Developing Presence |  A Mindfulness In Medicine Series

Developing Presence | A Mindfulness In Medicine Series

The Demystifying Physician Mindfulness Series

For many of my readers, the concept of mindfulness seems out of reach. The term evokes imagery of tranquil monks and bucolic hillsides, existing miles away, both literally and metaphorically. I created this series to shorten these distances, and to introduce mindfulness to practicing physicians as an easily accessible tool to combat physician burnout.

With the goal of demystifying mindfulness, I decided to create this 12 part series. Each post examines the relationship between mindfulness and a specific area of the practicing physician’s day-to-day life. They each include a physician’s story, and how the rigors of their practice currently hamper their ability to fully live that part of their life. After detailing their situation, I provide guidance for how that physician can utilize mindfulness to gain fulfillment in that area.

With each post, I give you an actionable step that will help you integrate that post’s topic into your daily life. I’m also going to give you an exercise that you can practice in your free time that will help strengthen your resilience, calm, and fulfillment. My goal is to transform mindfulness from a daunting, unapproachable ideal into a broad toolkit that you have easy access to. Simply put, I want to help you be a happier, more productive version of yourself, in the workplace and at home.

Without further ado, here is the second installment of Demystifying Mindfulness.

Today’s Topic: Mindfulness and Being Present with Patients

Our Physician: Dr. J, an internist in outpatient practice in the northeast. Dr. J writes:

I’m finding it almost impossible to be fully present with patients. I want to be 100% focused on every patient, but my mind seems to be everywhere else. I feel like such a crappy physician…on top of being overwhelmed with the workload I can’t even empathize with the people I’m treating. What can I do to be more present and caring with each of my patients?”


Dr. J


Dear Dr. J,

I want to emphasize two things: 1. This is something that almost every practicing physician experiences. And 2. As we continue our careers, it takes mindful effort to humanize our patients and maintain presence. We are overworked, are pulled in countless directions, and often have other things on our minds, like responsibilities outside of work. It’s not easy to give 100% of yourself to the patient in front of you when all you can think about is the charts you need to finish. Not only that, but we weren’t trained to empathize with patients! We were taught to be diagnostic scientists, not present, caring doctors. Compassionately dealing with each patient you see requires intention and cultivation. Here’s what I recommend:

Set an intention. You deciding that you want to be more present with your patients is powerful. Before each day of work, decide this again! Setting an intention for your day helps you chart your course, so you avoid finding yourself at the end of the day not having acted  the way you would have liked. The goal is not to be perfect here, but to begin to shift toward your goal. Intentionality is the root of mindfulness, and this is a concept that I’ll expand upon in future installments.

Commit to cultivating empathy toward your patients, and toward yourself. When you’re with patients, and you notice your mind wandering, remind yourself that you want to be more present, and return to the human being in front of you. The more times you remind yourself to feel this way, the more empathy you’ll develop for your patients and for yourself.

Most importantly, don’t beat yourself up for not being perfect. Forgive yourself if you aren’t as present as you’d like to be. Self-compassion is a crucial component of living mindfulness. While it may seem counter-intuitive, the kinder you are to yourself, the more likely you are to enact the changes you want to make.

Deciding that you want to be more present and caring with patients is an important first step. Implementing these mindful strategies will take you the rest of the way.

To your resilience,


Managing the Vortex of Fear

Managing the Vortex of Fear

Uncertainty can elicit a deep sense of fear and ill ease. Fear, like all emotions, has its place. We need to recognize this feeling and take time to tend to it. When fear becomes the major driver, however, it can take us to a dark place. Fight or flight is vital when we need to take rapid and immediate action for safety or for survival. When we don’t, fear can be paralyzing, leaving us feeling powerless, hopeless, and stuck. Fear breeds hostility, rigidity, and takes us to a place of reactivity as opposed to one of thoughtful and mindful activity. When we’re in fear, we move out of compassion for ourselves and for others.

To stay grounded and focused, we need to assess. What’s being triggered? Is it my safety and security? My sense of well-being? In this moment, am I facing a real threat? Or is my fear related to something that hasn’t even occurred, and may or may not occur in the future? This discernment is critical so that you can mobilize resources to cope with whatever it is that’s right in front of you, and build reserve to face future challenges as they unfold.

Check in with yourself right now. How resourceful are you when you’re in a place of fear? When you look back on decisions you’ve made based on fear, do you believe that you’ve made the best decision? Have you seen others make wise decisions? Now ask yourself the following question: when you’re at your best, are you letting fear steer your course or are you able to notice your fear, center yourself, and move forward from a constructive place? What would be different if your focus shifted from fear to calm and equanimity?

