Overcoming Disrespect in Medicine: Protecting Physician Dignity

An earlier version of this article appeared on the KevinMD website in August, 2023.

Treating patients with dignity is one of the cornerstones of our profession. While we’ve all had moments when we—or our colleagues—didn’t quite measure up, most of us genuinely aim to make our patients feel safe and respected. But what about the flip side of this dynamic? It’s not talked about nearly enough: physicians are often not treated with the same dignity by their systems or even their patients.

In this article, I’ll dive into the major shifts that have led to this reality and share five practical strategies to help you push back against the disrespect and reclaim your sense of dignity.

The Roots of the Problem: Disrespect and Breakdown in Advocacy

We’ve been conditioned to expect, and even accept, that patients in distress might lash out, but the toll this has taken on physicians in recent years has been enormous. As recently as five years ago there was still a general expectation of respect for the expertise and sacrifices that a physician’s work entails.

But disrespect from patients is currently at an all-time high, sometimes even escalating to physical violence from patients. A recent study found that more than one third of public health workers in the US experience some form of workplace violence. Examples included stigma or discrimination, job-related threats, and bullying or harassment.

Adding fuel to the fire is the rise of administrative oversight of physicians and their practices by people who may have little experience in direct patient care. Their reach extends not only to metrics and billing, but into personal and professional decisions that once would have been completely off limits.

What’s more, employed physicians may have little say into whether threatening patients can be dismissed from their practices. 

And at the intersection of patient and administrative stress are the widely published patient satisfaction scores. While these scores often have no relevance to patient outcomes, they’ve become yet another pressure point, pushing physicians to prioritize arbitrary expectations over doing their best work.

 Although physicians are tasked with regular training in sensitivity and respect for patients and employees, they get little instruction in how to protect their own dignity. Often physicians are advised to just let it go.

It’s not unusual for doctors, especially women, to attempt to deal with these situations with passivity and even self-deprecation, in a misguided attempt to get along. Younger physicians who lack strong mentorship may be especially vulnerable to these situations.

Unfortunately, these well-meaning attempts to smooth things over often have the opposite effect. They can actually embolden the bully and do nothing to improve the situation.

The status quo is not sustainable, and it is incumbent on healthcare systems to work to create safe and respectful environments. As a physician, you have more power than you may realize. Here are five ideas that you can implement right now:

How to Reclaim Your Dignity

 1. Establish Boundaries

Boundaries are essential for maintaining professional relationships and protecting your sense of self. Being a compassionate and caring physician doesn’t mean being a friend to your patients or colleagues.

Keep a clear line between work and personal life—avoid interacting with patients or administrators on social media, and be intentional about separating the two spheres. Setting clear expectations for respectful behavior can help prevent issues before they arise.

2. Advocate for a Respectful Work Environment

If you don’t stand up for yourself, who will? Open discussions about mutual respect—at meetings or through anonymous feedback systems—can pave the way for change.

Remember, you’re not asking for anything unreasonable. Advocating for policies that address disrespect and burnout can help create a healthier, more supportive workplace for everyone.

3. Strengthen Doctor-Patient Communication

Good communication is at the heart of the physician-patient relationship. By being empathetic and respectful in your interactions, you can set the tone for civility with both patients and staff.

Stay calm during difficult conversations—pause, take a deep breath, and step away if needed. Active listening, showing genuine interest in patients' concerns, and involving them in decision-making can help build trust and respect.

And although the EHR is great tool for communication, keeping EHR messages brief and focused can help to maintain your professional boundaries while addressing patient concerns.

4. Don’t Accept Disrespect

Firmly but politely calling out an incident of disrespect can be a first step towards creating a solution. When an issue persists or escalates, document what’s happening—it’s often more effective than just voicing complaints.

But if you feel that your safety or that of your staff is at risk, don’t allow yourself to be talked into accepting a dangerous situation. If you’re employed, your healthcare system bears responsibility. If your concerns are not addressed, sometimes engaging with and reporting to security or even law enforcement personnel is the best course of action to protect everyone.

5. Take Care of Yourself

Prioritize your own well-being. Make time for self-care, whether it’s through exercise, meditation, or hobbies to help you recharge emotionally and mentally. Mindfulness practices can give you tools that help you to stay present, focused, and composed during difficult encounters, preventing potential escalation.

Don’t overlook the importance of making time for your family, friends and loved ones. By nurturing these ties, you will stay connected to the world outside of your practice.

