active role, advocating more effectively when faced with challenging situations. Or it could be a recommitment to ongoing learning and professional growth.

It’s important to acknowledge that although the past cannot be changed, it can inform the future.

Here are some questions to ask yourself that might help to create mental space for new ideas:

• Are there ways that you can mitigate the consequences, even now?

• What would have needed to happen for things to have turned out differently?

• What actions are within your control?

• What resources might you need that were not available to you then?

• How might you respond next time you’re faced with this situation?

The Importance of Self-Compassion

As a physician, perfectionism is probably one of your driving forces. But at the same time, you may hold yourself to impossibly high standards.  

Although you may never have been taught this in training, at some point in your career, you will very likely make a decision that, in hindsight, turns out to be wrong. Other times, some outcomes will simply be beyond your control.

Self-compassion means treating yourself with the same kindness and understanding that you would offer a colleague or friend. And at the same time, caring for yourself helps you to stay present and capable of providing the best care for your patients.

Sometimes regret can feel overwhelming, despite your best efforts to overcome it. When needed, professional help in the form of a counselor or a coach can be sustaining.

Turning Regret into Action

It’s important to not only acknowledge regret, but to turn your reflections into action. Use this hard-earned awareness to make adjustments, both big and small, that will help you navigate future challenges with more confidence and clarity. Depending on the source of your regret, it might mean

• Taking a course

• Learning or perfecting a skill

• Seeking feedback or support from a trusted colleague, coach, or mentor

• Implementing measurable changes in a process or procedure

• Practicing mindful communication

• Setting clearer boundaries

• Reaching out to a mental health professional

Moving forward from regret is about progress, not perfection. It's about using each experience to inform your next steps without getting stuck in the past.

Discovering Resilience and Growth

Learning from regret will strengthen your resilience and shape your compassion for others who may find themselves mired in similar situations. Through this process, you will build a toolbox of strategies that will support you through the inevitable challenges in the future.

Regret may never completely disappear, but with time and practice, it can become a guide, pointing you towards opportunities for personal growth and a deeper connection with the values that first led you to find your place in the medical profession.

Physician Coaching or Mentoring: What’s the Difference?

An earlier version of this article appeared on this site in May, 2023.

As a physician coach, I am often asked to explain the difference between coaching and mentoring. It’s an important question, because both options are designed to get you from one place in your professional life to another. And sometimes a combination of both coaching and mentoring can be helpful. In this article, we’ll go over the differences between the two, and how each can help you to achieve your goals and dreams.

Coaching vs Mentoring: The Core Difference

The main difference is this: A mentor generally acts as an advisor. Since mentors usually have seniority and deeper experience in your area of interest, it is assumed they will know the right path to take. And mentoring typically focuses on your professional life only.

A coach does not give you the answers, but will collaborate with you to help you find and follow your own path. And coaching is not only about work. Coaching may be profession-focused, but it usually also encompasses your personal goals and well-being.

The Coaching Approach: Discovering Your Own Path

Coaching often begins by defining your own unique values— what sets you apart, what matters most to you, and how you envision your ideal life.

In coaching, the focus is on setting meaningful, actionable goals that reflect your personal values and current life circumstances. Using your values as a guide, a coach works with you to create the steps needed to achieve these goals, understanding that the desired outcome may evolve over time.

Unlike mentoring, where the mentor may have a vested interest in your professional trajectory, a coach remains neutral, providing space for you to explore all possibilities.

The coaching process is dynamic, and it often spans several months, or even longer, allowing for personal growth and adaptation. Coaches provide accountability and support through the stages of planning, commitment, and execution.

Why physicians seek coaching

A physician may seek coaching for a variety of reasons. Some examples include:

• Burnout

• Finding work-life balance

• Time management

• Career transitions

• Retirement planning

• Mindfulness

• Stress reduction

As you can see, these are often complex topics that do not have straightforward or defined answers. The process and outcome will be different for each person, depending on their own unique desires, circumstances, and stage of life.

Mentorship: Guidance from Experience

Mentorship, by contrast, tends to have a more defined pathway. If you seek a mentor, you likely have a specific goal in mind. That might be mastering a complex procedure, advancing to a leadership role, or establishing a successful practice. A mentor often has years of experience in your field and can outline the steps to help you avoid common pitfalls.

Mentors are invaluable, especially early in your career. They provide guidance, often within a hierarchical, career-focused relationship. Mentorship is about learning from someone else’s expertise to follow a clear, predetermined path.

How Mentorship Complements Coaching

While coaching and mentoring are distinct modalities, they are not mutually exclusive. Many physicians benefit from both coaching and mentoring, depending on their specific needs and the phase of their professional life. For instance, someone entering into a leadership role often seeks support from both a coach and a mentor. Or a physician dealing with burnout might seek out a mentor to help with specific aspects of practice management while at the same time choosing a coach to help traverse the complex issues that burnout can uncover.

Key Differences Summarized

• Coaching is about self-discovery and personal growth. Coaches help you set and achieve your own goals, both personal and professional, by empowering you to take charge of your journey.

• Mentorship is about learning from someone with greater experience in your field. A mentor can provide specific advice to help you achieve a well-defined goal in your profession.

Empowering Physicians: The Coaching Experience

Coaching is a process that brings clarity and honors your own values. It’s an exploration of possibilities, and a supportive experience that allows you the space and time to discover your own path.

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If you have questions about coaching and how it might work for you, please contact me through the website, or schedule your complimentary 30 minute discovery session.

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.

Coaching for Healthcare Leaders

As a member of the American College of Cardiology’s Physician Well-Being Working Group, I am fortunate to be part of the change that’s happening within cardiology and healthcare in general.

Coaching is increasingly recognized as a way to support and retain physicians, an aid for reducing burnout, and a tool that can improve the healthcare environment for physicians, staff, and the patients that we serve.

The first in a series of webinars put on through the ACC was presented in early 2024. You can watch it here, or maybe take it along with you and listen during your commute to work.

Strategies for Success for New Physicians in Outpatient Care

If you’re just getting started in practice, or starting over in a new job, it’s important to set yourself up for success right from the start.  This is true whether your career path is in academics or the private sector. 

Starting out on the right foot is not as difficult or mysterious as it might seem, but it can make all the difference to both your professional trajectory and your personal fulfillment.

In this article, we’ll focus on five key areas that will help you provide the best care while managing the demands of a growing practice. Developing these strategies early on can improve both patient outcomes and your own well-being.

1. Master Time Management and Efficiency

Let’s be honest. Managing a busy outpatient schedule without sacrificing the quality of care can seem daunting. Physicians often find themselves juggling patient visits, charting, and administrative duties without a definite plan. This can easily lead to inefficiencies.

If your position includes hospital work, supervising, or teaching responsibilities, these added challenges can snowball very quickly. But taking shortcuts only leads to more complications and frustration for both you and your patients.

Your strategy for success: Developing effective time management skills is crucial. Prioritizing tasks, utilizing electronic health record (EHR) templates, and implementing workflows that streamline documentation can save you valuable time.  

Task-batching and time blocking are crucial skills that will serve you well. Try to limit the amount of time you spend returning to unfinished tasks by getting them completed as soon as possible.  

