Using inquiry-based stress reduction to treat medical malpractice stress syndrome [PODCAST]

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“We are busy people who have had much success; looking at our painful thoughts is not something we have had the need or opportunity to do. We may be a little anxious, neurotic, even, but we are respected, helpful, and successful. We tell ourselves that our anxiety is a small price to pay for all this success. Sometimes it takes a life-changing event to see that the truths we hold so close are not helping us. We are successful despite our anxiety, not because of it.

Opposing counsel desperately hopes we do not question our thinking. They bank on the legal process bringing up so many underlying beliefs that we settle cases early or show up to trial withdrawn, anxious or angry. Our mental clarity, unfettered by stressful thoughts sometimes carried for a lifetime, is our best legal defense.”

Lara Patriquin is a radiologist and physician coach and speaker.

She shares her story and discusses her KevinMD article, “Using inquiry-based stress reduction to treat medical malpractice stress syndrome.”

Resources:

Putting stressful thoughts on trial: A live one-on-one Zoom course to thrive during malpractice

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/follow. Today on the show, we have Lara Patriquin. She’s a radiologist, physician coach, and speaker. Her KevinMD article is titled “Using inquiry-based stress reduction to treat medical malpractice stress syndrome.” Lara, welcome to the show.

Lara Patriquin: Thank you so much, Kevin.

Kevin Pho: We’ll get into your article in a little bit, but first off, briefly share your story and journey to where you are today.

Lara Patriquin: Thank you, Kevin. Well, I don’t know if you’re anything like this, but when I was in training, I really bought into the notion of delayed gratification: that once I had finished training, and once I was financially independent and got married and had children, then instantly and miraculously my life would get better and I would be happy. And that dream kind of helped me get through all of the stress associated with the training time that we had.

But then I was quite disappointed to notice that after all of that training, and with all the responsibilities of being a physician, all the responsibilities of being a mother, of being a wife, I was actually much more stressed out after training than I was before, and certainly much less happy after training than I was before I started medical school. And it came to a bit of a crunch, and I just said, “You know, what gives?”

Part of me wanted to drop everything and go to India and find myself and do all that, but I had too many responsibilities. I had too much going on. And so I really looked hard at the scientific notions of how the mind works, the scientific underpinnings of well-being. I looked at the more Eastern philosophies about that, and the Western psychological viewpoint about that, to really say, “Well, what can I do? I have worked so hard for this training. I worked so hard to become a physician, for this life.” And the status quo just wasn’t working. I was just too unhappy, too stressed out. And so it got me really looking at the underpinnings of how the mind works. Why is it that the mind gives us such a stressful impression of life? And what can I do to help that?

So the first thing I started doing was meditation. And meditation I only picked up later; this is nothing that I had grown up with, and in fact I had a little bit of an aversion to it. But there were these studies done in the early 2000s where they initially brought Tibetan monks and imaged their brains under MRI at the University of Wisconsin. And to me that was such a sign, because what they were showing was that the underlying neuroplastic process that we have naturally in our minds was actually working to change the structure and function of our brains through the process of meditation. The imaging had just caught up to be able to detect those subtle differences. And we were seeing those subtle differences in people who were practicing the piano, people who were studying and practicing different things. We could start to see the brain differences, kind of like a muscle, you know.

These reports came out really in the early 2000s, and part of me, as a radiologist, as a stressed-out radiologist, could not ignore this. And so I started a meditation practice of my own and found it so helpful, just to take the edge off all of the stress and these stressful thoughts that I was having, that my enthusiasm got the better of me. I then got a position teaching meditation at Kirtland Air Force Base here in Albuquerque, teaching airmen pre- and post-deployment to Iraq and Afghanistan how to meditate, the process of mindfulness, giving them some understanding of how their minds work and how PTSD happens, to be able to assist them somewhat with these incredibly stressful events of the war, stress beyond anything equivalent, anyway, to anything that we can imagine in the medical career.

And what that really taught me was that we are all running the same hardware. You know, if I look at the MRI of your brain or of my brain, or the MRI of an airman, or of a prisoner, or of a convict, they all look the same. We’re running the same mental processes, and we’ve got the same hardware. We have these very primitive parts of our brain, and we have these incredibly sophisticated parts of our brain, and it’s really the interface between all those parts of our brains that leads us to a lot of stress. Until we really understand that that’s the bugaboo, and how we’re generating our thoughts, we get caught up buying into everything we think. We get to trying to fix everything on the outside so that inside we feel OK. And as we know in medicine, as we know now with COVID, as we know right now with the markets and with wars, you can’t control the outside events in your life. And I was getting tired of trying to control the outside events in my life to make me happy.

