Physician wellness, Episode 1: Physician wellness and burnout

January 25, 2024

In this episode, the first in a four-part series, host Tony Passalacqua welcomes guests Dr. Charlotte Howard and Dr. Tori Olds to discuss how stress and burnout specifically affect the physician population. (45:52)

Also available on Apple, Google podcasts, and Spotify. A transcript of this podcast is found below.

Additional episodes in this series:

Transcript:

Tony Passalacqua: Dr. Charlotte Howard and Dr. Tori Olds are sisters and both licensed psychologists based in Austin, Texas. Their parents, Jev and Sydnor Sykes, are also psychologists and practiced in Austin, Texas for 50 years. The sisters built on their parents focus of training and quality care by expanding the reach of their practice, Deep Eddy Psychotherapy.

Deep Eddy, currently the second largest psychology practice in Texas, is the leading provider of effective, evidence-based mental health services, and trains therapists across the state to improve access to high quality therapy. Deep Eddie can be found online at deepeddiepsychotherapy.com. So that's D-E-E-P-E-D-D-Y-P-S-Y-C-H-O-T-H-E-R-A-P-Y.com.

Deep Eddie helps thousands of clients each week work through anxiety, stress, relationships issues, depression, trauma, and grief.

Dr. Howard, though still doing clinical work, has focused more on the business side of Deep Eddy and currently serves on the board.

Dr. Olds, leads a large international training group focused on the integration of experiential approaches to therapy. Her online continuing education courses for therapists are accessible through her website, www.toriolds.com. And that is spelled T-O-R-I-O-L-D-S. com. She loves translating complex psychotherapy concepts to the general public largely through her YouTube channel, which has more than 28,000 subscribers.

Dr. Olds serves as a faculty at the Academy of Therapy Wisdom, and as an associate instructor at the Coherence Therapy Institute.

Today, our topic is Physician Wellness and Burnout.

Tori Olds: Do you want to start, Charlotte? Jump in?

Charlotte Howard: Yeah, I think a little background is that our practice, Deep Eddy Psychotherapy, has been one of the main providers for Seton employees over the last 30 years. So, through that, we've always loved working with the Seton employees and prioritize them. So, through that, we've worked with a lot of physicians and nurses and all the hospital staff, and it's just been amazing to get that perspective from the inside about what physicians and everyone who works in a hospital, and also outpatient settings too, goes through and it's really evolved over time.

More lately what we've been realizing is the amount that EHRs and paperwork and doing things other than being with patients has really, really upset the physicians -- and understandably —and, and then also burnout seems to be a really big thing. Probably COVID had a lot to do with that. I thought it was already kind of going in COVID. So, we've just noticed that the physicians are incredibly overworked. They're overmanaged and highly monitored a lot of times, with filling out forms, and their bonuses are based on whether they check certain boxes, or things out of their control. And it makes a lot of the people we work with feel really helpless.

Tori: It upsets us too in a way. You know, working with these people I get so frustrated on behalf of doctors that they're doing this incredibly Important work and are being asked to do this extra “busy work” on top of that that is so frustrating and mind numbing and time consuming, you know, taking away from time with their actual patients that they probably prefer to actually just be doing what they were trained to do.

Um, so I know we get frustrated on their behalf a lot and also, you know, somewhat protective of doctors in terms of with the patients. And I guess this probably did get worse during COVID because of vaccines and the, you know, conspiracies and things, but, you know, it used to be that doctors were so respected and treated with, you know, they do really hard work.

Um, and I know I've sometimes been guilty of this, you know, researching something online and thinking that I know it, you know, telling my doctor. But I can only imagine that also must be frustrating too, to have your patients not trust you or doubt you, or think you have some kind of, you know, nefarious intentions or something. So, I think that's, you know, the research is showing the work dissatisfaction among doctors is growing and that's a big problem.

Charlotte: Higher levels of depression, substance abuse, suicidality. And the other main thing that I notice in the people we work with is anxiety, which we're going to talk about a lot today too, but it's obviously very high stakes in a lot of scenarios if doctors make a mistake and not only potential problems for their patients, but also legal issues.

And a lot of the doctors that I see feel some sort of imposter syndrome, which actually is common across careers, different professions, most of my clients, no matter what feel their imposter syndrome. They also have been prone to obsessing about, you know, they'll do a great day. And it doesn't matter the setting.

It can be my ER docs or my, you know, private practice. It's pediatricians and, you know, they work so hard the whole, their whole shift or their whole day doing so many wonderful things, helping so many people. But then they focus in on that one patient that they didn't really, maybe they didn't do something right.

They think, or they did it right, but it was just a very complicated thing, and they weren't sure or it had a bad outcome. And then they go home just obsessing about that one thing. And what a horrible feeling after doing so many good things. And it's just par for the course to be making some mistakes or to have really doing it right, but it's still going to not have the most perfect outcome. Yeah. It's just such a hard part.