Reclaiming your dignity as a physician will require commitment and fortitude. While it’s crucial to acknowledge the culpability of our healthcare systems, real change will depend on strong advocacy from physicians like you. By starting with the steps above, you can begin to build a workplace that’s not only more respectful but also more sustainable. And ultimately everyone, including the patients you care for, will benefit.

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

References

Fenton JJ et al. The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality. Archives of Internal Medicine. 2012

Ofri, D. The Business of Health Care Depends on Exploiting Doctors and Nurses . The New York Times. June 8, 2019

Schneider, B.J. et al. The Effect of Patient Satisfaction Scores on Physician Job Satisfaction and Burnout. Future Science. November 12, 2020.

Tiesman, H. M. et al. Workplace Violence and the Mental Health of Public Health Workers During COVID-19. American Journal of Preventive Medicine. March 2023

Yeluru H et al. Physician Burnout Through the Female Lens: A Silent Crisis. Frontiers in Public Health. May 2022

Retirement Planning for Physicians: Introducing the Future Self Exercise

For many physicians, the concept of retirement may seem distant, daunting, or even unattainable. That shouldn’t be surprising. It’s likely you’ve spent the greater part of your adult life as a doctor, and most of your youth studying and striving to become one.

The idea of leaving the profession may seem frankly overwhelming. After so many years of dedicating your life to others’ health and well-being, what does a fulfilling retirement look like for you?

Retirement is different for each one of us. Some people happily move out of the profession and take a new path, never looking back. Others will repurpose some of the skills they’ve acquired and dedicate that to an endeavor such as volunteering or teaching. And, sadly, some physicians mourn the life they’ve given up, never quite finding their footing in the outside world.

No matter where you are in your professional arc, the “future self” exercise is a powerful tool for envisioning and then creating a meaningful retirement. In this article, we’ll explore how you can use this exercise to develop and align your retirement plans with your personal values, dreams, and aspirations.

Introducing the Future Self Exercise

It can be difficult to imagine yourself many years into the future. Instead, a one-to-five-year time line might feel more tangible. That’s partly because it’s normal for our needs, wants, and dreams to change over time. If you think back to the person you were ten years ago, it’s possible that version of you feels very different from your current self. Research on the “future self” confirms that we often perceive this unknown version as an “other.”

Nevertheless, it is important to set yourself up for success and happiness for both the short term and the more distant future. Especially if it’s early on in your professional life, thinking of the future you as a person you care for can foster a sense of compassion and responsibility.

If you’re contemplating retirement, then the future you becomes much more knowable. And in this context, the future self exercise can be especially actionable.

This exercise can help you design your goals both by creating self-awareness and clarity, but also through aligning your current actions with your long-term hopes and dreams. You can’t control the future, but you can take ownership of your direction during this major life transition.

Your Step-by-Step Guide to the Future Self Exercise

Step 1: Set the Stage

• Choose a quiet, comfortable space to reflect on your life from the perspective of your future self.

• Have a journal or notepad ready for capturing thoughts.

Step 2: Imagine your ideal retirement.

• Close your eyes and picture yourself 1-5 years into retirement.

• Questions to consider:

  • What does your day look like?

  • Where are you living?

  • Who are you spending time with?

  • What activities bring you joy and fulfillment?

Step 3: Making an impact

• Staying with the future you, ask yourself:

  • What am I proud of accomplishing since retiring?

  • How am I continuing to make a difference or live meaningfully?

Step 4: Identify values and priorities.

• Still holding the future in your mind’s eye, reflect on:

  • What matters most to me in this phase of life?

  • How do I want to feel every day?

Step 5: Nurturing relationships and connections

• Sitting with your future self, consider:

  • Who are the friends, family, and community that I care about or hope to develop?

  • How am I creating a life that keeps me connected and supported?

Step 6: Carrying strengths forward

• Ask yourself:

  • What strengths and skills from my life as a physician do I use in this next phase of life?

  • How do I ensure that I continue to learn and grow?

Step 7: Write a letter to your future self

• It can be helpful to write a letter to your future self, describing your hopes, goals, and dreams. Seal it and set a date to read it in the future. Create a reminder on your phone or calendar to ensure that you don’t forget.

Translating Your Vision into Action

Once you’ve completed the process, take a look at what you’ve written. Highlight the recurring themes or patterns that stand out for you. Next, set actionable goals that will help you to create the life in retirement that you want to live.

• Financial goals: You may want to enlist a trusted advisor to help you plan out and refine your financial goals so that you are on track to enjoy your retirement without excessive worry about money or savings.

