Self-Compassion: An Elixir for Physician Burnout

Excerpt from the forthcoming Mindful MD. 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout

Our Most Important Patient: Ourselves

As physicians, we learn to be very critical of ourselves. Our training focuses much more on deficits than strengths. We see the attending physician sneer at a med student or another resident when they miss one item on a broad differential diagnosis of a rare symptom or finding. We are subjected to ‘pimping’ where we are asked a series of ever more demanding questions, only so we can be shamed when we can’t answer one correctly. The incessant ratings, rankings, and comparisons of training leave us comparing ourselves to our peers and focusing on where we’re coming up short.

Additionally, we learn to put others first and to always be there for our patients, no matter the time of day, and no matter how fatigued and drained we might be. While this altruism is laudable, we don’t learn how to apply that same nurturance to ourselves.

All of this leaves us looking to others to affirm our worth. In the words of mindfulness educator Sharon Salzberg: ”When we experience inner impoverishment, love for another too easily becomes hunger: for reassurance, for acclaim, for affirmation of worth.”

With self-compassion, we’re shifting the lens from outward caring to inward. We are including ourselves in the group of people who receive care, love, forgiveness, and attention.

While this is not what most of us in medicine learn, we can.

This makes me think of a coaching client who I’ll call Ayesha, who came to me because she was forever behind in her charting. In fact, when we first met, she had over 200 unfinished charts in the queue. A forty-two-year-old family physician, Ayesha loved taking care of patients but did not love getting their notes done. Moreover, when we looked at her experience charting, it turned out that no sooner did she log into the electronic record than she found herself besieged by inner chastising voices: What’s wrong with you anyway? You’re so lazy. Everyone else is so much better at this than you are. You’ve always been slower than others. I don’t even know why you bother trying.

These voices cut through her, rapidly plummeting her mood and leaving her feeling heavy and defeated. Whatever motivation she might have had to get her charts done rapidly disappeared, and the next thing she knew, she was checking Facebook, stopping to file her nails, and going over the family shopping list. Anything but facing this mean bullying voice that stood between her and getting her charts done.

I knew that we needed to bolster her ability to be kinder to herself, to say things to herself that buoyed her up rather than taking her down. But when I mentioned the concept of self-compassion to her, she looked surprised. “Isn’t that what we bring to our patients? They’re the ones who are sick. Why would I need to be compassionate to myself?”

This is something I hear from many of the physicians I coach. Additionally, many believe that self-compassion will breed self-pity; that it is self-centered and means they will wallow in themselves—basically, sit around all day complaining and eating bonbons. But when you stop and think about it, isn’t it self-centered to be focused on ourselves and all of our perceived faults?

Interestingly, when we are kinder to ourselves, there’s often a sense of expansiveness. We are actually less stingy in the compassion we offer to others. Even the scarcity that comes from identifying as the special one on the team lessens, replaced by an abundance mindset that allows greater compassion for others.

As Ayesha began to build her muscle of self-compassion, she noticed something shifting in her level of motivation. Instead of sitting at her computer procrastinating, typing a few words, and then checking social media, she now found herself better able to get the charts done. In being kinder to herself, she moved into a greater level of efficacy and efficiency. No longer under the thumb of the inner critic, her fear of inner censure abated, and she was much more able to get her work done. Slowly, slowly, slowly, and then all at once (how mindfulness progress typically works), Ayesha was able to put her inner critic aside.

When Ayesha first started utilizing self-compassion, she said that it felt artificial. “I didn’t believe any of it! In fact, it seemed like a complete farce. But I kept at it. And now, I certainly don’t fully believe it 100 percent, but I am starting to believe it a little bit. Maybe that will continue to grow.”

In her next coaching session, Ayesha reported that “In some ways it’s subtle, but I notice that I’m much more content at the end of each day. I have more emotional energy to get the work done. I am also noticing that I’ve been much more patient with my sixteen-year-old son, and I’m less reactive with him. As I develop more compassion for myself, I seem to have more for others as well.”

Perhaps this brief passage from Mindful MD can help you see ways you are being overly harsh with yourself. Perhaps it can help you see why kindness to yourself is actually the antidote for procrastination and inefficiency.

As you go through your week, see if you can replace inner criticism with a dose of mindful self-compassion. I’d love to hear how it goes!

Managing the Vortex of Fear

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.