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Psychiatrist Yekaterina Angelova discusses her article “Are you addicted to false urgency?” In this episode, Yekaterina explores how modern professionals, including physicians, get caught in a cycle of constant busyness and fabricated emergencies that drain focus, health, and joy. She explains the neuroscience behind the “mere urgency effect,” where our brains prioritize quick tasks over meaningful ones, and how this addiction to urgency fuels burnout and anxiety. Drawing on both research and clinical experience, Yekaterina offers practical strategies to pause, regain perspective, and break the reward cycles that keep us trapped in stress. Viewers will learn how to reclaim calm, redefine productivity, and rediscover balance in a world obsessed with doing more.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Yekaterina Angelova. She’s a psychiatrist, and today’s KevinMD article is, “Are you addicted to false urgency?” Katie, welcome to the show.

Yekaterina Angelova: Thank you, Kevin. It’s a pleasure being here and having this opportunity to share my story and some of the work that I’m passionate about.

Kevin Pho: All right, so let’s start by briefly sharing your story and then we’ll jump right into your KevinMD article.

Yekaterina Angelova: Sure. I’m a physician. I’m a consultation liaison psychiatrist by training. I work in a hospital setting with medically ill patients who have mental health needs during their hospital admission. I’m the first one in my family to become a doctor. I’m the only child of immigrant parents and the only grandchild of immigrant grandparents. Pressure is my middle name. Meeting expectations was my Olympic sport growing up, and I have all the medals, which is what brought me initially to my own experience of burnout and then to some of the work that I do currently in physician wellness.

A lot of people I have worked with in my career have been from similar backgrounds, one way or another, because let’s face it, the field of medicine selects for high achievers, for the multitaskers. Those of us who work well under pressure, who thrive in chaos. A lot of us were taught all our lives to always say yes, to always take on more, to always be available. Then we enter a system, the health care system, where these beliefs are completely exploited.

The health care system loves people who stay late without extra pay, who take on three jobs for the price of one, who are always on, who are always there at the drop of a hat. We are repeatedly positively reinforced for these habits with praise and more opportunities (a.k.a. more responsibilities), some awards, some certification or recognition that is essentially a temporary hit of dopamine. It doesn’t, in a lot of ways, improve life. We buy into it because that’s how our brain’s reward system works. It’s inherently flawed. It can’t tell the difference in the true value of things that we check off of our to-do list.

This is the realization that I came to in examining my own story and that of some of my colleagues and coworkers that brought me to a lot of this work that I do, helping people tell the difference between what truly matters to them and the rest of the noise that is out there, because there is so much noise.

Kevin Pho: All right. You talk about that in your KevinMD article, “Are you addicted to false urgency?” For those who didn’t get a chance to read your article, just tell us more about your work.

Yekaterina Angelova: Sure. My article explores this false urgency culture that is common in most of today’s workplaces, especially in health care. It’s so ingrained in us that everything is an emergency. We don’t stop to think about what is and what isn’t. We spend the majority of our days at work, and often outside of work too, in a stress response. As physicians, we know what this chronic stress does to our bodies and to our brains. We know it’s not good, but we’ve been repeatedly conditioned to believe that pausing equals slacking, rest equals failure. Not being busy, not being swamped, means that we’re not pulling our weight.

In my article, I coined this term, “nomergency,” to describe a situation that feels very urgent to us, but it’s not truly important or aligned with our priorities or values. Not every opportunity is an opportunity. Not every trivial request warrants our time or expertise. Some emergencies are just other people’s anxiety, poor planning, systemic failures, or simply things that can and should be handled by someone else.

Often we jump to take care of these things at the drop of a hat. Of course, technology has made matters worse because we’re always connected to this endless stream of urgency: the notifications that something in our shopping cart is about to be sold out, breaking news, that ASAP text from our boss while we’re eating dinner with our family. Once we see it pop up, we can’t unsee it. We start having all sorts of feelings: anxiety, guilt, catastrophic thoughts of all kinds, until we finally open and read that message. What we do by doing that is we reinforce this habit that we have to address everything immediately to relieve our own distress.

What ends up happening is we’re constantly responding to these new emergencies. Our focus is completely fragmented. We’re pulled in a hundred different directions, and the things that are important to us (our health, our rest, our leisure, our time with our families) always somehow end up on the back burner because no one is treating those things like a fire alarm or an emergency until they become one. Until we get sick, until we can’t keep up with our work or start to struggle in our relationships. That’s when we’re at risk of burnout or perhaps already burnt out.

