At the recent American Medical Women’s Association meeting, I had the chance to speak with medical students and residents about ways in which they might thrive during the grueling years of training. “How many of you have a sense of freedom in your lives right now?” I asked. Not one person raised her hand. Instead, they described their lives as stressful and overscheduled. I’m sure many of us – in medicine and outside of this profession – feel the same way. Here’s a link to the article on Doximity with ideas to help you thrive during training and beyond!
4 powerful ways you can thrive during medical training, career, and life. A physician coach shares perspectives and practices
Often, when we’re troubled by something, we’re given the well-meaning advice to “get over it.” “I’ve moved on,” we might say to ourselves or others, hoping we can ignore the uncomfortable feelings we’re having and get on with our lives. But the truth is that when something troubles us, there’s often a good reason. When we “get over it” without exploring what’s “under” it, we disrespect ourselves. We act as though our feelings, beliefs, and values don’t matter.
As a San Diegan for 35 years, I’ve grown accustomed to dense fog along the coast that obscures what I know to be a scenic vista. Beyond this fog, I know there is a panoramic view of the Pacific Ocean. Once the fog dissipates, I can see the complexity of nature – the beautiful though eroding coastline, marine life, the ebb and flow of the waves – that inspires me every time. Similarly, when we try to “get over” our emotions, we deprive ourselves of an understanding of the complexity of the world and our experience of it.
After the events in Charlottesville, I was unable to sleep, full of anxiety and fear that the hatred being expressed in Virginia could not be contained or transmuted. Rather than try to “get over it,” I decided to see what was under it. The first thing I found was anger that the world wasn’t a simple place where everyone could be happy, as I wanted them to be. Growing up in a family where negative emotions weren’t allowed, I had become very uncomfortable with them. I wanted the world to be a happy place, where I could remain in my emotional comfort zone.
As the hours passed and I explored an even greater complexity – the feeling of being powerless – my anxiety dissipated, just like the fog. While no resolution was reached in those early hours of the morning, I could see the issues more clearly. And in that greater vision grew a confidence that, while the violent expression of hatred wasn’t acceptable, resolution would only occur if both sides could understand their own feelings and desires, and be heard. The following month, I had an opportunity to put my newfound understanding into action. A fellow gym-goer began a diatribe filled with hurtful, overtly racist comments. Previously, I would have moved into the other room to avoid an uncomfortable confrontation. Understanding that this was about my feeling powerless and an unwillingness to empathize with others, I instead began a conversation. While I can’t claim that we changed each others’ beliefs, it felt both more powerful and hopeful to me to speak up than to cower and hope these opinions would simply disappear from our public sphere if I ignored them.
So the next time strong emotions are triggered by an event, comment, or action, take a few moments and consider what’s under them. What’s the emotion you’re feeling? What beliefs are fueling the emotion? What more complex truth can you see in the situation? By holding that complexity, see if you don’t feel greater security in a deeper understanding of the situation and the value you hold that feels imperiled. Once the fog dissipates and we see things more clearly, it’s usually easier to bridge gaps and find solutions. But first, we have to be willing to look under our emotions, rather than just getting over them.
As physicians, we make hundreds of decisions every day. Each is influenced by an intention, whether we are aware of it or not. Sadly, when we don’t communicate this, we leave a powerful tool untapped, resulting in a less focused and less powerful outcome than if we had harnessed its potential. And if we’re not aware of our actual intention, we often end up with an outcome that doesn’t satisfy us or the person we’re dealing with.
What do I mean by that?
Let’s say we enter an exam room, ready to discover how our patient has responded to a medication we started at their last visit. If our intention is to strengthen our relationship and treat them in a holistic manner, we’ll respond with compassion and curiosity if they report that they stopped the medication because of a side effect. But if our unconscious intention is to see them quickly because we’re running late that day, we’ll become annoyed and our frustration will show, making any discussion about a replacement medication or strategy less collaborative and, therefore, less effective. As Marlene Chism, author of 7 Ways to Stop Drama in Your Healthcare Organization, suggests, “If you feel obsessed that the conversation didn’t go well, check your intention. We are often unaware of our hidden agenda to prove someone wrong, win an argument or find an excuse to let someone go. When you have a conversation that goes south, reflect and ask yourself if you had any hidden agendas you were unaware of.” Bringing ourselves back to our overriding intention, to care for our patient, helps us stay focused on our real mission and allows us to act in accordance with our intent to help people, the most common reason most of us entered the profession of medicine.