Think about putting in a few hours up front to set up your chart management systems, including smart phrases and, where feasible, appropriate AI integration. Don’t be afraid to create a workflow to delegate simple tasks when it’s appropriate. When you organize your day efficiently, you will not only reduce after-hours work, but you’ll also improve patient care and satisfaction.

2. Cultivate Work-Life Balance

It’s become normal and sometimes even expected that your working day will bleed into your personal time. In the current environment, this often morphs from a slow drip to a frank hemorrhage.  This lack of control not only impacts you and your family, but ultimately can have a negative impact on your patient care.

Maintaining clear boundaries between your professional world and your personal life is essential to avoid burnout. The importance of your own well-being cannot be overstated. When you’re burned out, you’re more likely to make mistakes that impact your patients’ lives

Your strategy for success: Consider setting aside specific times for charting and answering messages, so you can limit after-hours communication. This is a technique known as task batching. By grouping a chunk of similar tasks together, you’ll achieve greater focus and get more done.

Don’t overlook your own well-being.  Scheduling time for self-care activities such as exercise or relaxation can help you recharge and maintain a sustainable work-life balance.

If there is a hobby or activity that you’ve been yearning to try, simply get started. Don’t expect perfection or even competency. Just do it for the joy of trying something new.

3. Build Strong Patient Communication and Relationships

Building strong relationships with your patients is key to delivering effective care. When patients trust you, you will deliver your care more efficiently, and you’re likely to see fewer after-hours messages and questions.

Your patients want to feel seen, heard, and cared for. However, developing this rapport can be challenging when time is limited, and managing patient expectations or difficult conversations can often feel overwhelming, especially for new physicians.

Your strategy for success: First, keep your charts current. When you go into the office visit armed with accurate and up-to-date information, your patients will feel more confident that they are in good hands.

Setting expectations early is important when managing difficult situations, especially when dealing with complex diagnoses or treatment plans. But having the data at hand and a plan in place is not always enough.

Of equal importance, your communication style matters. Listening actively, showing empathy, and offering clear explanations can improve the experience for your patient and inspire greater confidence in your care.

4. Sharpen Your Clinical Decision-Making Skills

As a physician, making sound clinical decisions quickly and confidently is part of the job. Dealing with the more complex cases can be challenging, especially when you’re still building your clinical experience.

In training, you’re continuously learning, but it’s important to remember that you’re never done. To be a doctor is to be a perpetual student. For optimal patient care as well as your own professional fulfillment, it’s critical to stay up to date.

Your strategy for success:  Staying current with evidence-based guidelines and refining your decision-making process will help you feel more confident when faced with uncertainty. Using decision support tools, collaborating with colleagues, having an excellent referral network, and continually educating yourself on new developments will ensure that you make informed decisions efficiently and wisely.

In addition to maintaining your CME requirements, consider subscribing to a service like JournalWatch, which sends out regular emails summarizing important research from multiple medical journals. Stay curious and engaged.

5. Cultivate Emotional Resilience and Stress Management

Outpatient care can be emotionally demanding, and it’s common for physicians to experience stress or compassion fatigue. To be clear, the role of healthcare systems cannot be overstated. If your situation seems toxic, it might be reasonable to look for other opportunities that are a better fit.  But often there are constructive and sustainable ways to improve the status quo.

Burnout continues to impact nearly half of all physicians. Those in outpatient care are disproportionately affected. Burnout and compassion fatigue are not your fault, but if you find yourself falling into a funk, it’s important to seek help.

More and more healthcare systems are offering coaching and other resources. When possible, take full advantage of those opportunities, or find your own. To ensure long-term success, it’s essential to build resilience and develop ways to manage the pressures of the profession. 

Your strategy for success: Incorporating stress-reducing strategies into your daily routine—such as good nutrition, mindfulness meditation, and regular physical activity—can help you manage the emotional demands of the job.

Building a support system of colleagues, friends, and family can also provide an outlet for discussing challenges and staying emotionally balanced.

Take advantage of coaching and other services that might be offered through your institution or professional groups. Or seek out a coach that specializes in physician burnout and related issues. If you are experiencing depression or other mental health challenges, contact a mental health professional. You deserve to feel well, happy, and invigorated.

Conclusion

Starting and maintaining your career in outpatient care comes with its own set of challenges, but by focusing on these five key strategies, you can build a strong foundation for success.

Mastering time management, improving patient communication, and developing emotional resilience will not only enhance your professional satisfaction but also improve the quality of care you provide.

By investing in your personal growth and well-being, you can thrive as a physician while maintaining a balanced and rewarding lifestyle.

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.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.

Art, Mindfulness, and Medical Practice: Wu Zhen’s The Fisherman

As a fine art photographer and a physician, I believe that visual art is a portal through which we can find powerful connections between ourselves and people from all walks of life.

For physicians and others in healthcare, art can provide a framework that offers the potential to build understanding and create greater trust. By spending time with a work of art, we’re able to explore what the world might mean to somebody completely different from us.

Art is also a way to access mindfulness in a way that feels meaningful and relatable. It only takes a few minutes of focused attention to gain a greater and more subtly shaded experience.

Think of the way that you listen to music. It may be simply background noise, other times entertainment, but there are times that the experience offer a gateway to new ideas, or a way to connect the dots that have been accumulating in your subconscious mind.

In a previous article, I shared the very contemporary insights and connections that we can access by spending time with Vermeer’s The Geographer, painted in the 1600s. In this article, I’ll explore an even older work of art: Wu Zhen’s The Fisherman.

Wu Zhen, The Fisherman (attribution: Wu Zhen, Public domain, via Wikimedia Commons)

Wu Zhen painted in the 14th century. In his lifetime, he was not really acknowledged or recognized as being an important artist. But about a hundred years later, he was identified as one of the four Great Masters of the Yuan. As a result, his work became a real point of reference for many subsequent artists, and that continues to this day.

When Wu Zhen was painting, his country was in chaos as a result of the Mongol takeover. Despite (or perhaps because of) this turmoil, there was tremendous cultural growth. At the time, there was a very powerful, industrious scholar class that was highly visible in public life. For the middle class, that was a realm of life to aspire to.

But there was also an idealized life of a simpler and more rural lifestyle. Although Wu Zhen was educated and could well have lived comfortably as a scholar, he chose to take his life in a slower direction, away from the turmoil and conflict that was part of life in the city.

Through his work, he sought to capture and distill the essence of his subject with line, shade, and pattern. Many of his works, like this one, included a poem written in calligraphy, which is translated by the Metropolitan Museum of Art as:

Red leaves west of the village reflect evening rays,
Yellow reeds on a sandy bank cast early moon shadows.
Lightly stirring his oar,
Thinking of returning home,
He puts aside his fishing pole, and will catch
no more.

So he lived this very simple rural lifestyle, yet was a man of great intellect.

At the same time, in the cities, other Chinese artists were creating more literal portraiture. But it was understood that there was a difference between this more factual based way of working versus the more ethereal and intellectual work of somebody like Wu Zhen.

In our contemporary age, such a longing for simplicity or austerity may be interpreted as a sign of a less sophisticated or uneducated mind. Yet these preconceptions can be misleading. Wu Zhen’s work is a reminder that in accepting such a one-dimensional stereotype, we may overlook the richness and depth of an individual. And we are all the worse for the loss.

