Month: February 2019

Doctoring through the ShouldStorm

Alison Escalante, MD is a practicing pediatrician who has developed a way of thinking and breathing through what she calls, “The Shouldstorm.”  As physicians, we face similar storms with our patients, colleagues, administrators, and ourselves.  She walks us through the ideas she presented in a TEDx talk and applies it to doctoring.     She can be found at  shouldstorm.com  And her TEDx talk can be found at  youtube.com/watch?v=mYT7EDi_nOs&t=387s   She did her undergrad at Princeton, studying Medieval Renaissance History, went to med school at Rutgers University-Robert Wood Johnson and pediatric residency at Duke and University of Chicago.  She is a former clinical instructor of pediatrics at Northwestern Feinberg School of Medicine and is now a pediatrician at DuPage medical group in Naperville, Illinois.  She practices what she preaches as the mother of two fun, friendly, rambunctious and startlingly wise boys.

Doctoring through the ShouldStorm

Alison Escalante, MD is a practicing pediatrician who has developed a way of thinking and breathing through what she calls, “The Shouldstorm.”  As physicians, we face similar storms with our patients, colleagues, administrators, and ourselves.  She walks us through the ideas she presented in a TEDx talk and applies it to doctoring.     She can be found at  shouldstorm.com  And her TEDx talk can be found at  youtube.com/watch?v=mYT7EDi_nOs&t=387s   She did her undergrad at Princeton, studying Medieval Renaissance History, went to med school at Rutgers University-Robert Wood Johnson and pediatric residency at Duke and University of Chicago.  She is a former clinical instructor of pediatrics at Northwestern Feinberg School of Medicine and is now a pediatrician at DuPage medical group in Naperville, Illinois.  She practices what she preaches as the mother of two fun, friendly, rambunctious and startlingly wise boys.

 