As leaders, stating our intention is an underutilized communication skill – and one that is easy to put into regular use. In leading a meeting or any group effort, stating your intention helps the group become focused and energized. Lead a meeting off by saying, “It’s my intention that we will cover these particular issues today and by the end of the meeting, we’ll arrive at decisions on all of them and plans to execute our decisions,” and watch the group fall into step with your stated intention and with each other.
If we start out along a path that isn’t clear, and we don’t know where we’re going, it’s hard to get excited and motivated. But if we see the path ahead and have a picture of where we’re going, we’re energized to take that trek together. As Yogi Berra warned, “You’ve got to be very careful if you don’t know where you’re going, because you might not get there.”
If we’re concerned that our words may be taken the wrong way, it’s helpful to lead with an intention. This lets the other person hear our words in the spirit we wish to offer and reduces the chance we’ll be misunderstood. If we’ve had difficulties with a person before and want to communicate with them again, we can begin with, “I know we’ve had our conflicts in the past. It’s my intention that today, we have an opportunity to share our perspectives with each other and come to a resolution together that works for both of us.” A space is now opened for respect, understanding and collaboration. And before any difficult conversation, stating our intention is an extremely powerful technique that puts a stake in the ground, inviting the other person to join us in this important venture.
By stating our intention, we become clear about what we wish to accomplish with any interaction and we enlist people to join our cause. It’s powerful both in its simplicity and its effect.
Let’s Make Those Resolutions Stick! Physician coaching provides solid ideas to make you successful in the new year
It’s January 8th, the day by which 25% of New Year’s resolutions have already been discarded. By the end of the year, 90% of our best intentions will have met the same fate. As we begin 2018, full of exciting ideas, are we doomed to have our plans fail? Does this mean we shouldn’t try to do better? To improve our lives? To learn, grow, or change?
Absolutely not! There are simple, yet powerful things we can do so our plans succeed!
I’ve written about using “structural architecture” to enhance our ability to bring about change in our lives. We can also garner support from Patterson’s insightful book, Change Anything, which offers six spheres of influence to help us do things differently:
Personal motivation: WHY do you want to make this change? How will your life be different once you achieve this? Each time you have an impulse to give up on your plan, reconnect with your motivation. Place visual cues of your goal in locations where you will see them.
Personal ability: new habits require new skills. To become more organized, a class on using your new computer program or app might be useful. To save for a vacation, a discussion with your investment counselor can identify appropriate savings vehicles.
Social motivation: as Patterson says, “bad habits are almost always a social disease.” Get your friends, colleagues, and family on your side. Tell them what you intend to do and why, and ask for their support and encouragement.
Social ability: changing a habit is easier when we get help – a trainer, coach, or mentor can be invaluable. Want to improve your speaking skills? Get a speaking coach!
Structural motivation: create short-term goals, with tangible rewards as you achieve them and penalties if you don’t. Treat yourself to a movie once you’ve read the journals on your desk, or donate $100 to a charity supporting a cause you abhor if you don’t.
Structural ability: adjust your environment to make it easier for you to succeed. Want to exercise regularly? Join a gym on your way home from work or put exercise equipment in front of the TV.
But there are reasons we live the way we do. To choose something different requires that we control our impulses to do the same things we’ve been doing. But what if we simply don’t have enough self-control? David Desteno, a professor of psychology at Northeastern University, advises that self-control gets a bad rap because it’s often linked to deprivation and discomfort. Instead, he has shown that we can access our self-control with feelings of “gratitude, compassion and an authentic sense of pride.” As you approach your new activities, take a moment to recall an event that made you feel grateful. If your new activity involves helping others, feel your compassion for them before you leave your house. Acknowledge your skills and what you’ve already accomplished. Doing so will help you feel more inspired, capable, and ready to commit the time and effort needed to accomplish this new goal.