How can you transfer the experience of art to the practice of medicine? Consider what happens when you meet a patient or somebody in your everyday life. With the brief time allotted for the encounter, you might only be given the outlines of that person, almost like a quick sketch.

Perhaps if you’re open to this richer way of seeing, you will take a few moments to appreciate those outlines, and to notice that more often than not, they do not fit into a simple template. In doing so you might be able to discern more layers than you first realized. Perhaps it’s the choice of clothing, the way they carry themselves, the book they hold in their hand. And as a result, your questions may become more nuanced and your listening more focused.

Think about this way of relating as creating sort of a bridge between you and the other person. You might be able to find a connection or trace a thread of a clue in the same way as you might experience a work of art.

If you want to learn more about the painting, and spend a few minutes in a mindfulness meditation focused on the work, I’ve created a YouTube video that you can access here.

An earlier version of this article appeared on this website in April 2023.

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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.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.

My Podcast Interview with Cyber-Security Expert Anand Naik

We all know that cybersecurity is crucial in healthcare to protect sensitive patient data, ensure the integrity of medical devices, and maintain the overall trust in healthcare systems. Whether in the role of physician or patient, we depend on the people and systems working behind the scenes to keep us safe.

As a host of the recent episode of Techlink Health Podcast, I learned a lot from Anand Naik, including how advancements in IoHT/IoMT security and AI-driven protection are being harnessed to safeguard the future of connected health.

For tech-savvy physicians looking for alternatives to clinical medicine, or side gigs in the healthcare sphere, cybersecurity might be an area that could use your expertise and insight.

Three Things Physicians Should Know About Meditation

An earlier version of this article appeared on the KevinMD website in November, 2o23.

Meditation is a hot topic with deep roots, but sometimes it feels like it’s being pushed as a modern-day version of snake oil for what ails the spirit.

The practice is often touted as an antidote to burnout, when in truth most of us know that a meditation app won’t solve the systemic issues that plague healthcare today. It’s no wonder that some physicians might be skeptical.

That’s why it’s exciting that academic researchers have been taking this ancient practice seriously. And they are discovering that meditation can have powerful and measurable benefits for your mental well-being, your memory, and even your physical health.

A quick search on PubMed.gov retrieves thousands of reports and peer-reviewed studies on meditation, the majority of which were published in the past 10 years. Getting a handle on the health benefits of meditation could take you down a fascinating, twisty-turny rabbit hole worthy of Alice in Wonderland.

There are many forms of meditation, but this article will focus on mindfulness meditation. This is sometimes known as Vipassana or insight meditation, although Vipassana is a more specific form of meditation that comes from the Buddhist tradition.

Mindfulness meditation is a form of meditation that focuses on being present in the current moment, slowing down your thoughts, and observing without judgement. These features make mindfulness meditation especially valuable for physicians.

Here are three things that you should know about mindfulness meditation.

Meditation may enhance your skills as a physician.

There is a broad range of research looking at the impact of meditation on neuroanatomy and neurophysiology. For physicians, the ability to focus on the details, remain present for our patients, and maintain equanimity when faced with stressful situations are especially important.

Meditation can help by

• Improving the ability of the brain to pay attention to a task

• Enhancing body awareness

• Helping you to regulate your emotions

• Increasing capacity for memory

• Boosting your sleep quality

• Improving your cardiovascular health

It may be best to meditate in the morning.

Although meditation may improve your sleep quality, there is good evidence that in the short term, mindfulness meditation can actually increase brain arousal. Why does this happen? The theory is that since meditation may help to focus the mind, this can result in heightened awareness and attention. That’s why it may be better for most people to meditate at the beginning of the day.

On the other hand, you may find that less focused forms of meditation can help you drift off to sleep. Apps like Calm and Headspace are good places to find these types of practices.

 A five-minute daily meditation can have lasting benefits

Morning might be the best time to meditate, but few of us are willing to wake up 30 minutes early just to sit quietly in a comfortable position. The good news is that a study of stressed-out mental health professionals found that a mere 5 minutes of mindfulness meditation can have important benefits.

How to get started with meditation

Getting started with meditation is easy. Counter to what you might have heard, you don’t have to escape to an ashram or travel to a tropical island to learn how to do it. I’ve written a quick-start guide to meditation for physicians that you can access here.

As a certified Mindfulness Coach, I share meditations online, along with many other excellent meditation teachers, but there are even simpler options. The Waking Up app is a fantastic resource, and includes a 30 day starter course. Insight Timer is another good choice.

As with many things, meditation isn’t for everyone. For some, it can even create mental distress. If you find that meditation provokes anxiety or agitation, it may be best to avoid it. And if you’re under the care of a mental health professional, check in with them first before beginning a meditation practice.

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.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.

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References:

Britton WB et al. Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness. Ann N Y Acad Sci. 2014 Jan;1307:64-81.

Fox KC et al. Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neurosci Biobehav Rev. 2014 Jun;43:48-73.

Hölzel BK et al. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011 Jan 30;191(1):36-43.

Kozasa, EH et al. Meditation training increases brain efficiency in an attention task. NeuroImage, 2012 Jan; 59: 745-749,

Krittanawong C et al. Meditation and Cardiovascular Health in the US. Am J Cardiol. 2020 Sep 15;131:23-26.

Lam AG et al. Effects of Five-Minute Mindfulness Meditation on Mental Health Care Professionals. J Psychol Clin Psychiatry 2015 March; 2(3): 00076.

Levine, G. N., Lange, R. A., Bairey‐Merz, C. N., Davidson, R. J., Jamerson, K., Mehta, P. K., Michos, E. D., Norris, K., Ray, I. B., Saban, K. L., Shah, T., Stein, R., & Smith, S. C. (2017). Meditation and cardiovascular risk reduction. Journal of the American Heart Association, 6(10). https://doi.org/10.1161/jaha.117.002218

Pérez-Peña M et al. Mindfulness-Based Interventions and Body Awareness. Brain Sci. 2022 Feb 18;12(2):285.

Rusch HL et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019 Jun;1445(1):5-16.

Taylor, G. B., Vasquez, T. S., Kastrinos, A., Fisher, C. L., Puig, A., & Bylund, C. L. (2022). The Adverse Effects of Meditation-Interventions and Mind–Body Practices: a Systematic Review. Mindfulness, 13(8), 1839–1856. https://doi.org/10.1007/s12671-022-01915-6

Youngs MA, Lee SE, Mireku MO, Sharma D, Kramer RSS. Mindfulness Meditation Improves Visual Short-Term Memory. Psychol Rep. 2021 Aug;124(4):1673-1686. doi: 10.1177/0033294120926670. Epub 2020 May 25. PMID: 32448056; PMCID: PMC8242403.

Wu R et al. Brief Mindfulness Meditation Improves Emotion Processing. Front Neurosci. 2019 Oct 10;13:1074.

The Sunk Cost Fallacy: When Physicians Struggle with Change

When I learned about the concept of “sunk cost”, I felt as if a giant lightbulb had clicked on in my head.  Suddenly, the reason behind so many misaligned decisions began to make sense.

The term, borrowed from economics, refers to our tendency to keep doing something that is not in our best interest due to expenses that have already been paid and are not recoverable. These compounded investments of time, energy, and capital can influence your decision making for years to come, leading to choices, both professional and personal, that are increasingly disconnected from your goals and values.