Tori: You know, that's kind of why we wanted to talk with you guys today, because you know, in terms of the external factors that are causing the stress, those things just need to change, you know, like we should fight for those things to change. You know, doctors should have good, healthy work environments where they're, you know, supported by their people above them and below them and everything, but that's going to take a while.

But so, but [what] we can talk about today [are] the internal factors that may exacerbate the problem or maybe, you know, make it even more difficult. Because we have seen some, we're kind of two overarching general themes. One is just kind of a perfectionism. You know, this is internally sourced pieces that make the, where we can kind of make it harder to deal with stress.

Um, you know, doctors. To get where you guys are, you have to be incredibly driven, you know, perfectionistic, hardworking, maybe hard on yourself. And then the other one also talks about is the caretaking part, or often doctors, maybe from their childhoods, even, you know, they were the ones fixing things and taking care of people and being the one that had this stuff together so that they could take care of others.

And I think, don't you think, Charlotte, like those two qualities, especially when they're together, can just kind of come together to create like a real lack of self-care and just increased stress, you know, on top of already having a stressful work environment. So, we'd really like to talk about just managing the internal pieces to prevent burnout and be happier at work.

Charlotte: Mm hmm. It makes sense that the reasons people might go into such a hard career and being a physician are either that they're incredibly driven or they incredibly want to help people or maybe both. A lot of times it really is both, but the problem is if that gets out of balance, then that driven nature becomes perfectionistic or overdrive where you don't care for yourself, as Tori said, and then the caretaking can, can be over.

Tori: Actually, that kind of prompts me to, to make our sort of first teaching point here. Um, the first discussion point, and this is really important information for therapists, doctors, anyone who's in a caretaking profession, and that is the new science around the difference between empathy and compassion.

Now empathy, we all have a positive association to the word “empathy,” and it is important. It is important to have some empathy, to have some, you know, when you see someone suffering, I mean you should probably feel something with them, right? On the other hand, and if we are driven, if we allow ourselves to lean too far into empathy, the research shows that that can really contribute to burnout.

So, thank God we have this other emotion called compassion, or it's more of an emotion, it's like a stance of compassion that is also very altruistic and wonderful that seems to be related to positive coping and resilience. So, I just want to highlight the difference between those two and talk a little bit about how you might practice leaning toward compassion and pulling a little bit away from empathy.

Charlotte: Um, just to jump in, those are, they are felt very similarly from the person on the other, other end. Right. If you're empathic, if you're compassionate, it, it actually, the research shows has exactly similar outcomes for your patient or whoever's receiving empathy or compassion, but very different outcomes for the person giving it.

Because empathy can burn you out, whereas compassion is actually a positive emotion inside you that leaves you feeling uplifted.

Tori: Yeah, yeah, right. So let me just say a little bit more. So, empathy is feeling with another person, whereas compassion is feeling for another person. So by with another person, I mean when we're feeling empathy, we are feeling someone else's pain.

You know, they're feeling heartache, we're heartache, you know, we're feeling heartache for their heartache, you know, we're feeling it with them, we're resonating. You know, in our bodies and, and our emotions.

Charlotte: And that's our nervous systems to mirror neurons and we're actually going through it.

Tori: Yeah, we can actually go through it. Like our brain, we're wired. So, we're such social creatures and having moments of that is really important. But if we sit there, if we live there where we're just feeling like if I'm giving bad news to someone, I have to be feeling heartbroken too. It actually is exhausting. Um, and we can have a, what's called a motion contagion where we take on, you know, other people's feelings.

Um, on the other hand. There is compassion, and compassion is, it's actually simply a desire to end suffering. So, it's more a motivational force. So, if you see someone suffering, rather than taking on and feeling their pain alongside them, if you can feel this inner motivation, like, oh, I think I can help, or I want to help, or, oh I don't, you know, I'm inspired, I care.

Compassion is more in the, you know, along the lines of care, you know, I mean, if you're close to someone, it might be even love, you know, it's, it's a warm feeling, and it is motivational. So, when they put people in brain scans, you know, people who are feeling empathy, obviously, are having negative emotional states.

But people, when you're, um, purposefully, you know, witnessing suffering, but, but purposefully training yourself to enter a compassionate state, it looks like, from a brain perspective, that you're having a positive emotion. Because compassion, technically, by the brain standards, is more of a positive emotion.

So, this is really important and beautiful because that means compassion does all the things in terms of motivating us to help, you know, that like Charlotte said, the other person will feel it warmly and receive it well, you know, and it connects us and it drives us to give and is not stressful on our brain and body.

It won't do the whole cortisol spike and all that, you know, if anything, it helps us. And I just want to say one study that demonstrated this with, um, medical students where one group received training and compassion, you know, mindfulness type compassion training. And the other group was waitlisted.

And the waitlist group, as you can imagine, I think this is second year students, you know, compassion was actually going down over time, you know, cause they're probably getting burned out and just, uh, you know, having a harder time. Whereas the control, I mean the, um, the participants, uh, in the, in the training — their compassion was able to stay high, because they were actually actively, you know, practicing compassion. And, um, for that group, they had less depression and less loneliness. So statistically, you know, significant difference. And interestingly, it was stronger. That difference was stronger; that protective force of the compassion was stronger for people who already were high in depression.

