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Flourishing in Medicine: From Surviving to Thriving Episode 12 From Burnout to Flourishing: Insights from Dr. Gail Gazelle · Flourishing in Medicine: From Surviving to Thriving

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  These are monumental issues that are not about to change. So what do you do? Do you just throw
• 0:08
  in the towel for this career that you've worked so incredibly hard to have? Do you just hand over
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  your happiness to a broken healthcare system? I don't find that a satisfactory answer. I think
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  physicians and others in healthcare deserve to feel really satisfied and fulfilled in their work
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  now, not in five years and certainly not just when they retire. So what are we going to do?
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  Welcome to Flourishing in Medicine from Surviving to Thriving. I'm your host, Dr. Mick Krasner,
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  and this podcast is brought to you by EmPRO, a medical professional liability insurance carrier
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  in New York State with a long-standing and deep commitment of supporting physicians through its
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  physician support programs. Today we speak with Dr. Gail Gazelle with over 25 years of experience
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  as an internist and hospice physician, now combining practical evidence-based strategies
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  with her extensive medical and mindfulness expertise in a coaching practice for physicians
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  and other health professionals for over a dozen years. She's a recognized figure in the media.
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  She's been featured in outlets like CNN, NPR, Oprah Magazine, and has been published in the New
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  England Journal of Medicine as well as other leading medical journals. Her latest book,
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  Mindful MD, Six Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout, underscores
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  her contributions to wellness. Our conversation today discusses her journey emphasizing the roots
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  of physician burnout in medical training and advocating for mindfulness as a key tool.
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  She introduces a coaching model to help physicians find meaning, address negative thought patterns,
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  and navigate systemic healthcare challenges while also highlighting the importance of focusing
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  on present moment experiences and distinguishing between helpful and unhelpful narratives in our
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  professional lives, ultimately exploring the transformative power of flourishing in medicine.
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  And now our conversation with Dr. Gail Gazelle. So Gail, welcome to Flourishing in Medicine.
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  We're just so excited to have this conversation with you. As I said, our podcast is new. This
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  is our 12th or 13th interview for it. And what's exciting is that you're the first physician who
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  has really devoted your life's work now to helping individually physicians and other health
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  professionals flourish and address burnout and to have such an experience dedicated and impactful,
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  I would say, individual is such an honor. So let's begin. I'd like to begin these conversations with
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  exploring with you a little bit about why medicine, through the experiences I've had as a
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  teacher and a clinician and working with students and colleagues, it's really, really fascinating,
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  isn't it? The reasons we go into medicine, sometimes there's common themes and threads,
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  of course, some have to do with early experiences with health and with suffering and being present
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  to that in our families. Others have to do with maybe a sense of service, maybe a combination of
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  experiences we've had in our education and college or whatever. So I'd really love to hear
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  you walk us through that pathway into medicine. And then as well, if you can tell us about how
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  you began to recognize health professional distress and threats to their wellbeing and then moved into
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  that. Great questions to start with, Mick. Thank you. Yeah, I was not somebody who as a child
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  thought I want to be a physician, but I found myself in college very interested in end of life
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  care. I actually volunteered in a hospice when I was an undergrad at Cornell and I didn't fully
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  understand why I was so drawn to end of life care. I just knew I was. And in fact, I decided to go
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  to medical school really planning to work in the field of end of life care, which wasn't really a
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  field back then. You know, palliative care wasn't really a thing. And I didn't fully understand why
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  I was so drawn to end of life care, but I understand now that because of early experiences,
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  not so much with premature deaths of family members, but actually growing up in a very
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  complicated, somewhat wounding family environment, there was a lot of isolation that I experienced
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  as a child. And somewhere in my psyche, there was a connection to a perception of how isolating it
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  can be for people facing the final chapter of their lives. And I now understand that that's
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  really what drew me to the field that became, you know, my clinical endeavor for most of my career.
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  And I like what you're saying. It is really interesting to see how does that add up? What
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  is it that draws us? So I'm kind of grateful in a way, you know, there are good things that come
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  out of any experience. And that was something that came out of, you know, a fairly wounding childhood.
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  Then to go to the second part of your question, I worked in clinical medicine for many years,
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  both as an internist and as a hospice doc. I was here at Harvard Medical School as faculty,
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  so I was doing a lot of teaching. And as we moved into, you know, let's say the 2010-ish,
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  you know, the level of burnout that we were beginning to see amongst colleagues was becoming
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  very real. And I myself had my own journey of burnout. And I was raising a child on my own.
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  I had a busy clinical career, a busy academic career. And I kind of was beginning to feel like
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  I was never good enough at anything. You know, I would feel really guilty if I was home with my son
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  that I should be doing more for patients. If I was at work taking care of patients or working
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  on teaching or other academic ventures, I would feel really guilty that I wasn't being a good
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  enough mother. And like many physicians, I was facing ethical dilemmas in my work. In my case,
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  in end-of-life care, I was being asked by a for-profit hospice chain to admit individuals
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  who weren't actually terminally ill as a way to bolster the numbers for that enterprise,
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  just one of the many ethical challenges that we can find ourselves in in our careers.
