Recognize That You Are Not Your Thoughts

For Mira, the inner chatter started when her alarm buzzed at 5:15 a.m.—and it was anything but calm and friendly. When she didn’t get out of bed to exercise: I’m such a slug. Why can’t I have the self-discipline other physicians have? I’ve never had what it takes.

When her 17-year-old daughter, Ella, wasn’t getting her homework done: What am I going to do about her grades? Maybe I should get her a tutor, but tutors cost a lot, and I need to save for college. My ex is making this so difficult. I can’t believe he’s resisting paying support again. What an idiot I was to marry him in the first place!

When traffic was jammed on her way to work: Why is everyone driving so slowly? I hate my commute. What was I thinking by moving to a practice so far away? Maybe I should quit and look for something closer to home. If I was only home more, Ella wouldn’t be having all these problems.

When she arrived late to her office, facing a difficult patient and another double-booked morning: It’s completely unfair that I have to see so many patients. I can’t stand it when patients like her are on my schedule. How am I ever going to get through another day like this?

Not even 3 hours into her day, Mira already felt overwhelmed.

While it seemed clear to Mira that it was her daughter, ex, commute, and schedule to blame for her overwhelm, that was actually only a partial truth. Her life circumstances as a physician and single mom were complicated. It’s no easy thing raising teenagers, being a busy physician, and meeting the demands of an overbooked panel of patients—a daily juggling act anyone would find stressful.

But the difficulties of Mira’s existence were multiplied by the soundtrack of thoughts that played in the background of her days.

What We Don’t Learn

Our minds are extremely busy places. Thought upon thought is how most of us go through our days. All these thoughts overlay our actual experience and, without awareness, become our experience. What goes on in our minds literally becomes the world that becomes the world we see.

For longevity in a stressful career like medicine, it is vital to learn to work with your own mind—it is truly the most important instrument you’ll ever operate.

Unfortunately, medical school doesn’t teach us how to do so.

In fact, the medical school curriculum is dominated by the vast amount of specific knowledge needed to practice medicine: Findings on complex biochemical pathways, the physiology of the heart and lungs, and even issues as esoteric and detailed as acid-base imbalances in the kidney.

But we don’t learn how to manage mornings like Mira’s. Alongside the core curriculum, we learn next to nothing about how we work, how we react, how to manage the complex emotions we experience, how to take care of ourselves and avoid burnout, and how to cope with all the change and uncertainty of the healthcare landscape. At the core of this is self-awareness and self-management, the foundation of mindfulness.

In all the hours spent on acquiring knowledge, little to no time is spent on how to manage our minds. Yet, our minds and the thoughts they produce form the portal through which we experience everything. This portal is the complex filter through which all incoming data is processed, and it dictates the learning, growing, understanding, and interpreting of all that we experience. And quite often, as was the case for Mira, what the mind generates are draining, fear-based overgeneralizations that do not always reflect the reality in front of us.

The first key to managing this complex instrument is recognizing that you are not your thoughts—the first way mindfulness restores your autonomy and cures healthcare burnout.

Training The Mind

Let me take a step back and explain what mindfulness is.

First and foremost, it’s the complete toolkit to managing your most important instrument as a physician (and as a human): Your mind.

A more traditional definition is that mindfulness is our capacity for awareness—conscious, open, receptive, and purposeful awareness—of what is occurring in the present moment. It involves utilizing this awareness to train our minds to shift away from the thoughts that most of us are preoccupied with and shift toward what we are actually experiencing, rather than our thoughts about our experience. It involves training our minds to shift toward the reality of what’s happening in the present moment, the one that is occurring right now. At its core, it is a way of being and relating to ourselves, our circumstances, one another, and the world around us.

With mindfulness, we are training ourselves in our ways of thinking, feeling, and behaving. We are training ourselves to see which of our thoughts are helpful and which are not. We’re training our minds to be less attached to the unhelpful ones, to let them pass through without giving them as much of our attention. A core part of this detachment is recognizing that the randomly generated blurbs created by our minds aren’t us.