So particularly people, you know, who are already kind of struggling, maybe vulnerable to depression. And if that's you, you know, doing compassion training can help sort of insulate you from some of the stress and burnout. Should I jump into maybe describing how to do that practice before we move on?

Charlotte: Let me say one more thing. And you can go ahead. So also, it is really important that the physicians be compassionate or empathic in terms of the outcomes. And there are a lot of studies on that, but one that I haven't read in a while, so I might be getting the details a little bit not perfect, but it was a college counseling center. They had, it was a very large study, and they had the doctors say to people who came in with colds during finals the exact same thing. Except one group one said one extra sentence. Like, “Oh, you're having finals right now. That must be hard to have a cold.” And that was it. Just everything else was scripted. And it was, they said the exact same thing. Prescribed the exact same thing. And the the patients who got that one extra sentence got better like two days faster. So, it does make a huge difference to our patients. But, you know, you can say something like that with, it's just compassionate. It's just noticing where they are without thinking, “Oh my gosh, I just would be, this must be so hard.”

And you're feeling in your body and you're getting all worked up and, and then you see 50 of those [patients] and you're just so depleted by then. But, you know, to be able to be like, “Oh, that's hard.” And, you're just noticing and you're feeling for them, just [being] compassionate but not actually feeling their pain.

Tori: That actually reminds me of a difference, this may be too detailed, but of cognitive empathy versus emotional empathy. So that would be using what's called cognitive empathy, which actually is not shown to be stressful on the person, which is just understanding the other person like cognitively understanding what they're probably feeling. Being able to accurately guess, “Oh, that's probably hard,” doesn't mean you're having to take it on but you can understand why you can put yourself in their shoes, and be like, oh, this is what I would be feeling if I were them, So, a comment like that, using cognitive empathy won't drain your system and will really help your patients.

So, if you're wanting to practice this, then if you get the concept and would like to give it a try, I mean, this is really, you know, classical, really. We're drawing a lot on, like Buddhist mindfulness meditations and things like that. Although people are really seeing them from a scientific perspective these days.

If you want to practice compassion, you can sit as you would if you were doing a mindfulness practice, which we will do a whole, you know, uh, podcast on mindfulness and how to, how to do that, what that, you know, means. But you’re just going to, you know, have it in a quiet moment in a centered space, you know, beginning to draw your awareness to the moment.

You picture someone that is close in your life, maybe someone you love, you know, a partner, a child, or a friend or mentor, um, someone that it's easy to feel compassion toward. And then you just picture them and then you really, you know, allow yourself to purposely feel like, “Oh, I don't want this person to suffer. I wish them all the good intentions.” You know, it's kind of like when you pray for someone or something, you know, it's like you're sending them good um, uh, wishes, um, and, you know, from, from your, from your heart space, you know, that warm feeling that comes. So, you start with someone easy to do that to, and you might spend, you know, three or four minutes doing that.

Then you move toward an acquaintance. So, someone that, you know, you don't have positive or negative feelings for. Then really spend a few minutes practicing, like, here's a human being, like, I may not know them well. I may not love them, but I'm going to send loving vibes toward them. I'm going to wish them well, and I can feel that.

You kind of meditate on that in a way for a few minutes. And then you pick someone that's difficult in your life. So it could be that sometimes is a close person, but it could be, you know, a stepparent or something, someone that's difficult, a coworker that's difficult. And then you practice. “Hey, like, I don't like this person, but, you know, I don't want them to suffer either, you know,” and you really find that sincere intention in your heart for them to have, you know, less suffering than they currently have and, you know, have good things in their life and then you practice, you know, feeling that toward them.

And then ideally, some people add just turning the lens and feeling it toward yourself. The science is showing it doesn't take a lot of mindfulness practice to begin making changes in the brain. So if you can even just do this for five minutes a day, you know, really practicing like, okay, I'm rehearsing the neural circuitry of compassion, you know, you can think of it that way, you know, so that my brain has more that automatic response versus, um, sort of leaning into empathy. I'm kind of practicing this stance. I'm ingraining this stance where I'm just rooting myself in desiring good for the other person, you know, not necessarily with having to take on their pain.

Tony: Charlotte, can you talk to me a little bit more about physician anxiety?

Charlotte: Yes, that is the other big thing we see a lot of. And, um, I mentioned earlier that sometimes people can obsess after a shift or even feel anxious during a shift. And a lot of physicians honestly feel scared before going in, or start to get anxious before going in because they know how intense it's going to be and they're going to have to face a lot of things.

Um, so the important part about anxiety [is that] system centered theory frames anxiety as a defense. It says anxiety is a defense against feelings. And I found that really helpful in working with my clients. And if, if they, if I can help my clients get in touch with their feelings, the anxiety actually goes away on its own.

