Month: July 2020

Seven Habits Of The Highly Resilient Clinician

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Before the present pandemic, we had an epidemic of physician and nurse burnout. A majority of those in healthcare caught in a cycle of exhaustion, cynicism, and loss of purpose. And all the change and uncertainty the virus has brought certainly doesn’t help! It’s now more imperative than ever that clinicians build resilience to all the pressures and stress of our careers.

In my 30 years as a physician and decade as a physician coach (having coached over 500 physicians,) I’ve seen seven habits, thought patterns, and practices that distinguish the ones who can thrive despite pressure, and bounce back from burnout, and those who cannot. These seven can be implemented by anyone, and are the difference between a calm, fulfilling, purposeful career, and burnout.

1. Resilient clinicians remember that life is short

Last I heard, death is inevitable. Illness too. Thanks to the pandemic, this is more in the forefront for all of us than it may have been before. But how often do most of us lose sight of these truths and delude ourselves by believing that death and aging affect others but not us?

The costs of this delusion are twofold. Firstly, ignoring the reality that life is impermanent means we can spend our days sleepwalking and biding time that won’t be there forever. We can spend hours on charts, and then come home and scroll on Facebook and LinkedIn, instead of taking in the goodness of our families and the present moments around us. 

Secondly, thinking that we and our families won’t experience pain,sickness, and tragedy, leads to much suffering when difficulty inevitably arises. We can feel like life has been unfair to us – or that we deserve better. 

Resilient clinicians recognize that the misfortunes of life happen to everyone – and they react with strength, compassion, and wisdom when they do.

2. Resilient clinicians let go of perfectionism

Are you a perfectionist? In healthcare, you definitely aren’t alone. It’s a trait that helped us get into and survive our training, but it’s also a trait that gets in our way as we progress in our lives and careers.

We can find ourselves overly focused on living the perfect life, on getting every one of our actions perfect life, on getting every one of actions perfect, on having the perfect exterior. All these expectations create a mountain of pressure for us. 

Feeling a need to get things perfect creates anxiety around the experience – whether it’s charting, spending time with our kids, or picking up a new hobby. And all that anxiety is exhausting!

Resilient clinicians recognize that perfection is largely an unattainable goal – and they realize that doing their best is what they set their sights on. They accept and enjoy the bumps in the road that come along the way. 

3. Resilient clinicians lean into gratitude

We’re told that gratitude is good for us but resilient clinicians know this deep in their bones. They spend time appreciating what they have and try not to focus on what they don’t. They count their blessings and they do so regularly.

Numerous studies have identified the multiple benefits of gratitude. Gratitude increases empathy and decreases depression and aggression. Gratitude improves sleep and decreases aches and pains. Gratitude enhances the strength of meaningful relationships and increases our sense of well-being. 

The more we focus on the blessings that we have in our lives, the more happy and fulfilled we become. The more we focus on what we do not have, the more miserable, exhausted, and grumpy we can find ourselves being.

Leaning into gratitude does not mean adopting some sort of artificial Pollyanna stance! What it means is taking time to appreciate what is truly good in your life. That may be the fact that you are employed, that your health is good, that your loved ones don’t have Covid. It may  also involve savoring a good meal, the warmth of a sunny day, or the smile of a close friend. Small or large, begin grounded in gratitude builds our resilience to the stresses we face.

4. Resilient clinicians know which thoughts to believe 

We all have filters that obscure how we view ourselves and our worlds. These filters lead to cognitive distortions – ways of seeing ourselves and the world around us that are inaccurate and untrue. We can have repetitive unhealthy, distorted beliefs in our heads, and we often stop questioning these. Instead, we may find ourselves reinforcing these over time, so that they only become  more and more concrete. 

Resilient clinicians recognize which thought patterns are serving them and which aren’t. They understand that thoughts are simply thoughts, mental events generated by the mind. They are curious and discerning, and develop the habit of observing rather than engaging with each and every thought.