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  And at the same time, my son developed Crohn's disease. Life became very medicalized. He's
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  doing great now as a young adult. But, you know, there was a lot going on. And that's when I began
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  to think maybe I want to be doing something different. I had gotten coaching myself,
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  actually, for burnout. I had found it just tremendously helpful. It was kind of like
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  leapfrogging forward on things that I thought were immutable. So that's when I pivoted in my career
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  and decided to become a coach for burnt-out physicians. That was actually in 2011.
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  So that's kind of a quick synopsis of my career back in my, you know, unique journey.
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  It's interesting. You mentioned isolation, perhaps some of it that you felt in this chaotic or
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  whatever the word you used in your childhood, and then the isolation that people at the end of life
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  perhaps could feel and how that really became a motivator for you. Can you say a little bit
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  about maybe the connection between your own journey of burnout and that element, that theme,
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  or the domain of isolation? Was that part of that for you? And also another thing, can you kind of
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  see how that was connected to kind of moving into helping others in that?
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  Yes. So, you know, whatever terms we use, chaotic, abusive, wounding, you know, it was a complicated
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  family environment. And I think it has been a theme in my work, the seeking connection,
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  seeking true, meaningful connection with others, because again, in many ways that was disrupted.
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  And it was another thing that was disrupted really was connection with myself.
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  And I think that's a big part of burnout. You know, again, if we kind of toggle from the past
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  to the present, for so many physicians, there's not only a sense of isolation, you know, with all the
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  siloing that we see and the overwork and the pressures and all the dysfunction in healthcare,
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  but there's a sense that they're just not connected to the broader sphere of meaning and purpose.
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  Right? I mean, here we are taking care of patient after patient after patient, and yet,
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  with so much noise going on around us, we can lose that sense of connection. So I think for me,
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  it's definitely been a theme in my own journey and my own professional growth and development.
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  And it's a theme that I see over and over around how we can really struggle in our careers.
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  It is really fascinating to think about, you know, even from the outside, to step for a moment
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  outside of medicine and look in and say, boy, that seems like a place in which one working in
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  that as a physician in particular would feel really connected because you are directly working
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  with patients. But there's so many factors that you've written about, spoken about, and even
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  allude to here that kind of can get in the way of that. So I think you're right, connection with
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  others, connection with oneself, really be having an intention around that and figuring out tools
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  that a lot that you talk about that you've shared to help build that. And with that, I'd like to
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  pivot a little bit, maybe you could tell us a little bit about now that work with physicians
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  and other health professionals in distress, whether it's coaching work or other kinds of work,
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  you know, reading your website, there's a mention of a model of health care and physician coaching
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  that you use. Maybe you can discuss that model or, you know, whatever it is about that work
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  that you find meaningful and has been so helpful to so many.
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  Well, we're really in a moral crisis in our profession, aren't we? There's so much
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  disillusionment, a sense of disempowerment, a sense of being a pawn in a broken system.
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  So I have a busy practice coaching other physicians. I've really had the pleasure and
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  I would say the privilege of coaching well over 500 physicians and physician leaders over the last
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  13 years. And one could think looking in, as you said, Mick, you know, what a fulfilling career
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  this is, how wonderful that you get to, you know, be with people in their time of vulnerability,
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  how very sacred that is. And there should be such a sense of meaning and purpose. But I think what
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  we're seeing with burnout is a real disconnection from our sense of meaning and purpose. And that,
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  for me, is where mindfulness comes in. So that's a big part, as you ask about the model that I use,
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  not just, you know, I think, as you well know, when people hear that word, particularly physicians,
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  they can kind of chuckle to themselves and think it's navel gazing or aging hippies in wood stock.
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  But it's so fundamental in helping people regain a sense of autonomy, which is really at the heart
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  of burnout, the loss of autonomy that many physicians feel in our complicated health care
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  system. So much external autonomy has certainly been wrested from the average physician. I'm
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  certainly not going to argue with that, you know, as we see the corporatization of medicine.
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  But really the mindfulness approach is about gaining autonomy over oneself, over one's mind,
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  over how one responds to challenges. And so when we look at physicians who are feeling very
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  disillusioned, I think what I see as a coach is that many times we've lost our focus. We've lost
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  really the focus on what it is that's deeply important, our sense of purpose, our calling,
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  why most of us went into the practice of medicine in the first place to help vulnerable human beings
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  in their time of need. We can be very focused, however, on everything that's going wrong.
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  The negativity bias that pulls us to that, the problem-focused lens that we learn in our training,
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  we begin to apply it to our own lives and careers, and we can be in feeling like nothing is going
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  well. And such an important place for mindfulness to actually question that thought, that overpowering
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  draw to the negative, to question it and to kind of do a daily practice. Well, what went well today?
