Mastering mindfulness: Restoring autonomy and curing burnout for physicians [PODCAST]

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Join Gail Gazelle, an internal medicine physician, physician coach, and author of Mindful MD: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout, where we explore the transformative power of mindfulness in health care. In this episode, we meet Mira, a physician and single mother struggling with overwhelm. Gail discusses how our minds can become consumed by negative thoughts, impacting our experience of the world. She highlights the lack of mindfulness training in medical school and introduces mindfulness as a toolkit for managing our minds. By cultivating awareness and detachment from unhelpful thoughts, we regain autonomy and combat burnout. Join us as we discover how mindfulness can empower physicians to navigate the challenges of their profession.

Gail Gazelle is an internal medicine physician and physician coach.

She discusses her book, Mindful MD: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and you can get CME for this episode by clicking on the CME link in the show notes. Today we welcome Gail Gazelle. She’s an internal medicine physician and physician coach. We’re going to talk about her book, Mindful MD: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout. Gail, welcome to the show.

Gail Gazelle: Oh, it’s a pleasure to be here, Kevin.

Kevin Pho: So we’ll get into your book in a little bit. First off, briefly share your story and journey to where you are today.

Gail Gazelle: Sure. I started my career in internal medicine, but what I really wanted to do was end-of-life care, and since I trained in the 1980s, to date myself, end-of-life care wasn’t really a field yet. So I got my first job working in hospice. I published an article in the New England Journal of Medicine about end-of-life care. It was an article bringing to light the unethical practice of slow or Hollywood codes.

And I continued my journey. I’m here at Harvard Medical School, where I’ve been for the last two decades, and I suffered through my own burnout. I had a child on my own. I felt really guilty when I wasn’t home with him. I should be with my patients. When I was at work, I felt guilty that I wasn’t doing more. That led me to get coaching myself and find it really life-changing, and then to become a coach myself.

I was really a pioneer in the field. I became a coach 13 years ago, and so I’ve had the pleasure of coaching over 500 physicians one-on-one, many more in groups, and really helping them find the balance and reduce burnout that I know is possible. That’s an overview of my journey.

Kevin Pho: So I want to take you back to that time where you first felt burnout, managing all the different aspects of both your professional and personal life. You said coaching was life-changing, and I’m sure we’re going to talk about this when we talk about your book, but what exactly was the change that coaching made in your life to help things out?

Gail Gazelle: Yeah, great question. I’m somebody who had years of therapy to help recover from some of the complexities of my own childhood. Therapy was great, but there were things that just weren’t shifting in terms of really how I saw myself, what I thought I was capable of, my ability to just enjoy my life and be present in my life, and my ability to really be my best self as a parent, as a physician, and as a human being.

Coaching just connected a lot of dots for me. It was really a tremendous surge in personal growth that helped me prioritize: This is what’s most important to me, and now I can see a little more clearly what’s in it for me to make the changes. So much of coaching really has to do with motivating ourselves, motivating our clients to make the changes to live the life and career that they want so much.

Coaching was just like leapfrogging forward. I laughed more. My patients would say to me, “Oh, Dr. Gazelle, are you in love now?” They’d seen me so much happier. I was a much better parent. I could put aside work more and really be present with my son, so I didn’t have to feel all of that parental guilt that I wasn’t doing enough. Those are just a few of the things.

It also really spurred my interest in mindfulness, the ability to really train my mind to focus where I wanted it to, to step out of all the mental stories of not being good enough, being an imposter, etc. So the benefits were just so profound, and again, those are the benefits that I’ve really been able to translate for the physician clients that I’ve had the pleasure of serving.

Kevin Pho: Of course, you’re a coach yourself now. So today, one of the most common reasons or issues that physicians come to you for?

Gail Gazelle: Oh, by far, burnout. It’s, “How can I possibly work in this demanding circumstance of health care when my value isn’t being seen, when my work isn’t being respected, when I’m just treated like a widget? How can I possibly withstand that?” That is by and above the most common thing.

Certainly, leadership development, work transitions, and behavioral modification, let’s say for people with anger management issues or disruptive physicians. But there’s so much disquiet, as you well know, with two out of three of us all suffering with burnout, and really, that’s the erosion of the soul. So by far, that’s the most common.

Kevin Pho: All right, and we’re going to talk more about that as we discuss your book, Mindful MD: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout. So tell us, how did your book come together?

Gail Gazelle: I’ve been working on this book for over five years. As a coach, you have an intimate window into the life of a fellow physician. All of my clients are physicians and physician leaders, and what I’ve seen over and over is the power of really getting to know our own mind: our own mental stories, all of our unhelpful thoughts, all of the ways that we kind of box ourselves in, in addition to the ways that the system boxes us in.