So starting to understand the mind from that perspective really helped me out, and then starting to understand what practices help, right? The meditation was super helpful. But then I got into a process called inquiry-based stress reduction. And I tell my clients, if meditation is like medicine, inquiry is like surgery. In the moment when we’re super stressed out because something is happening, our thoughts just start to go crazy about events. That could be, as I’m going to talk about later, in the malpractice lawsuit environment. It could be in a relationship. It could be our chairman telling us something we don’t like. It could be our kids rolling their eyes at us. The moment we get stressed, we are stressed because we’re believing thoughts that aren’t true for us. In this paradigm, this is how inquiry works.

What inquiry does is it gives us a very solid tool to see beyond all of these kind of crazy thoughts that we have, to be able to come to a place where our mind becomes tranquil again. Because as long as we’re believing our stressful thoughts, our stressful thoughts are going to stay with us. And so inquiry is a way to really see beyond these stressful thoughts to a place where the thoughts can’t stick anymore. And this was this tremendous technology that I thought was so effective for me, and then so effective for all of my clients in the military, now in the business community, and in medicine, to kind of change your mind about something in a really pretty short amount of time, you know?

I’m sometimes a little bit too impatient for this meditation and mindfulness thing. I don’t have multiple lifetimes to get enlightened. I need answers to my problem immediately, because there’s a lot happening. And so inquiry, to me, has just become this tremendous technology to help me see beyond what feels like an insurmountable problem and actually turn it into an opportunity.

Kevin Pho: And you talk about that in your KevinMD article, “Using inquiry-based stress reduction to treat medical malpractice stress syndrome.” Now, for those who didn’t get a chance to read your article, just walk my audience through it and share the story of why you decided to write it.

Lara Patriquin: Thank you. Yes. So, my malpractice experience: I had two malpractice experiences. One, I was sued, and the other was when I did expert witness work. And in both circumstances, I got incredibly stressed. Getting that envelope, finding out that someone had gone through all the pains to sue me, was incredibly distressing. And what happened to me when I had this stressful event is these reams and reams of thoughts came up that I couldn’t let go of, right? These are the thoughts that keep you up at 3:00 in the morning, thoughts such as, “They’re going to take me for everything I’ve got. I’m going to lose the respect of my community. I’ll never work again. They’re going to take all my money. It’s going to be a terrible experience.” These thoughts just populate our minds, and we can’t let go of them.

Even at this point, I’d already had a pretty significant meditation practice. I was pretty good at letting things go. This just became so sticky. And why it’s sticky: The lawsuit in itself isn’t the stressful event. It’s our thoughts about the lawsuit that are stressful, right? Your lawsuit wouldn’t be stressful to me, because my thoughts are, “Probably a great doctor. It happens. In high-risk specialties, it’s almost 100 percent sure that you are going to get sued,” right? So I wouldn’t see you being sued as a problem, but you do, because we hold these underlying thoughts to be true. One, I can’t make a mistake. Two, I will lose the respect of my community. Without the respect of my community, I am nothing. All of these are things that we have thought since we were children, and that were also super concretized during our medical training, right? Our medical training is an incredible thing, but it has not helped our well-being on multiple levels.

And so what inquiry allows us to do is to actually use the lawsuit as a jumping point for greater understanding of self, greater self-compassion, greater awareness, and greater wisdom. We can take all of these thoughts that we have, put them down on paper, and question them using this very formulaic, really wonderful, solid, programmatic way of looking at thinking, to see beyond them and to see, you know, is it really true, all of these things that I’m thinking about? Is it really true that I’m going to lose the respect of my community? Or actually, flip it around: Is it actually possible that this is going to help me in the community? How is it possible that this may be the best thing that’s ever happened to me, right?

And so every challenge, you know, it’s sort of ancient wisdom that any challenge we go through can become the greatest opportunity that we have. We can’t do it unless we know, and unless we have some kind of technology to convert it. And to me, inquiry-based stress reduction is that technology that allows me to turn what seems like a really big obstacle into an actual opportunity for self-growth and wisdom and compassion, and potentially new possibilities that you have never even thought about.

Kevin Pho: So walk us through that. You said that it’s a fairly formulaic set of questions that a physician should ask himself or herself during periods of stress, especially periods of malpractice-related stress. You talked about some of those questions earlier. Go into a little bit more detail in terms of what that exact process will entail.

