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Pediatrician and certified coach Jessie Mahoney discusses her article, “Why judgment is hurting doctors—and how mindfulness can heal.” She argues that the culture of medicine is steeped in judgment—from the language of “noncompliant” patients to the intense scrutiny of training—and that this culture is crippling physicians. Jessie explains that while judgment is often disguised as a tool for maintaining high standards, it actually drives shame, blame, and exhaustion rather than excellence. The conversation explores the high cost of this mindset, which drains energy and creates disconnection from patients and purpose. As a radical alternative, Jessie introduces the concept of Maitri, or unconditional friendliness, a mindfulness practice of replacing reflexive judgment with curiosity, compassion, and generosity. Listeners will learn practical ways to reframe feedback, opt out of the judgment cycle, and use mindfulness to protect their energy, build healthier teams, and begin to heal medicine from the inside out.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney, pediatrician and certified coach. Today’s KevinMD article is “Why judgment is hurting doctors and how mindfulness can heal.” Jessie, welcome back to the show.

Jessie Mahoney: Thanks so much for having me.

Kevin Pho: All right, what’s this latest article about?

Jessie Mahoney: Well, it’s about judgment, and it’s really inspired because so many people who work in medicine, we feel so—we have so much judgment about ourselves, and we don’t notice the judgment culture in medicine that we were raised in. What I see all the time is how much harm it causes to physicians, but also to patients and also just the whole culture of medicine.

And it strikes me as such an important thing to think about now because there’s so much we can’t do anything about in medicine and in our society, and yet there are things that we can do something about, and this is one of them.

Kevin Pho: So when you say that physicians face that judgment culture in medicine, what are some examples of what that could look like, and who is judging us?

Jessie Mahoney: Well, interestingly, number one, we judge ourselves, and that’s probably the most harsh approach. We cloak it in this idea of, “Well, this is what it takes to do better,” but it’s: “Why did you do that? What’s wrong with you? How could you not know?” And so there’s that piece, which is the hidden judgment.

Then we also tend to judge our colleagues, the person in the office next to us. We always look at the care other people provide and whether it’s to decide, “Oh, well, I would never have done that,” or to decide, “Why did they do that? They shouldn’t have done that.” We cloak that in the idea of improvement, if that makes sense.

And if you think about M&M, we also have just tons of judgment. It’s not so much, “How do we improve care?” or, “What can we learn from this?” It’s this blame-shame culture that we have, which is: something went wrong, it’s somebody’s fault. Instead of thinking about, “Oh, well, human bodies are complicated, medicine is complicated. What could we learn? How could we do better?” it’s much more of a, “Where did the mistake happen? Who is responsible?” We know from neuroscience that this doesn’t help you learn. It doesn’t help us change, and it leads to a lot of burnout and, oftentimes, even worse things like suicide, people feeling like they made a mistake.

I think just honoring that we have this culture and it was taught along the way, but that we can change it. Then the other piece that is also pretty disturbing is the language that we use in medicine. We also tend to judge patients, and it’s not done maliciously. It’s just the language that we were trained to use, like ‘complaining’ and ‘denying.’

Many of the diagnostic criteria use the words ‘incompetent’ or ‘failure’ or things like that. And so it’s just steeped in the culture in these very hidden ways that really does change the energy. None of those words—and judgment—is not particularly a healing energy, which is what we’re in medicine to do.

Kevin Pho: And sometimes that culture of judgment leads to the opaqueness and the lack of transparency that we in medicine are often accused of, right?

Jessie Mahoney: Yes, absolutely. I think when people feel judged, it’s the human tendency to go into shame and to go inside and hide. It doesn’t lead to open conversations and solutions to complex problems, which health and medicine are complex problems, whether they’re systemic or physiologic.

Kevin Pho: And for those who aren’t immersed in our world of medicine, how did it get to be this way?

Jessie Mahoney: Well, I think it got to be this way—I mean, the answer is I don’t know. It’s been this way since I came into medicine 30 years ago, but I think that it’s really steeped in this idea of actually providing good care, doing better, and using this judgment as a way of ensuring competence. It was really equated with caring if you would judge yourself harshly and have this hypervigilance. You know, I am in pediatrics, which many people think we’re the nicest and the least judgy, and yet we’re not. We, in fact, judge each other more harshly because it’s “for the children.”