EPISODE TRANSCRIPT

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Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians, Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing the Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of our respective employers.
Unknown Speaker  0:26
Allison Escalante is a pediatrician in Naperville, Illinois, who’s made it her goal to lift some of the burden off of parents shoulders, that’s inflicted by what she calls the shitstorm. She gave a TEDx talk called the parenting shouldn’t storm. So we discussed her three step method for weathering that storm and how we can apply it to both parenting and doctoring in terms of our patient interactions and our careers.
Unknown Speaker  0:56
Welcome back to the physicians guide to doctoring On today’s episode. We have Dr. Allison Escalante, a pediatrician in Naperville, Illinois. She did her undergrad at Princeton, which having gone to undergrad at Penn, we were frequently taunted with your safety school. So thank you Princeton graduate. I went she went to medical school at Robert Wood Johnson, and did her pediatric residency at Duke and then University of Chicago. So I guess she preferred Illinois to New Jersey, after Princeton and Robert Wood Johnson, because that’s where she’s chosen to stay. And she wasn’t give a TEDx talk called the parenting should school should storm. I have to say that very carefully. And we have another interview coming up with Lynn Marie morskie. And she has a podcast called quit happens, which I also need to say very carefully because they both share that double entendre. There’s a strong similarity there. Dr. Escalante is also an avid blogger at should storm calm. So Allison, thanks a lot for taking the time. be here today.
Unknown Speaker  2:01
Well, hi, Brad. But you know, I’m actually a New Jersey native and my family’s been there for generations. So we can’t knock the jersey. But yes, I have been in Illinois since I finished my training. And we are raising our kids out here. And it’s it’s a good place.
Unknown Speaker  2:18
Great. Great. And yeah, your your TED talk was TEDx Naperville, which is where you’re located. So before we start talking about the subject matter, subject matter, the shitstorm, how did you end up giving a TED talk?
Unknown Speaker  2:33
Well, that was very interesting. You know, the The first time I saw a TED talk, my husband showed me one and said, Oh, I think you’ll find that really interesting. And I watched it. And first of all, I loved the idea. But secondly, I thought, Oh, my goodness, I want to do one of those. That is so cool. And then, um, you know, I’ve been working on my project and what I was researching for several years, but once I had that idea of doing one, it sort of sat for a while. And then one day I decided to go to TEDx Naperville and and see if I could go about giving one myself. So I went to the conference and it was so much fun. Those are great conferences I recommend everybody goes. It’s full of really interesting curious people that are interested in lots of different subjects. And I just stayed late talking with various people, including the improv group that had done a joke session making fun of all the talks. And I ended up running into Arthur, who runs TEDx Naperville. And I said, Hey, how you doing? You know, I see you’re busy, but I have an idea. And I’d like to apply to talk next year. And he said, Well, give me your 60 seconds. So I gave him my 62nd idea. And his eyebrows went up and he grinned. And he asked me a question and I thought, This is great. And so we ended up getting in touch a couple months later and sat down and talked for probably two hours at Starbucks.
Unknown Speaker  4:08
And he said, Great, you’ve got to talk.
Unknown Speaker  4:11
Wow. So I think that brings up a point that we’re going to be talking about, again, later, that you had mentioned in our pre interview discussion about knowing your worth. And as physicians, sometimes we take for granted our expertise, right, you have all these researchers and big names that give these TED Talks. But what we need to recognize as physicians, as we’re physicians, we have expertise. So if you have an idea, it might be as simple. Your pitch might be as simple as just telling someone your great idea in the right situation. And now all of a sudden, you’re you’ve been invited to give it to give a TED talk.
Unknown Speaker  4:53
Well, that’s right. And I think most TEDx events have their own process and some of them you need You do apply through their website. Some of them it seems like you need to network TEDx Naperville is generally done through submitting a video. But what I’ve learned is that if you can’t share your idea in 30 to 60 seconds, then people are not going to keep listening. And I think it’s physicians were used to giving like, a morning report or a grand rounds with our research, and we’re used to qualifying what we say, to increase our authenticity. But that’s that’s just not how you’re going to want to talk to someone who’s interested in a TEDx because they want to know that you can communicate your idea briefly and clearly.
Unknown Speaker  5:42
So did you have your elevator pitch ready already had you honed it and given it before or you just let it happen?
Unknown Speaker  5:51
You know, I did actually prepare it but when he first Okay, here’s the truth. When he told me to give it to him, I I started to talk and I froze. And I giggled and I said, I’m sorry, I’m nervous. And I thought it was over. Right. But he, he just kind of like, shrugged his shoulders inside a little bit and let me go because he probably gets approached by a lot of people. But I went for it and I gave it again. And at that point, that’s when I got his. That’s when he connected with the idea.
Unknown Speaker  6:22
Fantastic. So, so what is the idea? Let’s talk about that.
Unknown Speaker  6:26
You know, parents love their kids more than anybody and so many people will describe parenting as living with your heart outside your body because it resides with your kids. I don’t know if you’ve ever felt that way. Brad.
Unknown Speaker  6:40
Absolutely. It’s currently outside my bed, my body two rooms down, and hopefully not making too much noise.
Unknown Speaker  6:47
nap time. But, um, as we’ve had a generational shift from the type of parenting that many people my age grew up with to parenting that’s really aware that we know so much about child development, and that things have changed. And maybe what our parents did isn’t the right way. Parents are bombarded by information and criticism and a culture that sends a message that if you’re not constantly doing for your kids, constantly worrying about your kids, and constantly optimizing yourself and your kids, you’re failing as a parent, and that is the parenting should storm.
Unknown Speaker  7:31
Yeah, I remember when we were sleep training, my first one, there was a New York Times article, and it it had discussed all of the different methods that were out there, and it didn’t say, this is the right one. This is the wrong one. It just said, these are the different options. These are the things that we can talk about. And you have to just find the one that’s right for you or don’t and the comments section had such vitriol about you’re doing permanent damage to your kids? How could you do that they’re going to have problems with it. Like it was, it was terrifying to read. And you could see a parent who is already sleep deprived and frayed at the edges, reading something like that and coming away thinking that they’re terrible person. So yeah, I completely understand that.
Unknown Speaker  8:23
It happens online. It happens in our Facebook groups. It happens with our friends and families. I recently did a survey on an online mom group to ask how many women had been a head experience mom shaming, and the number of women who checked off all of the above which included random strangers, neighbors, teachers, principals, relatives and friends. was astonishing.
Unknown Speaker  8:53
Yeah, I actually after seeing your TED Talk, it has hopefully definitely changed the way that I interact with my parents, because I’m an EMT. So I see kids and adults. And I’ve had a couple parents recently where they come in for like a tongue tie. And they talk about their experience with breastfeeding their older one. And now said, How, how’s that kid now? Oh, he’s fine. Great. Just please keep that in perspective. They’re fine. Everything is fine. Because Yeah, you just get you just get wrapped up in the minutia. So so you in order to help parents avoid that. You came up with a three step method, and I think we should talk about how that works in terms of parenting. But then I think it segues really well into doctoring. So let’s first talk about your three step method and how you describe that to parents. And then we’ll talk about how physicians can apply that to their one their parenting styles clearly, but their lives as physicians,
Unknown Speaker  9:58
right so it’s it’s wondering Full to get insight into the fact that the reason that we as parents are driven with a sense of anxiety is not because there’s something wrong with us. It’s rather a culture that’s really driving us. And it’s wonderful to recognize that I’ve had so many people interact with the talk or some of my writing, and just have a huge aha moment and a sense of relief. But then everyone’s next question is, what now? What do I do with that? How can I resist this, when everyone around me is doing this? You know, it’s so hard for us when an entire group is behaving and thinking a certain way for us to step out of that and do it differently. Because if I don’t take my kids to kumaon, maybe they won’t get into the good math class. And if they don’t get into the good math class, then maybe they won’t get into the good class in high school, and then they’re not going to go to a good college. Now, of course, that kind of thinking we will as a side note, that’s actually not actually Accurate or rational thinking, but that’s how it works for most of us. So what do you do? Well, every time you feel a should, or you feel that anxiety of being not sure, stop, sigh. And see, I’m sorry, let me say that again. Sigh, see, and start. So when we say it this, you breathe deeply into your body, but you let it out as slowly as possible. And this is a little different than how most of us are taught deep breathing. But it’s actually some really exciting neuroscience that has been found that it’s the slow out breath that actually moves us out of the fighter flight centers and into our common connected centers, which actually are located in the ventral vagus nerve. So that’s the first thing. Have you ever tried that one?
Unknown Speaker  11:59
I’m going to Right now, there we go away from the mic,
Unknown Speaker  12:03
then see, see your child, see the situation, see their body language, see what’s going on, see what’s going on with you. And this is an important part to see how you’re feeling. And then and only then start. And you can start something, you can start nothing, or you can start the wrong thing. And this is my favorite part about sicp. And start is that it’s designed to us our mistakes and our failures to grow us as parents and to grow our kids. So when we get it, right, we learn great, we’ve got something that works for us, but when we get it wrong, we might actually experience this should oh my gosh, I messed up. I should have done it this way. That’s okay. You can immediately sigh see and start again and It really incorporates a sense that mistakes are how we learn. And like a sense that we’re growing all the time. And then we show that to our kids. And I think that’s the coolest part of all.
Unknown Speaker  13:14
This, this reminds me of I think it might have been Freakonomics where they talk about the Chicago busing system where they followed kids over time, you know, you’ve got your wealthier areas, and you’re less economically inclined areas. And so what they do it or I’m not sure if they still do it, but they have a lottery or had a lottery where the the poor neighborhoods were able to enter a lottery to bust their, their kids, the rich neighborhoods, for school, and then they follow those kids over time, and saw how many of them went to graduated high school and four years, went to university how many went to a four year university graduated and those were there. Many metrics for success. And what they found was, it wasn’t winning the lottery or getting to go to the fancier school that dictated their likelihood for those metrics of success, but whether or not their parents entered them into the lottery. So it was intent more than the outcome. If you had parents that were interested enough in their kids outcome in their education, that was what determine their long term, their long term success. So I think it’s the same thing with what you’re saying with sigh, see, start. sigh Take a deep breath, take yourself a little away from this situation. Try and get a longer view of what’s happening with see and then start, but even if you make, what is the, quote, wrong decision. You’re still ultimately doing what you believe is in your child’s Bench BEST interest, which is at the heart of the matter whether it was the right or the wrong decision. As long as you’re not letting this damage your relationship with your child and stress you out and allow you to get worked up, you’re still making progress.
Unknown Speaker  15:12
That’s right. And I think constantly modeling right in front of my kids that up guys, I apologize, mommy made a mistake there, I’m going to try something else is really changing the way that they approach their own behavior. And I’m starting to see this kind of language from them. Oh, I messed up there, but I think I know what I could figure out to do next. And that, you know, I mean, it’s a buzzword, but that’s a growth mindset. And and that’s something that is is fundamental for us in managing our lives and in dealing with the challenges that come up.
Unknown Speaker  15:47
Can you give us an example of sicp and start?
Unknown Speaker  15:51
Well, sure. Um, so
Unknown Speaker  15:55