With these simple practices, we can make 2018 a year of growth and success.
What do YOU want to change or accomplish this year?
Want a successful 2018? Your Year in Review will point the way. Physician coaching helps us see where we’ve been so we know where we want to go next
Having lived in the same city for 35 years, I tend to shop at the same places, eat out at the same places, see the same people. I’m generally happy with all of that, or I would probably change my habits. And yet, as we close out 2017 and look forward to a new year, most of us hope it will be…happier, healthier, more productive, more prosperous, more fun, filled with more time with the people we love. Chances are, without an intentional and deliberate approach, 2018 will be a lot like 2017.
When we think about having “more” of something, we need to know our starting point. What made us happy and where was happiness missing? In what ways do we feel unhealthy now? What opportunities exist for us to become more productive or prosperous? What was fun and in what ways can we fill our next year with more of that? Who are the important people in our lives and how can we connect more?
I offer this Year in Review as a structure for you to take stock of your experience of 2017. Each question will prompt you to discover something important about the year you’ve lived and encourage you to create a vision and goals for the year ahead. Each of us has the opportunity to make 2018 MORE of everything we want. It just requires our attention, creativity, and commitment.
- Who did I meet this year that is now in my life? What do I value about this relationship? If I’ve learned something significant from this person, how can I put it to use in other areas of my life? In what ways do I want to develop this relationship in the coming year?
- What emotion caused me to grow? Emotions get a bad rap in our society. We’re taught they are dangerous, a waste of time, that we should “get over” them. In fact, emotions are the most reliable indicators of what’s true for us. Where we get confused is in appreciating the difference between acknowledging our emotions and expressing them. When we feel a strong emotion, something we care about is being ignored (and we feel angry, fearful, frustrated) or valued (and we feel happy, proud, grateful). Our emotional state is an early warning system that we are foolish to ignore, as our body language, tone of voice, or actions betray our true feelings. We’ve all experienced people with a frown on their face who insist, “I’m not angry!” when we inquire why they’re angry. As we tune into our emotions, we may find that our anger or passion spurs us to speak out or act, in spite of our fear of doing so. Becoming more authentic, honest and courageous offers us many opportunities to make a difference in our lives. Recognizing the power of our emotions helps us take greater advantage of this important source of information.
- In what ways am I different than I was at the beginning of the year? In what other ways do we want to use these new skills or characteristics in our life and the world?
- What did I do that completely surprised me? What allowed me to do this? As we know ourselves better, we become more confident and are able to use our talents in more intentional and productive ways. Since we surprised ourselves by doing this and are obviously more capable than we thought, what else might we want to do?
- What is the biggest challenge I faced? What was difficult about this? What internal and external supports helped me overcome this challenge? How might I put these supports to use on other challenges I’m facing?
- In what area(s) of my life did I make progress? What’s the next step I want to take with this? What am I still tolerating? How do I want that to change? What would make the biggest difference in my life?
- Whom did I help? What talents and skills did I use? Where else might they be of service?
- What am I most grateful for? How might I show my appreciation or experience more of this in the coming year?
- What were the most fun times I had? What opportunities do I have to include these activities or people more frequently in my life?
- A year from now, how do I want my life to be the same? How do I want it to be different? What is the first step I can take toward that end?
With my warmest wishes for a year of authentically being you – bringing your desires, passions, and gifts to every area of your life. The world is in need of everything you can offer. And in this way, 2018 will be filled with more of everything you want.
Dreading the holidays? Not if you give the gift of acknowledgment! Physician coaching makes the season festive
Here we are again! Another year has passed and we’re searching the internet, stopping by the mall, wondering what to get the important people on our lists. There’s always a new piece of technology or a good book, and most people appreciate something new for their wardrobe. Giving a tangible item is gratifying if the person shows excitement. Unfortunately, if the response is more subdued, we’re left wondering if we missed the mark or even insulted the person with our choice. Years ago, I was given a name necklace that read, “Helen.” While Helen is a beautiful name, it’s not mine. I recognized the people considered me important enough in their lives to give me a gift, but their choice didn’t do a good job of conveying their feelings toward me.