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  What went right today? So that's really pivotal in coaching physicians is not some kind of Pollyanna,
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  you know, like everything's going great, but let's take a realistic look. You know, a physician might
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  call me, you know, Gail, I'm really burnt out. I'm really struggling. Things aren't going well
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  in my career. I'm not sure I can continue. And then very tragically, they might say to me, you know,
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  it's all miserable. It's all gone to whatever that phrase is, hell in a handbasket or something like
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  that. And after being very empathetic about that, I'll kind of get curious. So I'm just curious,
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  you know, physician-client, if you look over your past week, were there any bright spots with
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  patients? Often there's a big pause because the mind goes to everything that wasn't going well,
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  that wasn't a bright spot. But after a little bit of probing, it's very common that the physician
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  will then say, oh, right. Yeah, I was taking care of Mrs. Jones and you know, she has really advanced
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  CHF, for example, and we're really at the end of the road. There's not too much more I can do. But
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  you know what? When I sat with Mrs. Jones, it was such a meaningful moment just being with her.
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  I could really see how much it meant to her that I'm there for her and that I'm not giving up on her
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  and I'm with her on this journey. And so you'll be sitting in a coaching session and the physician
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  starts warming up. Their face softens, their shoulders drop. And it just points to that we
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  can become disconnected from the truth because the mind is so busy telling us about everything
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  that's going wrong, of which there is plenty. But we lose our way. We lose our connection to
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  the goodness that is so available to us as physicians. I think that's right. I think the
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  negativity bias is real strong. And I'd like to explore a little bit more about the mindfulness
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  aspects. As you know, it's something that's really important to me too. So we really resonate. Before
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  we get there or come back to that, I'd like to first just talk a little bit about the roots of
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  burnout. You know, you talked about, you mentioned loss of autonomy, loss of our own sense of calling,
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  having lost that. I think it's always there, maybe buried a little bit. And one of the jobs you have
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  as the coach maybe is to help uncover that. A lot is discussed now, as you know, about how this
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  problem seems to be rooted in systemic and organizational dysfunction. You've already
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  alluded to that. You know, when we became aware as a general culture, as a medical culture about the
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  problem of errors and desired to address them, that this is an important thing to distress. And we
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  began to investigate. The discovery was that the major driver was not deficiencies of any individual
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  health professional, particularly physicians, but the systemic factors. And in your book,
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  The Mindful MD, about burnout, you say that the problem may very well lie with the systems,
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  but the solution, and I really like this next line, the only solution we have access to,
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  lies with us. And it is an interplay with us and the system and how we're in that and part of it.
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  So can you share some thoughts about what we know about burnout, what drives it, and how individual
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  sort of access to individual skills and capacities can actually influence the system,
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  which is really the source of the troubles. There's so much in the questions that you're posing.
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  So let me start and then you can redirect me as needed. The healthcare system is so challenged
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  at this point in time. There's no question about that. And if we didn't understand that before the
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  COVID pandemic, we certainly understand it now. Under resourcing, under staffing, inequities,
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  all kinds of, you know, the hassles of having to deal with insurance companies and, you know,
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  haggle to get a test that you know that your patient needs, the care and feeding of the
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  electronic health records, so many difficulties. So of course, the problems in the system bear down
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  on individual clinicians, not just physicians, obviously everybody who's working in healthcare.
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  So there's no question of how real that is. The question for me is, is there any component
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  that we can exercise control over? I'm a pragmatist. And I really wonder, you know, often when I speak
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  to groups of physicians or working one-on-one in my coaching, people will say, you know,
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  don't ask me to change myself. It's the system that's broken. And don't ask me to do anything,
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  let alone meditate or keep a gratitude journal. You know, how ridiculous is that? Until they
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  fix the system. And it's a reasonable thought, but then you might come back with a challenge, well,
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  you know, how soon do you think the system is going to be fixed? Next week, next month,
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  next year? And that's when people will roll their eyes and they realize that, you know,
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  these are monumental societal issues in a capitalist society where we don't have universal
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  healthcare, for example. These are monumental issues that are not about to change. So what do you do?
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  Do you just throw in the towel for this career that you've worked so incredibly hard to have?
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  Do you just hand over your happiness to a broken healthcare system? I don't find that a satisfactory
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  answer. I think physicians and others in healthcare deserve to feel really satisfied and fulfilled in
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  their work now, not in five years and certainly not just when they retire. So what are we going to do?
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  So in the Mindful MD book, in the first part, the very small part of the book,
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  which is the roots of burnout, I kind of take a deeper look. Well, what's going on for us?
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  What is it that we might bring to the situation that could actually be making our lives worse?
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  And that's really, to me, where medical training comes in. And there's so many wonderful things
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  that we learn in our medical training, and there are also things that can really get in our way.