this morning, it’s snowing out here, and we have a really Great local sledding Hill, super steep, super fun. And my husband decided he was going to take the boys sledding and the shoes, the shoes were in the mudroom but some of the boots were missing. And so this was of course a crisis because how are we going to work this out? So basically, when we pointed out that the boots were missing, there was kind of a panic. And some blaming started to get thrown around between the boys about who lost the boots and who might have taken them to school and not brought them home yesterday. And I was finding myself getting really tense. I felt my shoulders up by my ears. My neck was tense. I felt angry. I even noticed my fists were bawling. So I side and I let it out really slow. And then I could see that my kids were getting really angry with each other. But because I had just pulled out of crisis mode. I could also see that what was underneath that was not that they were angry or upset, but that they were just so worried about being disappointed and not getting to go sledding. So, I started and I said, Guys, we’re going to figure this out. And so the boy who didn’t have boots that fit, we got two layers of socks on and we put Ziploc bags on his feet. And I found some, I found some pipe cleaners and I wrapped them around the Ziploc bag so they would stay on and then we push old shoes on and I said, Great, you guys can go sledding, and it’s going to be fabulous. Now he was very doubtful, but this is exactly the kind of thing we would have done when I was kids. And we finally got everybody packed up and out the door. In the end, they found the boots in the car. Got out of the Ziploc bags and got it all got it all figured out. But that’s the kind of crazy zany solution that I never came up with before I started using this technique.
Unknown Speaker  18:00
Because everything had to be perfect, right? Like the worst.
Unknown Speaker  18:04
Yeah, if if if, I mean, if he got frostbite so badly that he would lose a toe, that would have been terrible, but the likelihood that something like that is going to happen for sledding for a little island, he’s climbing up the hill and walking and right, like, that’s not going to happen. So really, everything doesn’t need to be perfect. You know, the other, maybe worrying that the other parents in the neighborhood are going to judge you because your kids got plastic bags on his feet. But he’s not sledding. It’s great.
Unknown Speaker  18:37
Well, and what I think I love so much about the way that sicp and start changes the way you look at things is those thoughts this time around, didn’t even enter my head. Instead, I thought of other far more positive things like wow, if he goes sledding like this, this is going to be this stuff, a family legend and they’re going to be telling this story at Christmas someday to their own kids or Oh, wow, if some family sees them out there, they’re going to think, wow, that mom really solved that problem. Look at those cool Ziploc bags. That was pretty clever. And it just, it changes because I’m not criticizing myself so much, because I’m engaging with my own creativity and leadership. It just, everything becomes so much more positive and so much more doable. And then I start to expect positive responses from the rest of the world. Instead of worrying so much about the random should storms that can happen in the grocery store when someone criticizes your parenting.
Unknown Speaker  19:38
So let’s pivot a little to the doctoring should storm. Right. So I think the the easiest example would be you’re running behind in the office, you’ve patients that have been waiting for a long time. You’re getting frustrated, they’re frustrated, you’re going to have to issue an apology when it’s not even your fault because You’re running behind because the three patients before we’re all late, you know, I think that the size see start can be applied in that situation where you take that deep breath, let it out actually think that look that came up in episode for improving the patient experience where the recommendation was, before you ended that patients room, take a deep breath. But now that deep breath is going to be a little more specific. Take a deep breath, and then slowly let it out. See, I think see in that situation was trying to see things from the patient’s perspective, and then open the door and walk in and try and start that interaction in the best way possible, which is, I’m sorry, you’re waiting, you know, we try to do the best to to keep things on time. But I value your time. And you know, this is important to me. So thank you for waiting something, something along those lines.
Unknown Speaker  20:47
Yeah. And I think that’s that’s kind of something I have to do every day because I’m a pediatrician. So it’s rare that I’m actually on time. Because you know, people like to bring in those extra things. So we’ve done our visit and By the way, Dr. Can I ask you about this other thing, and by the way, so you know, so that happens a lot. But I think that what I’ve really noticed about this ice and start is that it’s not just a technique, it’s a model. And it changes the way you feel about things. So that instead of feeling really stressed out and frustrated that this is happening again, and people are going to be mad at me. I just accept that this is the way we are. And this is the way things are because this really is fundamentally a mindfulness technique. And what’s funny is when I see it differently, when I acknowledged myself that, hey, I just did the best I could right there and now I’m going to go do my best again. That is a completely different feeling from saying, Oh my gosh, I need to get this right. I really want to meet everyone’s needs and you know, I need to be on time for them. But I also need to meet all the stuff that they bring up. And oh gosh, but there’s also Press Ganey. And I mean, and then there’s all the phone calls. And and I got to do it right. And when I let that go, and I just say, Here I am right now, this is what I’m doing. I find that I’m so much more positive. And what’s really interesting about that is people seem to be a lot less annoyed with me. Because I just walk in with that acceptance, and then I’m right there for them. So that works well. But I think that the more fundamental thing is once I had my big intuitive pop, with a mom who was really struggling with breastfeeding, and those words initially came out of my mouth that made me realized I had found a method for people. It was only much later that I realized I had been using it as a doctor for quite some time, particularly with difficult diagnostic situations. So whenever I am Dealing with a complex diagnosis where or somebody suddenly just throws out that detail where you realize, whoa, this isn’t just stomach pain, what did you just say? And I found that I have been for years naturally sighing and centering, taking a look at the information, both the patient the situation, but also that intellectual information that I’m gathering in my head and then starting to generate that diagnosis. So I actually think it’s a it’s a really useful technique for being more accurate as a clinician.
Unknown Speaker  23:38
I think you need to be careful about it when you’re doing it in front of your patients, though, because I think a sigh can be miss it very easily misinterpreted, right? If you’re physically sighing in front of your patients, they might think, Oh my god, what does the doctor thinking about me? They’re thinking that they’re getting fed up without a pen. I’m talking so much and they don’t they’re not believing me. So I think It is important if you are using that technique in front of your patients that you somehow maybe even verbally address it.
Unknown Speaker  24:09
Oh, that’s super easy. I just say, Wow, you just said something really important right there. Let me just take a deep breath and really think this through. They love that.
Unknown Speaker  24:18
Yeah. Yeah, that sounds,
Unknown Speaker  24:21
remedies that problem.
Unknown Speaker  24:25
So, how could we also apply this technique outside of the clinical arena when it comes to say, our career aspirations or maybe lack thereof, right? Coming, I came from an EMT program, where all the graduates my year went into private practice. And I remember seeing a picture of a class that was many years before mine, were and they said and now every person in this picture Almost every person in this picture is a chairman. So that’s, that’s a bit of a shitstorm. Because the implication is, that’s what you guys should be aspiring to be. And if you’re not, well, you should be. So I think this this should storm can be applied in that area as well. Would you agree?
Unknown Speaker  25:25
I think so. Um, my class at Duke was the first class where I think half of us went into primary care but in general Duke was known for producing specialists and I remember feeling like less because I decided to take that path. I finished my residency at University Chicago and it was very similar to where most people went into academic medicine and I distinctly remember really a very inspiring talk given to us by someone very high in the department at University of Chicago just talking about how you have this great in education, you’ve been really fortunate to train at a top institution, you need to make an impact, make a difference. And he was really discussing doing research and doing medical research to, you know, cure cancer or make a difference in a disease. And I sat there wanting to just crawl under the couch because by that point, I was close to finishing and I had made my decision. And I was even told on the way out the door by a mentor that I really respected that I was throwing myself away. I think that when we can use a method like this to really connect with who we are and what we really are passionate about, or even that we are not yet passionate about. Anything, it leaves us more free to make an authentic decision. So in a situation like that, if I were back there now, I might be sitting there listening to him secretly doing a very slow out breath. And looking at what I knew about myself what I knew about my goals for a family what I knew about what I really enjoyed with patients, that would be my see step and then and then start by saying, Okay, I’m going to take what he said with a grain of salt, because the deeper meaning that there was, you know, do something good and make an impact. And in the end, I ended up there on my own path, because now I am doing what I’m really passionate about doing which is trying to reach parents and take some of the burden off their shoulders.
Unknown Speaker  27:52
That is, I think that’s great for if there are any pre meds or medical students or resident That are experiencing some insecurity in their choices. There are, you’re a physician, you have plenty of opportunity to make impact. But you just have to do it as as yourself. Don’t let anyone I don’t want to use that buzzword bully but, you know, try and manipulate you into doing things that that that you’re not interested in doing that you’re not passionate about. Certainly, you can’t spend your life doing. You know, absolutely being in love with every single thing that you do. I think that’s a little too pie in the sky. But, but if your passion is academics go for academics. If your passion is private practice, if your passion is research, you know, you’ll you’ll you will be making an impact no matter what you are. And I think the size C and start technique really helps people when they’re in that situation, right. They’re sitting in that audience and they’re being made to feel insecure. They can see them cells for who they are and what they want to do and how they want to how they want to make their mark. So I think that’s very, very pragmatic.
Unknown Speaker  29:08
Well, and I think one of the key features of the shitstorm, whether it’s the shitstorm, and parenting or the shitstorm, and doctoring is that it tends to value some things over other things. So for instance, the stories you and I just shared was valuing a certain type of work or a certain type of career path over other things. But why in the world would we undervalue the clinical relationship and the huge ripple effects of that small impact we make each moment in a room with a patient. I mean, so many people, just the experience of having someone really notice them and care about them and try to help them is the kind of experience that can make a little shift in their life and those things add up. So I’ve always found the shitstorm very interesting in the way it Does that now you know, the shitstorm tends to really value metrics and certain particular measurable metrics in medicine. And I’m not blaming anyone for that, because it’s come about by a vast, complex range of factors, including, you know, requirements from insurance companies and very well intentioned things. But fundamentally, certain things are now overvalued, as opposed to other things that are also very important, but maybe aren’t measurable by a metric. Is there anything else that you think we should be discussing today to help our our physician colleagues to whether the shitstorm I think the biggest thing and I think you and I talked about this in the pre interview, about the shitstorm is the way that it makes us feel unworthy, and so much of what makes us able to really connect with other people and connect with our world in a way that matters. is when we can come from a place of saying, You know what? I’m okay. And I’m going to do my thing here. And that’s what I love about what I see and start has done for me and for many of the people I know who have told me they’ve started using it is that it starts to shift you into a more of a place where you feel acceptable, as opposed to feeling like what you do isn’t important or isn’t enough or doesn’t matter.
Unknown Speaker  31:25
You’ve chosen a career. Do your do your best to look after your patients and, and don’t let the shitstorm get in the way.
Unknown Speaker  31:34
Yeah.
Unknown Speaker  31:36
So where can people find you and where can people find that TEDx talk?
Unknown Speaker  31:40
Sure. So if you go on YouTube, and you search the parenting should storm or you search by my name, it’ll come up. I’ve got a website and probably the easiest place to find that is www dot shitstorm. Calm and that shows my quick two minute videos with little tips at links to my blog. For Psychology Today,
Unknown Speaker  32:02
I even have a fascinating inspiration page.
Unknown Speaker  32:07
We are also on Facebook and we’ve created a group for parents called no more shitstorm. And we’re really having a great time with this group of parents and anyone is welcome to join if they want to enter the should free zone and see what that’s like as a parent.
Unknown Speaker  32:22
I think we should all spend some time in the should free zone. Well, Dr. Allison Escalante, thank you so much for talking to me today. I feel like our listeners will be better parents and better doctors for taking your advice. So I really appreciate it and appreciate the work that you’re doing.
Unknown Speaker  32:38
Well, thank you so much for having me on Bradley. I really appreciate it.
Unknown Speaker  32:47
That was Dr. Bradley Block at the physicians guide to doctoring. We can be found at physicians guide to doctor and calm or wherever you get your podcasts. If you have a question for a previous guest or have an idea for a future episode. Send Comment on the web page. Also be sure to leave a five star review on your preferred podcast platform. Our show is produced by guilt free Studios in New York City. You can find them at guilt free studios calm. Our theme music was written by our show’s producer voice, actor car and guilt free
Transcribed by https://otter.ai

