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Pediatrician and certified coach Jessie Mahoney discusses her article, “Why the future of medicine depends on leading from the heart.” Drawing from her experience leading a workshop for women cardiologists, she explores the sacred irony of physicians who are experts in the heart yet rarely tend to their own. Jessie explains how medical culture, especially for women leaders, rewards overwork and expects self-sacrifice, leaving no room for reflection. The conversation introduces her core leadership philosophy, which is grounded in the biological principle of diastole—the essential rest phase of the heartbeat. Jessie argues that this sacred pause is not a luxury but a necessity for sustainable leadership. Listeners will learn how to shift from leading with intellect and control to leading with intention, authenticity, and a wisdom that comes from the body, ultimately fostering deeper connection, a steadier presence, and a healthier future for medicine.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney. She’s a pediatrician and certified coach. Today’s KevinMD article is “Why the future of medicine depends on leading from the heart.” Jessie, welcome back to the show.

Jessie Mahoney: Thanks so much. Nice to see you again.

Kevin Pho: All right, so tell us what this latest article is about.

Jessie Mahoney: So I was inspired to write this article. I’ve actually been doing a lot of workshops on leadership and thinking a lot about how we lead in medicine. I am a former physician leader who has been to what we used to call in my organization, chief school.

And they taught us all how to lead in a certain way, in a framework that works for these big organizations. But what actually works in leadership? In working with leaders, I am really recognizing that a lot of those traditional ways we were taught feed into the things that work well in organizations but not necessarily for us as physicians and potentially for the physicians we’re leading.

Kevin Pho: All right. In your article, you talk about an irony of cardiologists forgetting their own heart. So tell us about that story.

Jessie Mahoney: Very recently, and that’s really what inspired the article, I was giving a workshop for mid-career women leaders in cardiology and recognizing that what we’re taught in medicine is to not pay attention to our hearts, not pay attention to our purpose and our passion, and to instead be responding to metrics. This is how we’re supposed to do it, and really leading from a place of depletion. And one of the things that I often teach in coaching is this idea of diastole. If you don’t have an effective diastole, you can’t have an effective systole. And yet as leaders, we’re taught to ignore all the physiologic knowledge that we have.

And so if you don’t take time to refill, then you can’t actually lead. And most leaders that we know lead from this sort of servant leadership and self-sacrifice, completely depleted, reactive, urgent, with fixed, managed, control-type approaches. The lessons from the heart are not that. They are to be steady and paced. The heart fills itself first with the coronary arteries, and it takes time to do that. It paces itself. If you are not in diastolic dysfunction, at any rate, it takes time to fill itself, and it has the space to fill itself. And most of us in medicine are very constricted and working on these tight schedules with no space to fill.

And so this idea of pausing and learning from the physiology is really helpful in leadership. It also really appeals to physicians who really do understand: your heart is there for the long life and has to keep working. And if we ignore that physiology, nothing works.

Kevin Pho: To go into more detail with that metaphor, when it comes to diastole, what would that look like for a lot of physicians and leaders? That rest phase, that pause, what does that look like for them?

Jessie Mahoney: I think it can look both micro and macro. So micro, even taking pauses during the day. I often call it managing your energy. We’re very compressed into managing time really well. Can you manage your energy well? So can you take pauses to take a few breaths? Can you go outside at lunch? Can you make sure that you take a day off each week? I know as a leader, for myself, I used to answer emails at night, and they’d come in in the middle of the night because sometimes people you’re leading work at night. And so there’s just never a pause to catch your breath or refill. And so I think in the micro, in each day, or even in each hour, how can you simply, as I often say, pause and breathe? We know that the breath actually physiologically changes us, and yet most physicians don’t ever breathe.

It can look like that. It also looks like taking time, like taking a vacation. And actually, as you know, I run retreats and I have people who come to retreats who are leaders, and they are still checking their email and still navigating scheduling from their time off. And that is not diastole.