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  So a few of them are the sense that we're taught that somehow if we're not perfect,
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  we're some kind of failure. We're taught to be very critical of ourselves, to say things to ourselves
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  we would never say to anybody, let alone somebody that we care about. We are taught that we are the
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  invulnerable captain of the health care team, the paragon of knowing, the one who always has an
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  answer, even when there isn't an answer, like in the beginning of the pandemic. And we're also taught
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  to always look through a problem-focused lens. We begin to see everything as a problem. We're the
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  fix-it guys. So it's not just patients that are problems, but we begin to see ourselves as a
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  problem, our lives as a problem, our relationships as a problem. And what I see as a coach and in my
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  own life and journey is these things make it hard for us to thrive. They make it hard for us to be
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  adaptable in a complex health system that requires adaptability and flexibility. We also come out of
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  our training really feeling like we have to prove ourselves, right? Which is a fear-based place. It's
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  a survival place. And I've coached so many physicians who are struggling, let's say, to get
• 20:35
  their charts done. And the chart for many physicians is not just a note, it's a proof of worth.
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  When people read my note, are they going to think I'm smart enough? Honestly, I've seen that in
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  countless physicians. And so then we sit down to chart and it's very loaded. It's not just
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  documenting a patient's visit, which is not a big deal for any of us, but it's loaded. It's loaded
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  with this extra baggage that then can make it very hard to be efficient. So I'll pause there and let
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  you ask another question, because I think there were more questions embedded. Well, no, I think
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  it's a wonderful place that you went with it. We recently interviewed for this show a medical
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  educator from Switzerland, and he was describing how this impacts the students and their learning
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  environments and how to kind of flip that around and to focus assessment for the sake of learning,
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  not for the sake of grading. That the assessment becomes a learning tool that you grow from,
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  not that you fear or just have to pass so you can get to the next thing. And it's just a different
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  kind of way of looking at it. Yet, you know, we in our training and in medicine and this,
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  I think it's a myth because medicine is really a team sport, we could say. It's really a
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  collaboration being the paragon, as you say, of the captain of the team. We still do have a sense
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  that we want to have control. And I think that's important. I think individually for all of us as
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  human beings, we want to have some sense of where can we have control and exert control, just in my
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  personal locus, you know. And then if we can't, we feel deficient or we feel worse. We feel
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  like a failure. You've written about imposter syndrome. And I think our listeners, many of them
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  are familiar with this. I think some of them may be familiar with it without even knowing that that's
• 22:29
  what they're experiencing, but maybe we can just go a little bit deeper into that particular aspect
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  and how that plays out and what are some of the tools you offer or would suggest to work with that
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  so we can move on from that in a sense and really get a sense of our self-worth and our skills,
• 22:47
  which we have tremendous skills and tremendous resilience. I love talking about the imposter
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  syndrome. Sometimes I feel like I was put on this earth to help people manage theirs because it is
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  so prevalent and it's very prevalent amongst high-functioning individuals like physicians,
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  not just physicians, but we, I think, in many ways are particularly prone to it. Some of us
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  so many comparisons are made during our training. We're compared to, you know, a peer, a fellow
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  intern. We're compared to the residents ahead of us. We're compared to attendings. Those comparisons
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  and what I call in the book, you know, comparisons, ratings, and rankings can in many ways plant the
• 23:29
  seeds of the imposter syndrome. This idea that somehow somebody else has what it takes, but do I?
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  It's one of the factors that I think lead to that sense of being an imposter. It can be helpful to
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  recognize that many of us are walking around feeling like an imposter. There are some recent
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  studies in physicians. The number that we see in, I think, in a recent study was about 30%, but I
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  think that's low. I've seen in almost every physician that I've coached, except for some
• 23:57
  random narcissist, perhaps, this sense, this pernicious sense that somehow I'm not as good as
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  others. I'm not as smart. I'm not as good a diagnostician. I'm not as empathetic. I'm not
• 24:10
  as good a surgeon, whatever it is. And it's only a matter of time until I'm found out. And when I do,
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  I'm going to be the laughing stock amongst my peers and my institution. So it's so painful.
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  It's so erosive. I share in the book, a vignette of a surgeon, a very successful surgeon who told me,
• 24:29
  you know, that every time I go in the OR, Gail, I think that's going to be the time people are going
• 24:34
  to see that I'm really not good at this. I really don't know what I'm doing. And boy, when he shared
• 24:40
  that, oh, such a weight that he was carrying, and he's not alone in carrying that weight.
• 24:45
  But it is so erosive of our sense of well-being. But let's flip it and think about, well, how do
• 24:51
  you manage the imposter syndrome? Well, one thing that I think is helpful is, first of all, realizing
• 24:58
  that many of us experience it. Right? So that's one part of it, the connectedness, the shared
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  humanity, that's such an important part of mindfulness. Another thing that's really important
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  is realizing it's only a thought process. That's all the imposter syndrome is, is a very seductive
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  thought process that the mind has generated. And then the mind, very subjectively, is seeking data
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  to support its sort of going story, its narrative that I'm an imposter and that others know more
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  than me. So we have to, you can kind of laugh a little bit when you realize it's just a fiction
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  that your mind has created. There may be a kernel of truth. There may be something that you're not
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  as good at and not as articulate or not as good as giving a presentation, you know, whatever it is.