Positive Philosophy: Ancient and Modern Wisdom to Create a Flourishing Life

Dr. Sanj Katyal is a radiologist and a student of positive psychology.  He wrote the book that he wished he had read 20 years ago and he in order to share what he has learned with us.  He combines the philosophy of the ancient stoics and Bhagavad Gita with the relatively new, science-backed positive psychology to help us live our best lives.  We cover the trap of hedonic adaptation and how this applies to physician finances and how this concept can cause an initially exciting profession to become mundane, and how to resist this.  We also discuss why we should all be meditating, practicing gratitude, and negative visualization – picturing yourself without to appreciate what you have.  Our discussion just scratches the surface and for more, read the book to learn how to achieve what the stoics called eudaimonia – the state of human flourishing. 

Dr. Katyal holds a Bachelor of Science with University Honors in Chemical and Biomedical Engineering from Carnegie Mellon University and a Medical Degree from New York University School of Medicine. He is the Founder of Positive Psychology Program for Physicians and President of Optimal Life Imaging Group, PC.

Dr. Katyal also holds certifications in Positive Psychology and Positive Psychology Coaching from Whole Being Institute. He has published and lectured extensively on well-being and the Science of Happiness to audiences ranging from college students to physicians. His research interests include developing a new model of optimal wellness incorporating principles from psychology, organizational leadership, health neuroscience and medicine. He is also investigating the effectiveness of positive psychology interventions on physician wellness/burnout. He is currently an Adjunct Professor at La Roche College teaching the class “How to Flourish: Lessons from Positive Psychology”.

He is the author of the Amazon #1 Best Seller Positive Philosophy: Ancient and Modern Wisdom to Create a Flourishing Life released in the fall of 2018.  Dr. Katyal lives with his family in Pittsburgh, Pennsylvania. His hobbies include kayaking, writing, and traveling.

Positive Philosophy: Ancient and Modern Wisdom to Create a Flourishing Life

Dr. Sanj Katyal is a radiologist and a student of positive psychology.  He wrote the book that he wished he had read 20 years ago and he in order to share what he has learned with us.  He combines the philosophy of the ancient stoics and Bhagavad Gita with the relatively new, science-backed positive psychology to help us live our best lives.  We cover the trap of hedonic adaptation and how this applies to physician finances and how this concept can cause an initially exciting profession to become mundane, and how to resist this.  We also discuss why we should all be meditating, practicing gratitude, and negative visualization – picturing yourself without to appreciate what you have.  Our discussion just scratches the surface and for more, read the book to learn how to achieve what the stoics called eudaimonia – the state of human flourishing.

Dr. Katyal holds a Bachelor of Science with University Honors in Chemical and Biomedical Engineering from Carnegie Mellon University and a Medical Degree from New York University School of Medicine. He is the Founder of Positive Psychology Program for Physicians and President of Optimal Life Imaging Group, PC.

Dr. Katyal also holds certifications in Positive Psychology and Positive Psychology Coaching from Whole Being Institute. He has published and lectured extensively on well-being and the Science of Happiness to audiences ranging from college students to physicians. His research interests include developing a new model of optimal wellness incorporating principles from psychology, organizational leadership, health neuroscience and medicine. He is also investigating the effectiveness of positive psychology interventions on physician wellness/burnout. He is currently an Adjunct Professor at La Roche College teaching the class “How to Flourish: Lessons from Positive Psychology”.

He is the author of the Amazon #1 Best Seller Positive Philosophy: Ancient and Modern Wisdom to Create a Flourishing Life released in the fall of 2018.  Dr. Katyal lives with his family in Pittsburgh, Pennsylvania. His hobbies include kayaking, writing, and traveling.