And I’ve seen repetitive patterns. There are things that we learn in our training that completely derail our sense of satisfaction as we go on: all the comparisons, the ratings and rankings, all of the pimping that we endure during our training, all of the comparisons that are made. If we’re not perfect, we’re a failure. All of those things really set us back.

And they also make it very difficult for us as employees now, as opposed to independent practitioners, because we’re taught on the one hand that we’re the captain of the team, we’re the one who has the answer, we’re the one who needs to be invulnerable. And here we are now, largely as employed physicians, and we are no longer the captain of the team. We are no longer the boss, and that dissonance is very hard for many physicians to manage. I’ve seen that over and over.

So the book really provided a way for me to share what I’ve learned, so many pearls of wisdom, specifically about mental training, that I know can help so many colleagues get out of burnout and maybe not even get into burnout in the first place.

Kevin Pho: So you articulate that tension so well, in terms of training physicians to be the captain of the ship, but also, as employed physicians, they’re not in that role. So what are some things that physicians can do when dealing with that situation? Because I’ve talked to hundreds of physicians on the show, they write on KevinMD, and they describe exactly what you’re articulating right now. So what are some first steps that they can take to resolve that tension?

Gail Gazelle: The first way that mindfulness can help with that tension is recognizing what we can control and what we can’t. I have seen so many physicians, let’s say, sit down to chart, for example, and it’s almost as if smoke is coming out of their ears. They’re so angry about the unfairness: “This is not what I signed up for. How could you be asking me to do this? I’m here to take care of patients, and this is unfair.” And sadly, that emotionality then makes it very difficult for them to get the charts done.

We have to harness what is under our control and what is not, and we have to reduce the expenditure of energy that we don’t have on things that are out of our control. So that’s one very important part of how mindfulness, getting to know yourself, your own patterns, where your energy is going, is absolutely critical to avoid burnout.

That dovetails with the need to reduce reactivity. Many of us are very reactive, right? We learn to be less reactive with patients, but we don’t learn how to be less reactive, let’s say, with administrators, right, or with what many physicians call the toxic boss. We can learn how to do that. Mindfulness can help us tremendously in regulating our emotions in a way that serves us.

I’m a coach. I’m all about the individual physician in front of me, and that’s what the book is about: a road map to help yourself really manage, given all the complexities in health care that don’t seem to be going away anytime soon. That’s what this is about.

And further, we tell ourselves a lot of stories. So for example, Kevin, and I share this in the book, Mindful MD, we might have a story about our own happiness: “I can’t be happy with this blank electronic health record. I can’t be happy with all these administrators. I’ll be happy when they get me a better boss. I’ll be happy when I retire.” And that’s a story that may have a kernel of truth.

But if you think back to, let’s say, college, maybe you had a story: “I’ll be happy when I get into med school.” Then you get into med school: “I’ll be happy when I finish med school and I get the right residency.” Then you’re a resident, and here’s really the kicker: “I’ll be happy when I become an attending.” Now, for everybody listening to this who isn’t an attending, you can appreciate the fallacy of this thinking. And yet it keeps us from actually finding contentment right now, because we’re always waiting: “It’s only when I finish this, then I’ll be happy.” And in fact, that isn’t what happiness is about.

So that’s another one of the ways that I get into in the book: How can you notice that storyline and work with it so that you can have what you want right now, the contentment, the career satisfaction that you’ve worked so hard to achieve? I think when people hear mindfulness, they think, “Oh, it’s so woo-woo, and she’s telling me it’s going to cure all the mess of health care.” It’s not that at all. It’s training the mind to focus where you want it to focus, so that you can really become the master of your mind, rather than what I think is true for many of us.

Kevin Pho: I think everything you’re saying, I completely agree with, and again, you articulate it so well. So tell me about the actual process of doing that. Physicians have been trained pretty much since high school or undergraduate to think and behave and react in a certain way. What’s the actual process like to change that mindset? What kind of time course? How much coaching? Like you said, you say it so beautifully, but obviously it’s easier said than done. Tell me about that process of changing that mindset.

Gail Gazelle: Yeah, well, I can liken it to building skeletal muscle. It requires a lot of reps, and I think that’s important, because these patterns of thought and behavior have been instilled since, as you say, high school. We could even argue grade school. By the way, we’ve been acting in certain ways for a long time, so there has to be some patience with the process.

But there are more than a couple of key strategies, and I include them in the Mindful MD book. This is a pragmatic book. This is not a pontification. So what are some of the strategies? Well, one of the strategies sounds very simple, but it’s taking purposeful pauses.

You’re in the middle of your day, you’re working with your medical assistant, and you’re not getting along with your medical assistant. Maybe it’s been a rotating door, given the shortage of good staff. And you say something to the medical assistant, and he or she rolls their eyes. OK, this happens, right? And you feel your emotional temperature just shoot through the roof. That’s the time to take a purposeful pause and calm yourself down. You do not want to say something that you’re only later going to regret and be called to task for by your administrator. So that’s a key strategy, and I outline that in the book. I give a lot of examples of how physicians can employ purposeful pauses.