Lara Patriquin: So let’s look at a thought. What would you think? I don’t know if you’ve been sued before. What do you think would be the first thought that would pop into your mind if I said to you, “OK, we’re suing you for the care of Mrs. X. You were obviously sloppy in your work, and because of that, this patient had a terrible outcome”? What first thought would come into your mind?

Kevin Pho: I guess the first thought would be, you would question whether you were a good physician.

Lara Patriquin: That’s right. So: “I’m not a good physician,” OK? We can start with that one. “I’m not a good physician.” The first question I would ask you is: Is that true? OK? In that moment, it may be true that you’re feeling it’s a no. It could be a no, and a no or a yes to that question is equal, but that’s just where you’re at.

The second question is: Can you absolutely know that it’s true that you are not a good physician? Right? Are you really in a position to understand that? Can you know that without a shadow of a doubt, right? So just open to the possibilities. It’s possible that how I’m seeing this experience isn’t the whole truth, you know? Because when we’re stressed, we’re 100 percent sure, you know?

The third question is: How do I react? What happens when I believe that thought? So who do you become when you hold the notion that you’re not a good physician, OK? For me, that would be, one, remembering every single mistake I’ve ever made in my whole life. Go back to grade school, right? It would be seeing images of myself in the future making more mistakes, getting more lawsuits. It would remind me of any negative feedback I’ve ever had. It would give me a sensation of constriction in my belly. It would make me feel like I’m kind of bottoming out and that my energy level goes down. It would make me resent my job. It would make me resent everybody involved in that lawsuit. It might make me resent the patient who’s suing me. On the other hand, it might make me think, “Well, maybe they’re right, you know? Maybe it’s really the truth.” And we start to see that we’re actually holding very discrepant viewpoints about things, but we’re holding them both, and we think they’re all true, you know? So that third question really allows us to say, “Well, what’s the identity? What happens to me when I’m holding that?” And once we’ve kind of exhausted that, and it’s really important to exhaust that, because if we don’t go there, we don’t actually see what really happens to me, you know? It’s like an inventory.

The fourth question is: Who would I be without that thought? And this takes a little bit of imagination, right? So, Kevin, you’re given this envelope, but for some reason, in your neurochemistry, you can’t entertain the thought that you’re not a good physician. So who are you when you open that envelope? Can you picture that event happening without holding “I am not a good physician,” right? I don’t know if you can imagine that. It’s a tricky thing to imagine, because it’s the first thing to go. But if I could imagine that I couldn’t think I’m a terrible physician, I actually notice I’ve got compassion for this person suing me, potentially, you know?

And that was the case for me as I did all of this a number of years ago. There’s compassion there. There’s compassion for the legal system. There’s compassion for the lawyer, you know? This is his job. This is what he does. He’s thinking this; he’s believing this. It’s not personal, right? It’s not personal to me. I really get that they don’t see me the way I see myself, that their image of the events that happened isn’t the same as my image of what happened, right? One thing happened, but we’re looking at it from two very different perspectives. So I can acknowledge, I can hold, that I’m OK and they’re OK, too. And that gives me the freedom in that situation, right?

That’s in that situation, without the thought. Then people think, “Oh, well, if I don’t think I’m shitty and I’m not hard on myself, I’m not going to defend myself.” We physicians hold that so tightly. Everybody does, but physicians hold it particularly tightly: Unless I’m hard on myself, unless I give myself these really hard expectations, and if I don’t meet them, if I’m tough, I will fail, you know? And we come to find out it’s actually the opposite that is true. I can really say now that I’m successful not because of my anxiety, and not because of being so hard on myself, but despite it, right?

So without the thought that I’m a terrible physician, as this is happening, I’m in a place where I can defend myself. I’m in a place where I can show up in court likable. And it’s really good to show up in court likable. It’s actually one of the most important strategies for you going into court, to show up likable, which is hard if you’re holding “I’m in this shitty position,” right? So then we investigate that, and then we go into the opposites. What would be an opposite to “I’m a terrible physician”? What would that be?

Kevin Pho: It would be, “I’m a wonderful physician.”

Lara Patriquin: “I’m a wonderful physician,” right? Yeah. What are the ways? Give me some examples, right? So I’ll ask you, Kevin, what are the ways in which you’re a good physician?

Kevin Pho: I listen to my patients. I give my patients the time they need.

Lara Patriquin: Are there other examples?

Kevin Pho: I empathize with their situation. I’m compassionate to the situation that they come up with. Yeah, so these are all questions that I would think to myself.