• Lifestyle goals: Begin to define your ideal balance between relaxation, hobbies, and productivity. Physicians often overlook their own health when life gets busy, but pre-retirement is a crucial time to make it a priority so that you are able to enjoy your retirement when the time arrives.

• Relationship goals: Define who you want to share your time with, and in what way. It’s never too soon to work on your relationships and cultivate friendships, even if it means a just brief text or email to keep the lines of communication open.

• Legacy goals: Explore ways to contribute to your community. That could take the form of teaching, mentoring, or volunteering, or anything else that appeals to you. This is a great time to explore areas of interest that you might never have had time for during your working life. You don’t need to make a commitment until you’re ready, but get to know where the needs are, and think about how you might contribute to something personally meaningful.

Although your goals and plans may change over time, the Future Self exercise can be a powerful way to strengthen your vision and jump start your plans. It’s never too early to begin taking small steps now to integrate elements of your future self into your current life.

When your life and identity have been shaped by your profession, it’s easy to feel overwhelmed and unmoored when you make the decision to retire. It can help to think of retirement as an opportunity to redesign a life that aligns with your values, passions, and aspirations. The Future Self exercise offers a powerful way to gain clarity and intentionally shape this next chapter into something rich, meaningful, and purposeful.

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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.

Burnout is an Expression of Grief, Not a Lack of Compassion

An earlier version of this article appeared on the KevinMD website in June, 2023

Over the last 5 years, the word “burnout” has become nearly synonymous with the state of healthcare. With nearly 50 percent of physicians surveyed reporting burnout in 2023, it’s an epidemic in our profession.

Physicians are often made to feel responsible for their symptoms of burnout, but by definition, burnout is not a personal failing or a psychological illness. Rather, burnout is defined as an occupational phenomenon that happens in response to chronic workplace-related stress.

Symptoms of burnout include:

• Exhaustion

• Cynicism

• Inefficiency

Burnout is not a failure of compassion.

If you’re feeling burned out, it doesn’t mean that you don’t care. In fact, burnout may be a natural reaction to the recognition that you are unable to provide the compassionate care that your patients need.

The experience of burnout may mirror in some ways the experience of grief. Both are a response to loss. And like burnout, grief is often experienced as exhaustion and difficulty thinking clearly.

Compassion fatigue on the other hand is defined as a sense of indifference to the suffering of others. It’s an emotional withdrawal often caused by exposure to traumatic events. For physicians, it may be a response to relentless illness and death.  The COVID-19 pandemic is a classic example of a driver of compassion fatigue, especially for those who worked in the ER and ICU in the early days of this disaster.

It’s not uncommon for physicians to experience compassion fatigue from time to time. It doesn’t mean that they are not compassionate people, but rather that they are suffering and in need of relief.  

We might consider burnout as a type of disenfranchised grief. But it is not compassion fatigue. In fact, equating burnout with a lack of compassion may be a heavy-handed way of placing the blame on physicians while deflecting it from the systems that created the problem.

As a coach, I have found that many physicians with burnout are in fact grieving the lack of connection to their patients. Often this is due to system-wide emphasis on RVUs combined with excessive clerical work that undermines their ability to spend meaningful time with patients.

National organizations and many health care systems are beginning to take note, and as supportive processes are put in place, rates of burnout do seem to be slowly improving. But there is much work to be done.

If you’re experiencing burnout, it’s important to recognize it for the wound that it is, have compassion for yourself, and create a plan to move forward.

In the words of the poet Rumi, “the wound is the place where the light enters you.” What does this light illuminate for you?

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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.

Mindfulness: A Surprisingly Practical Tool for Time Management

As a doctor you’ve studied, trained, and practiced for years, probably decades, to provide the best care for your patients. But as our world has become increasingly tech-driven and connected, the pressures from both within and outside of the healthcare workspace for your time and attention have multiplied.

Whether it’s pings from the EHR, text messages from the hospital, urgent calls from colleagues or families, or the never-ending torrent of emails, your attention has become more fragmented than ever before.

When you’re busy and feeling time-pressured, mindfulness may seem to be an uneasy, even unwelcome, construct.  Who has time for it? Yet it turns out that simple mindfulness practices can help you to reframe and de-escalate the struggles of the day.

Mindfulness won’t cure the ills that physicians face in the current healthcare environment, but it can mitigate their impact. In this article I will show you how using mindfulness can create the mental space you need to confidently and calmly manage patient care while protecting your precious time.