How do we let people know they are important to us? What gift can accomplish this goal every single time? The gift of acknowledgment is the answer to our dilemma!
Acknowledgement is simply letting a person know what we value about them. It may be a way they show up in the world – perhaps we count on them for their honesty. It may be something that they do for us – perhaps they make us laugh. It may be a way in which they inspire us – perhaps with their work ethic or the way they overcome adversity. Or it could be a single instance in which they made a difference in our lives – perhaps they covered for us so we could attend a family event.
Unfortunately, our profession (and society at large) encourages criticism more than compliments. “No news is good news.” We are told to assume that, unless someone points out what we did wrong, we are doing fine. So when we do take the time to acknowledge something we value, people notice. Often, they deflect the compliment. “It wasn’t a big deal.” “I wish I could be funny every time.” “Oh, you didn’t see the time I failed at that!” But if we hold our ground and repeat what we’ve said, they eventually understand they’ve been seen. And appreciated. That they made a difference.
We can deliver this sentiment verbally, with a note, or with a tangible gift that reflects what we find so valuable about each person. Goodness knows, there are refrigerator magnets that portray just about anything these days!
The results of our acknowledgments can be far-reaching. We get more of what we reward, so we encourage people to continue to bring this behavior into the world when we reward it with acknowledgment. We provide an important tool for people to begin to see their strengths more clearly, giving them greater confidence. We enhance our connection with them as they recognize we see and appreciate them. And we derive the pleasure of watching their delight. Bullseye! We have hit the perfect mark in gift-giving.
In The Fifth Discipline Fieldbook, Peter Senge describes a tribe in South Africa whose members greet each other not with, “Hello,” but by saying, “I see you.” The response to this is, “I am here.” There’s a lot of substance in this interaction.
What most people want is to be seen and to feel present and authentic in their life.
I can offer innumerable examples of people NOT being seen. Our daughter’s basketball coach never appreciated which players were best at guarding, dribbling or sinking 3-point shots and so let the talents of the girls go unutilized. While this was unfortunate, the inability to be seen pervades most of our professional lives, where it has even greater impact. Physicians aren’t valued for their excellent patient care because they are viewed as less productive than some of their peers. Budding leaders are passed over because those in leadership positions don’t take the time to notice their skills and desire to contribute. Our good ideas aren’t acknowledged because we’re not as forceful in asserting our opinions. It’s frustrating to not have people recognize what we have to offer – to not “see” us. It makes us doubt who we are and the value we bring. We wonder if we’re not seen because there’s nothing remarkable to see.
But being seen is just half of the equation. What about the part when we say, “I am here?” When we show up authentically and contribute in meaningful ways.
Much has been written about what holds us back from bursting out as the full version of ourselves. We fear we won’t be good enough or won’t be accepted. We secretly believe we’ve managed to fool people by hiding who we are and that, if they discover what’s lurking behind the facade we present to the world, they won’t like or respect us. The truth is, as Dr. Seuss so aptly advised, “Be who you are and say what you feel, because those who mind don’t matter and those who matter don’t mind.”
I’ve written before about my beloved cousin, who stayed hidden for decades. Now living as the transgender woman she is, she is a dynamic and positive force in her community, bringing people together to support important causes. While there have been difficulties in her transition, the aliveness with which she now lives is inspiring and she has found an acceptance and purpose that eluded her for most of her life. Until she decided to allow herself to be known, no one could actually “see” her. The “catch-22” is that, while we desperately want people to see and accept us, when we pretend to be someone we’re not, we never allow that to happen. We deflect any acceptance we receive because we secretly know that it is not our true self who is being accepted.
What aspect of yourself do you really want people to recognize? How can you let people know what you have to offer? In what way can you “be here” so that others can “see” the real you? Only by showing up as our authentic self can we bring our gifts to the world, connect with others and be accepted. Imagine how exciting it would be to live like that. To be here. And to be seen.