Questioning the filters through which we see the world forms the basis for Cognitive Behavioral Therapy and other highly effective psychological interventions. It’s also at the heart of mindfulness.  With mindfulness, we heighten our awareness of what their mind is up to. We begin to see more clearly when our mind is spinning a yarn about something, and when we’re focusing more on a mental narrative than the reality that lies before us. Doing so is key for building our resilience.

5. Resilient clinicians move past the Imposter Syndrome

The Imposter Syndrome

Many in healthcare suffer from the Imposter Syndrome, that belief that what we know is miniscule and what our peers know is massive, and that it’s only a matter of time until we’re found out as a fraud. But we don’t stop there. No, our mind is often busy fueling a host of self-defeating messages. 

Because we see ourselves from the inside, and know all of our own insecurities, flaws, and embarrassing failures, we feel like we pale in comparison to everyone else’s polished exteriors. 

Resilient clinicians are aware of this information imbalance, and work to be more gentle with themselves. They are able to view their own accomplishments objectively and they compare themselves to others less, because they know that they are on their own path. 

For more advice on how to overcome I.S.,, watch my CoachX on the topic.

6. Resilient clinicians let go of what they can’t control

It’s become clear that there is much that is dysfunctional in the American healthcare system. Whether it’s the out-of-control prices of needed medications, uninsured families having to utilize busy emergency rooms as the only way to access care, or the profound disparities in outcomes for African Americans, the problems are many. Sadly, many of the problems in our system are out of the control of most clinicians. Yet, how often do we find ourselves railing against some problem or other? Banging our fist, literally or figuratively, and wanting to scream “How can this be?” or “This has got to stop!”

Resilient clinicians know that all that railing dissipates their energy. They know that energy conservation is a key ingredient in avoiding burnout. They notice when their emotional temperature is rising and ask themselves: Is this something I can change? If it is, they think about how best to intervene. If it is not, though, they remind themselves that the one thing they always have control over is themselves! They can decide how much to engage and how much to let go. Doing so preserves their energy so they have it to utilize in taking care of themselves, their patients, and their loved ones.

7. Resilient clinicians have a growth mindset

In order to weather the storms of life, we have to have an internal belief that we can shift our own behaviors, and improve and grow. 

Think about your own thought processes as you read this piece. Did you think of these habits as things that could be adopted? As things that you could integrate into your life?

When you think about your shortcomings, do you think about them as immutable truths? Or things that you can incrementally improve upon?

Resilient clinicians take gradual approaches with things they want to improve upon, and they are gentle with themselves throughout the process. They know that self-kindness is more motivating that self-bullying! They know that resilience is built by being patient with themselves as they learn and grow.

Conclusion:

Resilience is something that lies within each and every one of us. But we don’t always realize this. I hope that you can take some time to reread this post, and choose one or two things that you’d like to do to build yours. Let me know how it goes.

If you enjoyed this post, I know you’ll enjoy my book Everyday Resilience. A Practical Guide to Build Inner Strength and Weather Life’s Challenges. 

BOOST YOUR RESILIENCE!

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Related posts

If you’ve missed any previous posts in our popular Mindfulness In Medicine Series, here’s a list of them for your convenience.

6 Ways To Overcome The Imposter Syndrome And Build Resilience

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What do Michelle Obama, Albert Einstein, Maya Angelou, and yours truly have in common?

We’ve all suffered from the Imposter Syndrome! (I’m flattered by any other guesses.) 

Take a second to think about how much damage the Imposter Syndrome has on your life. How many moments that should be greeted with excitement and passion that are claimed by anxiety and fear? How many compliments have you brushed off, how many achievements are taken for granted, how many moments lived feeling like we don’t deserve what we’ve created for ourselves?

What exactly is this pernicious, incessant phenomenon, and how do we get rid of it? 

I’ll dive into all of that below – but first, I wanted to share a brief moment where I felt like an imposter earlier this week. 