EPISODE TRANSCRIPT

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Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians were Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective in lawyers.
Unknown Speaker  0:28
On today’s episode, we talked to sans Cottrell, a radiologist and the founder of the positive psychology program for physicians. He’s the author of positive philosophy, ancient and modern wisdom to create a flourishing life. We talk about what positive psychology is and how it specifically applies to physicians, and how do we can use it to improve the quality of our lives. We talked about how to find more meaning in our work and why this is particularly important. If we do a lot of repetitive tasks like radiologists looking at scans, why we should be outsourcing as much of our job as we can and use that Time to not make more money but enjoy more life. And that gets us into the concept of hedonic adaptation. Also known as stop buying all that crap, it isn’t making you happy. We discuss why meditation is misunderstood and why we should all be doing it, and advocating that our patients do it as well. And we finished with the power of gratitude and negative visualization, and he gives us a tip for the best use of our time or waiting at a red light. This an all episodes are expertly produced by car and guilt free at guilt free studios. Welcome back to the physicians guide to doctoring. On today’s episode, we have Dr. sanj. Cottrell, a radiologist who recently both wrote a book positive philosophy, ancient and modern wisdom to create a flourishing life. So we get into his background on positive psychology reasons for writing the book and how, as a physician lessons from that book can help other physicians. So, Dr. Cottrell, thank you so much for being on the show today.
Unknown Speaker  1:57
Thanks, my pleasure, Brian.
Unknown Speaker  1:59
So First, just give us a little background on your training where you went to med school and residency and we’ll start with that.
Unknown Speaker  2:05
Sure. I did my undergrad at Carnegie Mellon here in Pittsburgh and chemical and biomedical engineering and went to med school at New York University School of Medicine. And I came back to Pittsburgh to do internship residency and body fellowship in radiology. And from there I worked, did some research work and academics and then shifted my focus from the research in radiology to the business of Radiology in the business of medicine joined a private startup radiology company where I managed a group of about 100 radiologists for the last 10 years. And it was really over that time that I began kind of experimenting with a lot of these ideas. You know, as part of my job, I would travel to a lot of different hospitals and interact with Different medical executive committees and hospital clinical leaders. And I began seeing a lot of discontent among the physician community over the past probably eight to 10 years. And I couldn’t figure out why. And one day, I was driving back from one of these hospitals and and I remember really clearly thinking, you know, I wasn’t unhappy, but I was wondering why I wasn’t happier. You know, I had achieved really more than anything I had dreamed of. I was married to my best friend, we have a great relationship we have for healthy kids. I had a really good job at a start up designing kind of innovative workflow. And, you know, growing up, I really didn’t have much tragedy, both sets of parents are alive. And I began to worry that if I couldn’t really figure out how to how to experience more joy and fulfillment when things were this good. I was ever going to deal with any real adversity when it came? And so, from that point on, I really started searching for answers. And really I was searching for answers to this single question. How can I learn not just to function but to also flourish. And that search took me to a variety of topics, philosophy, positive psychology, I came across a book, by tall Ben Shahar called happier. And he’s his claim to fame as he taught the largest class in Harvard and positive psychology. And I reached out to him, told him I loved his book and I liked the scientific approach to happiness. And he invited me to whole being Institute which was running a kind of a year long intensive certification program and positive psychology and that’s kind of how I came to, to get certified and formal training in positive psychology. Wait, stop
Unknown Speaker  4:58
for a second cuz You mentioned that you just reached out, you read a book that you liked. And you just reached out to the person who wrote it. Can you just give a little more detail on that interaction? Because sometimes we might read something we like but can’t really imagine getting a response from an author of we really enjoy their book, right? How did that take place?
Unknown Speaker  5:24
I mean, I just, I just found his email and I just, I just emailed him and I just said, I, you know, I’m a physician interested in well being and, and I really enjoyed your, your book I liked he had a kind of a model based in Science of Happiness. And, you know, I just wanted to I just thanked him for writing a great book that I enjoyed and asked him where I could learn more. You know, I think I think people underestimate or overestimate the difficulty of reaching out to People I mean, when I wrote my book, I reached out to a variety of very famous authors and sent them the book. You know, I mean, I asked him first if it would be okay if I sent him the book, but I talked to them about how their work has influenced me has influenced the ideas in the book. And most of them were very receptive.
Unknown Speaker  6:19
I guess it’s always nice to meet a fan. So if anyone wants to email me about the podcast, I’m I’m very receptive as well and I will be replying. So. So you talked about your training and positive psychology is that the whole being Institute?
Unknown Speaker  6:33
Yes.
Unknown Speaker  6:34
So tell us a little about that.
Unknown Speaker  6:36
It was a it was a really great experience. So we had a we had a one week immersion, onsite immersion at the beginning of the program. And then we had another at the end of the program and we had a final project that we would present and along the way, we had kind of online modules and group interactive projects together. So you can really, you know, you could do it alongside a full time busy job, although it made for a very busy year.
Unknown Speaker  7:08
But the the,
Unknown Speaker  7:11
the origins of the idea from my book came from my final project. And it was really the, I wanted to write a book that I wish I had read 20 years ago. Everything that I knew now, I wish I had learned when I was, you know, finishing up college or heading to med school. And that’s the angle that I wrote the book from and but that really all started from my final project and in whole being Institute.
Unknown Speaker  7:32
So why did you write the book? Let’s explore that for a little bit.
Unknown Speaker  7:38
Well, I had all these ideas, and I went on this kind of 10 year journey to figure out, you know, how to be happier and I was looking around and I saw a lot of people that were successful by anybody’s standards, at particularly physicians, who were really filled with no mild moderate levels of anxiety, depression, just general discontent. And, you know, we as physicians, we live our lives kind of waiting to get to the next level in our life, right next level of training, becoming an attending, becoming a partner, and then eventually, you know, waiting to retire or leave medicine. And I think a lot of us feel unfulfilled when we get to each stage. And I and I wanted to understand why that was. And you know, I got a lot of answers through positive psychology and also through philosophy. And I really wanted to write these concepts down into kind of a easy to understand daily code of optimal living, and I was really doing it for my kids. I have four kids and I really wanted, you know them to have something concise that were really major lessons that I had learned, in case I’m not around,
Unknown Speaker  8:59
everyone. reading that in the book and I thought it was a really beautiful reason for writing the book that a life full of lessons condensed into one tome, one succinct term for them to, to read, likely again and again at different stages in their life. Because I think as as you get older and mature, there are different ways to interpret and different lessons to be learned that have different significance in each stage of your each stage of your life. So I really, I really admire that, that reason for writing the book, I think we all have things that we that we hope to pass on to our children and, you know, fear Well, what if, what if we can’t so you’ve overcome that by by writing it all in a succinct way.
Unknown Speaker  9:44
Thank you.
Unknown Speaker  9:46
So the book wasn’t really written with physicians in mind though, right? Like as as I read the book, it’s, it’s it, I don’t think even mentioned the practice of medicine in it. It’s really written for everybody
Unknown Speaker  10:00
And that was on purpose. That was my editors. Recommendation Initially, it was really for physicians. And she said, this is, you know, these concepts don’t just apply to physicians, we understand the crisis of burnout, we understand the crisis of physician suicide and mental health. But she said, a lot of people have that, and a lot of people, you know, can benefit from here from hearing these things. And so we, we took out some of the specific anecdotes for physicians. And it was really for that reason that I started teaching these concepts specifically to physicians, it’s just kind of my way to give back to medicine which is, which has been, you know, a great career for me, and my way to contribute in my small way to to, to the well being of physicians. So,
Unknown Speaker  10:54
so that gets us into the positive psychology program for physicians, right. Your Your program for helping physicians who are suffering from burnout, can you can you tell us a little bit about your program?
Unknown Speaker  11:07
Sure. You know, I think I think the focus on burnout is, is kind of like the focus on traditional psychology, it really is focusing on the absence of disease or absence of negative things in your life, right? If you think about traditional psychology, it focus on moving the person who was functioning at a minus seven or minus eight, and moving them to a zero or plus one. You know, positive psychology said, well, that’s good, we need that focus. But we also need to need to remember that there’s a lot of people that are functioning and a plus one plus two that have a ton of unrealized potential. And we can use proven evidence based techniques to move these people to a plus seven or plus eight on the scale of flourishing, and I look at burnout, kind of the Same way, you know, they’re they’re barely functioning or not functioning. And we’re just trying to get them to zero. But most of the physicians that I know and I’ve interacted with, you know, a lot, most of them do function, right? We’re able to kind of, you know, get through the week we, you know, make toward kids games, we, you know, go out to dinner with friends on the weekends, but we still kind of live lives. And I’m including myself in this that really are far from our full potential and really from far from our version of flourishing in our own lives. And I think that’s where positive psychology and some of the evidence based research findings can really be transformative for physicians not just moving them away from burnout, which that can that has happened, but also taken the people that are functioning and moving them Really closer to to flourishing.