Start with Mindful Mornings

Mornings can often feel a little frantic, but finding room for a simple 5-minute mindfulness practice can help to set the tone for your day. Here are some ideas to get you started:

• Sit quietly with your morning coffee, allowing time for it to cool while you check in with your breath. Take a slow deep breath in through the nose, pause for a moment, and then breathe out through the mouth. You can use the box breathing technique, or simply find a rhythm that feels comfortable.

• Use a mindfulness app like Insight Timer or Headspace. You can enter the time you have available and you’ll find a wide range of guided meditations.

• Set a 5-minute timer and journal about anything that comes to mind.

Practice Mindful Transitions

Mindful task transitions can help you maintain your focus and prevent mental fatigue. Before moving on to a new task, appointment, or procedure, take a moment to pause, breathe deeply, and clear your mind.

You’ll be more present for your patient, which can build trust and connection. And this mindful pause can enhance your efficiency by helping to prevent the accumulation of mental clutter, or what is known as attention residue.

Embrace Single-Tasking

Multitasking used to be considered a prerequisite superpower for productivity. Doing two or more things at once--what could possibly go wrong? A lot, it turns out.

Emergency Department physicians may be the most pressed to multitask, with a recent Scandinavian study finding that almost 20 percent of their time is engaged this way. Not surprisingly, this study found that the more a physician multitasked, the more stressed they became. And other studies have found that multitasking can increase the risk for errors.

While you may not always have control over who or what interrupts you, it can help to remain mindful of the things that are pulling on your attention. When you are able to tune out distractions and put non-pressing matters on hold, you’re likely to be more productive and efficient with your time.

To tune up your ability to focus, regular meditation can help. That’s because mindfulness meditation is, at its foundation, a practice of returning your attention to the present moment.

Cultivate Presence

What exactly is presence? Actress Anna Deavere Smith, in her book Letters to a Young Artist, counsels that “Presence means you hold your own space, control the space around you, and sometimes welcome others into it.” Here she is describing the persona of an artist, but as a physician, you too are tasked with holding space, while simultaneously creating a place of safety for your patients to enter.

In being present, you are listening mindfully, without jumping to conclusions or judgments. You’re paying attention not only to the words but to the body language and, sometimes, to the unspoken fears beneath the words.

This might sound like it could add time to the encounter, but the truth is that when you lead with mindfulness, your patient is more likely to feel heard and safe. You are more apt to integrate information that might otherwise slip beneath your radar, so your differential may be more accurate.

And as you build trust, your treatment plan may be more readily accepted, and you’re likely to get fewer in-box messages or worried phone calls after the encounter.

End with Mindful Reflection

As you close out the day, take five to ten minutes to reflect on your “wins”, your “dones”, and your “to-dos”. Acknowledge both your successes and areas for improvement, without falling into self-criticism.

By creating a to-do list for the next day, you can set aside your lingering worries and unchecked boxes, knowing that you’ve made a plan to tackle them tomorrow.  

Your closing-down practice could even include stopping at a coffee shop on your way home to enjoy a cup of decaf and take a few minutes to journal and debrief before entering into your home life.

This time between work and home can also give you a safe space to decompress from your work day so that you’re able to be present for your loved ones, making the most of the time remaining in the day.

Conclusion

Mindfulness is not going to solve all that is troubling healthcare. It doesn’t mean pretending that the troublesome systemic problems facing physicians don’t exist. But by cultivating a mindful approach to the day, it’s likely that your time will be spent more meaningfully. And as a result, your focus and productivity will improve, and you’ll have more bandwidth to be present for your patients and your loved ones.

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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.

Twelve Tips for Creating Realistic To-Do Lists for Busy Physicians

An earlier version of this article was published on this website in July, 2023.

Creating a realistic and actionable To-Do list can feel like a daunting task for a busy physician. But the truth is that your To-Do list can free up hours of your valuable time, create structure out of chaos, and help you to reach goals that will bring you closer to your ideal life.

In this article, I’m going to share twelve actionable and realistic tips that will help you to develop your own sustainable To-Do List practice.

Tip Number One: Write it Out

I encourage you to write out your daily to-do list and carry it with you, rather than using your computer or phone.  Research shows that handwriting notes, including important schedule reminders, activates the brain’s memory functions more strongly than entering the information into an electronic device. My favorite tool is my Bullet Journal. But a simple piece of paper that you can slip into your pocket will do.

Tip Number Two: Don’t Include Everything

Your To-Do list should not include patient appointments, consults, rounds, or other foundational tasks of your practice. Instead, use it to create and keep track of tasks such as

✅meetings

✅strategic tasks

✅planning

✅study time

✅personal appointments

✅exercise

✅meditation

✅creative endeavors

✅any other personal projects that are meaningful to you

Tip Number Three: Make a Weekly Appointment with Your List

Choose a recurrent time to devote ten to fifteen minutes creating a list of your weekly tasks, keeping the above list in mind. For me, Sunday evenings work best.