And what you find is that then you go back exhausted. It’s not that you don’t have any rest or restoration, but you’re not having that chance to actually fill. So you’re partially filling. And we know when the heart partially fills, it doesn’t function well for the long term.

Kevin Pho: Physicians, as you know, are very, very structured. The fact that they don’t take advantage of that diastole is probably ingrained in them ever since pre-medical school and goes throughout medical school and residency. So in order to create that shift and give that space so they can breathe, on a practical level, how do you coach them to do that? Do you have to schedule it in? How intentional do they have to be?

Jessie Mahoney: One of the things that I actually teach as a leader is being intentional, and I think that’s the power. So for some people, it will be scheduling it. I have some people who have a note on their computer that they are going to take five minutes outside at lunch every day because what they discover when they do that is they can get through the afternoon. For other people, it’s choosing an intention of what kind of leader you want to be. So maybe you want to be a calm and grounded leader or a responsive leader, or for many, the word authentic really resonates. Or you want to be a sustainable leader, and if that can be your guiding light, then you’re showing up for your day and your meetings and all of that with that in mind.

I think the other thing is when people understand the diastole concept, most people recognize that you can’t function without diastole. I love the physiologic concepts for physicians because they get it immediately. And diastole is two-thirds of the cardiac cycle. For most of us in medicine, we don’t pay any attention to that. So I think this idea that you would go into heart failure helps them recognize that they have to make time for it.

I think that every physician has to approach it differently. You have to individualize what that is going to look like for you. For some people, they need to stop on the way home at a park for five minutes and meditate. For some people, they need to plan in an exercise class. For some people, they have to plan a pause every quarter; they’re going to take a week away. For many people, it’s actually recognizing the importance of it and recognizing that the time has to be taken and the consequences of not doing it. Once we begin to see that, because most people aren’t even thinking about it in medicine, we’re just reacting. We are told that leadership is an honor and a privilege, and so therefore we should just go and do it. And we’re reacting the whole way along rather than being intentional about what kind of a leader we want to be.

The other thing I think is really helpful is thinking about energy conservation as a leader. I have a lot of people coming back as leaders to coach with me knowing that they are depleting their energy by ruminating or trying to solve things they can’t or letting certain distressed physicians in their group drain them, and they see it. But it’s really, “How do I make this space, and how am I intentional so that that doesn’t get in the way?” And basically, I love calling it putting you into heart failure.

The other piece about the heart that’s not just the physiology is that I think when we lead from that heart-centered desire of what kind of a leader you want to be and how you want to support your teams, and really who you are, not who the world wants us to be, those are the leaders that, in fact, I think have the most sustainable and most impactful careers. And so letting that be part of your leadership voice and your leadership intention—I hear time and time again this idea of having an intention as a leader, what kind of a leader do you want to be? And most of us go to chief school to learn about what kind of leader we’re supposed to be, and that doesn’t actually help us. Then we’re reacting, trying to do this “supposed to,” rather than standing tall and shining our light and bringing our beliefs and value systems to it.

Kevin Pho: And as a leader, if they value that diastole, the people that they’re leading would see that and value that concept as well, right?

Jessie Mahoney: Absolutely. And I think one of my very first talks almost 10 years ago now was titled Leading with a Lens to Wellness. As physicians, we as leaders model self-sacrifice. We model taking the worst shifts. We model being the one who is the last one to leave. That doesn’t give anyone else permission to practice in a different way, and so I think the power really comes when a leader models diastole and shows the importance of refilling and allowing themselves to be present and whole and not depleted.

Then everyone else can also do that. If we don’t model that as leaders, then we’re sending this very mixed message, which does not allow other people to do it. Now, they could do it, but it doesn’t allow them to do it in good conscience without feeling guilt and shame about it.

Kevin Pho: One of the things you wrote in your article is that physicians or leaders sometimes need to unlearn urgency, right?