Imposter Syndrome At Work

I’m faculty at Harvard Medical School, which means in exchange for a fancy title, I get the wonderful privilege of teaching HMS residents each year 🙂

This week, we got started with our Zoom sessions, and I led several exercises to build resilience. I looked at the underslept, overachieving array of faces on my screen, and couldn’t help but ask myself what the heck I was doing there! In front of this incredibly acclaimed group of twenty- and thirty- somethings, the cream of the crop of residents, I felt like a massive phony. 

I was certain that my teaching methods paled in comparison to those of their superior instructors, and that I was better off signing off the Zoom session, or better yet, letting the residents teach me! 

In that moment, despite my professional accomplishments, my natural talents and honed skills, my years as a resilience, mindfulness, and burnout coach, and the fact that I’ve taught Harvard residents for many years, I felt like an imposter. 

The Imposter Syndrome is a sticky and pervasive sense that no matter how far we’ve gone, we have to constantly watch our backs for fear of being “found out” as frauds. 

Let’s see how some of the aforementioned icons put it:

Imposter Syndrome: Who Does it Affect? 

“(I) work to overcome that question that I always ask myself: “Am I good enough? Am I good enough to have all of this?” – Michelle Obama

“The exaggerated esteem in which my lifework is held makes me very ill at ease. I feel compelled to think of myself as an involuntary swindler” – Albert Einstein

“I have written eleven books, but each time I think, ‘Uh oh, they’re going to find out now. I’ve run a game on everybody and they’re going to find me out.” – Maya Angelou

“No matter what we’ve done, there comes a point where you think, ‘How did I get here? When are they going to discover that I am, in fact, a fraud and take everything away from me?’” – Tom Hanks

“I have spent my years since Princeton, while at law school and in my various professional jobs, not feeling completely a part of the worlds I inhabit. I am always looking over my shoulder wondering if I measure up.” – Sonia Sotomayor

Does any of this resonate with you? Do you ever feel like your successes were a fluke, that you aren’t as deserving or capable as your peers, or that one day you’ll be exposed as the lousy excuse for a success that you are?

Know that you’re not alone! Besides those above, many sources estimate that up to 70% of professionals experience I.S. at least once in their careers. And I have not met a physician yet who did not suffer from I.S. We all do! You may doubt this but that’s just part of the hold I.S. can have on us. We can even think that they are fake imposters yet we’re the real deal!  Let’s take a closer look at this disconnect. 

Build Resilience: Understand the Nefarious Info Gap Behind It All

The root cause of the Imposter Syndrome is a maladaptive belief we can all have about what other people are really like.

We spend all day with ourselves – and as we walk around, our past mistakes, embarrassments, and failures bounce around in our head, bumping against future worries about family members, finances, workplace conflicts, and occasionally, an experience in the present moment.

In the midst of all that high-definition exposure to our own rough edges – we see the shiny polished exteriors of our coworkers and those around us. We see smiles, happy marriages, thriving children, promotions, new houses, additions, and miss the inherent messiness of life that is carefully omitted from casual conversation.

While we’re all too aware of our own snafus, hiccups, and challenges, we’re all pretty good about not showing them. Add social media and relentless expectations for what success looks like, and it can be easy to start to feel like you don’t belong because you don’t perfectly fit the mold.

We can quickly believe that we’re on the far end of human failure, an outlier, a fluke, and an imposter.

Get to Know the Cycle of Perceived Inadequacy

In feeling like imposters, we tend to be hypercritical of ourselves and focused on what we perceive we aren’t doing well. And we’re equally hyperfocused on what we perceive others are doing well. We create what’s known as a cognitive distortion that leaves us feeling like an imposter. This is the cycle that keeps us locked into I.S. But is this an objective or subjective process? I think you’ll agree that it’s about as subjective as it can get. 

Moreover, the more attention we give what we aren’t doing well (and what we think others are) the harder it is for us to be resilient and confident in our work.