Once you’ve righted yourself, you can decide what action is the right next step. In the face of fear, small actions are best. You can set a daily intention to tune in to yourself and notice when fear is nipping at your heels.

Gandhi said “The enemy is fear. We think it is hate; but, it is fear.” His words ring true in the current political environment. Managing one’s fear could never be more important. Like anything, this requires practice. It’s well worth it, though, so that we can live with a sense of peace and contentment. So we can make decisions that we don’t later regret. So we can mobilize resources to be our best with all people we meet.

Please leave your comments and suggestions below so others can learn from your experience.

Combat Physician Burnout: Stress Strengths, don’t Strengthen Stress

Combat Physician Burnout: Stress Strengths, don’t Strengthen Stress

Focusing on Your Weaknesses Won’t Make You Stronger

In this week’s post, I break down why physicians should Stress Strengths rather than Strengthen Stress in order to combat physician burnout.

Last week, I was speaking with a medical director at a large practice who was telling me that he couldn’t understand why the physicians in his group were having trouble getting their charts done on time. I asked him what sorts of strategies he’d employed to try and make the situation better, and he told me he had:

  1. Issued email warnings
  2. told physicians that their pay would be docked if they didn’t do better, and 
  3. posted comparison charts of members of the group. He could not fathom why the performance wasn’t improving.

I also recently sat in on a meeting with a client of mine (an internist) and her non-physician supervisor. To my disappointment, the entire meeting was focused on patient wait times, an area where the supervisor determined she was not meeting targets. Not one word was spoken about the internist’s improved Press Ganey scores, the gains she’d made in consistently starting her day on time, and the positive comments staff had made about her performance. At the end of the meeting, my client broke down in tears.

How can anyone expect me to succeed when all they do is point out my shortcomings?”

Physicians are hyper-focused on their own flaws; we don’t need a supervisor to point them out for us. Negative reinforcement is an old and outdated leadership approach. A person’s path to growth and improvement lies in mobilizing their areas of strength.

Meeting with “the big bully” and seeing the “wall of shame” erode self-esteem and don’t lead to improvement. If you’ve been on the receiving end, you have no difficulty understanding how damaging these strategies can be.

What Research Shows About Negative Reinforcement

Gallup conducted a study when they analyzed over one million work teams. They found that only 9% of employees who are forced to work in an area of weakness are engaged, while 74% of their counterparts who are allowed to work in an area that uses their strengths are engaged. This isn’t a minor difference either; the gap is staggering.

Engaged employees tend to be more productive and happier at their work. One of the easiest ways to increase employee engagement is to help them align with their strengths.

Let’s try a simple exercise:

Think of a task you’ve been putting off completing. Imagine that you’re sitting down to do it right now. For 60 seconds, think about all the ways you believe you’re inadequate to get this task done:

  • I’m not smart enough
  • I’ll never get this all done
  • I’m not as disciplined as others
  • I’m a great procrastinator

Don’t hold back, pick your poison!

Now, mindfully, check-in with yourself. Rate your level of motivation to do the task on a scale of 1 to 10, where 1 = no motivation at all and 10 = let me at it!

Next, switch your focus to all the ways you’re more than adequate:

  • I’ve gotten this type of thing before
  • I am accomplished and well-regarded
  • I’m good at this type of task
  • Even when I procrastinate, I always cross the finish line

Sweeten the pot a little more by giving yourself an extra 30 seconds to think how good you’ll feel once the task is off your list.

Now check-in with yourself again.

Want to combat physician burnout symptoms but not sure what your strengths are?

While you may be used to focusing on your weaknesses, in your roles of physician and family member I can assure you that you have many. You simply could not have made it this far without them.

An easy way to find your strengths is to complete a basic personality traits test like the one provided by the University of Pennsylvania Department of Psychology.

How this relates to physician burnout combat

I’ve written about physician leadership and burnout in the past, and it’s clear that a deficit, weakness-based focus, and burnout go hand in hand.

If we want to avoid burnout or find out how to combat physician burnout, the strategies I mention in this article are key:

  • Stop focusing on what went wrong and start focusing on what went right
  • Help others see their strengths

Want to learn how you can reduce, deal with physician burnout, and promote healthy physician leadership?

Get my Anti-Burnout Physician Leadership checklist for further FREE tips on how to combat physician burnout.