Even chronic anxiety, even panic attacks, and a lot of times, anxiety starts to emerge, or panic disorder emerges, when people have been suppressing their feelings for too long. And that's because feelings, having feelings, are really an important part of our health and, um, you know, we're evolutionarily programmed to help process things and return to a regulated state through feeling our feelings.

Also, there's important information in our feelings. I love, um, my sister had told me about one theory that frames feelings as packets of rapid intelligence.

Tori: Packets. It's just a nice way of thinking of it. Packets of rapid intelligence. Yeah.

Charlotte: And that really is interesting because we get information much more quickly from our feelings than we do from our rational upper brain. And, so if we, if we need to know something quickly, then our feelings tell us, um, how to respond to a situation. And so anyway, packets of rapid intelligence, they have something to say in there, and if we ignore it, our bodies start to, to really get dysregulated and start to get anxious. Um, anxiety can also be like a fear response to our feelings because we don't want them to take over, and we're scared of having feelings, and a lot of that could be from childhood — if our parents didn't handle feelings well and they didn't want us to have feelings.

Tori: It's a very common thing, yeah, because we're such an emotion-phobic culture. That, um, you know, so many people have had the experience with their parents or with other, you know, teachers and schools here's where, um, you know, if we have emotion, if we're angry, you know, we're punished, you know, or our parents seem harmed by it, like, “Oh, I can't handle you.”

Or, if we're sad, you know, left alone and for a child to be left alone when they're feeling sad is actually overwhelming — like they don't have their neocortex wired in yet, like fully developed yet, they can't regulate themself. So, if a child is left alone emotionally and not really helped and supported by the parents to process their feelings, they're for sure probably going to develop what we call affect phobia, you know, fear of emotion, because their only association to it is, I felt overwhelmed and I couldn't function.

I felt alone; it was scary; it was too much; and so, you know, they pretty quickly learn to shut down feelings. But the problem is, we have feelings whether we like it or not. Like, there is no way to completely not have feelings, you know. If we could, that might be one conversation, but we really can't.

And so, if we have feelings under the surface and are, and never learned to make friends with them and learn skills about how to regulate them and use, you know, like Charlotte was saying, like, get the information out of them of like, “Oh, maybe this feeling is telling me I have a need that's not getting met.”Or there's a question I have about, “Gosh, should I change jobs?” A philosophical or life question that needs chewing on. Or there's a problem that needs to be solved. Or I'm doing something that's not in align with my values, you know, alignment with my values. Like, that's emotion's job is to get our attention and say, “You should probably focus on this, you know, like, like put some awareness here.” Like, this area is important, this matters. And that's really important, emotions tell us what matters to us. And, and we will have them on some level, whether we like are pushing them down or if we're getting flooded.

So, learning just to work with our feelings and so that we can, you know, stay regulated. We don't want to get overwhelmed. Um, but actually the fear of emotion is the thing that makes it overwhelming. So, it's like, it's like there's this lovely therapist, uh, you know, he'll say like, whatever you're not scared of can't hurt you. You know, like if you go, if you're not afraid of your anger, but can sit and be grounded because you're not, you know, panicking, you're not going to fight a flight response, you're grounded. You're just noticing, “Hey, I'm angry,” you know, then you're not going to have dysregulated anger. You're just going to really be able to get the information of like, “Hey, this wasn't okay with me.”

Or, you know, et cetera, either way, it is really important that we actually do the work in therapy or through a mindfulness practice to get really comfortable knowing what we feel like knowing the steps of how to have healthy emotion. Because it really will impact our mental health.

And by the way, just adding one thing from what Charlotte said, another thing that our system can do other than just make us anxious when we're feeling is it can say okay these feelings are a problem. I'm just going to shut down my motivational system – a kind of dopaminergic motivational system which drives emotion in order to not feel – and and that is what depression is from a psychological perspective. I know there's genetic vulnerabilities and things that can err people toward depression, but the psychological moment is the brain saying, “Okay, like it's time to shut down” for whatever reason, but often it's so that we don't feel.

So, it makes us more vulnerable to anxiety and depression. Um, and we see this a lot with our clients, like really, when they're able to just finally say, you know, I'm really mad that at this or I'm really upset or or do a piece of grief work You know, usually we have grief work from our whole life that has never been done, you know. Then the flow and ease that enters their system. It's like, okay, now my system isn't fighting with itself anymore.

Charlotte: And this is even, this is especially important for doctors because of the highly overused intellectual parts. And so, we have to balance that with feeling so that we can have happiness and meaning, you know, really um, meaningful lives. And our feelings are such a big part of that. And unfortunately, the culture in medicine has historically been, and I've seen, see that it's still pretty much true is that feelings are kind of seen as weak or you're supposed to be tough and have it together and, and I can see why in certain moments you don't want to, yeah you know, you can't just sit down crying [during] an emergency with a patient or something. But it is so important to circle back and to tell your body, “Hey we can't process this right now because we're in the middle of helping someone. But we can definitely cry after work or if it's hard for you to access your feelings.”

