Managing the Vortex of Fear

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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.

Top 5 Benefits of Mindfulness

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Top 5 Benefits of Mindfulness for Healthcare Providers

Modern conversation is dominated by discussion of the benefits of mindfulness in the healthcare industry. The implications are that not only can “being in the present moment” help us feel more in control of our days, lives, even careers but, it can help us take better care of our patients as well. Unfortunately, we are constantly distracted by email, social media, text messages, or, just as easily, by our own thoughts.

As a physician coach, I’ve seen first-hand how mindfulness can can have a major positive impact on physicians and other healthcare professionals. A popular misconception about mindfulness is that it is equal to spirituality, that it is the ability to completely clear our mind of all thoughts, or worse, an unequivocal detachment from life and the world around you. Instead mindfulness is simply complete awarenessbeing present with what’s going on in one’s life with kind awareness, questioning thoughts and assumptions, replacing judgement with compassion, and moving beyond preconceptions. In the healthcare industry, we become so focused on what needs to be done that we forget to simply be.

So how can mindfulness help physicians and other healthcare providers in general? Here are 5 benefits:

1. Mindfulness helps doctors achieve calm

Often our minds spin wildly, jumping from thought to thought. The swirl of thoughts can be like the torrent of a waterfall. We try to focus on a task and our mind goes to an argument we had that morning, a recent text, or how guilty we feel for eating those 3 additional scoops of ice cream last night. When we aren’t ruminating about the past, we fixate on a concern about the future, and anxieties and worries take hold. Even if there are no current stressors, our thoughts can take us into a downward spiral driving fear, rumination, and distress.

Mindfulness helps us realize that thoughts are simply thoughts, not reality.

Instead of being swept away by the waterfall, we learn to watch it from the comfort of the water bank. Creating some distance from our thoughts frees us from being trapped by them and allows us to access a natural calm and ease.

2. Mindfulness can help physicians improve their relationships

Despite being physically present with loved ones, it’s easy for our minds to be elsewhere. Often we stew about a meeting we have to plan for or replay a tense conversation with our boss, missing what’s in front of us. Mentally living in another moment, we can see our partner or children as the annoying distraction. We find ourselves impatient and short-tempered.

When we’re in the present moment, we detach from past experiences and future worries and give our full attention to those we’re interacting with. Drifting from the now is inevitable, but we can note this and gently return to the present. We all know how good it feels to interact with someone fully invested in us at that moment, and others immediately sense when we’re fully there with them. Staying in the present, we often find that it’s easier for others to join us there.

3. Living in the present allows for a broader perspective

When we’re in the mindless mode, we develop tunnel vision. We become stuck in a fixed reality that we have assumed to be true. Watching the world through this clouded lens, we have difficulty simply seeing and appreciating what is. Often times the way we see a problem can, in fact, be our problem, and part of being mindful is being open to challenging our own assumptions. One of the cornerstones of mindfulness is a quality of open awareness and curiosity. When we become inquisitive about a problem and question our assumptions, we see options that were previously outside of our field of view.

In addition, by shifting our focus to the present moment the magnitude of our problems begin to shrink. Right here, right now, it’s likely that our needs are being met, our health is manageable, and we can meet the challenges we face.

4. Mindfulness can help healthcare workers be more ressourceful

What if you could focus on what is rather than how you think things should be? Releasing expectations about your situation allows you to take action from where you actually stand. If you know what you’re facing, as opposed to an altered version of it, it’s likely that you’ll have more clarity. You’ll be able to see what the real constraints are and where there are openings for change. And all that energy that you’re putting into wishing things were different can be harnessed to take action with what actually is.

When you stay in the present moment, there is more available to you to come to a solution. You can then respond wisely and in a fully informed manner, rather than reacting blindly. You develop the superpower of conscious clarity. Watch this light animation of Dan Harris explaining how practicing mindfulness can be a superpower.

In this video, I explain what mindfulness is and how it can be applied to help physicians achieve their highest potential and lift them out of the detrimental cycle that can lead to burnout.