Sunk costs encompass the time, money, and resources you've already dedicated to your current situation. That could mean a job, a relationship, or even a big purchase. For physicians, the idea of cutting your losses can be especially tough if you’ve put your heart and soul into building your practice or establishing a reputation in your community, even if it’s no longer a good fit.

Understanding the Sunk Cost Fallacy

The sunk cost fallacy is the mistaken belief that because you’ve invested so much into something, you should continue to do so, even when it’s no longer serving you. This cognitive bias can compel you to shore up unwise decisions long after they have ceased to be productive or fulfilling.

It explains why it can be so hard to change, move forward, or walk away, even when you know that your existing path is neither sustainable nor sustaining.

However, this is precisely where the fallacy lies. The time and energy you've already spent are, by definition, "sunk"—they cannot be recovered, no matter what you decide to do next.

Therefore, the most important question isn't about the past but about the future: Is staying in your current job or situation the best decision for your long-term happiness and career fulfillment?

Moving Beyond the Sunk Cost Fallacy

If you’re feeling unfulfilled, overworked, or simply stuck in a role that doesn’t align with your goals or values, it may be time to consider a change. But how do you overcome the weight of sunk costs?  Here are a few ideas to help you move forward:

• Acknowledge the Fallacy:  Recognize that the time and effort you've put into your current job are not wasted if you decide to leave.

  These hard-earned experiences have shaped you into the physician and the person you are today, equipping you with valuable knowledge and skills that you will carry into any future position.

• Evaluate the Present and Future: Instead of focusing on past investments, be it time, capital, or focus, ask yourself whether your current role is helping you grow or holding you back. Is it contributing to your overall well-being, or is it draining your joy? Are you contributing in a way that feels right and true to your ideal self and the life you hope to live?

  Consider where you want to be in the next five or ten years. Will staying in your current position help you get there, or is it time to explore new opportunities?

• Reframe the Leap: Taking on a new job or position does mean starting over in some respects but take some time to reframe this idea. Physicians often undervalue their hard-earned knowledge and expertise.

  You're not starting from scratch; you’re starting from experience. The wisdom, skills, and insights you've gained in your current role are assets that will make you more effective and confident in your next position.

• Seek Support: If you're struggling with the decision to leave a job, consider seeking counsel from trusted colleagues, mentors, or a physician coach.

  Sometimes, an outside perspective can help you see the situation more clearly and provide the encouragement you need to take the next step.

Conclusion: Embrace Your Experience

Don’t let the weight of past investments hold you down.

Changing jobs or moving into a new position can be daunting, but it’s crucial to remember that your past efforts are not lost.

Your hard work has girded you with the tools and insights you need to thrive in your next iteration, be it a new medical practice, a leadership role, or a creative retirement.

By following your own personal compass and moving beyond the sunk cost fallacy, you’ll empower yourself to make decisions that align with your true goals and values.

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.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.

Rethinking Work-Life Integration: When Work Takes Over Your Personal Life

With the rise of EHRs and telemedicine, the term "work-life integration" has rapidly become an administrative buzzword.

Initially proposed as an alternative to the traditional "work-life balance" concept, the term encourages blending your professional responsibilities with your personal life. However, for physicians who are expected to be always on duty, this approach can paradoxically increase stress and decrease balance.

In this article, I’ll explore why work-life integration might not be the promised panacea for getting it all done.

The Myth of Seamless Integration

Despite the corporate happy-speak, work-life integration often translates to being ceaselessly connected.

For physicians, this means being perpetually available for patient queries, administrative tasks, training modules, and continuing education. This expectation of constant and immediate connectivity can lead to burnout and decreased job satisfaction

By definition, personal time is for the parts of your life that cannot be fulfilled at work.

Childcare, working out, maintaining relationships-- the list of things that pull on your personal time is endless. For the most part, these responsibilities and more require your full engagement.

But a focus on work-life integration can create an expectation of multitasking. This hits solidly against the basic tenets of the medical profession, which demands focus and precision.

Multitasking, as we all know by now, is a misnomer. Beyond the mental stress of juggling multiple tasks simultaneously, the unwieldy cognitive load can impair a physician’s ability to provide high-quality care.

The Impact on Personal Life

When work infiltrates all aspects of your life, personal time is often the first casualty. It’s common for physicians to find themselves checking emails during family time or thinking about patient care while trying to unwind.

Ultimately, you’re neither fully there for your patients nor for yourself and your loved ones.

While work-life integration is often hailed for its flexibility, it can lead to longer working hours under the guise of convenience.

Let’s be clear. You’re probably not bringing your toddler or your elderly mother to your office. And you’re not taking a walk with your EHR.

As someone whose parents were both full-time physicians well before the days of the internet, I can tell you from experience that it’s very unlikely that your home life is being integrated into the workday. A few furtive emails and rushed phone calls hardly count as connection.

Professional Implications

The stress and fatigue resulting from a lack of clear boundaries between work and personal life can increase the risk of medical errors. A tired and overworked physician is more prone to making mistakes, which can have serious consequences for both patients and the healthcare system.

But the threat of serious medical errors isn’t the only potential drawback of the constriction of your personal life. The consequences are not usually so blatantly obvious. Although it may be uncomfortable to admit, continuous engagement with work-related activities can lead to emotional exhaustion, reducing your ability to empathize with and care about your patients.

This diminished capacity for empathy and engagement can adversely affect patient satisfaction and trust, as well as outcomes.

The Bottom Line

For those in administration, creating a culture that supports and empowers physicians to do their best work is crucial. It’s time to go beyond talking points and take action. Removing unnecessary and burdensome “click work” is one way to reduce a physician’s load. Allowing support staff to handle simple messages and requests is another.

For physicians, establishing clear boundaries between your personal and professional lives can help to maintain your mental well-being, ensure the delivery of quality care, and support a fulfilling and sustainable personal life.

Despite the popular business-speak narrative around work-life integration, true balance often requires a clear separation of work and personal life, so that both may flourish.

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.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.

How Do You Know if You’re Burned Out?

Burnout is not going away.

It’s no surprise that nationwide, levels of burnout reached record highs during the pandemic, impacting over 60 percent of physicians. But now that we are back to a semblance of normal, the percentage of physicians experiencing burnout symptoms hovers a little under 50 percent. That’s still far above the “baseline” of 38 percent in 2020.

Topping the list of burnout-inducing specialties are

💉Emergency Medicine,

💉Internal Medicine,

💉OB-GYN

💉Family Medicine

Although burnout has decreased in all of these groups, more than 50 percent of doctors surveyed in these specialties described classic symptoms of burnout.

While any improvement is good news, the fact that nearly one in two physicians across the board are suffering from burnout is nothing to celebrate.

Not only is burnout demoralizing, but it also contributes to job turnover and increased healthcare costs. Not surprisingly, a Mayo Clinic study found that burnout can raise the likelihood of medical errors. And a 2019 study reported a conservative yearly cost to the US healthcare system of $4.6 billion dollars.

So how do you know if you're burned out?

❓ A. Is it just a feeling?
❓ B. Is it something we can measure?

