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Integrative pediatrician Mary Wilde discusses the article “The pause medicine never taught us to take.” Mary discusses how medical training conditions clinicians to fear rest and prioritize a treadmill of servitude over personal well-being. She shares insights from teaching medical students who found clarity and emotional release only when forced to step away from their studies. Mary describes her experience hosting retreats in southern Utah and how physical distance from the clinical environment provides a necessary vantage point for accurate self-assessment. The conversation explores the physiological benefits of silence, including neurogenesis and cortisol reduction, while highlighting the systemic and personal barriers that prevent doctors from seeking renewal. Discover why creating open space is not a sign of weakness but an essential act of wisdom for every healer.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Mary Wilde. She is an integrative pediatrician. Today’s KevinMD article is “The pause medicine never taught us to take.” Mary, welcome to the show.
Mary Wilde: Thank you so much, Kevin.
Kevin Pho: All right, so tell us why you decided to write this article on KevinMD in the first place.
Mary Wilde: I have just been really interested in the concept of physician wellness and the relationship between resilience, empathy, and burnout. As an IPE course director, I work with medical students, and I created this curricular innovation called Empathy Lab. In this lab, the students are given the opportunity to choose one of five activities. One of these is a renewal activity because we know that when burnout sets in, then often there is empathy loss. So to try to proactively look at this, I assigned a renewal activity. It was just so remarkable to me how many of the students talked about how hard it was to step away. They were afraid to step away and they were afraid to stop studying.
Then there was also a very ingrained pattern that came up in so many of the reflections that they wrote. It was this idea that when they stepped back after taking this pause, they felt so much more renewal, clarity, and productivity. It just made me reflect about how in medicine at all stages we are not very good at pausing. We are taught to go and go and go and almost exist in this disembodied state so we can continue to churn out the volume, see the patients, and get our work done. But when we have the courage to pause, then it can help us also be more clear and more productive and just have a lot more enjoyment in the process as well.
Kevin Pho: So you talk about that connection with burnout and empathy loss, and when you talk to these medical students and they told you they were afraid to pause, what were some of the reasons they said?
Mary Wilde: I think that in medical education there is so much information, they just didn’t want to miss that studying time. They thought that if they took their hands off that wheel of studying they would miss something or that they would be behind. We all know that there is just more to know than any of us can know. So it is this fear that we can’t take that pause because there is always too much to do and too much to know.
Kevin Pho: There was a term that you used in your article called “the treadmill of servitude.” How is that different? You talk about how in medical school they are afraid of missing some knowledge, but then how would those feelings manifest in more seasoned physicians?
Mary Wilde: I think in some ways it is just this muscle memory. We just get conditioned to operate that way and we don’t even realize that we can pause. I have heard it said that the first branches of the ascending aorta are the left and right coronary arteries, and so the heart oxygenates itself first. Yet we forget to oxygenate ourselves first. It is just this paradoxical thing that we think we can’t look away, we can’t step off the treadmill. But when we do and then get back on, it goes so much better.
Kevin Pho: I have talked to thousands of guests. That is actually the first time I have heard this variation of that metaphor where the coronary arteries oxygenate itself first with the left or right coronary arteries. I always hear about on planes when the oxygen mask goes down, they instruct you to wear it yourself first before you put it on someone else. So I like that metaphor. That is the first time I have heard it used that way. Tell us the first steps that physicians can take to pause. You said that this is like muscle memory, so like any habit, it is difficult to break, right? So when you coach and talk to other physicians, how do you get them to pause?
Mary Wilde: Well, it is a challenge because we all know that we have CME money, we have professional development money, and there are opportunities to take a pause in a beautiful location and in a renewing space. So many times we just leave that untapped and unused because we literally, like these medical students, cannot break away. So my advice is just do it and really attend to the matters of the heart because when we do, we can be in alignment. The triad of burnout is this emotional exhaustion, a sense of cynicism or empathy loss, and then this sense of not having an impact or the futility of our efforts. But when we can pause and get in alignment, there is much less emotional exhaustion and there is much less sense that we are not having an impact. It is like a car that is out of alignment and the tires are wearing in a lopsided way. It just wears on us when we keep moving forward without a pause to align.