Build Resilience with 6 Simple Strategies

After reading about how pernicious the Imposter Syndrome can be, you’re probably wondering what steps we can take to combat it! Here are 6 highly effective strategies you can use to let go of imposter beliefs, build resilience, and gain trust that you are worthy of the success that you have attained. 

1. Take the leap of faith 

A core cause of the imposter syndrome is a flawed picture of what other people are like. We’re stuck with our mind 24 hours a day, so we see our nastiest thoughts, we’ve been there for our worst moments, and we know our flaws all too well. But all we see of the people around us is everything they want us to see – everything they’re doing well! Social media only furthers this information imbalance.

The best way to get around this gap is to take the leap of faith that other people are experiencing and have experienced the same self-doubt and negative thinking  that you have. Look at the array of people who experience this – Michelle Obama, Tom Hanks, Albert Einstein, Maya Angelou – to name just a few. Understanding that it’s normal to experience self-doubt and that the people around you aren’t as perfect and polished as they may seem decreases the power of the imposter syndrome. 

2. Notice and Name

A core truth that I teach my clients and that is essential to overcoming the Imposter Syndrome is recognizing that thoughts are, in fact, just thoughts. In other words, these randomly appearing neuron-firing events are just that. As successful professionals, we subtly learn to take our thoughts as fact but not the truth is that not everything we think about ourselves is true.

When you recognize yourself having an imposter thought (“I hope they never find me out,” “I’m not good/smart/talented enough for this,” “I don’t belong” etc.) notice that thought, name it, and remind yourself that the thought is just a thought and nothing more. Just the act of labeling slows down our amygdala over-activation and involves our prefrontal cortex, giving us the space and presence to choose how we respond to the thought. 

Being able to detach/ de-identify with negative thoughts is a core part of my coaching model and a resilience skill that my clients quickly master. When we are able to notice a negative thought, nod at it smilingly, and go do what we wanted to do anyways, the thoughts quickly lose their power, and fade away. Much like the clouds in the sky.

3. Focus on the facts

In detaching from the Imposter Syndrome, it can be extraordinarily helpful to view your accomplishments as someone outside of you would see them. 

Take some time to write down a “brag sheet” or a list of all of your professional and personal accomplishments. Push yourself to write them down as objectively as possible. Then, in times when you are mired in self-doubt, take a look at your brag sheet. 

Being able to reference an objective brag sheet helps us get over all of the humps towards self-belief that we create for ourselves. 

Here’s an example from one of my physician clients

Achieved a 3.7 GPA undergraduate. 

Survived medical school and residency

Practiced medicine for 15 years and patients are  happy with my care

No malpractice cases!

Purchased a home and paid 40% of the mortgage

Make beautiful knitted and crocheted sweaters

Am an amazing godmother and friend 

4. Build your strengths muscle

In business and in our careers, most of us are trained to notice problems and focus on the things we need to fix. it’s the negativity bias we hear so much about. 

This thought pattern can be very helpful when dealing with sick patients, relationships that need repair, struggling students, or the problem sets that we are yet to complete. But it can be very maladaptive when building resilience and dealing with our own minds. Most of the professionals I’ve coached are entrenched in negative beliefs and are so used to focusing on their weaknesses that they feel like they don’t have any strengths! This is a pattern that can be quickly reversed – it just takes intentionality. And practice.

Focusing on strengths gives you more energy and resilience to tackle the challenges in both your professional and personal life, giving you more confidence and helping you develop a realistic sense of your strengths. It’s helping people develop  these upward spirals that really make my day as a coach. 

5. Develop catchphrases 

At times, the negative chatter in our minds can be so stormy and overwhelming that noticing and naming isn’t going to cut it. In times like these, when we get caught up in the storm, it’s helpful to have some catchphrases in our arsenal that we can utilize to calm us and bring us back to the present moment. 

