The holidays are upon us and it’s the time of year that is supposed to bring cheer. Being with loved ones and celebrating together. Returning to places that bear fond memories. Exchanging love and gifts. The oft-romanticized season brings the belief that we’re supposed to be happy, and a sense of wanting if we are not.
Societal expectations surrounding the holidays can leave many feeling a sense of insufficiency and isolation. There may be deep frustration and disappointment, and sadness aplenty. We may experience the loss of family and love, wish our lives were different, or hope for things that might have been. We receive little modeling about how to manage sadness, and many people work hard to push this emotion away. As we navigate the internal conflicts that come with events like the holidays, there’s an important question to consider: is it better to avoid sadness or does sadness have an important role in our emotional well-being?
Pixar’s recent movie, Inside Out, sheds light on this question. Populating the mind of a teenage girl named Riley, the movie has five main characters: Joy, Sadness, Anger, Fear, and Disgust. While Joy, voiced by Amy Poehler, tries to push Sadness as far away from Riley’s consciousness as possible, Sadness comes forth as Riley’s family move across the country, she loses long-time friends, and has trouble fitting in with the new crowd. Joy’s attempts to quell Sadness contribute to Riley feeling confused and angry, and becoming isolated from her family. We witness how difficulty managing emotions can lead teens to make impulsive and dangerous choices. As Riley’s external world becomes more and more impacted by her volatile emotions, Joy finally realizes that it’s critical for Riley to experience sadness as part of her path to happiness.
The movie, and its exploration of emotions, is based on well-founded research. Dr. Dacher Keltner, a psychology researcher at UC Berkeley, worked as the scientific advisor to the movie as did Paul Ekman, whose research on a multitude of cultures initially identified these universal emotions.
Movies like Inside Out use popular culture to help show how to normalize emotions. Meanwhile, research, like that from the Greater Good Science Center and on emotional intelligence, provides evidence that sadness can help people improve attention to external details, reduce the bias formed by inaccurate judgments, increase perseverance, and promote generosity and learning. It may even promote the formation of new memories. And being more comfortable with a wider array of emotions decreases stress, and increases one’s ability to face and manage conflict and change.
However difficult it is, experiencing sadness is a crucial part of life. Don’t be hard on yourself if you feel it during the holiday season. In fact, increasing your comfort with emotions that you once tried to avoid leads to heightened confidence and balance. So, if you find yourself feigning a smile or grabbing another slice of apple pie to dull your sadness, try to remind yourself that your body and mind are feeling this for a reason. It might just make you happier in the long run. While our sadness most likely has different roots than that of a young teen, we can learn from Disney and perhaps get to know our own emotions a little bit better.
It’s that time of year again when many people are already feeling a sense of inadequacy around their New Year’s resolutions. While yearly resolutions help some, the tradition is often unsuccessful. The goal may be too big, it can be challenging to maintain motivation by oneself, and the tendency toward self-criticism are but a few of the factors that combine to make realization of one’s goals a daunting task. The good news is that simple strategies can help you reach your goals. Try these 10 tips:
- Start small.
Taking on a large goal is tempting, but it’s also the most sure-fired way to fail. If the goal is too much of a stretch, it can fuel a downward cycle: lack of achievement, decreased motivation, and self-criticism. By starting small, you increase the likelihood of taking the vital action steps, and each “win” helps build your belief that you can achieve your goals. This creates an upward spiral of confidence, motivation, optimism, and competence: all key ingredients of self-efficacy and success. Gary Hamel, author of the 2007 Amazon best business book of the year, The Future of Management, defines the key to success as “win small, win early, win often.”
- Envision success.
Envision a day in the future where you’ve accomplished your resolution. Close your eyes and sit for a few minutes, letting yourself bask in the experience of having reached your goal. Experiencing this wonderful state is much more motivating than berating yourself over something you weren’t able to accomplish. It can help you shift your focus to self-motivating questions such as “what small step can I take TODAY to help me get to this feeling?” and “what is a new way of thinking about my goal that will help me experience more of this feeling?”
- Let go of old goals.
If you haven’t moved forward on a goal year after year, it’s time to think about what’s holding you back. Putting something on the list after years of not succeeding can start the year off with a sense of shame and disappointment. One option is to include a resolution to forgive yourself for things you didn’t accomplish and start taking credit for all that you do achieve.
- Keep your list short.
Would you rather succeed at three out of three resolutions or one out of ten? It’s much easier to focus on a small number of goals than a long list. And think of the satisfaction you’ll have checking each one off!
- Focus on “wants” instead of “shoulds.”