That’s really the culture, I think, in medicine: this is a caring, serving, outwardly focused profession, and so, therefore, we must judge one another inside to make sure we’re performing at the highest level. But we actually know that we don’t perform at the highest level if we are judging, right? Because we’re releasing cortisol and norepinephrine. Your brain doesn’t learn in that way.

So if we really want to learn from what I like to call “undesired outcomes”—because we call them bad outcomes—and I think if we want to learn from that, judgment is not the way to learn. We know that from neuroscience. So could we be curious, or could we actually show up with kindness and compassion, recognizing that the work we do is hard, it’s complex, and that patients don’t read the book? Diseases don’t actually read the textbook.

I think it’s that it came from what I would see as a good place. I don’t think it’s malicious, but I think if we don’t call it out and change it when we see it and when we know it, that we’re missing a real opportunity to help medicine heal and help patients heal.

Kevin Pho: So, as you mentioned, you’re a pediatrician, so how does that culture of judgment affect your day-to-day practice, whether it’s in a clinic or in a hospital?

Jessie Mahoney: Well, one, it’s the judgment of self: “Did I miss something, and might I miss something?” And this idea of really not having your own back. Our default thought pattern in pediatrics is not, “I did the best I could. I went through all the options.” It’s when something happens, it’s, “What did I miss? What did I do wrong?” If I’m being so honest, when something happens, we go back to the chart and we hope, “Oh, I hope it’s not me. I hope it was someone else that made the mistake.” That’s how the judgment shows up.

I think we also tend to look at our colleagues’ care once we haven’t figured it out, thinking, “Well, what did they miss?” That’s really the thought, or “What did I miss?” rather than, “Hmm, how can we be curious? I wonder what’s going on here? What can we learn? Where is there a clue?” You know, outside of medicine, we think of failure or not getting it right the first time as a learning opportunity. I have a son who works in a startup; it’s just learning. But in medicine, it’s judgment and, “What’s wrong with you?” And so I think that even in peds, we look at our colleagues and we say, “Well, how could this have happened?” And at systems as well.

I think we even judge our staff and our support staff. It’s, “They didn’t get this right,” instead of, “How can we help them learn? How can we grow?” Interestingly, in peds, when we look at kids who are developing, we don’t say, “How come they didn’t learn to walk yet?” Right? It’s, “How can we help them? What support do they need?”

If you’re thinking about training, I think it’s the same thing. We tend to, as attendings or as faculty—I coach people a lot about, “Well, how do I give this negative feedback or help this problem resident?” instead of, “How can we foster their development or their growth?” or thinking about leadership. We have performance improvement plans.

But what if we were investing in our doctors? We need doctors. We have such a shortage, right? So how can we invest in people and recognize that the work is hard? I don’t know a person who goes into medicine who isn’t good-hearted and wanting to change the world because there’s so much else you could do that would be so much easier. Right? But instead, we judge, and I think many people leave because of that energy, which just doesn’t feel good. You’re trying your hardest, and yet you’re constantly being judged.

Kevin Pho: So let’s talk about some paths forward. In your article, you talk about the concept of maitri—unconditional friendliness. Tell us what that is.

Jessie Mahoney: Well, it’s really this idea of kindness and compassion; that’s how I like to think of it. But I love it because it’s this kindness to yourself and compassion for yourself, assuming good intent. In mindfulness, we would call it generosity.

In other cultures, they call it maitri. I really like this idea of being kind to yourself, kind to those you work with, and kind to the patients that you care for—kindness for society and all of the people suffering and struggling. So, it’s this rather than judgment and rather than pointing fingers and looking at what’s wrong; it’s, “How can we do better? What can we learn from it?”

But it includes yourself, which I think is one of the key pieces. In yoga, we actually call it ahimsa, which is “do no harm,” but it’s do no harm to yourself. It’s showing up with this loving, caring intent, which I think we cloak judgment in in medicine, but maitri doesn’t actually include that.

Kevin Pho: So what would that look like? When you are doing your coaching sessions with a physician, how do you break that loop of self-judgment? What are some things that those physicians listening to us today could do?

Jessie Mahoney: Well, the first part is to notice where you’re being judgy. I’ll often ask people to take a week and just notice how often you’re judging yourself, and it’s usually hundreds of times a day that you criticize yourself or say something negative, cloaked in, “I’m improving, I’m doing better.”