Some of my clients have a hard time crying because they've repressed their feelings for so long. But just sitting with your hand on your heart and maybe your other hand on your belly and maybe your head bowed a little bit so that you can tune in to what's going on in your body and invite feelings from your day.

Kind of think back of all those hard situations with patients or just in your life. Um, to let your feelings come up. And of course, therapists can help you get in touch with your feelings. That's not the easiest process sometimes for some people.

Tori: If I could just give like a, this is sort of like very, it's not pop psychology, but it's kind of cutesy language for it that's become popular in terms of like knowing how to track or just organize your emotional experience.

People have been talking about the difference between clean pain and dirty pain. So, not moralistically, I don't, I don't really like the words clean and dirty pain, but just to give you a, it could capture something.

So clean pain is like the genuine, like the immediate emotional response we have to something like something's not right. And we feel angry, or we lost something, or it's not going, something's not going well, and we feel some sadness or grief, you know, that's kind of like our fundamental core emotions.

But often, in our attempt to avoid those emotions, or just please people, or do, uh, some other pressured thing that we just learn, and we're conditioned we have to do, we can create sort of unnecessary suffering. So, there's the unavoidable suffering, because life's not perfect, so we're going to suffer some, you know, and that's kind of healthy.

And then there's the unavoidable suffering that sort of we spin out to. The avoidable, then there's the avoidable suffering that are things, you know, we create through narratives and stories we tell ourself or from our inner critic or from, you know, just avoiding our feelings like Charlotte said and then feeling anxious and that, you know, we kind of cutely call dirty pain.

But when you're having a hard time, it's like, okay, beginning to learn to differentiate. Is this clean pain or dirty pain? Like, is this, unavoidable suffering because something is actually hard and I'm just feeling sort of the accurate emotional response to that? Or is this suffering that's sort of being created by my mind, you know?

And then we can slow down. You can say, okay, if it is sort of dirty pain, can I just slow down and see what's like the clean pain underneath I'm avoiding? Because you can't process dirty pain. There's no point in even feeling it, honestly. It doesn't process through. You can cry dirty pain tears and they won't help you.

You know, it won't feel like a release. So it's like, okay, let me see if I can feel really, what am I feeling underneath? That I'm like spinning out into all these places and then obsessing and telling myself I'm bad or comparing myself to others or making it, you know all the things that we do you know kind of defensively, but they actually create most of our suffering, you know it's like a lot of our suffering.

Um, so I think that's in relation to this topic. That's such a foundational, just general emotional wellness piece to learn, you know, it's like tracking that difference, slowing down when you're suffering and say, “Okay, if this is unnecessary, can I pause? Can I see where that's coming from? What's happening? What's creating that, and can I just go underneath it to see like what I'm really suffering about like what's really bothering me underneath?”

Charlotte: I'm just thinking about one of the physicians I work with, and she gets off a shift. Yeah. And then she's obsessing about how she made one little mistake, or really mostly is just wondering if she might have made a mistake. And she calls a couple of people to consult and everyone thinks she handled it fine. But then she continues to go over it and over it in her mind. So, can you apply? Can you apply anything like dirty [pain]? Like so what would she do?

Tori: So, I mean, I guess, I think she would slow down and see if she can find underneath, like, what's the real vulnerability, what's the real need in her that's not getting met, or what is she sad about? The needs of her patients that are not getting met? Like, maybe she's hitting up against that because she's working in a context where her patients really aren't getting a systemic level, like the care they need, or, or she's just hitting up against like some grief that hasn't been processed.

And I'm like, gosh, there's a lot of suffering in this world or, you know what I mean? Or her own, maybe it taps into some of her own unprocessed grief when her mother died and she doesn't want to see that happen to her patient, you know, those kinds of things that's like, that are more like essential and true. And like, that really is a problem. That's a real problem, you know, versus like, I'm making up this thing that I did something wrong. You know?

Charlotte: And would the clean pain be, you know, she's getting in touch with a part that actually feels not good enough? Or, you know, because maybe she didn't live up to her parents, or she, you know, so is that, that's what you mean by the underlying pain?

Tori: But there was a time when she really did feel the pain of not getting enough love, let's say. And that's clean, and it's true, and it's pure, and it's something she could like support and move through and process through.

Charlotte: I think when in doubt the key is just to feel your feelings, because that is a tall enough order. But this is, this is good to know. The difference. The clean/dirty pain thing is really just to know to keep going deeper. To try to … you're going to be much more effective if you can get to the core pain underneath.

And it doesn't have to be about work. You know, it's instead of being annoyed that your partner didn't, you know, clean the dishes, it's like, I don't feel loved by him or her. And so that's kind of the, the difference that we're talking about in terms of what you are feeling. And then let yourself have your feelings in relation to that.

Then you're going to be getting a deeper level of healing. And I just wanted to say, uh, one, you know, throw in one other thing that this is particularly important. Repressing feelings is also really bad for our physical health. And I'm sure all of you have seen many, many examples of where people not, they go through a trauma or they have some other pain in their life and it's manifesting through all sorts of physical symptoms.