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  But that's just a kernel. And then your mind, which the mind is very good at, is generating
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  this whole storyline. And that's the beautiful thing about being mindful, is you begin to notice
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  these stories. You begin to see that there, many of them are downright wacky, right? The fictions
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  that our mind creates. And then you can begin to chuckle a little bit at it and take the whole
• 26:06
  thing less seriously. And it doesn't weigh you down in the same way. So for me, those are two
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  really important components of moving beyond the imposter syndrome, recognizing that many of us,
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  if not all of us, experience it. And then also just kind of noticing the story that your mind
• 26:23
  is telling you and realizing you don't have to believe it. Yeah, I think what you're describing
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  is, you know, an approach that's used in the mindful self-compassion is first recognizing
• 26:32
  our shared humanity. We tend to do this to ourselves. We experience this as part of being
• 26:37
  human and then applying mindfulness to it about really seeing that, oh, it's a thought. Interesting,
• 26:43
  if true, I can explore it. I don't have to necessarily buy into it. So I appreciate that.
• 26:49
  You know, a lot of your work coming back to the mindfulness-based nature of it, I think that's
• 26:53
  what's really unique about it. And I think it's partly why it's successful, the work that you've
• 26:57
  been doing. I really resonate with it. It's clear that qualities like, you know, beginner's mind,
• 27:03
  acceptance, not resignation, but really an honest assessment, being aware of judgment,
• 27:08
  being aware of our striving nature, all these are, and other qualities help us to work honestly and
• 27:14
  authentically with what you talk about in your book. I think it's a chapter or a section on
• 27:20
  working with what is. So maybe you can unpack that a little bit for our listeners.
• 27:26
  Sure. The other piece of this, and I think you alluded to it earlier, is this word mindfulness.
• 27:32
  You know, is there any other words we can use? Because I think culturally now, and with the
• 27:38
  zeitgeist and how the commodification, corporatization of mindfulness itself can get in the way of our
• 27:45
  colleagues who are really dedicated people that use scientifically-based approaches to help others,
• 27:53
  but also understand that humanity can be a little bit hesitant when it comes to that word itself.
• 27:58
  Well, let's start there. Mindfulness is about awareness, awareness of what's going on right
• 28:05
  in front of us, awareness of where the mind is taking us, the thoughts about what it is
• 28:12
  that's going on in front of us in the present moment, actually our true experience. But it's
• 28:18
  not awareness alone. It's awareness so that we can train the mind to focus where we want it to
• 28:25
  focus, to focus more on the actual experience than the thoughts, stories, narratives about the
• 28:30
  experience. So another way to think about mindfulness is mind training. And I'm not the
• 28:36
  first to see mindfulness in that way, far from it. You know, a pamatrodra and otherwise sages have
• 28:43
  helped us understand that mindfulness is about mind training. And we're training the mind to be
• 28:50
  our ally. We're training the mind to focus where we want it to focus out of the stories, out of the
• 28:56
  flitting about from the past to the future. And fundamentally, we're becoming the master of our
• 29:03
  mind rather than being the captive. So that's what I would say it's really a fundamental toolkit,
• 29:10
  not just for healthcare, but for all of us in terms of how we see the world, because we see
• 29:15
  everything through the human mind. It is the lens that we see everything through. So far better to
• 29:22
  have a clear lens than a blurry or flawed lens that frankly most of us have. I know I had it for
• 29:29
  most of my life. So that I would, you know, add my assumptions and my projections and my beliefs and
• 29:35
  my worries and my fears to what I was actually experiencing, because that was the lens that I
• 29:39
  would look through. So that's the first part of your question. The second part is about what I
• 29:44
  call the fifth way that mindfulness restores autonomy and cures healthcare burnout, which is
• 29:50
  working with what is. So, you know, I was just doing some group coaching this morning, a group
• 29:57
  of female physicians who were lamenting the corporatization of medicine and how limiting it
• 30:03
  is. One of them had gone back into training. It was a second career for her. And she was just saying,
• 30:09
  you know, I don't know if I can stay in this. They have all the control. They're calling all the
• 30:13
  shots. You know, I can't be happy with everything that's going on. I have no control over, you know,
• 30:18
  how things are going in my practice. And there was some magical thinking that it should be
• 30:25
  different. If only healthcare was different, I could be happy, for example, is something that
• 30:30
  came up in that group. But the question is, is healthcare different? Or is healthcare the way
• 30:36
  healthcare is right now? No matter whether we like it or not, whether we think it should be
• 30:41
  different, it is the way it is. And we can expend so much emotional energy wishing it were different,
• 30:49
  painful energy, energy that we do not have to spare, and energy wasted that makes it harder for
• 30:55
  us to be skillful and resourceful in effecting change in the broken systems in which we work.