Focus on what you truly want to achieve, rather than on things you believe you “should” be achieving. To be successful at any life change, you have to really want it. It pays to take the time to consider what it is that you truly want, teasing out the things others have said you should do or stop doing. Similarly, Ryan and Deci’s theory of self-determination tells us that intrinsic motivation is much more powerful than that generated by external forces.
- Resolve to “be” instead of “do.”
Make sure to include resolutions that involve “being” and not just ones that require “doing.” For example, a resolution could be: “This year, I will have more moments of being present with my family, times where I’m not focusing on all the work I have to get done.” “Being” resolutions are ones that you can achieve at any time. Even if you stray on a “being” resolution, you can accomplish it the next day… or even in the next hour.
Start every day off by planning one small step you’ll take to get closer to your goal. This method of breaking down the larger goal into more feasible parts is a great way to make incremental change. It also reminds you that you, truly, are in charge of your fate.
- Find an accountability partner.
Whether it’s your spouse, a friend, a coworker, or a coach, it’s much easier to follow through on goals if you have a buddy. In the best-case scenario, you’ll hold one another accountable. Tell your partner to go big on the cheerleading and championing as it’s much easier to succeed when there’s someone rooting for you and shouting, “I know you can do it!”
- Don’t use your resolutions as a means to beat yourself up.
This is an area where many people falter. If you’re like most people, you probably have plenty of inner critics badgering you as it is. New Year’s resolutions provide fodder for these pernicious and ever-present gremlins. It’s much easier to move forward from a place of competency and strength rather than one of deficit and inadequacy. Try to keep your focus on what you are accomplishing instead of what you are not.
- Don’t let a sense of failure stop you.
It’s all too easy to swing from the high of “this is the year I’ll accomplish X” to the low of “I just did the opposite of X; I’ll never achieve my goal.” In reality, every day represents a new opportunity to move toward your goals, so go ahead and be sure to seize an opportunity. This is true for New Year’s resolutions and true for any goal in your life. If failure presents a major hurdle for you, you can always think back to #6 and try to “be” instead of “do.” You might be surprised at how a change in perspective—viewing failure as a platform for growth instead of for sinking—can help you achieve different aspects of your goals.
Go forth and decide what steps you’ll take today. Even if you falter from your path, every moment of your life can be used to institute change. Remember, self-improvement is always within your reach.
An Interview with Harvard Medical School’s Empathy Expert
Dr. Helen Riess’s research on empathy, based on ground breaking studies at Massachusetts General Hospital, has been the subject of articles, radio discussions, and a popular TEDx Talk. Riess’s focus on educating physicians and medical professionals on the use of empathy in medical practice is an old yet revolutionary idea, one that ties directly to the epidemic of physician burnout. Dr. Riess’s belief that empathy can be both taught and learned has led to the creation of Empathetics,LLC, an empathy education program for physicians, nurses, and other medical professionals, where she serves as the Chief Scientific Officer.
Dr. Riess, an Associate Professor of Psychiatry at Harvard Medical School, is the Director of the Empathy and Relational Science Program at Massachusetts General Hospital. Her approach to empathy in medicine is meant to aid physicians in cultivating a better medical experience and a sense of personal well-being for both the patient and the physician.
In the following interview, Dr. Riess explores her interest in empathy, her research, and how empathy coaching can help medical professionals.
Why is empathy so important for physicians? Why now?
As a psychiatrist, my work has been strongly influenced by the work of Heinz Kohut, who was one of the first in the field to hypothesize that empathy was the sin qua non of good medical care. Kohut believed that by taking the patient’s perspective, physicians could better understand what patients experience and thus be better positioned to effect improvement in their health. In the last decade, many of my patients have talked about difficulties in the physician-patient relationship, a sense of not being heard or understood by their physician. I found it very disturbing that patients spent therapy time talking about being dismissed by physicians around issues of importance to them.
In this same time period, understanding and awareness of physician burnout has emerged. We are understanding more clearly that medical training seems to blunt the empathy medical students first bring with them to medical school. The confluence of seeing what was happening with my own patients with national trends in physician burnout led me to look more deeply.
I began to wonder: If empathy can be down regulated in medical training, could it be up regulated? Could increased empathy help to decrease physician burnout?
What has your research revealed overall?
That human beings are hard wired for empathy.
Being able to take the perspective of another and appreciate their suffering underlies survival of our species, through cooperation and through shared concern of one another. We have visual, auditory, tactile, and emotional resonance when we see fellow humans suffering. This calls forth our own emotional responses that make us want to help. However, this ability is quite mutable, subject to many conditions that affect medical professionals. Based on multiple studies, people are most likely to help people who are most like themselves, or if they are dissimilar, those who have suffered in a similar way. For example, if both have lost a child, both will have more empathy that transcends their personal differences.