5. Mindfulness helps foster confidence and creativity

When we focus on what’s actually going on right now, we shed comparisons with others, harsh judgments about ourselves, and our analysis of our circumstances. All of these thoughts sap our natural creativity, and besides being overly-critical, they are rarely accurate.

When we live in the present moment, our attention is focused on what we’re experiencing and instead of getting caught up in negative self-talk; we can simply note it and move on. We leave rigid ways of understanding our experience behind. This flexibility clears room for new thoughts and ideas, and the results are often a rush of creativity.

Integrating mindfulness practices into our lives provides a multitude of benefits: we spend more time in the here and now, we experience less anxiety and more calm, and we enjoy deeper and more meaningful relationships. We reduce the tendency toward tunnel vision and see more options and choices, and this helps us feel less trapped by our circumstances. And we remove barriers that stifle our creativity and confidence.

It’s easy to get absorbed in our email, phones, and the most recent text message. Just as easily we get lost in our own internal thoughts. When you find yourself distracted, worried, or anxious, take a few minutes to bring your attention to your breath. It’s a sure-fire way to access the present moment.

Learn How to Be Mindful Within the Present

If you’d like to learn practical tricks to develop more mindfulness and develop greater balance, download my free guide From Burnout to Balance: 10 Steps You Can Take Today. In this guide, you’ll be given 10 tools to better manage the most common afflictions physicians are faced with today from shedding guilt, to overcoming the Imposter Syndrome and make time to reenergize. 

Download the leading healthcare guide to reduce physician burnout.

Gain the balance you need to:

  • Reclaim your purpose
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  • Lead with strength and calm

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Comparison: The Thief of Joy

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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.

Ron Epstein Talks Mindfulness & What Mindful Practice Offers Healthcare

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Ron Epstein, MD, Professor of Family Medicine at the University of Rochester Medical Center, has played a key role in bringing mindfulness to American healthcare. His research focuses on improving communication between patients and physicians and promoting mindful practice and self-awareness in clinicians. His 1999 Journal of the American Medical Association article was one of the first on mindfulness in a major medical journal. mindful practice for patient care

Mindful Practice: Dr. Gail Gazelle Talks Mindfulness With Ron Epstein

Gail Gazelle: Thanks for taking the time to speak with me about the importance of mindfulness in healthcare. How did you become interested in the topic?

Ron Epstein: When I was 17, a friend taught me how to meditate. I found that it gave me a sense of grounding and connection. I continued my contemplative practice. Many years later, while developing an assessment system for our new curriculum in Rochester, I began thinking, “What is it that makes a good doctor?” I knew that it was more than just skills and factual knowledge. A student can list the causes of cryoglobulinemia but that doesn’t necessarily make him or her a wise clinician. It is more – it is the ability to be attentive, curious and present and to cultivate a “beginner’s mind.” So I started asking students different types of questions – reflective questions – such as “What are you assuming about this patient or this situation that might not be true?” “Are you having strong feelings about the patient that could affect your decision-making?” Typically students hadn’t been asked questions like these. It made them stop, think, and be self-aware and present.

Being a good doctor involves the ability to listen deeply and to be present with someone who is in distress. But, no one teaches those skills; even in communication skills courses we learn what to say but less attention is about how to listen. When I took a careful look at myself I could see that there were times when I practiced well and when I didn’t, and it had to do with the same sort of mind states in my meditation practice – when I’m at my best, I’m more self-aware. Mindfulness goes beyond cognitive reflection. When you’re in the presence of someone who’s depressed you may feel a heavy feeling in your chest. You might feel a tensing of your neck with someone who’s agitated. Being open to your own somatic markers and your own emotions is important– not only for you as a clinician, but for your patients. You bring your whole self to the care you provide. Mindfulness involves awareness of the physical, emotional, and cognitive–and also of your own mental state– are you tired or distracted, how well is your mind working right now?

It’s possible to cultivate these qualities. The brain works differently when you’re being mindful as opposed to not, and meditation practice is a kind of deep learning, that we now know can promote neuroplasticity.

Gail Gazelle: Where do you meet resistance about mindful practice in the medical profession?