Kevin Pho: You mentioned that a lot of physicians are trapped in this world of constant notifications, constant “nomergencies,” and requests. Sometimes we can’t just determine what’s a true emergency versus something that isn’t. For those physicians like yourself, who’ve been in that world for decades and ever since undergraduate education, running on that treadmill, how can they break free from that? How can they tell the difference between what’s truly an emergency from what’s not?

Yekaterina Angelova: That’s a great question. One of the first things that I learned in my journey through burnout is to pause, take a step back, and think about what is happening. The very curious thing is that as a psychiatrist, we’re deeply familiar with human behavior and how the human brain works. But we don’t think about it when we are in the midst of whatever is going on. The first thing I recommend is to remember that a lot of our emotional responses are simply an evolutionary alarm system. It was created through hundreds of years of evolution to keep us safe in environments that no longer exist.

That anxiety that we feel when we get an ASAP request from our boss is our amygdala, our limbic system, our primitive brain activating our stress response to help us run away from bears or tigers. That guilt that we feel when we decline an invitation in order to rest or say no to someone to prioritize something else was designed or evolved to help us avoid possible social transgressions that would banish us from our tribe and leave us exposed to predators, starvation, and all the elements.

We’re not fighting off bears anymore. We’re not being left out in the cold to perish by our coworkers. Those things aren’t happening anymore, yet our world has evolved much more rapidly than our brain’s alarm systems. I think once we can appreciate that, we’re given an opportunity to make a different choice: to pause and think and choose to prioritize our focus and our peace over chaos and guilt.

Kevin Pho: You mentioned that our health care system, whether it’s a hospital or academic medical center, exploits that physician need to keep responding to these new emergencies. How can physicians set those boundaries when they’re working in those settings?

Yekaterina Angelova: That’s a great question. We operate under this illusion, I think, currently in the health care system that because we’ve reduced work hours and some of our physicians are unionized, we have solved the crisis. But we continue to struggle. We continue to struggle in silence. We continue to lose excellent, hardworking, kind people to burnout, to addiction, and even to suicide. We’re being erased from our own lives on a daily basis because we’re not living them. We don’t reward boundaries. We don’t reward confidence. We don’t reward curiosity.

One of the ways that we can start to fix this or address this is to adjust some of our reward systems in our workplaces. We all learn best by positive reinforcement. If you’ve ever trained a dog or raised a child, you know this well. Through some of the work that I’m doing (I’m currently writing a book also titled Nomergency), I’ve been sharing some of the ideas in it with some of my coworkers and colleagues. They’ve started to use the term, naming those “nomergencies” when they come up and identifying them to give us that psychological distance and then decide what we’re going to do in response, instead of automatically reacting to every single one of them.

Then we must create ways that we positively reinforce pausing, resting, and taking care of ourselves instead of high-fiving each other in the hallway when we tell each other that we’re so swamped we’re going to fall over and die. Just finding other things to praise and reward in each other.

Kevin Pho: Do you feel that the culture of medicine will ever come to embrace that and make that nonstop work culture less glamorous? Can medicine ever come around and adjust?

Yekaterina Angelova: I think so. I see this in some of our younger generations of trainees who are embracing their physical and mental health and learning to set boundaries and limits compassionately and in a flexible manner. Because boundaries are not walls. They’re gates. I like to think of them that way. We don’t want to shut everyone and everything out, but we want to be selective about what we let in. I do see a shift. I see a shift, and I have a lot of hope for those to come.

Kevin Pho: We’re talking to Yekaterina Angelova. She’s a psychiatrist, and today’s KevinMD article is, “Are you addicted to false urgency?” Katie, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Yekaterina Angelova: Sure. I want to make sure that I reiterate that the work that we do individually does not replace the desperate need for systemic change in our health care system. But it does make our lives more focused, more peaceful, and more aligned with who we are. My final take-home is: Rest is productivity. We have to prioritize rest at all costs to maintain our compassion, our focus, and our health. Secondly, urgent does not always mean important. We do not have to be doing something in order to be someone. Our worth is inherent. We are enough, and there’s absolutely nothing that we need to be doing to earn compassionate peace. We deserve it as much as anyone else.

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

Yekaterina Angelova: Thank you, Kevin. Thanks for having me.