But noticing again, I think if you go back to kids learning to walk, they don’t feel bad about themselves. They just get up and try again. They assume they’re doing their best. So I think number one is noticing. Number two is really that self-compassion, and that’s common humanity. We’re all here trying to be good humans in the world, and maybe not every human, but maitri would say every human has goodness in them and is trying to do their best in the world.

Then, be intentional about how you want to move forward. Judgment, for example, is very draining, so can you recognize how it impacts you and decide how you want to move forward? I often say it’s very hard to get from being mean to yourself or judgment to self-compassion, but can you be neutral? Can you just not judge or opt out? Can you be curious? “I wonder what I can learn from this,” or, “How interesting that this happens.”

I think also recognizing this generosity, which is assuming good intent, telling a neutral story, or not telling a bad story about what happened. So, “I don’t know why this happened,” could be a neutral story. I think it’s often the same thing with, “I wonder what my colleague was thinking.” It’s asking what I would call helpful questions rather than harmful questions. When we can stay in curiosity and compassion and out of this depletion and reaction, we can actually choose to move forward differently.

I love this idea of an intention, which I think is something we really don’t use in medicine because it’s choosing how you want to show up. So you might say, “I’m going to choose to be curious.” When I see that my patient showed up in the ER—that for me was always, I immediately would go to the chart and say, “I wonder what happened. What did I miss? When did I last see them?”—it’s, “Can I be curious about what happened in a non-judgmental way?”

When you choose something with intention, that’s what your brain focuses on. If our brain doesn’t have anything to focus on, it goes to the negative, which is judgment. Simply by setting that GPS in that direction, you can keep yourself out of that negativity. But again, if you don’t even notice it, which most of us don’t, we’re so acculturated to it. We just think it’s normal that we don’t make change.

I think another thing, too, is to think about your dot phrases, and if you have control over what they say, maybe take out the words ‘complain,’ ‘deny,’ ‘state against’—things like that where you can. Obviously, in the ICD-9 or the diagnosis codes, you’ve got to use whatever’s there. But where you have control, can you change things there just to change the energy by which you move through your day in medicine?

Kevin Pho: So I’m sure that you know that the current culture of medicine where there’s a focus on performance metrics, patient satisfaction scores—right? That’s the epitome of judgment. Now, how can you reconcile that tension between breaking self-judgment and the environment that we’re currently in? How can physicians navigate that?

Jessie Mahoney: Number one, I’ll just honor that it’s tricky, right? Because that is actually not really about care. It’s about money, it’s about business, it’s about other things.

So part of it for me was really recognizing that a lot of those metrics weren’t about—they weren’t a judgment of my doctoring, they weren’t a judgment of my caring, they weren’t a judgment of how I was taking care of patients. They were simply being measured for other business metrics. If you cannot over-personalize it, that can be helpful.

I think when you’re grounded in, “I’m doing the right thing for my patients,” which is a constant reminder, right? Because you’re being told things outside. My hope is that things will ultimately change, but they’re not going to change if we stay seeped in judgment of ourselves and one another. Part of it is recognizing which of those metrics are about good care, good health care, and what are actually metrics someone’s trying to measure to compare insurance plans, for example.

I like to think about peer review and M&M, which also kind of fit in that category. Those are really more about malpractice and health care systems than about your care. So recognizing, if you can go into it as a, “What can we learn from this?” And I’ve actually worked with quite a few physicians who lead those programs in coaching. I think when they shift their framing of those sessions, then people want to come. Then the conversations open up, and we can actually learn more.

This is a bit of the physicians taking back what’s right and helpful for patients from these bigger, overarching, higher systems. Absolutely, it’s not easy, but we have to start somewhere. We can start at least from within and by recognizing that those metrics are not necessarily about us.

Now, I fully acknowledge that often our raises and bonuses and pay and all these things come from that. But resisting the reality of that also isn’t going to help us. And so it really has to come from within and from caring for each other.

Kevin Pho: We’re talking to Jessie Mahoney, pediatrician and certified coach. Today’s KevinMD article is “Why judgment is hurting doctors and how mindfulness can heal.” Jessie, as always, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: I think the biggest take-home message is that if we aren’t aware of the judgment and we don’t notice it, pay attention to it, and decide to show up differently, then we’re really contributing to some of these challenges.

And so while there’s so much out of our control, there is this piece that is in our control. We get to choose how we show up, how we treat ourselves, how we treat our colleagues, and the language that we bring to teaching the next generation of physicians and caring for each other as leaders. That is in our control.

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

Jessie Mahoney: You are welcome. Thank you for having me.