I’ll share some of mine: 

“I am worthy and talented and I deserve this”

“I trust my judgement and I make strong decisions”

“I am endlessly resilient to whatever life throws at me!”

Or my motto:

“I am good, I do my best, and I cannot control all the rest” 

These can be incredibly powerful in gaining our footing during turbulent times. Try these out and see for yourself. 

6. Start the conversation 

Oftentimes, seeing is believing. It might be a lot to ask to take a “leap of faith” and assume that what’s going on in our heads is actually going on in most of the people around us. So check in with your friends and coworkers and start the conversation about the imposter syndrome. You don’t have to share every single dire moment you’ve been experiencing, but opening up and sharing some of the thoughts and emotions that you’ve experienced around the imposter syndrome can have a couple of surprising effects. 

Firstly, naming and talking about this shame and doubt has a way of taking the wind out of its  sails. Being able to shed light to these experiences makes Imposter Syndrome anxiety much more manageable. Secondly, you’ll be surprised how many of your coworkers and colleagues are experiencing exactly the same imposter beliefs  as you. 

Conclusion:

Utilize the steps laid out in this guide and take time to appreciate your strengths and accomplishments, to talk with the people around you about the imposter syndrome, and to notice and name imposter thoughts without attachment or judgement. This is a syndrome you can move past and you can live a shame, doubt, and imposter-free life! You deserve it.

Nothing makes me happier than helping people vanquish their imposter beliefs. For a 30-minute complimentary coaching session.

Related posts

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Don’t Call Me a Hero: Resilience and the Imposter Syndrome in the Time of COVID-19

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With the pandemic raging on, we’re all aware of how hard healthcare providers are working. Intensive care units pushed beyond capacity, insufficient protective equipment, people caring for patients with great risk to their own health. It’s appropriate that we think of these brave individuals as heroes. Yet, in client after client that I coach, what I hear is that many don’t consider themselves that way. In fact, many bristle at the term. Let me share one such individual who I’ll call Susan.

When Susan left her ED shift at an NYC hospital in the middle of April, she did not feel like a hero. She had intubated 3 COVID pts, an 88-year-old man, a 65-year-old woman, and a 45-year-old mother of two teens. Two of these patients were transferred to the ICU. The mother of the two teens was not. She died in the ED. Susan was overcome with grief. In her 10 years of working as an emergency physician, she’d had never had shifts like this one.

As she drove home, a profound sense of exhaustion came over her. She was so exhausted that she wasn’t sure she’d make it from her driveway into the house. Not sure if she’d have the energy to sit with her own teenage daughters. Not sure if she’d be able to return for her next ED shift.

And when she stopped off to pick up the groceries her husband had texted her about, a neighbor and the checkout woman started clapping and proclaiming loudly that she was a hero.

But Susan thought to herself:

“I am not a hero. Heroes save lives. And I was unable to save that 45-year-old mom.” 

“Heroes are selfless—they put others first, and don’t worry about themselves. All I could think about during this shift was what if I become infected? What if I infect my family?”

“Heroes are never afraid. I’m terrified that I’m going to end up dying of this too.”

“I am definitely not a hero. At best, I’m some kind of imposter hero. And I can’t stand when people refer to me as if I am.”

Avoid Physician Burnout: You Don’t Have to be Perfect to be a Hero

In addition to all the anguish and uncertainty health care providers experience as a result of the pandemic, there is also, for many, a sense that if we’re unable to help or save every patient we treat, that we’re somehow falling short. Susan had difficulty focusing on the lives she saved; instead, her focus was on the ones she could not save. It was not so much on what she was able to do to help her patients, but more on what she was not able to do. Her lens was on the ways she was failing to live up to an unrealistic standard of perfection.

And if we look at others who are considered heroes, it turns out that this may simply be part and parcel of the experience. 