If you answered B, you're right. Burnout isn’t just a trending term. There are standardized tools to measure burnout. The Maslach Burnout Inventory is the granddaddy of burnout tools, and has been in use since 1981.

Burnout affects doctors of all ages and across all spectrums. It is not a personal failing, and it’s not a mental illness.

If you’re experiencing burnout, it’s important to understand that burnout is not your fault, and you’re not alone. Here’s what you need to know:

✴ According to the World Health Organization and the ICD-11, burnout results "from chronic workplace stress that has not been successfully managed."

✴ Symptoms of burnout include:

🚫 feelings of low energy or exhaustion
🚫 negative feelings or cynicism about your job
🚫 loss of motivation and a sense of detachment from work

✴ Burnout is not a mental health condition.

So how do you know if you’re burned out? If you're wondering if you've just hit a rough spot or if you're truly burned out, you could invest in the Maslach Inventory. Or you could save yourself a little time and money and take a simple Two-Minute Burnout Inventory created by Chris Bailey for Harvard Business Review.

If you're a physician living with burnout, you don't need to suffer in silence. There are ways to get through it, but you can't always get there on your own.

Systemic changes to our profession are critical, and there are signs that change is coming. But while we wait for the slow gears of progress, it's important that you take care of yourself now.

Your health, your loved ones, and your patients are counting on you. If you’re feeling burned out, consider coaching, either through your institution, or through a certified Physician Coach. Studies, including a randomized controlled trial published in 2024, have found coaching to be an effective strategy for reducing physician burnout.

There are no easy answers to the complex issues facing healthcare today, but getting clarity on your own needs and values will empower you to chart your own course.

An earlier version of this article was published in April 2023.

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.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.

The Hidden Downsides of Meditation: A Guide for Physicians

As a physician coach and certified mindfulness meditation teacher, I find meditation to be a powerful and sustaining practice.

Meditation, especially a mindfulness practice, has been shown to improve focus and to mitigate stress and burnout. It can even improve sleep quality.

But while meditation has numerous benefits, there are also a few drawbacks that are not often discussed. With widespread recommendations for meditation and meditation apps, it’s important to keep in mind that meditation is not for everyone.

For some people, meditation may have unintended, and unexpected consequences. In some cases, simply changing the time of day or duration of practice can make all the difference. In this article, we’ll explore the potential downsides, along strategies for getting the most benefit from meditation and mindfulness practices.

Mental Health Impact

Because of its inward focus, meditation can sometimes bring up uncomfortable emotions or past traumas. People with diagnosed anxiety often benefit from meditation, but they may be especially vulnerable to this negative effect.

Of course, it’s normal to feel a little anxious when you are not accustomed to sitting quietly. Cultivating stillness can take time. But if the anxiety does not lessen, or if you are not able to let go of uncomfortably intrusive thoughts, then meditation may not be right for you.

And while detachment is often a goal of mindfulness meditation, some people may develop a distressing sense of detachment from reality.

Longer meditation sessions, including meditation retreats, are more likely to cause this type of trouble. If you are prone to anxiety or depression, it makes sense to keep your sessions to 20 minutes or less and to approach meditation gently.

Seek professional guidance if intense emotions or memories arise that are difficult to manage on your own.

Insomnia

Mindfulness meditation can improve your sleep quality. But a focused meditation at bedtime might actually cause the mind to become more alert, making it harder to fall asleep.

Consider meditating in the morning, mid-day, or before you head home from work. That way you’ll refresh your mind and gently reset your focus for the rest of the day ahead.

Decision Making

For many people, mindfulness meditation can improve decision-making speed and help with goal setting for positive outcomes.

But if you are someone who consistently tries to find the “best” possible choice when making decisions, you may find that mindfulness practices actually make it harder for you to make decisions. Instead of taking action, you might find yourself ruminating on all the possible outcomes.

Physical Discomfort

Sitting for extended periods, especially without proper support or in an uncomfortable posture, can lead to physical discomfort, including back pain, stiffness, or joint pain.

When meditating, ensure you are sitting in a comfortable position, perhaps using cushions or a chair for support. You might even find it more comfortable to meditate lying down.

Another option to consider is walking meditation. You can find these types of meditations on most meditation apps.

Many people are not aware that the physical practice of yoga developed as a way to prepare the mind and body for meditation. Yoga works by releasing stress and strain in the muscles and guiding you to consciously slow down your breathing pattern.  When time permits, consider incorporating gentle stretching or yoga before meditation.

Conclusion

While meditation can be a powerful tool for improving focus, reducing stress, and enhancing sleep, it’s important to be aware of its potential downsides.

By starting with shorter sessions, being mindful of any arising emotions or negative feelings, and ensuring a comfortable posture, you can minimize risks.

Reach out to your mental health professional if you feel that meditation has aggravated or brought on uncomfortable feelings or persistent symptoms.

For many people, setting the stage for meditation with gentle stretching or yoga may offer a more sustainable and beneficial experience.  

If meditation isn’t for you, don’t force it. Instead, you can find a similar mental reset by simply taking a brief walk or finding a minute between patients to take a few slow, deep, purposeful breaths.

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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.

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Rethink Your Path: Embracing the Be-Do-Have Paradigm for Physicians

Do you ever find yourself daydreaming, thinking that if you only had (x) then you could do (y), and finally be (z)? Perhaps if you only had more time, more money, a spouse, or something else- then everything would fall in line.

This is what is known as the Have-Do-Be mindset. It was first described by the late psychologist and spiritual teacher Ram Dass in the 1970s, but it remains remarkably contemporary.

Put another way, the "have, do, be" concept is a way of thinking about how we relate to the world around us. According to this framework, it’s easy to build our lives around the belief that our possessions, actions, or achievements will make us happy or fulfilled.

But in truth this way of thinking can actually hold you back from achieving your dreams. It can make you a passive observer, giving up your power and your agency in service to an imagined future over which you may have little control.

Instead of focusing on what you wish you could have, and what you are unable to do, you can flip the script by reflecting on who you want to be right now.

By making this choice, the path forward, the doing, becomes so much more clear. While the “having”, or what you might define as success, may not always be directly in reach, each step will move you closer to the life you want to live. And what may at first have seemed to be the goal might ultimately shift into something a little different, but even more fulfilling.

Be

Reversing the script can feel uncomfortable because it forces you to become accountable to yourself.

Getting started right now, rather than waiting for some unmapped date in the future, can be unsettling. And searching for firm footing to define exactly who you want to be can feel a little awkward.

But there are a few simple steps that can help you to get there with more clarity and certainty. And once you do so, you will begin to discover a sense of calm and purpose that may have eluded you before.

The key to getting started is to identify your own personal guiding principles.

What kind of person do you want to be, both personally and professionally? In other words, what are your core values? How can you live them out in your work as a physician and in your broader life as a friend, partner, parent, citizen, community member, or individual?

This exercise can be enlightening and sustaining. If you’re looking for a way to define your own personal values, my Core Values Worksheet can help.

Do

By naming your core values and aspirations, you can make intentional choices rather than simply reacting to external pressures or expectations.

Your priorities and goals will become clearer and more personal. And from there, you’ll be able to define the steps you need to take to keep yourself on track.

This could be as simple as setting aside a little protected time each day to work on your goals, or it may mean making a major life change. You may surprise yourself by what you discover as you work through this process.