With mindfulness, we are training ourselves to become the master of our minds, a skill that is especially important for physicians.

Mira, like most of us, was anything but.

Without this training, we are like a boat adrift at sea. We don’t have an anchor or a compass to steady and guide us. We don’t have the tools to right our thinking or manage the complex emotions that arise in our stressful lives and work. In a sense, our mind is allowed to run wild. We are left prey to our circumstances, without what we need to work with them. We are left reacting to everything that occurs around us. For many physicians, this means having few tools to manage all the instability, change, uncertainty, moral distress, and turmoil a career in healthcare now involves.

The good news is that these are tools mindfulness provides.

If you enjoyed this excerpt, please order your copy of Mindful MD today!

Shoulds and the Paradox of Self-Motivation

I was coaching a physician recently who was struggling to start an exercise regimen. To protect her anonymity, I’ll call her Jamie.

Jamie had started and stopped exercising many times in the past but had never stuck with it. I could well understand this as she’s a mother of three with a busy career — her days are anything but quiet and full of free time.

Like many, Jamie had put on weight with her pregnancies and struggled to lose it. She also had a family history of diabetes and was worried about the extra weight increasing familial risk.

She’d tried everything from the Whole30 diet to Noom, from working out at her Y to shifting to an elliptical in her basement, and from having her husband push her to keep her accountable to app upon app, but nothing stuck. She just couldn’t get herself to stay motivated, no matter what she tried.

Like many others, Jamie didn’t know why she couldn’t do regular exercise. She just knew that she couldn’t. Having never gotten below an A- in her life, Jamie felt that, with exercise and self-care more generally, she was getting a big fat F.

So, Jamie and I got deep into discussion, and I asked her a few questions to help her understand what was getting in her way. I first asked her to share her thoughts on exercising. Here’s what she said:

  • I should get up at 5:15 every day and get on the elliptical.
  • I should be able to stick to my exercise routine.
  • I should be better at this.
  • I should be like other physician moms who figure out how to fit exercise into their busy lives.

Unfortunately, none of these thoughts improved her ability to sustain an exercise program. Something was still missing. 

Could it be that all these “shoulds” were actually getting in her way?

I’m wondering how you approach making a lifestyle change, developing a new habit, or getting some demanding task crossed off your to-do list. If you’re like me, Jamie, and many others, you may approach the issue by telling yourself that you should make the change. You should improve, you should become a kinder, more efficient, better person, you should just do whatever it is that you’re wanting to do. 

Unfortunately, all this “shoulding” may actually be stealing your motivation, rather than building it. As I discuss in my 2020 book, Everyday Resilience, these inner ‘should’ voices are ones we all have, yet without proper tools and skills, can really erode the inner resilience we all possess. At times, this voice of should can even become one that is punishing, harsh, and shaming, can’t it? It can even creep into our thinking around all kinds of things.

  • I should get out of bed early and get on the exercise bike.
  • I should be able to stick to my diet.
  • I should start meditating.
  • I should be nicer to my spouse.
  • I should be more patient.
  • I should get that work done.

Before you know it, all these shoulds then lead to a whole other level of self-judgment:  

  • What’s wrong with me not getting out of bed early and exercising?
  • Everyone else seems to be able to know how to manage their weight issues, but not me.
  • If I don’t get it together, I’m going to end up a fat diabetic sloth.
  • Why am I so unmotivated? What’s wrong with me that I don’t have the willpower everyone else has?
  • Why can’t I just suck it up and do better?

All of this begs the question: Have your shoulds motivated you? Have they helped you make the changes you want?

There’s a reason why so many of us can answer with a resounding ‘no.’ The fact is that telling ourselves that we should do something takes us away from the intrinsic or internal motivation that is what truly motivates us to do anything. The should takes us to an external source of motivation, one that is less likely to get the job done. The should leaves us trying to motivate ourselves because society says so or your parents told you to or how you think you should be doing something or other. It takes us away from what truly drives us in life — our desires, our passion, and what’s in it for us to take the action we want to take. We may believe that an external entity like money, keeping up appearances, or receiving praise from others will get us there, and they might for a brief while, but rarely in a sustainable way.