Take, for example, Japanese retired police detective Yukio Shige. He regularly goes to Tojinbo Cliffs, infamously known as “suicide cliffs,” and together with a group of volunteers, looks for people who are experiencing so much darkness that they are contemplating taking their own lives. While his work has saved hundreds of lives, when interviewed he says that he was only doing what anyone should do. 

Or Marine Sargent Dakota Meyer, who received the Presidential Medal of Honor for his service during the Afghanistan war. Rather than stay at a relatively safe distance from an intense fire-fight in which fellow Marines and Army soldiers had been caught in an ambush, as he had been ordered to do, Meyer went time and again into the killing zone. During a six-hour battle, he evacuated 12 of those pinned down, provided cover for another 24 to withdraw to safety. Yet, when asked about his service, he claimed that he was not a hero, that the true heroes were the ones who saved everyone.

Imposter Syndrome = the Opposite of Resilience

While it’s not just healthcare workers who can feel like an imposter, is it possible that medical and nursing training makes physicians and other healthcare workers particularly susceptible? There are a few aspects of training I’ve heard about from the hundreds of physicians I’ve coached. 

  1. Never show weakness

We’re taught in our medical training to never show weakness, always have the answer, and always be in command. If we deviate from any of these, we learn that we’ve come up short, that we’ve failed. We’re not taught that doing our best is good enough. Instead, we’re taught: if we’re not perfect, we’re a failure. 

  1. Focusing on deficits

Our medical training sets us up to focus more on what we’re not doing well than on what we are. When I ask colleagues whether their training focused more on their strengths or their weaknesses, they uniformly say it’s the latter. Instead of chief residents and attendings seeing all the ways they’d applied themselves, tried so hard to learn new material, and did well, what stands out for most is the episodes of being told that they weren’t good enough. This focus on our deficits carries into having difficulty appreciating the good we’re doing during the pandemic.

  1. Making comparisons

The hierarchy inherent in medicine is something trainees learn to internalize: surgeons are better than pediatricians, and the medical specialist is higher up the ladder than the generalist. These comparisons and fixed beliefs around worth also set physicians up to feel like they’re imposters.

All of these factors combine to fuel a sense of being an imposter. And, as I show in a recent Harvard Institute of Coaching CoachX I gave, the Imposter Syndrome is an under-recognized cause of physician burnout. And, here’s an infographic I’ve developed on this topic:

Imposter Syndrome Infographic. Gail Gazelle MD-min

How can Mindfulness Build Resilience?

1. First, we have to train our minds to focus on what we are accomplishing, as opposed to what we are not. It’s just too easy for our minds to gravitate to what we think we could have done better, or to what remains undone. That’s the negativity bias in action.

Fortunately, however, we can teach our mind to focus more on the positive. One simple strategy to do so is, at the end of every day, write down three things you’ve accomplished, small or large. This provides a mental reminder that can help shift where you focus.

2. We also have to challenge our imposter beliefs. We can be overly attuned to inadequacies in ourselves and equally hyper-focused on what we perceive others are doing well. Thus, we generate an artificial divide between where we believe we are and where we believe others are. We create a “delta” that we then reinforce by where we focus our attention. In a sense, we filter out data points that don’t fit with our beliefs. This is actually the definition of a cognitive distortion. 

And while we may pride ourselves on our objectivity, these cognitive distortions fuel the imposter syndrome by the subjectivity they generate. Vanquishing the imposter syndrome requires pushing ourselves to look for objective data upon which we base our self-assessment. 

3. We need to be compassionate with ourselves. Susan, and everyone else in health care, is working extraordinarily hard each and every day. The more we can put aside self-criticism and be as kind to ourselves as we are to our patients and loved ones, the more we can see the full truth of our experience.

For Susan, following these three steps helped her shift her focus to the good she was doing in each and every shift. 

We can’t always change the impact the pandemic is having on the lives of our patients, but we can build our ability to give ourselves credit for all the good that we accomplish.

Recent COVID-19 related well-being and resilience posts and resources

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