• 31:01
  So for me, that's what working with what is, is all about. Let's face reality here. Let's take off
• 31:09
  the glasses, you know, good, bad, or whatever they are, and actually see things for what they are so
• 31:14
  that we can deal with them most effectively. So for me, that's the clarity that knowing our own
• 31:21
  stories and tendencies and beliefs can help us with the clarity, but it's also a sense of efficacy
• 31:29
  and very definitely a sense of autonomy when we can step out of faulty lenses and see things from
• 31:36
  where they are. And again, in that chapter, I talk about, you know, the I'll be happy when malady.
• 31:42
  And just, you know, to digress for a minute, you know, you're in high school and you're thinking
• 31:47
  you want to be a doctor. Well, I'll be happy when I get into a good college. And you're in college,
• 31:51
  and you're thinking, I want to go to med school. I've got to take the MCAT. I do. Oh, I'm going to be
• 31:55
  so happy when I get into med school. Then you're in med school. Well, it's not always a walk in the
• 32:00
  park. And you start thinking, I'm going to be so happy when I finish med school and I become a
• 32:04
  resident. Then you finally match, you get into a residency, and here's the kicker. You think to
• 32:10
  yourself, I'm going to be so happy when I finish my training and I am an attending. And for any
• 32:17
  physician attendings out there, somebody who's graduated through their training, you'll probably
• 32:22
  chuckle at that one because it's hard being an attending. It always has been, and it's hard now
• 32:27
  in this day and age. So we have to question these stories, this thing that we can be so invested in,
• 32:33
  I'll be happy when. And really question, well, how can I be happy now? How can I be happy in these
• 32:39
  precious moments in this one life that I get to lead? You have a great way of making this very
• 32:46
  clear, simple in a certain kind of way, but also very relevant and important. I'd like to just stay
• 32:53
  a little bit on this topic with mindfulness, because this is another area that I think people
• 32:58
  get tripped up in, and it has to do with the stories. We often recognize that stories often
• 33:05
  are tacit, unrecognized, unexamined, the ones that we tell ourselves and we perceive them as the
• 33:10
  truth. And as you've experienced in our mindful practice and medicine program, that there's also
• 33:15
  great value in reflecting on the different kind of stories of those that we experience as clinicians,
• 33:22
  teachers, educators, administrators, that we rarely reflect on. It's a different kind of story,
• 33:28
  isn't it? They can become sources of meaning, purpose, inspiration, being robust and energetic.
• 33:34
  So I think this is confusing for folks, and maybe you could talk a little bit about this. Your books
• 33:40
  are full of incredible stories. Thank you to you, and thank you to your colleagues whom you've
• 33:47
  coached, who allowed you to share some of those, because they're really illustrative. They're
• 33:52
  incredible because of not only what those individuals have gone through, but also there are
• 33:58
  stories, right? I mean, they're shared by us because we can really relate to them. So maybe
• 34:05
  talking a little bit about stories, those that are really helpful to reflect on and how we can get
• 34:10
  tripped up in it a little bit. Yeah. Well, let me just say that for any listeners that are interested
• 34:17
  they can download a free chapter from the Mindful MD book at https://gailgazelle.com/mindfulmd/
• 34:24
  So stories, yeah, it's interesting. Stories can be very rich and very positive. They're
• 34:32
  our lives, our stories, our history. They can also be unhelpful. So that's the distinction.
• 34:40
  With mindfulness, we're training the mind to pay attention to things that are helpful to us and to
• 34:49
  detach more from things that aren't. So if it's a story, you know, that is something about a
• 34:57
  vacation that you had or an important relationship or your career trajectory, well, that's deeply
• 35:03
  meaningful. It's not like you need to throw that out somewhere. But if there's a story, as we were
• 35:09
  just talking about with the imposter syndrome that is only serving to make you feel down on yourself,
• 35:17
  less than, uncapable, and you're kind of carrying that story around and fostering it,
• 35:24
  well, that's an opportunity to notice that story and ask yourself, is the story helping me?
• 35:31
  Is it helping me grow? Is it helping me show up as I want to show up? Is it helping me feel good
• 35:37
  in my days? Is it helping me be at my best when I get home with my family? Because
• 35:42
  at least I know that for myself, many of my stories, they're pretty weighty and they're,
• 35:50
  they have an element of fiction in them. You know, as I alluded to earlier on, I grew up in a very
• 35:56
  abusive home. And for many years, my storyline was kind of like that I'd suffered more than others.
• 36:02
  And in that storyline, I kind of thought, well, I deserve something. I deserve people to notice
• 36:09
  me. I deserve people to, you know, be more caring of me. That didn't exactly enhance my relationships.
• 36:18
  Because whoever I was in a relationship with had their own suffering that they'd endured. And who
• 36:23
  knows if it was more or less and worse in one domain, you know, suffering is a part of life.
• 36:29
  But I was really caught in that story. And once I began to see that the shared humanity,
• 36:36
  that everyone suffers, nobody gets through this journey of life without suffering in one way or
• 36:41
  another. Once I could see that, and I could realize like, how did I really know that what I
• 36:46
  experienced was so much worse than somebody else? And how did I even know that that meant I was
• 36:51
  deserving of special treatment? Once I could unravel that, my relationships really flourished.