Be sure to include tasks that may not be due the following week, but that might require planning over the next several weeks to months. For those tasks, make note of the deadline so that you can prompt yourself to plan accordingly. These might include

⭕lectures

⭕papers

⭕vacation planning

⭕studying for boards

⭕tax preparation

⭕business planning

⭕writing an article

⭕learning a new skill

Tip Number Four: Take Ten Minutes Every Evening

Each evening, take ten minutes to review your tasks from the day, revisit your weekly task list, and create a list for the following day. It’s easy to add more things to the list than you can reasonably accomplish. To avoid this trap, include a general range of time required to complete each task. That way, you’ll keep your plans realistic and set yourself up for success.

Don’t forget to take into account steps that you need to take to reach your upcoming deadlines. Keep these events in mind as you plan your list and break down the necessary steps into actionable tasks.

Tip Number Five: Prioritize, Delegate, and Delete

Prioritize your tasks so that the most important things take priority.

Before committing to your To-Do list, take a look to see if there are tasks that you can delegate or automate. If so, decide how you are going to do that, and put those steps on your list. Although this can take some time to work out at the beginning, it will save you multiples of time once you’ve put the process in place.

Tip Number Six: Batch Your Tasks

Now that you have your To-Do list, think about how you might organize or cluster several related tasks together. This is known as “batching”. Mentally, this keeps you from constantly switching context, a hazard of multitasking. It can also help you to avoid procrastination.

By batching your tasks, you’ll optimize your time and keep your focus. And that will give you more breathing room, or margin, for the things that matter the most to you.

Tip Number Seven: Take Advantage of Unexpected Open Time

Refer to your list when you find yourself with unexpected open time, especially when the tasks only require limited blocks of concentrated effort. Even 10 minutes of focused work can reduce your in-box burden.

Tip Number Eight: Use a Timer

When possible, use a timer to encourage yourself to maintain focus. Twenty- to thirty-minute segments are usually a good idea. But when you’re struggling to get started, even a five-to-ten-minute commitment can get the task launched.

The important thing is to overcome the inertia that might be holding you back. If possible, turn off notifications on your phone or computer to limit interruptions during high-focus times.

Tip Number Nine: Budget Your Energy

Think about optimizing the way you use your time. Use your low-energy times, like the end of a busy day, for things that demand the least amount of focus. And use the times where you have the most mental energy for those commitments that require creativity and mental flow.

Tip Number Ten: Beware of the Energy Drain from Your Devices

Although device use is a necessity of life, it can also be an attention drain. Consider setting a timer for checking email or surfing the web. And whenever possible, batch your email time so that you’re not constantly checking your inbox. Delete, unsubscribe, or delegate whenever possible.

Tip Number Eleven: Allow Time for a Pause

Whenever feasible, give yourself time for a mental pause. Most people need at least 5-10 minutes per hour in order to maintain optimal focus. Although that may not always be possible during the busiest times of your workday, try to build brief pauses into the structure of your after-hours time.

Consider adding a daily meditation to your To-Do list. You can use this as one of your mental pauses. A brief meditation using one of many available apps (including HeadSpace and Waking Up) may help you to re-focus the mind and let go of the stress of the day. By practicing mindfulness meditation regularly for even a few minutes, you’ll train yourself to become more present and less irritable.

Tip Number Twelve: Don’t Give Up

No matter how you structure your To-Do list, remember that it can take several weeks for a habit to stick. Choose a method that will be easy to access and easy to remember. If you skip a few days, simply start over. And make sure to take a little time at the end of each day to review the day’s tasks and set up your list for tomorrow.

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

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

My Podcast Interview with Livia Robic of Withings for BeamO

I recently spoke with Livia Robic of Withings about the BeamO device for the TechLink Health podcast. This handheld consumer device includes a pulse oximeter, a thermometer, a mini-ECG and an electronic stethoscope.

BeamO is designed to help physicians take better care of their patients remotely, and was named one of Time magazine's "Best Inventions of 2024". This was such an interesting and engaging episode, and I can imagine a number of scenarios where this device could make a difference for patients with chronic disease or those recovering from surgery. I’m excited to see what the future holds for BeamO!

You can find our conversation anywhere you listen to podcasts, or through the Spotify link below.

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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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.

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 your tendency to keep doing something that is not in your 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.

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

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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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.