Unknown Speaker  13:02
So let’s let’s get into the book then. So they’re important, some important concepts and, and I appreciate some of the times that you do allude to yourself in the book because you’re, you’re mentioning these lessons. And it sounds like you’re this Zen master. And then you bring us back to reality and say, actually, this is what really happens in my life. So it allows us to get a little glimpse of what life is really like for you, and you know that you’re really very similar to the rest of us just trying to find a way to to improve yourself. So one of the concepts that you talked about is, is eudaimonia. If I’m saying that correctly, and it sounds a little like skin disorder, something you might want to treat with anointment. But but it’s not. So what is it?
Unknown Speaker  13:52
Yeah. So before we talk about what you demonio is what you know, it’s talking about the word happiness, and I think the Don’t I try not to use the word happiness? Too much like, if you look at the website and the program, there’s really very little talking about happiness. And I think the problem I have with the word is that it’s really incorrectly used. You know, if you ask somebody a, you want to be happy the answers, of course, and then if you go a step further and say, Well, what does it mean for you to be happy? You know, it becomes a little less clear. And I think the problem is most people think of happiness as a transcend emotional state. You know, I was happy last week when I was on, on vacation, or I’ll be happy when, this weekend when I’m not on call. And that’s not that’s not the type of happiness that Aristotle was talking about when he made his famous quote, you know, happiness is the meaning and purpose of life, the whole aim and end of human existence, I think something like that. The word that he and other philosophers really uses eudaimonia and that really means a state of optimal living over a long period of time. flourishing is really the correct translation. And so it’s not a transy and emotional state, but it’s really like, our power, several aspects of your life going for you over a long period of time. And that’s, that’s really the the goal, you know, any successful life is going to have struggles and it’s not going to be, you know, pain free and you think back to your own lives. Some of the best periods of growth and success followed periods of significant adversity and hardship. And so I think moving away from this transient state, and thinking about a state of optimal living over a period of time, longer period of time, this is a better way to keep things in perspective.
Unknown Speaker  15:53
And what do you mean by optimal living,
Unknown Speaker  15:56
flourishing really, you know, like our
Unknown Speaker  16:01
Mentally, are you? Are you engaged in a career that utilizes your abilities? From a family perspective? Are you? Do you have good work life integration? are you raising resilient, responsible kids that care about the world? And not just their next video game? spiritually? are you connected to a cause larger than yourself? Whether that’s, you know, religion, service, charity, nature, whatever, you know, so kind of the entire spectrum of being
Unknown Speaker  16:43
is is really what flourishing is about.
Unknown Speaker  16:46
Okay, so you really, you really broke it, broke it down pretty succinctly there, right? So there’s your work life, that you want to be able to maximize your potential, but at the same time, not to the detriment of your family life which you want to be able to maximize The, the development of your children. And then the third aspect seems to be service. Right? You mentioned service among other things, but spiritual, religious nature, but ultimately that’s in terms of that that’s giving back. So I think all of that can really be classified as service so that the those are the three elements. Am I am I leaving anything out?
Unknown Speaker  17:25
I think I think physical well being is a big part. You know, you as physicians, we know that, you know, if you don’t have your health, you know, you’re, you’re in a, you’re in for a world of pain. So physical well being through nutrition, optimal nutrition. Exercise, is really another key component, because you know, how you feel physically can obviously affect how you feel mentally, and vice versa. So, the mind body connection is definitely another aspect of flourishing It needs to be optimized.
Unknown Speaker  18:02
And one of the things that you mentioned in the book that applies specifically to physicians is, is finding meaning in what you do. So we’ll explore what just one of those subsets of the flourishing and that in your work life. And I think this is probably more challenging and your specialty than others, right, because as a radiologist at the beginning during your training, you’re learning so much and you’re interacting if you’re especially at an academic hospital, you have all this different specialists coming through to talk to you and you’re finding out what’s going on the cases and you’re, you’re helping people to, to learn from learn what you know, and help them to interpret imaging. So you’re getting a lot of positive feedback, but but as you get out into, into practice, you might end up just looking at films over and over never seeing the patients and so you’re not really finding that meaning anymore, because you’re not seeing how you’re affecting an outcome. So how how can you help someone in a specialty like yours to, to bring meaning back into their occupation?
Unknown Speaker  19:09
Yeah, it’s a great question. And I think one of the reasons that radiologists have really high rates of burnout despite despite fairly good work schedules and relatively high income, is exactly the reasons you alluded to is they lack meaning or they lose meaning in their day to day, work life. And, you know, if you think about what brings what brings meaning to physicians in general, it’s really that interaction with the patient, it’s helping the patient it’s feeling like you’re contributing to the, to the care and improvement of health of that patient. And then it’s also having a, you know, discourse with your referring physicians, your colleagues and technologists in the department and radiologists Are you know, they’re removed from all of that potentially. So, you know, I was working with a radiologist a couple years ago, and he had a real problem with this. And so what we decided to do is every third patient that came up on the worklist, because we read probably 100 cases, day give or take, you know, some every third or fourth case, you know, relate that patients demographic to somebody you know, in your life, and read it from that perspective, whether it’s an aunt or of, you know, family member or friend. And if you do that enough, you start thinking about each case, from a from a patient perspective, it’s not just a another name or it’s just not another rule out happy. It’s actually a 35 year old for you know, that, that you may be able to relate to better and doing that. really helped this radiologist and really infused, re infused, I should say, a sense of meaning and purpose from his work life in there. And I do that all the time when I’m reading cases. And the other thing is that, you know, you know that the referring physician interactions, as well as patient interactions are important. So you try to optimize the time and be present for those interactions. So when I’m doing a liver biopsy or tumor ablation, I’ll spend, I’ll spend a lot of extra time with a patient with a patient’s family, because I know that I’m going to get just as much out of it as they are. And I think that’s just just being aware of what aspects of your job provide the sense of meaning, I think is a good step and then just trying to figure out ways to design your workflow to optimize those enter actions can go a long way.
Unknown Speaker  22:03
Yeah. So you mentioned optimizing the workflow. What would you say to the people that say I listen, I just don’t have time for that. I just I’ve got too much pressure to read all these cases and see all these patients. I just, I just can’t do it.
Unknown Speaker  22:18
Yeah, I mean, I think that that’s a problem and we have we, you know, we, if you think about like, if we’re referring for family medicine or internal medicine physician, their problem will point of interaction or what I call physician zone time, which is there you’re you’re when you’re in the zone and you’re getting meaning out of your, your, you’re using your skill to help somebody and you’re deriving meaning from that interaction. That’s your kind of physician zone. time there’s is really the the patient interaction right? And em ours and data entry. have really made me A lot of this difficult. And so you know, what we did in my startup was we use scribes for radiology, so everything was done. And the only thing that we had to do was look at the films be present while we’re reading the films, think about what we were reading and all the transcription and the pre pre loading of ICD 10 cases were already put in there and the post transcription and checking for typos was done by somebody else. And reason we did that was not so we can read up, you know, 200 Films instead of 100. We did that so we can buy time to do these other things to spend extra time with with technologists, teaching them spend time with referring physicians not being bothered when a when a doctor calls and wants to go over a case.
Unknown Speaker  23:49