Another really important strategy is to really build more compassion for ourselves. It is really hard being a physician. It always has been. It is doubly hard working in today’s health care environment, with the corporatization of medicine, the emphasis on the bottom line, all of the below-grade tasks, and all of the moral injury that we know is part and parcel of the physician’s life.

So we have to shift from being an inner bully, an inner critic who’s telling us everything that it perceives we’re doing wrong, to actually being an inner friend, an inner ally. And again, that can sound very soft, but I have seen it be a game changer for physicians struggling to get through each and every day and get the many tasks done, and then actually come home and actually give some kindness and attention to those that they see on the other side.

Those are just a couple of examples, Kevin, of very pragmatic things that we can do that help the mind shift from these well-established patterns into patterns that are actually much more resourceful for us.

Kevin Pho: We’re talking to Gail Gazelle. She’s an internal medicine physician and a physician coach. We’re talking about her book, Mindful MD: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout. Gail, tell us a success story, maybe a before-and-after picture of a physician that came in burned out, in the scenario that we had talked about earlier, and what kind of changes did they make to make a measurable difference in their life?

Gail Gazelle: Yeah, great. I’ll call this physician Susan, and I’m not giving away confidentiality here. Susan came to coaching. She was a medical specialist; I won’t even say what her exact field was. And she came to coaching really burned out, exhausted, dragging through the day, very cynical about the practice of medicine: “Why did I even go into medicine in the first place? I’m not making any difference. Why bother?”

And Susan is a mother of two teenagers, and when she would get home, she just had no bandwidth left to actually be patient with these teens. And they were teens; they had their own issues, and they wanted Mom to just take them here and take them there, etc. And she was just really irritable with them. She was waking up at night having mental shouting matches with her administrator in her practice. So she was really at the end of her rope when she came to coaching.

And she was somebody, like most physicians, who loves to learn, so she was eager to learn new ways of being. She’d never really turned the lens of learning on herself, and coaching provided that very important space and opportunity for her to do so. And she was really out of alignment with who she wanted to be and how she wanted to be showing up.

So we have to shine a light on: Who could I be? What is that better version of myself? Because we lose sight of that when we’re in burnout. We don’t know that there’s a better way; we’re just going down. So part of the coaching was really envisioning who her best self was, how she wanted to be showing up at work and with this precious time with the teenagers, who, you know, would be leaving home in a matter of years. That was one thing that we did.

We also did a lot of work on the comparing mind. That’s what we call it in mindfulness speak, because she was comparing herself to all of these other physicians whose shiny outside was all she saw. She didn’t see the struggles, but she had this motif that somehow she wasn’t measuring up. So we needed to break that cycle of self-criticism, that inner comparisonometer that really was only serving to wear her down.

I’m really happy to say that Susan was willing to put in that work. It does take work. It takes reps, just like going to the gym, and part of my job as a really seasoned coach is building that momentum and that motivation. So I think Susan would be the first to say that she’s a lot happier now. She’s a lot lighter. She’s been able to set more boundaries at work. When something happens with an administrator, she doesn’t take it as personally. She doesn’t take it as seriously. She can see that poor administrator: They’ve got a tough job too, and “How can I work with this person rather than against that person?”

So she’s got an ideal of who she wants to be, and she sets an intention every single day to show up a little more closely to that ideal. It’s not like she’s waking up doing cartwheels, don’t get me wrong. Her life is tough as a mom and as a very busy medical specialist; there’s no question about that. But she has more tools to manage all of that, to surf those waves of difficulty, so that she feels prouder at the end of the day, and she has more emotional bandwidth to spend time with her teenagers. That’s just one vignette that I hope can be helpful to your listeners.

Kevin Pho: And my final question, Gail. Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Gail Gazelle: Yes. Let me say first, if people are interested in the book, they can download a free chapter at gailgazelle.com/mindfulmd. They can read a little bit for themselves and see that this is not just another book that says, “Oh, go meditate and do yoga, and life will somehow be wonderful,” because it is really not that at all. So that’s the first takeaway: Please avail yourself of this resource.

The second takeaway that I think is critically important is that there’s no question that the health care system in this country is struggling mightily. Many would say it is dysfunctional and broken. But the key takeaway is that each of your listeners does not have to hand over their happiness and their career satisfaction to a broken system. They don’t. And that’s the key here: realizing that there’s room for hope, that yes, the system is a mess, and I’m going to be the last one to challenge that, and you can still enjoy this career that you have really sacrificed so much to have. I think that’s the most important takeaway.

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

Gail Gazelle: Total pleasure, Kevin. Thank you so much.

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