Have

In defining your values and taking action, you will begin to find yourself living a life that aligns with who you are now and who you hope to become.

The “have” part of this equation will become more real and more attainable, rather than simply a dream.

As you grow towards your own North Star, your goals may shift a little, or maybe even a lot. And that will be how you know that you are on your own path.

Most importantly, if you’re feeling stuck, take action and don’t give up. You’ve done this before. If you got through medical school, you know that you are capable, resourceful, and smart. Your time may be more constrained now, but taking even a 15-minute block each evening to plan for the day ahead is a good place to start.

Know that through action you will find clarity.

An earlier version of this article appeared on this site in May, 2023

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How to Begin a Meditation Practice: A Guide for Physicians

As a cardiologist, a certified mindfulness meditation teacher, and a yoga teacher, I’ve been fortunate to learn from a diverse group of mentors, ranging from world leaders in cardiology to a former Buddhist monk.

I learned about the power of meditation early on in my professional life and found that the presence and equanimity it cultivated inspired both my medical practice and my life outside of medicine.

If meditation sounds a little too nebulous, out-there, or maybe even intimidating, take heart from knowing that meditation is something that many of our key thought leaders practice on a daily basis. It’s not a new trend or a fad. In fact, mindfulness meditation has been incorporated into healthcare since the 1970s, when molecular biologist Jon Kabat-Zinn, Ph.D.  founded the Mindfulness-Based Stress Reduction Clinic at the University of Massachusetts Medical School.

Meditation can enhance your skills as a physician, improving your ability to focus on details and remain calm under stress. It may improve your sleep quality and even enhance your cardiovascular health.

You don’t need a guru or even a class to learn how to meditate. In this article, I’m sharing some simple ways that you can get started with meditation.

Start Small

Begin with just 3-5 minutes of meditation each day. Even this short duration can offer significant benefits. From there you might try a 10-minute practice.

Some people prefer longer meditations, but it’s good to know that when scientists compared 10-minute to 20-minute sessions, there was very little difference in overall mindfulness measures.

Use Guided Meditations

If you're new to meditation, guided meditations can be very helpful. There are many apps and online resources that offer free guided sessions tailored to different needs and preferences. Some good options are Head Space, Waking Up, Insight Timer, and Calm. Most have free or introductory options.

Find a Quiet Space

It’s hard to meditate when there are too many external stimuli. Although you can learn to meditate anywhere, start by choosing a quiet, comfortable place where you won't be disturbed. If you can close a door and put your phone in do-not-disturb mode, so much the better. This will help to create a calmer environment for relaxation and focus.

Eventually you’ll be able to incorporate this sense of focus and ease into your daily life wherever you happen to find yourself.

Focus on Your Breath

A simple way to begin to meditate is to focus on your breath. Close your eyes and take slow, deep breaths in through the nose and out through the mouth. There are a number of different ways that the breath can be used in meditation, but there’s no need to overthink it. Just settle into a rhythm that feels comfortable. By bringing your attention to the sensation of the breath, you’ll use it to anchor your meditation.

Go for a Walk

Walking meditation is a legitimate and ancient form of mindfulness practice.  Instead of using the breath as an anchor, walking meditation brings purposeful attention to the movement of your feet as they contact the ground.

Walking meditation is generally slow and contemplative, and often involves walking back and forth on a path. It’s not about getting from one place to the next. It can be done in the space of your living room, but there’s no reason you couldn’t use your walk from the parking lot to the hospital or office as a walking meditation. Most of the apps I’ve referenced above offer options for walking meditation.

Although traditional walking meditation is not fast, some runners find rhythmic running meditative when they mindfully attend to each stride.

Be Consistent

Like anything else, getting started with meditation is a habit to be cultivated. Since briefer meditations of 5-10 minutes can be highly effective, let go of any tendency to think that longer is better.  Consider setting a goal of 3-4 five-minute sessions per week and see how that feels for you.

Don’t give up if you’re not noticing any difference right away. One study found that 8 weeks, but not 4 weeks, of daily meditation improved mood, attention, and fatigue.

Listen to Your Inner Wisdom

Keep in mind that meditation isn’t right for everyone. For instance, although many people with anxiety find meditation helpful, some people will experience worsening anxiety or an uncomfortable feeling of disconnection while meditating. Longer meditations (over 30 minutes) are often more problematic, and retreats can be especially triggering.

If meditation is not right for you right now, remember that simply taking a mindful pause can make all the difference in a hectic day.

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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 Manage Interruptions and Limit Attention Residue: A Guide for Physicians

It’s not just your imagination. It’s more challenging than ever to maintain your mental focus at work.

💉 EHR alerts

💉 Phone notifications

💉 Interruptions from staff

💉 Attention sapping apps

💉 Email

All of these and more conspire to make focus more difficult than ever before.

These constant interruptions and the lingering effects of shifting attention, known as attention residue, can severely hamper not only your effectiveness and productivity, but also your own well-being.

Resolving the current state of disorder in healthcare will require systemic change, including a fundamental shift in the functionality of many EHRs.

But protecting your headspace is a critical skill that can help you stay above the fray.

In this article, we’ll explore strategies that you can use to retake control of your mental focus, manage interruptions, and minimize attention residue in your daily life and practice.

Understanding Attention Residue

Attention residue happens when you switch tasks, but a part of your mind remains stuck on the previous task.

The little breadcrumbs that remain can jumble up your thoughts and make it harder to focus. And once you’re interrupted, no matter whether the issue was urgent or trivial, it’s easy to switch over into another unrelated brain drain, such as checking your email or social media, rather than returning to the task at hand.

Realistically, interruptions are a part of life in most medical settings. Apart from a few innovative healthcare systems, the current state of affairs creates the perfect setup for attention residue.

Each interruption requires a mental reset, which can take a considerable amount of time and effort. Ultimately this leads not only to decreased productivity and lost focus, but also to increased stress.

This isn’t just theoretical. Research looking at Emergency Department physicians and nurses has found that interruptions from a broad range of sources can seriously degrade the ability to remain focused and aware. What’s more, the disruptions in this study occurred on average about 11 times every hour.

Strategies to Regain Mental Focus

Ideally, our healthcare system leaders will realize the importance of creating pathways that will minimize interruptions. This process is underway in a number of medical systems. But even under the best of circumstances, interruptions are going to happen. Here are a few ways that you can limit the mental drain.

Prioritize and Plan

This can be a difficult step for physicians, since we don’t always have control over the way the day might go. But simply outlining your top priorities can help by giving you a focus and a “north star” for the day,

Start your day by outlining your top priorities. Whenever possible, highlight high-impact tasks when your mental energy is at its peak. For many people, that is the first thing in the morning.

Use tools like the Eisenhower Matrix (also known as the Time-Priority Matrix) to distinguish between urgent and important tasks, and mitigate those less important time-wasters.

Time Blocking

Whenever possible, consider setting aside specific time blocks for different types of tasks. For example, set aside uninterrupted time to study for your boards, or for administrative work. If you have some control over your schedule at work, scheduling similar patient visits may be helpful, so that your mental flow is less likely to be interrupted.

Communicate your schedule and your plan to create these focused blocks of time to your team (or your family) to minimize unnecessary interruptions. Getting buy-in from your schedulers and administrative staff can help to make time blocking work for you.