Lara Patriquin: That’s right. And you might think, and for me anyway, it was like, “Yeah, I tried my darnedest. I show up, I come on time. It’s important to me,” all this stuff, you know. I think of potential awards that I may have won in the past. So it’s really important then that we give specific examples of why the opposite of what we’re thinking isn’t actually true. And in that, we start to build up this case again and get a closer look at reality.

And what happens to my clients when they do that is they can see, “Yeah, you know what? I am a good physician, you know. I went to a good school. I work my hardest.” And then also, “I see that other people that I considered really good physicians are also getting sued, you know.” Everybody knows somebody who’s getting sued, right? It’s so rampant, you know. If something’s happening to 96 percent of your colleagues, are you going to say that they’re all terrible physicians? We can’t notice that until we’ve gone through this process. We can’t really come back to that realization and see the situation from a higher perspective if we’re caught up in that tight, tight place of “I’m a terrible physician.”

So that, in a nutshell, is the work, right? It’s an ancient process. We’ve really been doing it since Socrates, but this particular methodology is called The Work of Byron Katie. All of it is free on thework.com, and it’s been very, very popular in the self-help arena. Her books have sold millions and millions of copies. There are all these followers who follow her. But more recently, in the last 10 years or so, there’s been some really well-done research showing how this process can help in multiple arenas, in particular in cancer patients, burnout in teachers, and I think in the military as well, that this process can really help people live with less stress, you know? What stresses us out is our thoughts about these events, right? That’s what really brings us down.

And so we’ve seen that tremendously during COVID. All of the thoughts that we had about COVID, you know, it’s not COVID itself that causes the stress; it’s the thoughts that we have. And that’s why we noticed some people were fine and some people really, really suffered, you know? And so, in my opinion, inquiry can take you the whole way. This is something you can use with a fatal diagnosis, you know? This is something you can use in the most terrible situations. I’ve done it with people who’ve lost children, who’ve had a spouse commit suicide, with stage four breast cancer diagnoses. There’s nothing that this process can’t help with in those places. It can bring you right to the mat, you know, right down to those things that we would call really, really tricky, but then you start to see, you know, maybe they’re not.

And I’m sure you’ve had patients who get a diagnosis, and initially it seems like the worst thing in the world, and some of them, even before they die, think, “You know, I’m grateful this happened to me. I’m grateful that I’m finishing my life in this way.” And in my opinion, then, inquiry-based stress reduction is really like a wisdom accelerator. How do I get that beautiful wisdom that some people have at the end of their lives now? How do I shorten the period of time it will take to get over this lawsuit? Because some people go out of commission for two or three years: “Once this is over, I’ll be happy.” It’s kind of like saying, “Once COVID’s over, I’ll be happy.” Well, then there are wars, and there’s this. There’s always going to be something, always. So that’s inquiry-based stress reduction, and it’s such a wonderful and effective technology to help with our stress.

Kevin Pho: We’re talking to Lara Patriquin. She’s a radiologist, physician coach, and physician speaker. Her KevinMD article is titled “Using inquiry-based stress reduction to treat medical malpractice stress syndrome.” Lara, what are some of your take-home messages that you want to leave with the KevinMD audience?

Lara Patriquin: Well, one is to start to think about stress as believing in a thought that’s not true, right? So the next time that you’re stressed, start to get the understanding that it’s not the outside events that are stressing me out. It’s the thoughts that I have about them that are stressing me out. And when I hold a thought to be true that isn’t actually true for me, the outcome is stress. Stress is just my wiser mind saying, “There’s a problem here in your thinking,” right? From there, we can then use that stressful thought, bringing it into inquiry, to allow us to see beyond it, to improve our wisdom, improve our compassion, and bring us back kind of home to ourselves, right?

Our birthright is to be kind and loving and wise and funny, you know, all of those tremendous qualities of children. That’s who we really are. We fall out of that when we start to believe these anxiety-provoking minds. And practices such as mindfulness or inquiry, or even some of the practices you might do, your yoga, your music, your cooking, are really ways to get the wisdom of getting out of that very tight, constricted appliance we call the mind. And in particular, what I’d like you to think is: Don’t believe anything you think. It’s all made-up junk, right? So look into inquiry-based stress reduction if it speaks to you, and if it doesn’t, look into the other things that do speak to you, right? We’re only here once. We can make our experience here so much better if we start to understand a little bit how our minds work and practice the things that allow us to see beyond it.

Kevin Pho: Lara, thank you so much for sharing your time and insight, and thanks again for being on the show.

Lara Patriquin: I really appreciate your time. Thank you.

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