And I think scribes in Ed and scribes in internal medicine and family practice are are starting to take hold and they’re really returning the physician patient. interaction back to where it was or where it should be. And that’s, that’s an example of optimizing your external workflow to maximize your your physician zone time and meaning. So you mentioned two things that it can really take us in two different directions. And I want to speak about both of them. The first one was, you mentioned being being mindful and present when you’re when you’re looking at the scans. And that’s something that you discuss in the book. But But the other is that we’ll get to first is, if you’re being more efficient in how you’re using your time as a physician, you can read more, you can see more patients, you can read more scans, and therefore you can make more money. Right? Correct. So that gets us into the the hedonic adaptation, right, you’re making more money, but that’s not bringing you any more of this eudaimonia is the I mean, I’ll just call it happiness. But ultimately, all that money that you’re, you’re, you’re now seeing patients with more efficiency making more money, but that money isn’t going to bring you the happiness what you’re saying is getting more out of your work making it more fulfilling, bringing it back to the connections with your colleagues, and technicians and patients. That’s where that efficiency should be used to, to direct your attention not to making more money so you can spend more money.
Unknown Speaker  25:31
That’s exactly right. And I think that’s that’s he donek adaptation is a huge problem. And basically what that means is, we get used to everything in our lives, that’s constant all the positive things in our lives you know, will eventually take for granted you know, our our private practice job, our BMW or big house. You know, even our families, our spouse or kids That will eventually become just kind of, you know, part of what normal life is. and physicians are, are really in trouble because we live the kind of delayed gratification, right? So we put off enjoying the fruits of our labor until you know, the next each difficult stage is past. But if you just get used to whatever next stage you get to, it’s just a vicious treadmill and that’s why they call it the hedonic treadmill. You know, that was that was a huge lesson that positive psychology really elicited from a research perspective and you know, philosophers like the stoics talked about a 2000 years ago, which is why they talked about you know, that all you need for really happiness and life of eudaimonia is Is inward, right is, is within you. It’s how you act, how you treat others. It’s how you, it’s your virtues, and your character. And what you do with that character to alleviate suffering around you, that’s really all that they thought was needed. And you know, positive psychology is really kind of confirming that. So
Unknown Speaker  27:20
a few episodes ago, I had someone who calls herself the frugal physician. And she, she fell into that trap, right, she bought the big house and the fancy cars. So on top of all of her debt, from medical school, she ended up with a bigger mountain of debt, which became very stressful, and now she blogs about her much more minimal lifestyle and how much happier she is because of it. And ultimately, that has a name, right. That’s the hedonic adaptation, that that she recognized, was happening and I think that’s this is an important point for physician burnout because You know, we have this, we have this these mountains of debt, we have the expectations that society puts on us for what the life, they expects us to lead the house, they expect us to have the cars, they expect us to drive the vacations they expect us to go on. And so we try to live on up to that, not realizing that that spending makes us have to work more. And if we have to work more, it puts us under more stress, and then it just becomes that hedonic cycle. And we can’t keep up with it. Are we over just keeping up with it? And and ultimately, it’s not making us happier. And so what what you’re saying is, find things in your work life that you can outsource and offload, not in order to increase your efficiency so you can make more money, but rather increase your efficiency so you can enjoy the work you’re doing. And then enjoy the time that you have away from work.
Unknown Speaker  28:54
That’s exactly right. And it’s important understand that, you know, we’re we’re wired this way from a evolutionary perspective. You know, I think when you think about things from an evolutionary perspective, it helps because you can stop beating yourself up for it. But you know, he donek adaptation is a very useful drive for survival. Because, you know, if things that were constant in your environment didn’t kind of fade away into the background, you wouldn’t be able to respond quicker to new threats or stimuli in your life. Right. And so this is a survival technique. You know, nature just wanted us to survive long enough to procreate, but didn’t care how happy we were along the way. So, you know, it’s, we’re wired that way we have, because we’re wired that way. To combat combat donek adaptation takes some intentional effort and strategy. And I think the biggest thing to do is really to learn how to pay attention, cultivate attention to the good aspects of our life, and I think really cultivation of attention is really going to be the new currency for everything, you know, whether it’s attention to the present moment and mindfulness, whether it’s attention to the good aspects and cultivating gratitude, an attitude of gratitude, or whether it’s attention to the physicians downtime, and you know, the aspects of your job that really give you the most meaning. It’s all it all comes back to attention to the right things.
Unknown Speaker  30:28
Well, our in our attention has already been monetized, right? All of those apps, that that suck our attention, and it’s being sold. So all those advertisements and the apps are designed, they’re like, slot machines, right there at every so often you’ll get an email, that’s actually of significance, but most of the time it’s garbage, but you just we just keep checking and checking and checking. And same with Facebook, right? We keep scrolling and scrolling and every so often there’s something interesting but most of it is This is garbage and they know that and they design these algorithms such that we couldn’t continue to stroll and continue to give give our attention which is a hugely valuable currency to them for free and then they’re selling it to someone else.
Unknown Speaker  31:16
That’s exactly right. And you know, I really worry about you know, my kids generation because they’re, they’ve been raised on it. I think we you know, I’m 50 I’m but turned 50 and I think my generation can can use some strategies to really block it, but some of my you know, my kids friends, I see them there. They’re just hooked on their phone all the time, and they’re just giving away their attention for really No, no useful purpose and I just finished teaching a positive psychology class at a local college. And our final project was self improvement using some techniques and positive psychology. You know, are applying concepts to life improvement. And half the class was trying to reduce their time in their cell phone. One kid described himself as a lunatic, he would check the same thing, every three or four minutes, even though he knew there was nothing new on his Twitter feed his Instagram feed, you just couldn’t stop themselves. And so, you know, the intentional protection of your attention is is really important. And there are strategies to do that. But it’s, it takes take some, some doing,
Unknown Speaker  32:34
so that that mindfulness that you were talking of, that you’re speaking of, I think, you know, as physicians, when we’re training, we’re constantly thinking about what needs to be done next, right as residents. We have this list of things to do, and we constantly need to get it done. Now, that’s, that’s our job, right? Just handle it. Everything that needs We done so we’re always as soon as we’re done with it, we’re on to the next thing. And even while we’re doing one task, we’re thinking about what needs to be done next. And now as as attendings. We have more control of our time. And so that mindfulness that that you mentioned, we, we have more control over it. But we can also end up on the hamster wheel. Right? We can end up you want to you said, you know, you become an attending and then you become partner. And then you’re thinking about retirement, but even, you know, people that are in academic jobs, they’re their assistant professor and then their professor or maybe they’re trying to become the chairman. Right? There’s always that next rung. So we’re
Unknown Speaker  33:42
trained
Unknown Speaker  33:44
to think that way, right? in medical school and residency, you’re trying to be the top of the class, you’re trying to get the most competitive. How do we get off that hamster wheel and stop and be more mindful about what we’re where we are.
Unknown Speaker  33:59
I mean, it’s a It’s a it’s a problem, I think, you know, meditation is a really good start to do that. And I think, you know, there are a lot of good apps that, you know, you can meditate from for two to five minutes. And it just, it just trains your brain to slow down and allows you to just keep coming back to a point of focus, whether it’s your breath or a mantra or whatever, or a guided meditation. I think that’s something that’s key for us. I think, you know, changing your external environment is huge as well, you know, I, I made my kids turn off all their notifications on their phone. They don’t use their phone, their phone is in a different room when they’re studying or doing their homework. We have limits on their phone, and when they hit their limit, it goes on the charger which is not in the room. You know, physicians can do the same thing. You know, you you know, I tell I tell radiologists That, that I work with, you know, when you’re reading films, just read films and don’t check your phone, put your phone in your backpack for 45 minutes or and then take a break, check it and then go back. To do that, I think the whole idea of multitasking and walking in the halls looking at your phone. I think that’s, that’s all detrimental. I don’t think there’s very, ever a good reason to do that, you know, for the most part. And for most people.
Unknown Speaker  35:34
I’ve heard that if you like let’s say you’re looking at films and you tab to your email, and then you go back to films, your efficiency in reading that film is going to be significantly less for I don’t remember but a certain period of time. So you’re actually decreasing your efficiency by by clicking back and forth and trying to multitask but really, what you’re doing is you’re Guess you need tasking, but poorly?
Unknown Speaker  36:03
You’re not. That’s exactly right. The other distraction studies done that say anywhere between 12 and 23 minutes to get back to your pre distraction, concentration levels. And this goes for, you know, people look, examining patients and using their EMR back and forth to I mean, it’s the same, it’s the same. It’s a context switch of your brain. It’s not actually multitasking, your brain is just rapidly shifting context, back and forth. And there’s a there’s a cognitive price to be paid for that. And I think if you realize that, you can get much more enjoyment and peace by just focusing on what you’re doing. But it takes it takes some constraints that are placed by, you know, that have to be replaced on your on your own.
Unknown Speaker  36:54