Medical professionals need to be reoriented back to the humanity of each individual they care for. Left unaddressed, lack of physician empathy is only going to worsen given the increasing time constraints, emphasis on productivity, and the many other growing pressures physicians face. Unfortunately, lack of support for their own needs will lead to more and more resentment and compassion fatigue. It’s similar to trying to draw water from a drying well. It’s simply not sustainable.
What did your research reveal on an individual level?
I designed courses that address improving awareness of other, self-regulation in difficult situations, ways to open the mind to what others are experiencing, and to shift perspectives to evaluate all this rationally. I studied this in over 100 residents from 6 different specialties. Physicians were taught how to empathize with the person’s experience rather than the person, who may be behaving in a difficult manner that shifts attention away from their suffering. For patients that were the most challenging to empathize with, physicians were able to increase empathy. Learning how to see the person behind his or her difficult behaviors helps to bring out natural tendencies to help. With a brief, 3 hour spaced education training, there was significant improvement in taking the patient’s perspective.
Additionally, I found that once awareness heightened, physicians wanted to develop empathy even more. The demand for this training began to far exceed what one person could meet. This was the impetus for creating an e-learning training company, which led to the formation of Empathetics. We did not want there to be any impediment to creating true culture change in large organizations, so the e-learning platform was built.
Do you see empathy training as a stand-alone program?
The Empathetics e-learning platform can easily be combined with other coaching strategies. Optimally, every person could use an individualized approach. This could include live classroom facilitators when a blended learning approach is desired for group or e-learning combined with individual professional coaching. Empathy e-learning may be sufficient to move people from good to excellent but others may need more specialized attention. For example, my recent paper with Drs. Gazelle and Liebschutz addresses the use of professional coaching to mitigate physician burnout. Physician coaching, in addition to what can be learned from the web-based platform, can help physicians find deeper satisfaction in a career that, frankly, has become very burdensome.
How is this tied to the future of medicine?
My dream is that all physicians will become more empathic and that there will be no barrier to empathy training. Increasing empathy can increase sense of meaning, coherence, and inspiration for physicians drowning in administrative burdens. What we offer through Empathetics is a basic CME course that is accredited by the Massachusetts Medical Society that could deeply impact how medicine is practiced. The training is available both for individual learners and large group cohorts.
Empathy makes both parties feel good. Because really, at end of the day, what could be more gratifying? As George Eliot said, “What do we live for if not to make life less difficult for each other?”
Dealing with physician burnout in a colleague
Two hours of administrative tasks for every hour with patients. A proliferation of non-physician administrators deciding how the day is going to run. Little in our training about how to cope with uncertainty and change. It’s no surprise that physician burnout rates are approaching 60%. Despite being so common, when we see a colleague struggling with physician burnout, we may not know what to say. Responding appropriately can bring someone back from burnout and may even save a life. Here are some tips to help with physician burnout in a colleague.
Approach the situation with compassion
Burnout is often referred to as erosion of the soul, and for good reason. With it comes a great sense of despair, hopelessness, and isolation. We lose our perspective.
Often there is no better remedy than the kindness of a colleague, someone who has walked in our shoes and knows what we’re experiencing. Approach the colleague with the empathetic aim of letting them know that you care about them, you’ve noticed that they are struggling, and you’re there for them. Afraid of saying the wrong thing? Here are some ways to convey your concern.
“I can see you’ve had a rough week.”
“I’m concerned about you.”
“I get why you’re feeling this way.”
“I don’t have answers but I want you to know I’m here and I care about you.”
“You deserve to feel better.”
“I know these feelings will pass.”
Normalize the experience
With burnout comes a sense of personal inadequacy. Everyone else seems to be coping with all the stress. What’s wrong with me? Tell your colleague that what they’re experiencing is normal and that many physicians are having the same feelings. Let them know there’s nothing wrong with them. Make it clear that these harsh feelings do not mean that they are a failure. And, no matter what they’re thinking, that experiencing physician burnout is a normal response to the stressors of modern practice and doesn’t mean they’re in the wrong career.
Don’t problem solve or give advice
As physicians, we’re conditioned to fix whatever problem the person in front of us has. It is quite literally what we are trained to do. But with burnout, we need to suspend our desire to problem-solve. Instead of doing something, we need to focus on simply being present with a colleague’s suffering.