Somatic stuff. I mean, obvious ones like IBS, but it goes way beyond that. Chronic fatigue. Yeah. And I remember as a teacher, when I was a professor at University of Iowa, one of my students was, had diabetes and he was losing his eyesight over the course of the semester. And he was, he was also having some really awful digestive issues. And apparently they scheduled surgery, I don't know, for something going on with his digestion and they were going to go into surgery. But unfortunately, one of his close friends died. This poor guy having a really hard semester, um, and he cried straight for two weeks, and he didn't come to class.

And then he came back, but we were learning about this kind of thing in class, and he, and he stayed after class and told me, but his digestive issues completely went away after crying for two weeks. Which makes sense. He was crying about the loss of his friend, but truly, when we grieve, we grieve all of our past losses.

So it gave him a chance to actually let out the feelings about losing his eyesight. That I guess he had really been defending against because it's just too big and scary to feel all that. And so then, thankfully, he didn't have to have the surgery. But, you know, our, our emotions are just so important in terms of how they impact our physical and definitely mental health.

So having that is, I mean, we just have to look inside and let ourselves feel.

Tony: Charlotte, you know, one of the things that I found really kind of beneficial there was that exercise. Could you kind of explain that exercise a little bit slower?

Charlotte: Yeah, so you, maybe you could just try it here and put one hand on your heart, doesn't matter, and it's kind of the center of your chest, so it's your heart's center, and then one hand on your lower belly. Which, yeah, even lower down. Yeah, exactly. Your very lower belly button.

Tony: So it's kind of like just below your belly button? Yeah, on your belly button. Exactly. Or on your belly button.

Charlotte: Yeah. And that can be really, it's almost lower than, it's holding because that part I kind of think of as the inner child. Like a lot of times when I'm doing inner child work with people, they get really shaky down there or have feelings that kind of come up from all the way down there. But also your heart center has a lot of that nervous system in your heart and gut that, that has a lot of feelings. So, take a few deep breaths there.

And the reason I say to bow your head a little bit is because our brain so easily wants to take charge and think of all this stuff and just stay in autopilot. But bowing the head allows you to kind of [say], “Okay, mind, thank you. You work so hard, but we're kind of bowing down to let our awareness sink into our body.”

So Tony, you can just, yeah, let your awareness sink down below your hands. Kind of almost behind your hands into your body. And then with that, you just notice your sensations. You're noticing, you're inviting. I ask yourself, how do I feel?

Or maybe there's something specific that you think you might be feeling. Like I do this when I'm having a grumpy day, and I just notice, wow, I'm walking around kind of short, and I'm looking around, you know. And then I'm like, ooh, I need to kind of, this is like a dry sponge trying to clean up around here.

I need to like dip it into the water of love in a way to get it all nice and supple. So I just pause, bow my head, put my hands like this. And then you're sort of tuning in, and if it's one of those days for me, as soon as I put my hands like that and focus in on my chest and abdomen, I can usually get a few like, aww, you know, maybe a few tears or I feel something. Sometimes it's anger.

Tori: And just to add to that, if you're not sure, sometimes it can be helpful just to say out loud the different feelings, like, I'm feeling angry. And then just see if it resonates, and if it doesn't, you pass the next one, I'm feeling sad. Because sometimes when you say something that's true, it's like the deeper mind says, “Yes, I resonate with that.”

So sometimes if you're not sure what feelings you might go through, like, I'm feeling vulnerable, or I'm feeling, you know, worried, you know, even though it's not, you know, but like, you know, I'm feeling like, and just try saying some things out loud and just see which one sort of like shakes you a little bit, like, oh yeah, that's it.

Charlotte: Alone. There's some that are not really primary feelings, but they help us access what we're really feeling, unloved, or unsupported, or you know, something like that, will help us get in touch with the feeling.

Tori: Yeah, and you can even like then, feel from there like is there something that I'm not, a need that's not getting [addressed] that you know like okay I'm feeling sad, then you might even say I'm feeling sad because I just kind of see what comes, you know? Like, I'm feeling sad because you know, and then, you know, and then sometimes, you know, because… there's a, there's a, um, I think in psychology, it's called name it to tame it … but like the moment that we say the accurate feeling. Or we, you know, have an intellectual like, “aha [moment].” Like, “Oh, it's just because I'm feeling because of this.” There's a way it really aligns our nervous system and kind of calms the subcortical that, you know, the amygdala and all that.

It's like having language for things really is regulating. So sometimes even just saying, if I say I'm feeling sad or I'm feeling sad because, I'm lonely. Like, that, in some ways it opens the feeling, but it also helps it stay, like, helps us stay grounded in the face of it, because it also keeps the neocortex online.

Charlotte: Also, just to throw in there, our nervous systems are best regulated by touch and tone, so this is just adding a little touch. But also the way Tori was saying that yeah, I feel sad. That's a little more of see the tone is a little more caring and gentle and you know, it won't work if you put your hands there and your and your hands are kind of rough And you say I feel sad.