Mindfulness and Meditation

Consider incorporating mindfulness practices into your daily routine. Techniques such as deep breathing, meditation, or yoga can help improve focus and reduce stress.

Meditation in particular has been found to be helpful in improving attention, focus, and memory and reducing stress. Just like medication or physical therapy, it’s important to be consistent. In one study, it took 8 weeks of regular practice before the impact of meditation was clear.

Taking a mindful pause before and after each patient, study, or procedure is a great way to mentally reset. In many cases, even this very  brief break can improve your efficiency.

Meditation might sound intimidating, but it’s really quite simple. This article shows you how you can easily get started. Don’t just think of meditation as something that you can investigate when you have the time. There is good evidence that engaging in a regular meditation practice can enhance your attention and mental efficiency.

Limit Multitasking

Multitasking used to be considered a superpower. But now we know that when people multitask, they often make more mistakes. And because of inefficiency, it may actually take longer to get tasks done than if each one was done separately. That’s especially likely if both tasks require mental energy, rather than rote memory.  

By focusing on one task at a time, you may improve the quality of your work, reduce the cognitive load, and actually save time.

If you have tasks that are time-consuming and not realistically amenable to completion in one sitting, break them down into smaller, more manageable steps. That way you can think of each step as a separate and achievable task. It can be helpful to write each of these sub-tasks out and check it off the list when it’s completed.

As you knock out these smaller to-dos, you’ll feel a sense of accomplishment. That can reduce the attention residue that builds up when you stress about unfinished work.

Set Boundaries

It’s not surprising that research has found that interruptions increase the likelihood of errors, which may put your patients at risk.

What’s more, these unwanted intrusions also impact your own mental well-being, provoking measurably high levels of anxiety and annoyance.

Ideally, set clear boundaries with colleagues, staff, and patients regarding when you are available for interruptions.

When practical, limit social and nonessential chatter when you’re focused on something that requires deep thought or careful consideration. Reading studies, creating notes, reviewing charts, and developing treatment plans all fall into this category.

Use simple visual cues, like a closed door or a "Do Not Disturb Unless Urgent" sign. Distractions can’t all be eliminated, but taking these and other attention-preserving actions will likely build awareness and respect for your focused time.

It can also be helpful to set expectations with patients and staff that non-urgent in-box messages will only be addressed during or after certain hours of the day.

Conclusion

Maintaining mental focus requires practical, intentional strategies and consistent effort. By experimenting with some or all of the steps I’ve listed above, you will enhance your ability to concentrate, manage interruptions, and reduce attention residue.

Developing these practices will not only improve your productivity but also contribute to better patient care and support your own vital well-being.

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If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.

How to Get Started as a Medical Writer

An earlier version of this article originally appeared on Doximity.com, where I was an Op-Med Fellow from 2022-2023.

Side gigs are a hot topic for physicians. Some people do it for the extra cash, others want to stretch and learn something new. Some doctors are looking to pivot from clinical medicine entirely and may use a side gig like writing to test the waters.

As a medical writer since 2009 and an author of four books aimed at a lay audience, I have learned a lot about the process, including how to make connections and what it takes to get published in the popular press. But before going any further, let me be clear: Unless you are a celebrity with a powerful platform, you probably aren’t going to get rich off of medical writing. Not even a little.

That’s not meant to discourage you. Writing is a fantastic way to clarify your position, share information, and get in front of a larger audience than you might otherwise find. It’s also a terrific way to deepen your own knowledge base.

Writing can open doors to other opportunities that you may never have considered. And it will introduce you to a world of people, including publishers and other writers, that can expand and challenge your point of view.

In this article, I’ll share my own journey as a medical writer, including my pitfalls and successes. I also offer suggestions that may make your own process easier and more rewarding.

One caveat: When I talk about medical writing here, I am referring to my experience of writing health-focused books and articles for the general public. There are other forms of medical writing, including working within the pharmaceutical industry, working on continuing education, and creating regulatory documents for governmental organizations, that follow a very different set of rules and standards. In some cases, these companies may offer full-time employment.

Like many physicians, I have written for medical journals and presented at innumerable conferences and grand rounds. As a woman in cardiology since the early 1990s, I was enough of an oddity that I was often tapped to give talks and presentations to both professional and lay groups on women and heart disease.

Being comfortable with putting words on paper, and learning to present information in a cohesive, conversational way was an important foundation for my first book, The Smart Woman’s Guide to Heart Health, published in 2009. I’ll be honest. This was not a quick or easy process. It took me several years, carving out 30 minutes here and there to work on my project, but the knowledge I accumulated made me a better physician and communicator.

My book began as a way to address my patients’ questions about diet, supplements, exercise, stress, and other issues that impact cardiovascular health. I realized that fellowship prepared me very well to take care of critically ill patients, and to competently manage preventive care, but I had a very shallow understanding of the impact of diet and lifestyle, and I knew virtually nothing about supplements. These were the questions that my patients kept bringing to me, and I wasn’t comfortable simply addressing their concerns superficially. At the time, the Adkins diet (a precursor to the Paleo and Keto diets) was resurging, so writing critically was a great way to delve into the medical research.

Like most physicians, I depend strongly on evidence-based care. Writing the book was a fantastic way to educate myself, and to become an expert in an area that was crucial not only to cardiovascular health, but to health and well-being in general.

However, it was not a money-making enterprise. The book was published by an independent publisher that required that I pay up front for the services, which included an editor. The publisher also offered marketing services, which I naively bought into. Though I was happy with the book and reviews, and my patients and practice loved it, I never made back the money that I put into it.

Two years later, I decided to take a shot at getting a contract with a traditional publishing house. This time, I received an advance, and the book, Best Practices for a Healthy Heart: How to Stop Heart Disease Before or After it Starts, was published in 2011. That was also the time that my practice was acquired by a large healthcare organization.

I learned belatedly that due to the strict bylaws of the organization, I could not effectively publicize or promote my work. That was important because most publishers rely on (and may even contractually require) their authors to market their books through multiple platforms.

Nevertheless, having now created a body of work as a medical writer, in 2014 I was asked to co-author The DASH Diet for Dummies with two well-known dietitians who were happy to do promotional work. That book is now in its second edition and sells dozens of copies per week.

Had I never sat down and started writing, my financial bottom line would probably not be much different, but writing has given me so many other interesting opportunities.

Writing made me a better educator for patients and trainees, teaching me to communicate more concisely and clearly. It brought many people into my practice, which benefited me, my partners, and my organization.

I’ve written and presented for a number of organizations and websites, receiving modest but still meaningful compensation for my work. I am recognized as an expert in my field. And writing has given me a platform and a way to connect with people from all over the world.

So, how can you get started as a medical writer?

I recommend starting small, testing the waters, to discover if writing is something that feels right to you. From there, you can always move up. Here are some practical ideas to spark your imagination:

Create a brief series of handouts for your patients.

For example, perhaps you’re frustrated with the lack of educational resources that you can offer your patients. You have an idea of creating a handout, but you don’t know where to start or how to get it done. Maybe you think someone else would do a better job, and you don’t want to look amateurish, so you just let it slide. Meanwhile, you’re spending extra time trying to get your ideas across to patients in the limited minutes you have in the office schedule.