Ron Epstein: Those physicians who consider that their stress only has to do with the work environment may have difficulty looking inside themselves to appreciate the ways in which their reactions to stress are healthy or unhealthy. If their clinical environment feels out of their control then they wonder if their efforts really make a difference. Some might even ask, if the world of medicine is so crazy and you’re helping people be more accepting, are you being complicit? My answer is no. I think that in becoming more self-aware, people become more energized to change themselves– and change the system. mindful practice for patient care

It’s also important to realize that mindfulness does not necessarily create a state of peace, it’s cultivating awareness of things as they are. That can be difficult. It’s building awareness and resilience at the same time. mindful practice for patient care

With meditation, you become more comfortable being present with a wider range of emotions, learning that you actually have a greater degree of control and choices about your reactions. You can choose how you respond. You can temporarily set your distress aside – metaphorically putting it on a shelf next to you. You see that you are not your anger, or your sadness, or your pain. You begin to understand that anger or distressing physical sensations are things you have the ability to work with.

Gail Gazelle: True. It’s important that we don’t let our feelings define us. Is it fundamentally the separation, the “I am not this?”

Ron Epstein: It’s the ability to notice “there I go again. So and so said something and my blood pressure went up by thirty points, isn’t that interesting.” With mindful practice, you get the capacity to be a little bit more able to make choices in situations that you thought were choiceless. I think it’s allowed me to engage on a personal level or principled way, without getting caught up in the fear, emotion, and the distress. So all of that’s there but I can step back and think: what’s wrong with this situation, well this situation is unhealthy. And then choose how to respond. I also think it’s important to be public about being mindful –it encourages and emboldens others to do the same.

Gail Gazelle: What does mindfulness offer when you can’t control the external circumstances, for example, when practice demands are impacting patient care?

Ron Epstein: I think you can first offer clarity regarding what you can impact and what you can’t. In virtually every environment you have some choices. The environment may be very toxic in American medicine but medicine has always been difficult, albeit in different ways.

Gail Gazelle: We’re in a challenging time for physicians. How can mindfulness help? mindful practice guidelines

Ron Epstein: Mindfulness allows you to have a clearer sense of who you are, of what is important, and where to direct your efforts. Sometimes it makes clear the choice to go somewhere else. It’s a sense of control. In the most difficult situations, you can still be present, and that presence itself is something patients value. It is something that can’t be taken from you: the capacity to listen, and the capacity of being honest with yourself.

Gail Gazelle: I know you think big about what mindful practice can offer healthcare. Would you share your thoughts on the topic?

Ron Epstein: I do think big. There are some health systems that are committed to becoming more mindful. Several medical schools now have required mindfulness programs for medical students.

I recently worked with a health system that has compassion as their mission statement, and they seem to be taking it very seriously. They believe that if they achieve financial success but are not compassionate, they have failed. At a 2-day workshop for 300 of their clinical staff, the CEO was there the whole time, and I never saw her take out her smartphone. She was present, communicating her availability and commitment. That is important. mindful practice guidelines

Practicing mindfully helps patients feel like they’re being listened to and attended to. I believe it can reduce errors resulting from inattention and haste, and it can promote caring and professionalism when things go wrong. Perhaps it can limit the use of mindless aggressive care for people who will only be damaged by it, enhance the sustainability of the healthcare workforce, and reduce turnover, all of which would cost us less.

Mindfulness programs in the corporate world may increase productivity, but more importantly, they can help people feel a greater sense of meaning in their work lives. I recently spoke with a cardiologist friend who was tired and bored after a day reading stress tests and EKGs. Mindfulness could alleviate the boredom by taking that moment when the patient is getting on and off the treadmill to acknowledge the humanness of that person, to see the novelty in the familiar, and to appreciate the connections he has with his staff. mindful practice guidelines

Gail Gazelle: So it takes it from isolation to the greater purpose. Isn’t that what’s most important?

Ron Epstein: Yes, because sometimes we forget what it’s all about. Ultimately, medicine is about people. mindful practice guidelines