• 37:00
  Really. You know, I think to myself about what I jokingly refer to and my friends refer to as
• 37:06
  Old Gayle and New Gayle. Old Gayle was trapped in some of these stories. And they were really
• 37:14
  self-fulfilling prophecies, actually. They left me feeling more alone and unfulfilled in relationships
• 37:22
  and not really having the deep connection that I so sought. So I hope that sharing that personal
• 37:29
  vignette, you know, can help your listeners think about stories that the mind, again,
• 37:34
  they're very seductive. It's amazing how we get seduced by our mental stories. I didn't question
• 37:39
  that story for a long time. But once I started meditating more and becoming the observer of my
• 37:44
  mind and the ability to question whether what was going in my mind was helping me or not,
• 37:50
  that's when I could really unpack that story. And then I had so much more autonomy because
• 37:55
  I could decide, do I want to pay attention to that story or not? And it's been the pathway to so much
• 38:01
  deepening in my relationships, you know, as a mom, as a partner, as a coach, as a friend,
• 38:08
  as a member of my community. New Gail is a much happier person. She's a much more authentic person.
• 38:15
  She's a much more loving and compassionate person. And it's a lot easier living in New Gail's skin
• 38:21
  than it was living in Old Gail's skin. That's wonderful. You know, sadly, we're nearing
• 38:29
  kind of the end of this because I'm enjoying this so much. We will definitely have to do a part two
• 38:33
  at some point. I did just have a few more things I wanted to talk about if you can,
• 38:39
  more like a thought experiment. So, and this podcast is about flourishing in medicine. So
• 38:44
  when you are receiving care, what's it like to be cared for by a physician, another health
• 38:50
  professional who you can tell is flourishing? And then once you've kind of thought about that and
• 38:58
  shared what that would be like for you, when you're doing your work, when you're completely
• 39:02
  in touch with what's going on, you're mindful, you're in the flow, and you're feeling a sense
• 39:09
  of purpose and meaning and you're flourishing, what's that like to do your work in a flourishing
• 39:14
  way when you're truly flourishing? So both receiving that flourishing into colleague,
• 39:20
  professional connection, and then also your own flourishing.
• 39:25
  Well, I had a medical experience yesterday, benign. I had a couple of routine tests,
• 39:31
  a bone density, and a thyroid scan. And I was so struck that from the minute I entered the building,
• 39:41
  which is a multi-specialty practice building here in Boston, people were friendly. They were smiling.
• 39:48
  There was a little bit of, oh, can I help you? You know, I couldn't quite find the office for
• 39:52
  the thyroid scan. And a person was just kind and, oh, okay, you know, here, go down there.
• 39:58
  Then the technicians were just kind. They were just friendly and kind and, oh, this must be a
• 40:05
  little scary for you. You know, it was a follow-up on a thyroid nodule. So of course, you're wondering
• 40:09
  what it is. You know, you're in good hands. Like, there was just a sense, you're incompetent, kind,
• 40:15
  caring hands. It's so profound what an impact that has when we're a vulnerable patient.
• 40:22
  Just that sense of humanity, that sense you're a human being, you're recognized as a human being,
• 40:27
  you're not just some, you know, you're not just some object going through their system that they
• 40:33
  don't really invest in or care about. It's a profound difference. And I think most of us who've
• 40:38
  had medical experiences of any kind or a loved one, you can really see the difference. So it's
• 40:44
  small things that carry a lot of weight. So that's on the receiving end. Then you asked me to flip it
• 40:50
  to the giving end. It's so powerful to be there for another human being. For me, you know, in all my
• 40:57
  years as a physician and now in all my years as a coach to really be of service to another human
• 41:03
  being, it's quite profound how fulfilling that is. You know, it just, I know, I know for me,
• 41:10
  it just totally, it's a little bit of a high. You know, yes, the helper's high that you're needed,
• 41:17
  but much more than that, just to connect with somebody in their time of difficulty, whether
• 41:21
  it's a patient or a colleague or whoever it is, that being of service, because, you know, it takes
• 41:27
  us out of ourselves. And, you know, I think it was the Dalai Lama said, you know, if you want to be
• 41:32
  happy, think of others. If you want to be unhappy, focus on yourself. I'm very aware of the truth of
• 41:39
  that, that when we're there with another human being really present for their difficulties,
• 41:44
  helping them if we can, but simply being present, it's a very satisfying experience. I don't know
• 41:50
  what's going on with my dopamine and oxytocin levels. I can only imagine that they're going
• 41:55
  up. Certainly my cortisol levels are going down. Absolutely. You know, we had Tina Runyon, who is
• 42:03
  a health psychologist and really an expert on the physiology of stress and the physiology of
• 42:07
  connection talking about this. And I think we are evolutionarily designed as a social species to
• 42:16
  feel good, to care for others. Absolutely. And it's important that we feel good doing that because
• 42:23
  we need each other. We can't live in isolation, clearly, clearly. Yeah. So finally, the last thing
• 42:30
  I'd like to ask you is what do you like to do for fun? I mean, I'm sure, and some of it could be
• 42:37
  your work because it sounds like that's immensely satisfying to you. But in addition to work,
• 42:42
  what other things do you enjoy? I love being out in nature. And I happen to have a proud,
• 42:50
  happy canine companion who loves being out in nature. So I get out in nature a lot. So that's,
• 42:55
  that's, you know, excellent. I am also an avid pickleball player. I have caught the pickle bug,
• 43:01
  pickleball bug. So I play two to four times a week and it totally floats my boat.