It’s easy to feel a bit overwhelmed when tackling a writing project for the first time. Keep in mind that it doesn’t have to be complicated or detailed. A few salient bullet points may be all you need. Start by setting aside a little time to make a simple outline and work from there. You’ll provide something of real value to your patients, and you’ll ultimately create more time to focus on patient care.

Start a blog.

You don’t have to write a book to get your ideas out there. Simply choose a topic you’re interested in, tell a brief story around it, and provide information that you know your patients, family, or friends want to know. Write as if you’re having a conversation, and then stop after a few hundred words.

There are all sorts of options for free or low-cost websites on the internet. It’s great to be consistent, but don’t beat yourself up if you can’t do this regularly. Once a month is a good way to start.

Reach out to a wider audience.

Once you’ve written a few pieces and have your bearings, consider reaching out to your local newspaper to share one of your posts or offer your services. You can also offer your expertise to services like Connectively, where journalists are often looking for quotes.

Consider writing brief pieces to post on LinkedIn under your own account. This can be especially useful if you are able to discuss new research or health conditions that appeal to a broad audience.

Consumer health magazines or online resources may also be interested in your work. Check their websites for submission details. I found my current writing gig with GoodRx.com on a physician job board, and have been writing for them consistently since 2021. I love working with the editors and improving my work. And it’s great to be able to share my knowledge and insight with a wide public audience.

Consider an e-book.

Self-publishing is a much bigger industry than it was just a few years ago. The downside is that you will need to pay for an editor to review and help you refine your work. Or you can enlist a colleague or trusted friend to proof-read and make suggestions.

Find a publisher.

Writing a book is not for the faint of heart. The hours you put into it may never be compensated. But there is nothing like the feeling of your own book in your hands. If you are really intent on working with a traditional publisher, you will need a literary agent. Resources such as Publisher’s Marketplace and Writer’s Digest can help you drill down your options.

Conclusion

You probably won’t get rich as a medical writer, and you may not even make minimum wage when all is said and done. But you will enrich your experience as a physician, become a better communicator, and create opportunities you may not have even considered. Writing can be a path to lifelong learning, and patients and other physicians will appreciate your expertise. Not to mention, you’ll meet a wide range of people whose paths you may not ever have crossed otherwise.

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’re interested in learning more about my coaching program, you can schedule an introductory meeting by clicking the link below.

My Podcast Interview with Dr. Kevin Smith

This was such an interesting conversation with facial plastic surgeon and ENT Dr. Kevin Smith for TechLink Health! I was fascinated to learn about the link between migraines and nasal health. Dr. Smith’s journey from college athlete to cutting edge surgeon gives him a unique perspective, which he shares on the podcast.

Dr. Smith's story shows how the combination of clinical excellence, curiosity, and persistence can impact patients' lives in meaningful ways and spark new innovations.

Maximize Efficiency and Achieve Work-Life Balance: The Time Priority Matrix for Physicians

Do you ever finish the day feeling as if the time raced by, but instead of making progress on your goals, you’ve just been putting out fires?

With a constant surge of urgent issues, combined with your daily responsibilities and opportunities, it can be challenging to prioritize effectively.

Using the Time Priority Matrix can help you to visualize not only where but how you are spending your time. By categorizing your daily activities, you will discover how your attention is being directed, and where you might be able to streamline and optimize the way you use this most valuable and limited resource.

This tool is also known as the Eisenhower Matrix. Former US President Dwight D. Eisenhower didn’t create the idea, but he famously referenced Dr. Roscoe Miller, a former president of Northwestern University, when he said: "I have two kinds of problems: the urgent and the important. The urgent are not important, and the important are never urgent.”

The matrix was subsequently popularized by Stephen Covey in his landmark book The 7 Habits of Highly Effective People.  It’s something that’s often taught to business leaders, but the concepts can easily be applied to physicians and anyone else seeking to take back some control of time and attention.

How to Use the Time Priority Matrix

Quadrant I tasks are both urgent and important. Ideally these are limited, but as a physician, these tasks are part of daily life.

The critically ill patient, the urgent report, the call from a worried family member. Often these issues are out of your control. But sometimes there is a way to mitigate the urgency, and that's where Quadrant II comes into play.

Quadrant II: Preparation, planning, and prevention fall into Quadrant II. By working in this quadrant, you anticipate and trouble shoot before trouble arises. That's what preventive care is all about.

You can also apply this idea to your own life. For example, if you're studying for your boards, taking a set amount of time every day for a few months will get you much farther ahead than waiting until the last couple of weeks to study. And learning a new skill or technique and making the time to practice it will ensure that when you need it, you'll be more confident and prepared.

Building trusting relationships with patients and colleagues also falls into Quadrant II. By taking the time and putting in the work at the outset, you’ll build trust and confidence. Ultimately that will enhance your ability to provide care more efficiently and collaboratively.

Work in this quadrant might not always be exciting or immediately fulfilling, but it will keep you on track to accomplish the goals that are meaningful to you.

You can apply Quadrant II ideas to your personal life as well. Think about your relationships, family, and other interests. What can you do to ensure that the things that matter to you outside of work are cared for and able to flourish?

Quadrant III is more problematic. In this quadrant, you're dealing with things that are not particularly important, but which require some urgency to complete.

As a physician, you're probably all too familiar with this quadrant. Interruptions, EHR redundancies and pre-authorization inefficiencies that have to be addressed are daily if not hourly occurrences. Some meetings and much email fall into this category.

Sometimes it can help to work on these things in "chunks" so that your attention is focused and you can be more efficient. This is known as task batching, and it can be a highly effective way to clear out some of the clutter that routinely piles up. Making it clear that these non-urgent issues will only be addressed on a certain day at a given time is one way to not only set boundaries but to limit interruptions.

Delegating whenever possible is an important aspect of Quadrant III management. For example, can someone else be assigned to fill out routine paperwork, leaving only the physician-specific sections for you to complete? Perhaps staff can be empowered to respond to simple patient requests for notes or documentation, or to schedule a visit when it’s clear that a non-urgent call or message requires more than a simple response.

Quadrant IV is where you have the greatest likelihood of clearing out some time and space. Mindless scrolling, low-value emails, watching random TV shows, and stressing over social media are good examples of this quadrant's activities.

Sometimes you need a little downtime, but being cognizant of how you are spending it may help you to gain some well-earned margin for the things that matter most to you.

It can be a great thought exercise to think through the way you are using your time. The Time Priority Matrix is a valuable tool that can help you to manage your workload and your personal life more effectively. By identifying and prioritizing tasks based on urgency and importance, you’ll have a tool that can enhance your productivity, improve patient care, and help you achieve a healthier and more fulfilling work-life balance.

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 Appearance on Dr. Bill Lombardi’s Journey to Better

It was a thrill to appear on legendary cardiologist Dr. Bill Lombardi’s podcast The Journey to Better. I was honored to be invited onto the show to discuss mindfulness, goal setting, and combating burnout.

Dr. Lombardi is one of the highest-volume operators for complex PCI and chronic total occlusions in the world. He has been open about his own struggles with well-being in this high stakes and intense field of cardiology. His episodes will resonate for cardiologists, but also for any physician who has experienced the struggles, highs, and lows of caring for patients in today’s world.