And I think it takes practice to and one technique that I’ve read about is called the Pomodoro method we have typers but I guess whoever came up with this has a tomato timer, or maybe it was Dr. pomodoro. I don’t know. But you know, you set a little timer, and then you say, I’m going to stay on this task for a certain period of time. And then over time, you’re going to be able to extend that without, without it being painful for you, you can just you practice your way to a longer attention. That’s exactly
Unknown Speaker  37:23
right. And there’s a great book called Deep work by Cal Newport that talks exactly about all this stuff. Yeah.
Unknown Speaker  37:31
Yeah, I think it’s the they talked about the flow state. Correct.
Unknown Speaker  37:35
He talks about flow states, but he also just talks about what you’re referring to, as well as some distraction studies. It’s a great book, deep work. I think physicians can really benefit from that.
Unknown Speaker  37:47
And I think at a point we get away from even thinking of what we do is as deep work, right, like, when I have the 10th patient in a row, or I’m just removing your wax, it’s not technically challenging. It’s not in Interesting. You know, it’s it’s not really I don’t know, if I’m really in the flow state in that position I personally, I find enjoyment in it, even though it’s it is relatively mundane, because I’m gonna chat up the patient I talk with them I you know, see if I can help them in any other way or just let you know just being an ear, I guess no pun intended an ear for them to just to listen like like your barber might do. So I think finding, finding ways to to make the mundane interesting might be might be helpful to if you’re not finding yourself with as many opportunities to be in the flow state. And you kind of mentioned a little bit about meditation. And I think it’s, it’s something that’s misunderstood, right people think that meditation is all about clearing your mind and I’ve got too much going on. I can’t clear my mind. I’ve got too busy I can’t, I can’t do it. But but that’s not really what meditation is. Is it?
Unknown Speaker  39:02
No, it’s not at all. It’s not about having an empty mind. All it is is about cultivating a single focus to your mind. And when you when you, you know, when your monkey mind the Buddha’s called the Buddhism call, he calls it the monkey mind when it starts just, you know, going up going off in various directions, you just bring it back to a single focus. And that bringing the act of bringing it back to a single focus is really what meditation helps train you and it lays down neural pathways. I mean, there’s a there’s a huge field that’s developing called health neuroscience. And you know, you look at the effects on functional MRI with meditators. After just eight weeks, there’s increased grey matter, grey matter thickness, there’s increased activities in areas like the hypothalamus and prefrontal, prefrontal cortex. There’s decreased activity in the amygdala. Which is really your zone of, for your source of kind of negative emotions and anxiety. I mean, these are real findings that any physician can look at. and be like, wow, that’s, that’s impressive. And that makes sense. And these aren’t, we’re not talking about, you know, 30 years of meditating, we’re talking about 10 minutes for eight weeks in this one program, but it’s been replicated many times. So I think it’s just, it’s just laying down neural pathways and, and just training, training your brain to bring it back to a single point of attention
Unknown Speaker  40:39
to your, it’s basically the practice of paying attention to what you want to because ultimately, your brain is going to get distracted, it’s going to wander off in another direction. And your job during the meditation is to recognize that it’s wandered away and then bring it back to that. So you’re, what you’re doing is over and over. You’re just practicing paying it attention to what you originally wanted to pay attention to. So it’s almost like a practice of paying attention.
Unknown Speaker  41:05
That’s exactly and I love the way you just, you just phrase that that’s a great, great way to say yeah, that’s that’s completely true.
Unknown Speaker  41:13
And there are health benefits to it. So, you know, as, as physicians, it would be good for us to do it because of all the all the all the benefits that you were just discussing. But it also has other physiologic benefits and as physicians, right, we see patients that suffer from heart disease and hypertension, and anxiety and depression. And so there are real clinical benefits of it. So we start doing it, and we firsthand learn the benefits of it. It helps us but then it’ll help us explain it to our patients and demystify it to our for our patients. So you mentioned some of the health benefits in the book, where were they going?
Unknown Speaker  41:51
Well, I mean, the American Heart Association, you know, recommends meditation as a as one of the old Agilent therapies that’s been proven by itself to lower blood pressure, lower the risk of cardiovascular disease, stroke, and improve immunity immune function. I mean, these are all real, measurable, objective findings. And they were so robust that the American Heart Association is actually, you know, it’s on their website. There’s a whole white paper on it.
Unknown Speaker  42:29
immune function, so, you know, I see patients with ear infections and sinus infections, and I’m constantly being asked, What do I do to strengthen my immune system and they’re all trying elderberry and vitamin C and akinesia and all of these things that are really been disproven. And I say, you know, get good sleep, exercise, eat well. But I didn’t realize that I should also be telling them that meditation can actually help their immune system.
Unknown Speaker  42:57
Oh, yeah, I mean, because you know, the common path. way for a lot of disease, as you know is inflammation and stress is one of the one one of the inputs on inflammation. And so if you can lower your stress response through things like meditation, walking in nature is another one that’s been proven to do that. So, you know, just walking is a huge benefit, obviously, optimal nutrition sleep, or the other things, but those are all those are all improvement in the stress response, which then in turns lowers in inflammation, which has a variety of cascades, downstream
Unknown Speaker  43:39
sand. Is there anything else that you want to discuss with us on the podcast today?
Unknown Speaker  43:44
No, I mean, I think, you know, one of the things that I would probably ask everybody to do is negative visualization. This is you know, I’ve worked with lots of physicians and I think one of the things that’s transformative strongly for me, is, you know, when you’re at a red light Instead of reaching for your phone to check your email for the hundredth time that day, just keep your phone in your glove in your console or whatever. And just take a breath in and visualize something good in your life and then visualize your life without that, just for 30 seconds. It really, you know, our brains are wired to respond to bad versus good. So, you know, cultivating gratitude with writing down three good things at night, three times a week is also very good. But I think coupling that with just negative visualization on a drive home from work is really, really impactful. And it’s really worked wonders for a lot of physicians and myself included. So I would just urge people to try that.
Unknown Speaker  44:48
Yeah, the gratitude. I think there’s a lot of good data behind that as well. My my father in law’s a very religious man and he says, Grace before every meal, and so before For each meal, he recites things that he is thankful for. And he is one of the most Zen like even keeled. He is he is very rare that you see him flustered. And I think that’s because before each meal, he recites things that he’s grateful for, and, and it’s had a powerful impact. And so we Yeah, we try to do that as well. So so so the practice of gratitude, you said, write three things down three days a week.
Unknown Speaker  45:30
Yeah, three times a week before you go to bed. three good things that happened and why that’s been that’s got a ton of research behind it. It’s probably positive psychology. His greatest contribution to science is the study of gratitude. And then the flip side of that exercise is negative visualization where you visualize you know, your job, your group imploding, you lose your hospital contract, what are you going to do about it? You know, and it may seem like a morose texting But it actually makes you appreciate what you have when you think about losing it. And actually visualizing it, in your mind is powerful.
Unknown Speaker  46:10
And I think that’s from the Stokes as well, right? Didn’t they dress in burlap once a week or something like that, too, so that they would appreciate their fine garments.
Unknown Speaker  46:19
Yeah, they practice poverty once a month, you know, and so they wouldn’t fear it. And then they appreciated their, you know, good food as opposed to their bland food thing that they did. So they had they had a lot of mind tricks and mind hacks that they did but you know, positive psychology is really kind of backing up what they did with research, you know, and so it’s really an interesting time in the field. But
Unknown Speaker  46:45
sands this was a really great conversation. Tell us where people can find you.
Unknown Speaker  46:50
Well, I have a website positive psychology for physicians calm and you know, that’s a that’s a free program. It’s broken into five sessions. I do via Skype or in person and it’s just, you know, something that I do because I, when I managed a group of 100 radiologists over 10 years, I just used a lot of these techniques for discontented physicians and it worked and you know, I’ve got probably about a 34% increase on average in well being based on the well being index using this. So it’s a pretty, pretty impactful program. And it’s not that long, it’s just five sessions. And then, you know, if you’d like check out my book, positive philosophy, all the proceeds go to school in Appalachian Kentucky that my son and I do mission trips on each year. So love to be able to support the school so if you feel feel like it, check out the book and contribute to a good cause.
Unknown Speaker  47:53
Man, I feel a little guilty that I got the the free version when it first came out.
Unknown Speaker  48:00
Alright, well this has been a great conversation. I really appreciate you taking the time and sharing all this and I really encourage everybody to look them up and, and read his book, positive philosophy, ancient modern wisdom to create a flourishing life.
Unknown Speaker  48:13
Thanks for having me, man. I really appreciate it.
Unknown Speaker  48:16
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you are interested in being a guest or have a question for a prior guest send a message or post a comment
Transcribed by https://otter.ai