The Uber driver pulled up, saw our roller bags and exclaimed, “I’m so sorry! My trunk is filled with my gear!” I initially wondered why she would have agreed to take us to the airport, knowing her trunk was full. But, after easily placing our bags in the front seat, she explained she was in the Army band and needed to keep her gear with her at all times. She spoke more about her military career and shared that she had also chosen to attend “jump school,” where she learned to parachute out of planes. It had been a pivotal experience in her life. In spite of being injured in a jump, she emphatically declared she would do it all over again. This single choice had changed her perception of herself, increased her confidence, and allowed her to see she could expand beyond the limitations she had previously placed on herself.
It’s easy to see how our beliefs affect our choices. If we believe people are innately good, we are more easily trusting and helpful toward others. If we believe hard work will pay off, we apply ourselves and are willing to study or work extra hours in order to reach our goals. But this cause and effect relationship can also work in reverse – we can just as easily affect our beliefs by the choices we make.
If we make a choice in our relationships – personal or business – that doesn’t turn out well, we might easily start to believe we can’t trust ourselves to make wise decisions, or that honest, trustworthy partners don’t exist. That belief will then fuel other choices – not to open our hearts or engage in other collaborative efforts. Instead, if we formed the belief that this particular person wasn’t the right choice or we weren’t a good fit, our future choices might be very different. It makes it important to question any conclusion we draw from our experiences.
Many times we want to make a certain choice, but lurking in the wings and ready to derail our good intentions is a limiting belief we aren’t even aware of. We might choose to take on a leadership role but inwardly believe we’re too introverted to succeed. We might choose to begin an exercise program but secretly hold the belief that we don’t have the determination to stick to it. Although some beliefs seem grounded in our values and therefore set in stone, most are simply subjective thoughts. When our beliefs don’t support the choice we want to make, we are doomed to fail.
A very helpful step when we want to make a new choice in our lives is to explore the beliefs we have about it. What is the evidence for these beliefs? When we find a disempowering belief, we can ask ourselves what else we can believe that will make it more likely for us to be successful. Instead of believing we are too introverted to be a good leader, we can recognize that many successful leaders are introverts who bring significant strengths to leadership, such as greater inclusiveness and engagement of their team. How will that change our attitude toward becoming a leader? What new thoughts and feelings might that generate? As we experience the internal shifts by changing our belief, we can sense our commitment to our new choice growing stronger.
What new choices would you like to make? How much more exciting, fulfilling, or interesting would your life become, once you let go of limiting beliefs and find more empowering beliefs to support your new choices and success?
This weekend, I’m attending the SEAK conference, a large gathering of physicians seeking non-clinical career options. You might wonder why, after the time, energy and money physicians invest in their careers, so many want to walk away from it all. As we know, burnout affects more than half of all physicians. Many circumstances account for this epidemic – loss of autonomy, not feeling valued, frustration with increasing regulations and insurance company demands, erosion of the doctor-patient relationship, the disproportionate amount of time spent on clerical tasks…the list is long. As a physician, you’re probably cringing as you recognize the impact of each of these realities on your own satisfaction.
Many of these issues will require a change in the system in which we work or the culture of medicine in order to restore the sense of satisfaction that used to be the norm for physicians. If you are feeling burned out, waiting for a sea change doesn’t offer much hope. Is there nothing we can do to feel better now?
While it’s understandable to feel that our work IS our life, it’s crucial to realize that it’s only one aspect of it. Often, I’ve found that physicians focus their dissatisfaction on work, when their biggest source of unhappiness comes from somewhere else. This makes it worthwhile to take a look under the rug – at the other areas of our lives – to see where we have room and leverage to improve.