Tori: It's the nonverbals. It's the non, you know, it's like the things that we would do for a child that like really communicate to our deeper brain, like I'm being connected to right now and it's safe.

Charlotte: Yes. And also, yeah, nonverbals go along with that touch, tone, nonverbal communication goes with when you're doing this with a kid or a partner or anyone, that's what communicates with the nervous system. Am I safe? And, um, can I relax and trust and feel? So the more you can do that for yourself, What are you feeling? You know, it's going to get a lot further than just, okay, what am I feeling? Am I mad? I am mad.

Tori: Oh, that one might fit. That last one might fit. I am mad.

Charlotte: And actually a lot of people are afraid of anger.

Um, but, and that's because, you know, they've either seen their parents act out the anger or they have a history of acting out anger. But, again, I just want to say that repressed feelings, that's what happens with them, is they get acted out. And so, it's safer to feel your anger than to repress it and then later explode on someone or on yourself.

We can also act our anger by self harming, attacking ourselves, all those things. Yeah, so, if you are able to just feel the sensations of anger. I'm angry. Wow. Oh my gosh. Lots of energy. There's hate. I've got it. Yeah.

Tori: I feel there's impulses. Like I've got, I want to punch that person, but you're not going to do it. You're just letting yourself experience like. Yeah, I'm really pissed and you make space for it.

Charlotte: Feel it in your arms, feel it in your, you know, really let the sensation move through you. And then it can just pass out, pass through. Yeah. But we don't want to either shut it down or act it out. It's just a matter of looking at it straight in the face and feeling it. So that you don't repress. Yeah. That's very important.

Tony: Well, thank you for walking me through that exercise. That was, that was really helpful. Thanks. Is there anything else that helps out with anxiety?

Charlotte: Well, one of the biggest resources we have is relationships. So similar to what we were just saying about the nervous system is best regulated by touch and tone and nonverbals.

If we can get that from someone else, it helps our body feel very safe and kind of detached from the anxiety. It helps the fear calm and our bodies to, to regulate, and that's evolutionary. We are social creatures or social animals and so, and that actually happens through the medium of emotional connection.

So, that's why, again, it's so important to have feelings, and if you can do that with another person, it's even more powerful, because then they can comfort you. And so vulnerability with other people is kind of the key in allowing you to get this comfort, to use, fully use your social resource, and Tori can talk a little bit more about resource, but resources are just incredibly powerful in terms of whether we think we can meet a challenge, and whether, yeah, stress response, go ahead.

Tori: Yeah, I mean, it's just our brain is always it's asking, do I have enough, you know, do I have enough resources to survive? And that's kind of its job is to manage our resources and make sure we have enough. I mean, primarily glucose, you know, but oxygen and other things too. But you know, usually oxygen is pretty easy to come by, so that's not, but, but really, do I have enough energy?

Do I have enough food and okayness? And like, am I gonna die? Am I gonna starve? And one of the main ways that our specific survival niche as a, as a species was to help each other and to resource each other. So, if we were part of the group. Like, good chance, that was our best chance of survival, that was our best chance of getting shelter, food, you know, let alone procreating and everything else, but that was so, it's so fundamentally, um, important for us.

To have each other in order to survive that the brain actually reads social connection as straight directly as resource that we can talk a lot about that, but I won't go into the details, but it's like, it's like bioenergetic resource. It's like, it's like food. Like I need that. That's good. That's going to help my survival.

So the moment that we have actual connection, really of any kind, it's just that emotional connection is the most bonding. And we really want to feel like that person, we have each other's back. Like that's the proof is in the pudding. Like if I'm upset and someone's there for me. Wow, that's like evidence that we have each other's back and we're facing life together.

Charlotte: Yeah, like a wolf. Imagine a wolf approaching you and you're alone. Yeah. Versus a wolf approaching you, and you're with your whole tribe or you're with all your people. You're going to marshal a lot less energy from your organs to deal with this issue if you have people with you.

Tori: Yeah, that's right. So we're much less likely to go into a stress response where you're, yeah, as Charlotte said, literally pulling energy from your organs, you know, adrenaline and you're, you know. Um, when you feel connected, you're much less likely to go into stress response. So that is really, you know, just essential. For of us have hard lives, you know, but especially doctors with all the stress they face.

But you know, a lot of times you'll hear quoted this wonderful study -- and I'm so glad it's become so famous because it's the longest, it's the Harvard study -- it's the longest longitudinal study of human wellness and development ever. It's over 80 years running now, you know, started off, you know, 80 years ago.

So, they've really watched a couple of generations - they've tracked. And it, and it just incredible amounts of data, you know, health, mainly health data and lifestyle and what's going on in these people's lives. And just the, the basic takeaway, I'm sure they learned a lot, but they always report, this is the takeaway from that study is that it, what matters are relationships, you know, feeling connected.