Five Reasons to Hire Yourself as Chief Life Officer

Five Reasons to Hire Yourself as Chief Life Officer

Every organization has a leader, from presidents to department chiefs to CEOs, CFOs, CMOs, and even CROs (Chief Risk Officers). So what is a CLO? It’s the most important one of all: Chief Life Officer. It’s a position that is open in each of our lives but the one that’s least likely to be filled.

Many people live according to the wishes and desires of others, living with a sense that they don’t take enough charge. Some may take charge in one area of their life but let others slide. Others may simply let the winds of life decide their course. Wherever you are on the spectrum, there is often a lot of dissatisfaction with the perceived amount of day-to-day control. If you want to become more resilient to life’s challenges, it’s vital that you have a sense of internal control. It’s thought that strengthening internal control decreases burnout. Thinking of yourself as your CLO is a good way to strengthen this sense.

Becoming your own Chief Life Officer involves taking stock, thinking about what is most important to you, and questioning how you define success for yourself. It’s about aligning your life with your deepest values and claiming the meaning you want. Here are five key questions to help you build an individualized “job description” for your CLO.

    1. What are your core values? Is it having meaningful relationships?For many, the meaningful relationships in their lives are what they hold as most important. Or is it determination? Trust? Is it behaving with integrity, fighting injustice, appreciating nature, maintaining orderliness, or acting with compassion?A simple exercise you can do is to picture an experience where you feel you acted at your best. This could be anywhere — at work, on a vacation, or with family or friends. Take a few minutes to identify and recall that experience. See if you can relive it vividly, right now, mentally, physically, and emotionally. As you do so, focus on why you picked this particular experience. Notice what it was about how you acted that felt so right. Look at this list of values and notice which ones resonate for you. It’s the things you uphold when you’re acting at your best, as defined by you, that is your shortlist of core values.


    1. Are you living according to your own internal compass?Once you’ve established a clearer sense of what is most important to you, perform an internal “audit” to see whether you’re living in a way that is aligned with your core values. Look over the past few weeks of your life. Did you act according to what’s most deeply important to you? Look at what’s on your calendar for the week ahead. Can you think about how really living these values can help you with tasks and challenges? The more you can uphold what is truly important to you, the more you’ll be in the driver’s seat of your life, and the more you’ll feel proud of your actions, small or large.


    1. How do you define success for yourself?For many of us, much of our sense of success has been built on external measures or what we think others expect of us. It’s all too easy to follow the path we believe we should follow rather than the one we truly want. We may base our sense of self on external parameters such as job stature or expectations from others. Take time to notice which successes truly matter to you and which ones don’t.Establishing your own definition of success allows you to find happiness, satisfaction, and a more fulfilling life. Wherever you are on your life path, your CLO can help take you a few steps further.


    1. What’s your vision of your life?When you think about who you are at your best, what is it that you offer to the world? We each bring unique gifts, strengths, and talents to our community, workplace, and to those around us. At times you may feel small or like you have little control over your life. In reality, though, you are the only person who has control over your own mind and over your actions. If you don’t develop and pursue your own vision, you can be sure that no one else will.One way to develop your vision is to think about who you want to be in the future. Jump ahead five years and picture what you want your life to look like. Combine your core values, your definition of success, and your uniqueness. Let yourself think large. Take some time this week to think about what you dream about achieving and about what legacy you want to leave. Begin writing your personal vision statement.


  1. Are you spending time in ways that reflect what’s truly important to you?When you’re clearer about your vision, you can think more about how you spend your time and make more mindful choices. Although you may be working more than you’d like or doing many things you need do to stay afloat, being in touch with your CLO helps you carve out time each and every week to move closer to the things that are truly important in your life. It may be only a few minutes, but it’s critical that you delegate where possible, say “no” to extras, and say “yes” to things that are in alignment with your life vision.

It’s hard work and takes a lot of practice, but it’s your life we’re talking about here. What could be more important?

As with any new position, there’s a learning curve to becoming your CLO. It won’t happen overnight. It’s a process of self-examination, self-awareness, and intentionality in your actions. What step can you take today to begin to fill this vital role? If you don’t fill this role, who will?

Leave your comments and suggestions below so others can learn from your experience.

Holidays and the Science Behind Sadness

Holidays and the Science Behind Sadness

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.

Retooling New Year’s Resolutions to Set Yourself Up  For Success

Retooling New Year’s Resolutions to Set Yourself Up For Success

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:

  1. 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.”
  2. 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?”
  3. 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.
  4. 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!
  5. 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.
  6. 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.
  7. Plan.
    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.
  8. 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!”
  9. 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.
  10. 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.