On that same note, we also need to avoid giving advice. Giving advice sends an implicit message that the person doesn’t have the inner resources to solve their problem. Not only that, but the last thing someone wants to hear when they’re low on energy, overwhelmed by demands, and disconnected from any sense of meaning is “I know how to solve your problem, here’s what you should do.” Simply listening without suggesting any action can help someone in burnout begin the critical step of gaining perspective on their situation.
Help them connect with their accomplishments
When we’re in burnout, we’re focused on everything that’s wrong, with the workplace and with ourselves. We’re disconnected from meaning and purpose. Positives slide off us like Teflon and negatives stick as if attached by Velcro. Whatever our strengths and accomplishments may be, we believe we have none. It’s critical to find a way to reconnect with the things we are accomplishing.
Ask your colleague if they’d consider keeping a running list of three things they accomplish every day. This simple exercise can provide ballast against the pull to inadequacy and negativity, and potentially help relieve some of the symptoms of physician burnout.
Let them know seeking help is not a sign of weakness
We learn early in training that seeking help is a sign of weakness. We’re the head of the team and we’re supposed to have all the answers. Yet, we can’t solve every problem by ourselves (no one can.) Reassure your colleague that asking for help is a sign of health, not weakness. Recommend that they speak to loved ones and other colleagues. Encourage them to seek coaching or other professional help.
While you can’t change the external landscape, know that applying these tips can make a big difference in a colleague’s ability to see a way forward.
In summary, remind yourself to listen compassionately. Normalize their experience. Avoid the temptation to give advice or problem-solve. Help them see their strengths and accomplishments. Let them know that seeking help is often vital and is not a sign of weakness. Reassure that they can find a way to meet the intense demands of practice with much less anguish.
Get more resources on physician burnout.
Data confirms high rates of physician burnout, but it doesn’t tell us how burnout can be avoided. In fact, data on preventing physician burnout is almost nonexistent. One thing we do know, however, is that physician leadership skills a key variable. Physician leaders can make or break a workable culture. A 2015 study from the Mayo Clinic found that qualities of physicians’ leadership accounted for 47% of the variation in physician satisfaction and 11% of the variation in physician burnout. Looking at their study, a number of leadership attributes stand out that can be helpful in avoiding physician burnout.
If you’re a Physician Leader or Executive looking to bolster their management and physician leadership skills, learn more about my Physician Leadership skills and Executive Coaching services.
Physician leadership skills and physician compassion
Compassion is a core value for most physicians but is increasingly bypassed in medical practices. Recently, I coached a 47-year-old Internal Medicine medical director who oversaw 80 primary care physicians. Much of the stress of his job was conveying edicts from the administration to the physicians he supervised. At the end of a particularly terse medical director meeting, the Chief Medical Officer bluntly told the medical directors that, in addition to recent cuts, they would need to inform their physicians of a further 10% pay cut. There was no discussion of the impact this would have and the news was delivered in a cut and dry fashion. My coaching client felt morose, defeated, like a cog in the wheel of the healthcare factory. The communication had flown completely in the face of compassion, a core value for him. He wondered how much longer he could go on in his position. He noted that if the same news had been delivered with concern for the impact it would have, while the consequences would still be painful, he would have experienced a greater sense of hopefulness and community. I coached him around maintaining his values by learning from this experience and never repeating this type of conduct. We continued to focus on making sure that each and every one of his communications conveyed the compassion he knew first-hand was vital in maintaining morale and avoiding physician burnout.
Employee engagement has been hailed as the single most important factor in determining levels of satisfaction with work. In a 2012 meta-analysis of research studies, Gallup found that compared with the bottom quartile, companies in the top quartile for engaged employees had 22% higher profitability, 10% higher customer ratings, and 48% fewer safety incidents.
Engagement is the antithesis of burnout. The many administrative burdens physicians face making it difficult for physicians to engage fully with their most important task: caring for patients. Physician leadership skills makes a pivotal difference. Given the many metrics coming down the pike, leaders need to constantly orient their approach around such questions as: “While metrics need to be pursued, how can I focus on how hard my physicians are trying rather than whether they’re meeting each specific target?” “What actions can I take today to help my physicians feel more energized and engaged.” “How can I facilitate my physicians performing at their best?” Sometimes small actions go a long way to facilitating engagement.
Recognizing a job well done
Everyone wants to feel valued and recognized for their contribution, yet in the current healthcare environment, too often the emphasis is on areas of deficiency rather than successes. A Chief Medical Officer I coached worked with her team to achieve large improvements in productivity. To remain competitive, however, metrics revealed that further improvement was needed. While her tendency was to focus on the gap between where clinicians were and where she wanted them to be, I coached her to focus on the gains rather than the deficits. She worked to ground each communication with her physicians on the strides they had made, identifying what strengths and skills they had used to make improvements, and assisting them in utilizing similar approaches to glean greater success. In a subsequent satisfaction survey, her physicians gave her the highest scores.
