The Demystifying Physician Mindfulness Series
Does Mindfulness In Your Medical Practice Seem Unachievable?
For many of my readers, the concept of mindfulness may seem out of reach. The term evokes imagery of tranquil monks and mountain tops, existing miles away, both literally and metaphorically. I created this series to bridge this distance, and to introduce mindfulness to practicing physicians as an accessible tool to combat burnout.
Each post in this series will examine the relationship between mindfulness and a specific area of a physician’s day-to-day life. They each include a physician’s story, and how the rigors of practice hamper their ability to fully enjoy that part of their life. After detailing their situation, I provide guidance for how the physician can utilize mindfulness to gain fulfillment and mastery in that area.
With each post, I’ll give you an actionable step that will help you integrate the post topic into your daily life. I’ll also provide 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, at the workplace and at home.
Without further ado, the inaugural installment of Demystifying Mindfulness!
Today’s topic: Overwhelm
Our physician: Dr. P, is a cardiologist in a large Midwestern practice:
“I don’t know what to do. I feel like I’m drowning in my work. Every day of my practice feels like a battle, and when I’m with patients all I can think about is getting to the end of my day. I used to be in love with my practice and I don’t know what happened. Now, my work feels meaningless, and I’m completely overwhelmed. What can I do?”
Dear Dr. P,
You’ve already won half the battle. You’ve noticed that you’re locked in an ineffective pattern at work, and you’re interested in strategies to improve your situation. This realization is no small thing! What I want you to start doing is focusing on your physical experience. You’ve just wrapped up with your last patient of the day, you’re late to make it home for dinner with your family, you still have a half dozen charts to complete – what does your body feel like? Is your heart rate elevated? Are your hands tense? Are you sweating? Get in tune with the physical sensations that accompany the feeling of overwhelm, and you’re well on your way to combatting it, and feeling more in control.
Physical sensations often precede feelings of overwhelm; in some ways they’re an early warning system that can help you break the vicious cycle. Once you notice these physical precursors, take a brief pause. If you can take 5 seconds in between patients to take deep breaths and ground yourself, that’s a victory. See how many of these pauses you can give yourself in a workday. While this may seem trivial, over time, mindful pauses will begin to weave together into a calmer day, and a calmer and happier life.
In addition to your feelings of burnout, you wrote that you no longer feel connected to your work. Overwhelm and lack of passion and fulfillment often go hand in hand. Of course, it’s challenging to stay connected to work when it’s so demanding. Reducing feelings of overwhelm by mindfully pausing throughout the day will help you feel more authentically connected to your work, and may revive some of the enthusiasm you’ve experienced in the past. Reciprocally, mindfully nourishing your commitment to patients will shrink feelings of overwhelm.
At the end of every day, I encourage you to write down things that went well in your day. Focusing on what went well can reconnect you to your strengths and your sense of meaning. As doctors, we are trained to focus on what is going wrong. Give yourself structured time to focus on what is going right.
Give this mindful strategy a shot and look forward to being more present and fulfilled in your practice.
To your resilience,
Dr. Gail Gazelle
Have an idea for a future Demystifying Mindfulness post? Want Dr. Gazelle to help you tackle your problem? Write in at email@example.com or contact us on the website.
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.
When you wake up in the morning, are you ready to take on the day, or do you want to pull the covers up over your head and crawl into a cave?
As noted in a recent New York Times article, “Why You Hate Work,” a 2013 Harvard Business Review study of 12,115 white-collar workers revealed that 70% of workers do not have time for creative or strategic thinking at work, and 50% do not find meaning and significance in their workplace.
This problem of finding purpose or engagement at work affects all white-collar workers, including physicians in nearly every specialty and field. A pioneer in burnout research, Christina Maslach defines burnout as a three-dimensional syndrome made up of exhaustion, cynicism, and lack of sense of meaning and accomplishment. Does any of this resonate for you or the physicians you know?
As a physician coach, I have worked with many clients suffering from physician burnout who are not only dissatisfied in their work, but feel disillusioned and without purpose.
I recently worked with a mid-career neurologist who was frustrated by the never-ending changes in her workplace. It seemed as if the rules changed by the week, with hard-to-understand updates to the EMR, and rotating practice managers, one more challenging to work with than the next. My client became so lost in frustration and negativity that she wondered why she was even practicing medicine anymore.
Engagement is the antithesis of physician burnout, and is defined as a positive, fulfilling, state of mind characterized by vigor, dedication, and a sense of flow in one’s day.
The New York Times article points out that employees are more satisfied and productive when their foundational needs are met, including creativity, value, and a sense of connection and purpose at work.
When engaged, white collar employees are more motivated, feel more personally invested, and tend to become absorbed in their work. When they come up against challenges, they are inspired to find creative ways to problem-solve. In addition, these employees find greater work-life balance, and have an overall sense of optimism and happiness. This is critical for physicians, given that they experience levels of burnout of 30-60%.
Engagement is increasingly recognized as vital for self-determination and productivity in the workplace. Organizations that encourage employee engagement are experiencing higher profits, improved safety records, and higher retention rates. Simple workplace measure such as providing breaks and acknowledging hard work can go a long way in increasing engagement.
Through physician coaching, my neurologist client experienced renewed motivation to effect change in her workplace. She pushed leadership to develop a wellness committee. We worked on many strategies to help her manage the changes and stresses of her position. Over time, she learned to focus more on her strengths, celebrate small daily accomplishments, and gradually re-engage.
If you find yourself overcome by disengagement and burnout, please check out my new FREE ebook, Building Your Resilient Self: 52 Tips to Move from Physician Burnout to Balance. I created this resource specifically for physicians. In the book you’ll find specific strategies to prevent and counter physician burnout.