I’ve worked with clients who believed the source of their despair was work, when the greater concern was that their primary relationship was lacking in some way. Dealing effectively with their relationship led them to discover a more positive feeling about work. Others found that health issues were plaguing them, causing daily pain and anxiety. Once they addressed and found better ways of managing these medical concerns, they experienced greater comfort and confidence that permeated other areas of their lives. Still others, inundated by the demands of work and reluctant to share their concerns or feelings of despair, isolated themselves from friends and family. By reconnecting with these important people, their newfound relationships introduced a broader array of interests and balanced their lives, giving work a more reasonable and healthier degree of influence over how they felt.
One simple way to help us take stock of our lives is by using a “Wheel of Life.” This graphic allows us to easily see where we are most and least happy. By considering what would improve our assessment of each area, we can take steps to bring our lives closer to our ideal. We may still encounter the same frustrations at work, but as we lessen the dissatisfaction with other parts of our lives, we may find we’re better able to tolerate those frustrations. We might even discover we’re more creative and resourceful in dealing effectively with them. And we will open more avenues for joy to come into our lives. Work, although a passion and calling for many of us, is still only one aspect of our life. Let’s give it the proper amount of attention and not let it overshadow or limit the power we have to improve the overall quality of our lives.
Making our own well-being a priority – today and every day. A physician coach offers steps to improve patient care, extend our careers, and bring joy to our lives
9.5 million entries on Google for “physician wellness” speak to what a big topic it’s become. Hospitals, medical groups, and medical associations are including an increasing number of programs on physician wellness.
So why do 300-400 physicians continue to take their own lives each year?
Because, for many of us, our own wellness is at the bottom of our list.
We need to recognize that our well being is the foundation of good medical care. When physicians are stressed or suffer from depression or anxiety, the quality of our care is negatively impacted. Our productivity diminishes. We leave our profession, or we leave our lives. Wellness is like the people on the bottom of a human pyramid. Although we tend to focus on the person at the pinnacle of the pyramid – look at their grace, balance and poise! – without a firm foundation, they would topple. The same is true of our own personal wellness.
In her excellent article, Danielle Ofri cites the ongoing culture of perfectionism. Clearly, one needs to be fairly perfectionistic to obtain the grades and scores to get into medical school, to acquire exponentially increasing amounts of scientific knowledge and understanding, and to conform to high standards of practice. Knowing the stakes are high compels us to drive ourselves and keeps our anxiety levels high. As perfectionists, we focus on our small mistakes, our less-than-perfect outcomes, when a more balanced appraisal of our performance would be more accurate – and healthier. We can improve our well being on a personal level by keeping a journal of our successes and asking ourselves, “What did I do WELL today?” as each day comes to a close. This will provide a broader view of how we’re doing and allow us to balance our inevitable shortcomings with the many excellent actions and outcomes we provide.
As a group, we can address systemic problems – the inefficiencies of the EHR, a focus on productivity over quality of care, insensitivity to individual physicians’ needs. Arranging exam rooms so physicians can see both the computer screen and the patient should be imperative. Physicians’ requests to adjust their schedules so more complicated patients are given longer appointments or to allow for family or personal needs should be easily accommodated. Support staff such as scribes should be immediately incorporated into the routine and culture of healthcare, just as the EHR has been incorporated. This will help to alleviate some of the stress and will allow physicians to feel as if they are being supported by their organizations.
There are excellent, evidence-based interventions that build resilience and restore physician wellness. Shanafelt et al showed statistically significant improvement in all measures of burnout when groups of physicians met biweekly for an hour for mindfulness, reflection, shared experience and small group learning. The groups continued for 9 months and improvements were sustained at 12 months. The benefits of mindfulness practices and exercise are well known. We all know that nurturing outside relationships and passions improves our state of mind and lowers our stress. What’s missing is our own prioritization of these things in our lives.
When we give ourselves even a small amount of time to focus on us – personal reflection, activities that nurture our soul or reconnect with ourselves such as meditation or walks in nature, time with those we love, eating healthy foods – we tell ourselves that we are important. Good decisions like this lead to other good decisions during the day.
What will it take to make your own well being a priority? What small step can you take today to support yourself? Give yourself 30 minutes a day for your own wellness, and watch your life immediately improve.
(Hint: For some ideas, click here)