• 43:06
  And I also am an amateur artist. I do a lot of crafts that I find very enjoyable. So when I'm
• 43:14
  not working, it's often one of those three things. Lovely, lovely. Well, Gail, this has been
• 43:20
  wonderful. It's great to see you again, talk with you again, and connect in this way. And I hope we
• 43:25
  can stay in touch. Is there anything else you'd like to share with the listeners? Anything else
• 43:30
  you want to make sure they hear from you? Well, Mick, we make sure that we're able to hear
• 43:35
  you. Well, Mick, we met in 2016 when I took your and Ron Epstein's wonderful course,
• 43:42
  the mindful practice course, which was just fantastic. What an incredible opportunity it
• 43:48
  was. So I want to share my appreciation to you, Ron, and the whole team for offering that to so
• 43:54
  many physicians, so many of us in need. Thank you. Really appreciate that, Gail. Thanks.
• 43:58
  Thanks for listening today. We will include a summary of today's podcast and links about
• 44:04
  Dr. Gail Gazelle and other topics discussed in the show notes. I'd like to conclude with
• 44:10
  sharing another practical exercise to help you flourish during your workday. Central to Dr.
• 44:18
  Gazelle's coaching work is mindfulness. And today I share with you a mindfulness exercise reflecting
• 44:23
  on our path in medicine. It was produced a number of years ago by Ampro as part of a series of video
• 44:29
  offerings for physician support and will make the video version available to you as well.
• 44:38
  I would invite you to sit with me for a few minutes and engage in a very brief meditation
• 44:43
  practice that you can do at the beginning of your workday, at the end of your workday, in the middle
• 44:48
  of your workday, even right before you enter a patient's room. And I'd like to invite you to
• 44:53
  sit with me in the middle of your workday, at the end of your workday, in the middle of your
• 45:00
  patient's room. So as you sit, starting with an awareness of your physical body, your feet touching
• 45:08
  the floor, your legs, your thighs, your bottom touching the seat of the chair,
• 45:15
  your arms are at your sides and noticing how you're resting your head upon your neck. You don't have
• 45:23
  to sit any particular way but think of sitting in a way that wakes you up.
• 45:34
  And as you sit quietly, reflect for a few moments on what brought you into medicine as a profession,
• 45:43
  what drew you into medicine, what was the calling?
• 45:52
  It may be that it hasn't turned out quite exactly the way you planned and that's okay.
• 45:56
  Reflecting for a few moments about what were those inklings, those feelings, those desires you had to
• 46:11
  attend to the care of others?
• 46:13
  When did you first notice that you were interested in working with life and befriending life, if you will?
• 46:32
  As you reflect on your sense of calling,
• 46:35
  noticing how you can call on that sense of calling even now in the practice of medicine right now in
• 46:44
  this moment, as you begin your day, as you end your day, as you encounter the next patient.
• 46:53
  As you end your day, as you encounter the next patient.
• 47:07
  Noticing how this feels in your body.
• 47:10
  Noticing the effects it has on you emotionally in terms of joy, satisfaction, meaning.
• 47:24
  Perhaps noticing how it engages your mental activities with a desire to do a good job.
• 47:33
  To work diligently and also to enjoy yourself.
• 47:47
  Thank you for joining me and I hope you'll try this once in a while and see how it works.
• 47:53
  This brief meditation practice is available on YouTube and on YouTube.
• 47:58
  And see how it works. This brief meditation practice is available to you as a video file.
• 48:05
  Please review the show notes where you can access it. I hope you found this podcast and this
• 48:13
  exercise useful to you and look forward to having you back for our next episode of
• 48:18
  flourishing in medicine from surviving to thriving. The podcast has been brought to you by EmPRO.
• 48:25
  In charge of recording and editing the podcast is our technical director Stan Sainjour.
• 48:31
  And the person really responsible for the existence of this podcast who invited me to host it is the
• 48:36
  Vice President of Education at EmPRO, Gerri Donohue. If you'd like to hear more about EmPRO,
• 48:43
  please visit www.myEmPRO.com. If you'd like to know more about EmPRO's peer support programs,
• 48:51
  visit www.myEmPRO.com/peer-support. If you're a physician or medical student
• 48:58
  in a need of urgent support, please consider calling the physician support line at 1-888-409-0141
• 49:08
  or visit www.physiciansupportline.com. For information about me and my work, please visit
• 49:16
  www.MickKrasnermd.com or www.mindfulpracticeinmedicine.com. Hope to see you next time.