And you may have heard, you know, the statistics that they have, that like loneliness is as hard on your health as smoking 15 cigarettes a day. So just letting that breathe because that's huge. You know, more than cholesterol, more predictive of health and cholesterol level and all sorts of things. I mean, it's huge, you know, if we feel lonely, which is a huge epidemic and I can't imagine doctors are immune to it, but they may be even more likely because they're so busy, you know, too busy to sometimes invest, you know, in their other relationships, but somehow finding some way, some reading groups or, you know, reconnecting. You know, sometimes we don't have family that's safe or whatever, but finding some people -- and it has to be healthy connection. You know, people who are married, but in high conflict marriages, that was not good for their health, you know. So high conflict relationships, although it wasn't so much about the level of kind of like bickering, like some of those relationships, they would bicker at each other all the time, but if they felt like at the end of the day, this person really has my back, like they know me and they care about me, like maybe we, you kind of peck at each other and get annoyed with each other, but it's not high conflict like where we're screaming and it's toxic it's just kind of not perfectly smooth.

That is also very healthy and helpful for relationship. Certainly the quality of the relationship matters so, you know things like couples counseling or marital counseling or groups like Charlotte leads some wonderful like groups, therapy groups where people deeply connect - sports teams, you know, so, you know getting together socially with other doctors I mean these pieces are so really valuable.

Charlotte: Deep Eddy Psychotherapy has a lot of groups. We specialize in groups, but when you get, you know, 12 people in a room all talking about how they feel toward each other, and so that they can understand their relationship dynamics, it helps you practice having feelings. But also understanding what comes up with you in a relationship.

Like, do I hide from a relationship? Do I shut down? Am I attracted to the wrong people? Do I get angry at everyone? Do I kind of push away when they try to give me care? Or am I, do I communicate in a way that pushes people away when I have feelings? Um, all of those, I mean there are many dynamics. But essentially what people do is have their feelings together and feel so deeply healed and connected through that.

So I'm a big proponent of group therapy. Yeah. It's incredible.

But I also just want to highlight earlier when you were saying, you know, you marshal resources from your organs to, to meet a threat and, and that's especially important with anxiety because You know, if you say, Oh, we've got a test coming or something, and you, you pull a lot of like fight or flight kind of energy, it's just going to be sitting there because there's nowhere to run. There's nowhere to fight. So that's, that's why we feel anxious is, is we've got all this energy that we just decided we needed to pull, to use, but there's nothing to really use it on. And I, you know, in fact, our blood goes away from our brain and all those things, so it's not great for thinking either, but that's just evolutionarily what we do is when we feel that threat.

Tori: That's called an evolutionary mismatch, and it's really prevalent with our mental health, because we evolved to be like running across the savannah, you know, you know, using our body to face discrete challenges that then pass, you know, like we're running, and then we survive. But now we're facing chronic, chronic social challenges, basically, uh, or problem solving or test taking, mental, you know, responding to an email and fight or flight in that moment is very not helpful. In fact, it probably tangles us up, you know, then we don't find the words and we're not thinking as clearly. And so, um, so I think we have to serve a lot of compassion towards ourselves because that is really difficult to have like a vault to, you know, for our stress response to be for physical problems, you know, and then have all of these mental challenges we're trying to do where our stress response gets in the way.

Tony: Charlotte, do you have one last thing that you'd like our listeners to leave with? Uh, with the understanding of physician wellness and burnout?

Charlotte: Yeah, just mostly that you're not alone in all the very difficult things you're facing as a physician. And we hear the same things over and over and over and over. It's almost like a broken record. Um, all of our physicians are saying very similar things. And so you're definitely not alone. And a lot of it is systemic issues that unfortunately, a lot of the physicians feel they don't have a lot of control over. Um, but I think, you know, burnout and anxiety are two of the big ones. And, you know, I wanted to say in summary that we can fight back against a kind of toxic doctor culture. These are the things we can control is the culture among physicians. So part, so ironically, I guess, in summary, the two things we would really want to emphasize are to feel your feelings and to need others.

Which is kind of ironically, I think, counter to doctor culture, you know, because I think physicians really are taught to be so autonomous and so stoic and to not have feelings or they're [seen as] weak. So, I think that that would be our takeaway is you're not alone, but you've got to do some things that really run counter to some of the toxic aspects of, of doctor culture, which is you've got to feel your feelings and you have to let yourself need others and utilize your social resource.

Tony: Thanks. Tori, how about yourself? Do you have anything that you would like to add to our listeners? One last takeaway.

Tori: Yeah, well, I was just touched when Charlotte was saying you're not alone.

I think that's so important because when we don't talk about things, we feel like we're the only one going through them. And so even if it's just in your mind knowing like, okay, all these other doctors probably seem like they have their stuff together, but we're all in the same boat. That can really undo aloneness as well.

Tony: And thank you for listening to this podcast. If you are a policyholder, please feel free to contact us with any questions by calling 1-800-580-8658 or check out our resources at tmlt.org and clicking on our Resource Hub.

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