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We’re joined by Diane W. Shannon, an internal medicine physician and physician coach, to explore the hard lessons of career sustainability and the importance of intentional self-care. Drawing from personal experience and years of coaching, Diane shares practical strategies for setting healthy boundaries, advocating for yourself, and creating space to recharge. Whether you’ve faced burnout or are looking to avoid it, this conversation offers actionable insights to cultivate a balanced and fulfilling career.

Diane W. Shannon is an internal medicine physician and physician coach.

She discusses the KevinMD article, “Unexpected lessons in self-care from my backyard garden.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Diane Shannon. She’s an internal medicine physician and physician coach. Today’s KevinMD article is “Unexpected Lessons and Self Care for My Backyard Garden.” Diane, welcome back to the show.

Diane Shannon: Thank you so much.

Kevin Pho: It’s great to be here, Diane. So for those who didn’t read your article, tell us what this one’s about.

Diane Shannon: Yeah. So this was something that happened to me this summer in the midst of the heat. We had moved in the late spring to a new house. And this one had window boxes, and I’d never had window boxes before and thought, oh, this is great.

The house didn’t have a lot in front of it. So I went out and bought some plants. The ones in the window boxes did great. And I put these nice little red—I don’t know what they were because I, at that point, had not looked at the label, didn’t know what they were—but bought these plants, put them in, looked great.

The next morning, six o’clock or whatever it was, 6:30, I went out for a jog. All the flowers were gone. They had been eaten by the cute little rabbits in our backyard. And this was—once I thought about it, you know, got over the frustration—this was a lesson. This is something I could have known. It turned out those were coneflowers or echinacea.

And it turns out those are something that rabbits love. There are other plants they don’t love. And had I done a little research about this, thought about it first, I might have learned that. So this was a lesson I learned the hard way. And I started thinking about what other lessons in my life I learned the hard way.

And a big one for me was intentional self care. As you know, I’ve told my story before. I burned out after only three years in primary care many years ago. Did not see a way to not burn out again. And there was very little talk about physician wellness in those days. So I moved into writing and only recently have come back to really, for the past decade, have been focusing on physician wellbeing.

And there’s a lot I’ve learned in the process, but sometimes you don’t get those lessons in time to go back and do a do-over. So now I focus on helping other physicians to think about some of the lessons I learned.

Kevin Pho: So when you hear stories from other physicians, you know, using that metaphor that you told about your garden, how can they rabbit-proof their careers?

What are some of the things that you’ve heard that they’ve done that could have been prevented perhaps if they got a do-over?

Diane Shannon: Right. Well, I think one is, as I mentioned, like intentional self care. And what does that mean? It doesn’t mean, “Oh, I’m going to go for a spa weekend once a year, and that’s going to be it.”

It really, I think, starts with looking at how, if this is true—and it usually is—how is work spilling over into your personal life and leading to not enough space, not enough energy for the things you care about, the people you care about, and taking care of yourself. And so often when I’m working with folks, it is looking at their work today, their work week, and some of the things that get in the way.

So often that is people pleasing, perfectionism, self-criticism, not knowing how to set boundaries or how to articulate that or articulate a request for something in an effective way. And so all of that spills over. And with the changes over the past five, ten years in what the health care system is, there is so much less slack in the system.

And so all of that pressure is coming onto physicians and spilling over into their personal lives. So a piece of it is looking at the work week, the work day, and tweaking that so that there is more space. Then you can begin thinking about what intentional self care looks like, and often that is prioritizing something that fills you up and whether that’s getting exercise, a good amount of sleep, a hobby that you enjoy, time to really be present with the people you care about, that makes a huge difference.

Kevin Pho: And when you say that sometimes professional work spills into a physician’s personal life, what are some stories that you’ve heard of what that may look like?

Diane Shannon: Yeah, well, you know, speaking with some folks just this week, it is about so many hours at work or in the evenings on the electronic health record, that there literally is no time.

And for one physician, I just spoke with recently, she said the reason that she finally looked to get some help was her husband was saying, “I’m tired of you complaining about work and having no time to do anything.” And she said, “Yes, it’s true. I have just kept putting work first because I didn’t see another way.”

So I think that’s a big part of it. And even if it isn’t doing the actual work, it’s thinking about the work or stressed about the work or finding it very difficult to have time truly away where you can totally recharge. And that’s something I’ve actually worked on a project this past year with the AMA about what does real PTO look like and how do you get it and how do organizations support physicians to have time truly off.

So that’s one piece of it—having that time to recharge—but there are other aspects as well.

Kevin Pho: So let’s talk about one of the first steps that you mentioned earlier: setting boundaries at work and carving out that time at work. So how does one go about doing that, perhaps in a primary care setting?

Diane Shannon: Yeah. And I work with a lot of primary care physicians. I think the first step is to pause for a moment and just say, “Are there any places where I’m getting in my own way?” And so one of those that comes up is people pleasing in interactions with patients. “Am I trying to do everything they ask in one visit versus saying, you know what, we’re going to deal with this today. You’re going to need to come back or we’re going to have to deal with these other things separately.” And sometimes people feel this pressure to have all that dealt with, which makes that particular visit spillover. Then there’s no time to finish the note. The whole day gets away from you.