One thing that has been a passion of mine is that I started out working in the resilience space with anxious kids and creating a resilience program for kids. I quickly realized that all this work can translate into the physician wellness space. So I created a retreat and CME conference in southern Utah with the beautiful red rocks where we hike at Zion and examine our own hearts through nature and the creative arts. We have poetry workshops, art workshops, and music workshops to really take that time and have that container for a pause. It is a beautiful and healing experience.
Kevin Pho: The medical training system also is not amenable for their trainees pausing. I think in your article you told a story about a student who had to postpone saying goodbye to his grandfather. Tell us a little bit about that story and what it says about medical culture resisting pauses.
Mary Wilde: Yes. I think that when we don’t pause, we miss very, very important things and important milestones that we can’t go and take back. So in my article I talked about a medical student saying that he had hesitated to step away. But because of this assignment to a renewal activity, he decided to go back and spend some time with his grandfather who was dying. The grandfather did pass away, and the student was so glad that they had stopped and gone to attend to that.
I am a mom of eight sons and these are my loves. While I am probably unique in having this many children, we all have loves. We have those things that attend to our hearts. When we neglect these things, it is like the oxygen is slowly coming out of us and we become disembodied and less happy and less productive in our work. We all want to be caring and present physicians, and we all want to be happy individuals. So the bigger umbrella can’t just be serving this machine of productivity and this industrialized medicine view. We must attend to our own hearts so we can provide compassionate care and breathe while doing so.
Kevin Pho: So tell us a success story from one of your physicians who has been on one of your retreats. You mentioned hiking in beautiful Utah. Tell us about how that changed a specific physician who maybe was resistant to pausing or maybe a little bit burnt out, and how that changed perspective affected that physician.
Mary Wilde: Well, I will tell you a couple of different stories. One is that this retreat is interesting because a lot of wellness retreats attract female physicians mostly or exclusively. This retreat tends to be about 50 percent men and 50 percent women.
Kevin Pho: Why is that? Why do most retreats typically attract only female physicians?
Mary Wilde: I don’t know. It is just how it is. I think maybe there is more of a cultural norm for women to be emotionally connected and thinking about these things. Whereas maybe there is even less room sometimes for male physicians to feel like they need to pause and attend to themselves and get aligned. So I am very happy that there is space for male and female physicians to come and be renewed.
There was one physician who talked about how just being around the mountains and just seeing the grandeur around him and even just that reflection of nature helped him really connect to his higher self and what he really wanted in his life and how he wanted to grow. It is just this natural thing that happens when we allow ourselves to be in beautiful spaces.
Then there was a female physician who initially was not even going to come because she said she couldn’t even pause long enough to figure out the travel logistics. She felt like she really needed this so much, but she couldn’t take the time to figure out the logistics. I actually just asked where she was coming from and I made an itinerary for her and said here you go, take it or leave it, but the work is done for you, please come. And she is coming this year and so I am so happy for that.
I think there is that initial barrier sometimes with just trying to arrange the time off, submitting the form for reimbursement, and dealing with these very small barriers, but they feel so large when we are already so overburdened. So sometimes it is just taking that little step to give this gift to ourselves to pause.
Kevin Pho: How can a physician tell the difference between standard work stress and what you write about as the state of total life overload that is most associated with burnout? How can a physician make that distinction?
Mary Wilde: I think you know, and this has been one thing that I have learned in my research about resilience, burnout, and empathy. I am working on a book about how to survive the rigors of medical training and practice, kind of looking at that intersection of where excellence and wellness meet. But I think that it is when we start feeling this empathy loss that it is like the canary in the coal mine. It is when it is not just stress, but it starts becoming that our hearts are turned off a little bit towards other people and we are kind of existing in this disembodied state. So there are so many practices that we learn at the retreat to help reverse this, even micro renewal practices that we can implement in 30 seconds or less throughout the day to really try to stay out of this disembodied and misaligned state.
Kevin Pho: We are talking to Mary Wilde. She is an integrative pediatrician, and today’s KevinMD article is “The pause medicine never taught us to take.” Mary, let’s end with take-home messages that you want to leave with the KevinMD audience.
Mary Wilde: Yes, I would just say attend to your heart. If you are going to attend to anything like a team or a service department at the hospital, don’t forget to attend to your own heart. Sometimes that requires a pause.
Kevin Pho: Mary, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Mary Wilde: Thank you, Kevin.