Let’s take a deeper dive into what it is that will truly provide the motivation you need. When you think about why all the shoulds actually erode our motivation, you can likely see the answer. After all, we humans tend to do things when there is something in it for us to do so. The old WIFM, or what’s in it for me, is an important truism.

The key is to make sure you’re aligning with your WIFM as opposed to the internalized voice of parents, teachers, and others which actually only serves to tap into our brain’s threat-defense system. Recall that this is the fight/flight/freeze system that our primitive brains developed to protect us from danger. Thank goodness our brains evolved in this way to ensure that our species rose up the evolutionary ladder! But in the modern world, this system is activated by threats of a psychological nature, ones that tell us we’re not good enough, smart enough, thin enough, or, in Jamie’s case, fit enough. And once the threat-defense system is activated, we’re operating in survival mode, small, withdrawn, fearful, and only focused on getting by. All too often, the result is procrastination, distraction, or avoidance.

For true self-motivation, we can go to an important psychological theory. One of the most influential theories on human motivation, in fact, is self-determination theory, which originated from the work of psychologists Edward Deci and Richard Ryan, who published Self-Determination and Intrinsic Motivation in Human Behavior in 1985.

The SDT informs that we tend to be driven by a need to grow and gain fulfillment. One of the core assumptions behind the SDT is that developing mastery over challenges, learning, and growing is essential for our sense of self.

SDT also points to the fact that while we may be temporarily motivated by external rewards (money, prizes, societal messages, recognition or validation by others), internal sources of motivation fuel the most desire and commitment toward our goals. Also, tapping into our intrinsic desire to achieve a goal can be a powerful motivator and keep us going when external rewards aren’t enough. While the idea of intrinsic motivation may seem like a new concept, it’s something we’ve known about for quite some time. Many studies confirm the truth of SDT, bolstering the fact that intrinsically motivated people are more able to reach their goals – resulting in happier and healthier (and more motivated) people.

Tips to self-motivate

Reading this, you may be wondering: what’s the alternative?

SDT helps us understand the true ways we can motivate ourselves. What’s key is getting in touch with the “why” behind the change you want to make. That will take you to your WIFM and help you move forward toward your goal.

When I asked Jamie about her WIFM, she readily identified that exercising was important for her so she could avoid diabetes and have the longevity she wanted to be there for her family. Her WIFM also meant how good it felt to fit into some cool clothes she had worn before giving birth. Instead of beating herself up with a litany of shoulds, when she focused on what was truly in it for her, she felt more of a sense of ease about exercising. In our next coaching session, she proudly told me that she had stayed on her exercise program for the entire prior month, a first for her. Of course, it was still challenging to fit this into her busy days but now she was able to do so.

Since I’m all about pragmatic approaches, here are 5 tips to self-motivate and reach your goals.

    1) Pay attention to the voice of the shoulds. Honing this type of self-awareness is always the first step in effecting any change. And guess what? This type of self-awareness is also known as mindfulness. After all, mindfulness is about getting to know what is going on inside and around us. We pay mindful attention in a kind and friendly way, not by adding more “shoulds” onto the existing pile! Why is mindfulness so important? The simple answer is that it helps us to be more present and aware in our lives. And this can make a huge difference in how we feel and experience both ourselves as well as the world around us.

    2) Now that you’re aware of when the shoulds are present, broaden your awareness by noticing how you feel mentally and physically when you experience them. Do you feel uplifted and excited to move forward? Alternatively, perhaps you experience a sense of dis-ease, a downward sense of gravity that pulls you back toward the shoulds. Get in touch with how different the extrinsic and intrinsic motivation feels to you. Since the latter likely leaves you much more uplifted, this will also contribute to greater motivation.