Now, having that conversation with patients, if you haven’t been doing that, that is uncomfortable and it’s a new way of interacting. And I think sometimes because of that discomfort, folks don’t take that step to begin setting boundaries. And it’s not just with patients, right? Anytime you begin setting boundaries, if you haven’t been doing it, it is going to feel uncomfortable, right? But it’s something that becomes easier with practice, and it doesn’t—we don’t set boundaries because we’re malicious. We set boundaries because there’s a need that we need to have filled for us to be our best, whether that’s interacting with our patients, with our colleagues, or with our families at home.

Kevin Pho: What kind of tips do you share with physicians in order to be better boundary setters, whether in the exam room or when they’re talking with administration?

Diane Shannon: One of the things that I do is help people to focus, to see what are the benefits of setting boundaries, right? If you haven’t been doing that and you are caught up in this feeling of “It’s going to be uncomfortable, this person’s going to be upset with me,” it helps to balance that out with, “Okay, well, what are the benefits of you’re doing this? Who is going to benefit?” And sometimes patients benefit from that as well. So I think that helps a great deal.

And also owning that your desire to meet that person’s needs is coming from an altruistic place. That’s a great thing. We’re not asking you to get rid of that, but just to tweak it a little bit so that there’s some balance between what it appears this person needs and what you need.

Kevin Pho: Right. I think so often we are taught and what’s modeled for us in medicine is self-sacrifice to an extreme, and some self-sacrifice we absolutely need in medicine, right, to really be there for patients. But when it gets to an extreme and our needs are just nowhere in the picture, what happens is we burn out.

So let’s talk about younger physicians or physicians coming out of residency. This may be their first job, and we’re talking about being more proactive in preventing burnout. And one of the ways that you said was setting boundaries, but sometimes that’s difficult to do as an early career physician. You’re in a new setting and you’re in a new job, and throughout residency, you’re used to saying yes all the time because that’s one of the definitions of a resident. How can they make that transition as a young career physician?

Diane Shannon: Yeah. There are a couple of things. One is, I think if it were me, I would look for maybe an older physician who has a lifestyle and a way of setting boundaries that you admire and ask that person how they do it. See if they’ll mentor you a bit, right? So that they’re modeling for you a way of being.

Now, it is difficult when you’re kind of taking your first steps out; it’s stressful for a whole bunch of reasons. But that’s one thing that I would say. The other is to get really clear early on on what your ultimate goals are, not what you see or think you should do because so-and-so is doing it. For instance, maybe that person is on track to become a professor, like maybe that’s super important to them, and they’re doing all sorts of research, and you start thinking you should be doing research. But if you stop and think about it, is that really the path you want to be on?

Right. Maybe you want to write a book. Maybe you want to work with a certain patient population, and that’s what really fires you up. So I think it’s those things. The other piece that I would say is having some sort of support and training around advocating. So how do you begin to advocate and understand what those decision makers are looking for so that you are more likely to get a yes about the things that you need to be different in your practice environment?

Kevin Pho: Tell us a success story, perhaps from one of your coaching sessions, where you implemented some of these techniques that we’re talking about and it moved the needle in that physician’s career.

Diane Shannon: Absolutely. Gosh, there are so many. Let me pick one of them who is a primary care physician. I mentioned her a lot because we were both so shocked at how quickly these changes helped. She’d been in practice 14 years, working 0.6 FTE, so three days a week seeing patients, but was working every single day in order to complete charts, get back messages, look at, you know, review lab results, et cetera.

She said, “I just want one day off, just one day where I am not on the computer or around work.” And so she developed a list, like pausing for a moment, thinking about where she could change something. She thought, “I could do my charting a little differently.” And so she set this goal of trying to finish more charts before seeing the next patient.

And that—there was discomfort there because she said, “But that next patient is waiting an extra two minutes. Right? Who am I to make them wait longer?” So she did a couple of things to help finish those charts. One of them was really looking at how concise her notes were. The other was to do a little bit of pre-charting the day before.

So just those few things. And within two weeks, she had a day off. And she continued to tweak that so that she has now most weekends off except for about 45 minutes on Sunday when she prepares for Monday. And it has made such a difference in her life, you know, and she said, “I love my job again.” So, but like I said, both of us were really surprised at how those small changes, when she really focused her attention there, made a huge impact on her experience at work every day.

Kevin Pho: We’re talking to Diane Shannon. She’s an internal medicine physician and physician coach. Today’s KevinMD article is “Unexpected Lessons in Self Care for My Backyard Garden.” Diane, as always, we’ll end with some take-home messages that you want to leave with the KevinMD audience.

Diane Shannon: I think what I would say is just—what’s the takeaway from that last story that I told? Sometimes with burnout or just being overwhelmed with work, we cannot see the little places that we could change, or we don’t think they’d make any difference.

And what I have seen and what I would share is look for those small places where you have some agency and just try and experiment, just see if it helps a little, and you may be surprised at what a big impact it makes.

Kevin Pho: Thanks, Diane. As always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Diane Shannon: Thank you, Kevin. Great to be here.