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!

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.