Communicating with positivity
We spend most of our waking hours communicating with others, but very often the rush keeps us from doing so in a respectful and positive manner. In a 2004 study of 60 top management teams engaged in annual strategic planning, the single most important factor in predicting organizational performance was the ratio of positive to negative communications. The research revealed that in high-performing organizations, the ratio of positive to negative communications in their top management teams was 5.6 to 1. By contrast, in low-performing organizations, the ratio was 0.36 to 1. In a recent physician resilience retreat I led, I asked the audience how their risk of burnout would improve if their leaders focused more on the positive. The responses were instructive: “It would be infectious,” “I’d be more productive,” “I’d be less irritable,” “There would be less spill-over with my family.” Anecdotally and empirically, the evidence for positive communication is high.
A principle of effective leadership is listening affirmatively and supportively, being open to the input of others, and not jumping in with one’s own opinion and advice. Leaders who inspire dedication, sacrifice and grit are ones who listen openly. As noted by Stephen Covey, effective leaders communicate with the goal of seeking understanding. A key skill is to ask open-ended questions. Open-ended questions communicate a deeper interest in the person’s response, increasing their sense of being heard. By shifting from questions that suggest a right and wrong answer, open-ended questions encourage others to respond more fully, contributing to greater engagement.
If you’re a physician leader, take heart in knowing that your actions can have a significant impact in mitigating physician burnout. Even if you’re suffering from physician burnout yourself, you can help motivate physicians to overcome the challenges they face. If you are a front-line clinician, please feel free to forward this post to your physician leadership. Many physician leaders are excellent clinicians or researchers and bemoan the fact that their physician leadership skills are limited. Most are happy to learn ways that they can improve.
If you’re suspecting a colleague may be suffering, here’s how to respond to physician burnout in a colleague.
How much time do you spend on mental comparisons? Looking on Facebook and thinking everyone else has better relationships and is much happier than you? Thinking that everyone in your peer group is smarter than you? Or fretting about how much fitter, thinner, smarter, or more successful you were at a different point in your life? Much of our stress, frustration, disappointment, guilt, and regret is the result of comparing ourselves to preconceived ideas about how we should be acting, how we should be looking, and how our personal successes are perceived by others. Theodore Roosevelt once said that comparison is the thief of joy. Indeed, comparisons often keep us in a mental hamster wheel of self-doubt and lack of confidence. To combat physician burnout, it is critical to decrease the tendency toward comparisons.
But comparison allows me to improve my performance
You may believe that comparisons keep you on your toes. Let’s test this out. Think about any times you’ve compared yourself to someone else in the past week. Did the comparison help you feel good about yourself and your circumstances or did it send you into a spiral of self-critical thoughts? Did you feel energized and optimistic about your circumstances or did you feel defeated, inadequate, and that your life would be forever deficient?
Like advertisements, comparisons hold us in the belief that if we only had product or service X, we’d be happier, feel and look younger, and be the king or queen of our world. While it’s always good to work toward life improvement, comparisons typically leave you unable to focus on the satisfaction inherent in your current circumstances. Comparisons push your focus onto either the past or the future, or simply what’s wrong with the present. Comparisons keep you from being content and perhaps more able to accept what is. Right now.
How to stop comparing yourself to others
As a physician coach, here are four steps I teach to overcome the pull to comparisons:
- Start tuning in to your own thought processes. Simply begin noticing when you are going into comparison-oriented thinking. Try not to judge yourself. Jot these instances down so you can begin to see how often this occurs.
- Once you’ve noticed that you’re making a comparison, name it to yourself. Say to yourself “there I go comparing myself again.” Doing this begins to create a distance between the comparison you’re focusing on and the reality of the situation. Having that distance and separation is vital in having choice and control over your own thoughts.
- Now ask yourself: What is the cost of this thought process? What would I gain if I spent less time on these mental comparisons? Journal about these questions.
Now for the challenge. When you find yourself making a comparison and coming up short, push yourself to think of at least three ways you, your circumstances, your thoughts, and your actions are right and adequate just as they are. Your mind will call you back to the land of comparison and self-criticism. Your job in this step is to exert equal and opposite force in the other direction! Definitely take notes here.
These steps take a lot of practice. What you will gain, though, is the ability to see your own strengths and accomplishments. You’ll find yourself experiencing more calm and a stronger sense of your own self-worth. Harkening the words of Theodore Roosevelt, you may even find yourself experiencing more joy.