    3) Now ask yourself: what is in it for me to make this change? What’s important about this? How will it help me? If it’s still unclear, try to identify the consequences of staying in the situation versus making a change. What will happen if you stay? What will happen if you change? Again, focus on what is important about this—not what other people might think or how they will react to your decision, but what’s in it for you. To enliven this, take a few moments to try on the desired state. Just like trying on a new sweater, notice what this will feel like for you. Notice how your body will feel. Perhaps there’s a sense of relief, a release of physical tension. You may also find that you’re feeling lighter, more energetic, or clear in your mind. Perhaps there’s a feeling of confidence, certainty, and freedom.

    4) Replace the should with “I want to because ___”. Fill in your reasons at the end of this sentence. Whenever your mind takes to a should, go back to this key sentence. Make it a mantra for what truly has meaning for you.

    5) Lastly and most importantly, be kind to yourself. Be patient with yourself. If you fall off your path, avoid the temptation to add more shoulds (and shame) to the situation. Remind yourself that establishing new patterns takes time and the willingness to keep starting anew. Remind yourself that you are an imperfect human amongst other imperfect humans.

    A little self-kindness and self-acceptance go a very long way.

    In conclusion, changing and establishing new habits takes work. Motivating ourselves is something we all have to work toward. But if you want to reach your goals, you’ll motivate yourself by focusing on what’s in it for you to do so. This is the surefire way to build true, lasting, and successful change. With the right combination of factors, it’s more than possible to stay motivated and achieve any goal you may have. 

    Practice these 5 tips and you’ll free yourself from the tyranny of shoulds.  I can almost guarantee that you’ll soon be the one moving forward on whatever goal is truly important to you. The more you practice, the better you will become at creating exactly what it is you desire. And the better you get at creating your desired states, the more successful and happy you will be in life, in every possible way.

    Physician Mindfulness Retreat Helps Physician Burnout

    Physician Mindfulness Retreat

    For the first ever Physician Mindfulness Retreat, 20 physicians came from across the US to learn during the Martin Luther King holiday in January. There was a wide range of medical specialties represented, from Psychiatry to Family Medicine, Palliative Care to Radiology, General Internal Medicine to Obstetrics. Physicians trudged bravely to Massachusetts in the dead of winter from such points as California, Washington state, Wisconsin, Louisiana, Michigan, North Carolina, and Florida. The commonality was a desire to develop tools to manage the many stressors of practice.


    What Physicians Had to Say about the Physician Mindfulness Retreat

    The learning was completely experiential from interactive exercises to journaling to yoga. Mornings began with morning meditation and yoga. Dr. Paula Gardiner and I gave talks but there was no boring powerpoint!

    Topics included:

    • How training sets us up for burnout and doesn’t give us the skills we need to manage it
    • Ways to work with your judging mind to decrease suffering
    • Building self-compassion as a way to manage self-doubt and the Imposter Syndrome
    • Strategies to manage challenging emotions and cultivate positive ones
    • Tips for spending more time being and less time doing

    From a walking meditation to the ocean, to the hot tub (with suits!), to delicious chef-prepared meals, and time with new colleagues, in addition to all the learning, this physician resilience retreat provided many opportunities to relax and renew.

    A Second Physician Mindfulness Retreat is Coming October 2018!

    Last year’s feedback was so positive that we’re offering a second retreat October 26-28, 2018. For more information, contact us today.


    Mindfulness-based Coaching: Beyond The Physician Retreat

    Mindfulness-based Physician Coaching™ is Dr. Gazelle’s unique approach to helping physicians avoid burnout, decreasing reactivity, improving leadership, and developing true presence at work and at home.

    Utilizing a wide variety of evidence-based techniques, Mindfulness-based Physician Coaching™ helps physicians improve work satisfaction, create more balance, and lead more fulfilling lives.

    “With Gail’s mindfulness coaching, I have more authenticity, ease, and enjoyment both at work and at home. The challenges in professional and family life remain, but I am more efficient and at ease with my clinical work, more comfortable with a wider range of emotions, and am living a much happier and full life.”

    For more details on physician mindfulness-based coaching, please via our physician coaching page.

    Comparison: The Thief of Joy

    comparions-physician-burnout

    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:

    1. 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.
    2. 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.
    3. 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.
    4. 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.