Jessie Mahoney: Yes. For a lot of physicians, that goes against the grain, and it is sometimes very difficult to unlearn that mindset. I found it’s really about being discerning because urgency is needed in the OR or the ER or in a code, but we need to discern what’s urgent and what’s not. As a leader, everything that comes in feels urgent, and everyone else that you’re working with also has an urgency bias because that’s what we have in medicine. And so for me, it was asking, “Is this urgent? Is this not urgent?” and also recognizing that sometimes other people’s urgency is not actually my urgency. We often will get requests for credentialing paperwork, but it’s really due three weeks from now. But in our brain, when we are not being discerning about that, it’s very exhausting.

Then we perpetuate that culture of urgency with our own colleagues and our teams. And then that is just energetically depleting, and medicine’s hard enough without this false sense of urgency. So I think it’s about recognizing where urgency is needed and where it is not needed. If the leaders could show up with a more measured, and we’ll use the heart analogy again, paced response, that would be so much more helpful for everyone.

Much of the conversations that we had when I was on a team that was opening a new medical center felt urgent, but it was opening in six months or a year. And so there’s this energetic depletion that comes with it. It needed to be dealt with today, but it didn’t really. It’s not that you don’t do it; it’s just that the energy that comes along with that makes medicine much more taxing and draining, and it’s already taxing and draining by its very nature.

Kevin Pho: So one of the things that you wrote about is that when you were doing that retreat with the female cardiologists, that room was what you described as a sacred space, a safe space. So what goes on in that room? You wrote that sometimes these physicians can stop pretending. What is it like to be in that room?

Jessie Mahoney: I think when we create these spaces that are away from where you work—and a lot of these leadership groups, actually, the most powerful ones I see are where leaders come from all parts of the country and they’re together as leaders, but they’re not with the people that they work with directly—there’s a sense of safety and vulnerability to really show up as humans in medicine. And that cloak of what people are thinking of you gets left behind wherever you came from. And that is where people are really able to look at themselves and look at who they want to be and how they want to experience medicine. I often think of those quotes about how you have this one wild and precious life, and we often don’t pause to think about that in medicine. So many people wake up at 50 or 60 and say, “How did I get here? And what have I been doing?”

And so I think when you pull people out into a room where you’re really talking about the human spirit, and you’re talking about intention and you’re talking about purpose rather than the tools to help make it work and to be more efficient and to meet the metrics, people really allow themselves to grow and show up in really unique, creative, and vulnerable ways. In medicine, we are taught that being vulnerable is dangerous. You don’t want to be judged, and yet in these small, sacred spaces, being vulnerable is actually quite valuable. And I think what people recognize is that they are not alone, they’re not isolated, and they do belong. With that sense of understanding and shared acceptance, that’s really where people are more capable of shifting into a more authentic, honest space of where they want to go.

When we are in our fight-or-flight, overwhelm, urgent, usual space, we’re not really able to do that. It makes sense because your body’s being threatened; nobody starts changing themselves and being thoughtful and reflective in that environment. The other thing I think is there’s real power in bringing people together to have these conversations. And I’ll say, especially with women, I think that there’s this sense of safety. What I’ve seen more and more is the power of one woman—and that’s how this last group came together—saying, “This is something that’s really needed and it doesn’t exist. And I will create it because it’s needed.” And that experience is really a beautiful gift where people are also coming and feeling really taken care of and like they matter. And that allows people to go deeper and really tap into who they are. Physicians are such amazing people. When given the chance and gathered together away from all the confines and outer noise, amazing things can happen.

Kevin Pho: Today we’re speaking with Jessie Mahoney, a pediatrician and certified coach. Today’s KevinMD article is “Why the future of medicine depends on leading from the heart.” Jessie, as always, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: I think my take-home message is to pause and be intentional as a leader, to be your honest, authentic, vulnerable self. If we don’t model healthy, sustainable leadership that does include diastole and does include our set of values, we don’t create an environment where others can do the same. So if we don’t lead from that place of authenticity and heart, the culture of medicine isn’t going to evolve as it needs to.

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

Jessie Mahoney: Thanks so much for having me.