Newsletter #4

  Your Weekly Dose of Positive Medicine 

Burned out on burnout? Discussions about the crisis of physician burnout are everywhere, from medical journals to mainstream media. The statistics are troubling with over half of all physicians reporting at least one symptom of burnout. Physicians are leaving medicine early, and the number who would recommend medicine as a career continues to decline. Experts cite both organizational and individual approaches to mitigate burnout including  flexible work schedules, the use of scribes, electronic medical record improvements, and mindfulness classes.  These are steps in the right direction.

The larger truth in this crisis is the absence of burnout does not equal wellness. Most physicians are able to function. We get through our days, make it to some of our kids activities and even manage to go out to dinner on the weekends. We survive the work week as we look forward to our next vacation. We do this because that is what we have always done. We put our heads down and do the work. We often project ourselves past the next exam or to the next stage of our lives to help us get through the stress. We become masters of delayed gratification. We develop the mindset of “I’ll be happy when…” I get into medical school or match into a good residency spot or make partner or have enough money to retire etc…Along the way, we may have some bright spots – falling in love, having kids, taking great vacations. We may even reward ourselves for our hard work with a new car or nicer house. We deserve it. But deep inside, “something is missing”. We have achieved most, if not all of the goals we have set for ourselves. Yet despite our hard work, many of us remain unfulfilled with our careers and often with our lives. What is it that we need? A better job with more money? A different car? A different title? Better vacations?


We have all struggled with these questions and many more. How do I stop wanting what I don’t have and start wanting what I have? How can I fully enjoy the present while also preparing for a better future? How can I spend quality time with my kids while they are still around? How can I have a career that uses all of my potential? Of all the questions that many of us have asked, the most important one was this – How can I learn to flourish and not just function?


Fortunately, there are answers to be found in an evolving field devoted entirely to the scientific study of flourishing:  positive psychology.   Unlike traditional psychology which alleviates distress and moves a patient from a -8 to a 0 or +1 (if they are lucky), positive psychology focuses on a patient that is functioning at a +1 and tries to move them to a +8 on the flourishing scale. We need both areas of focus. There are many people that are functioning well by most standards but are nowhere near their potential level of fulfilment. Positive psychology can help. It provides a functional blueprint of evidence-based techniques and principles that can guide physicians away from burnout, beyond functioning, and toward flourishing.


While there has been considerable research and advances in Positive Psychology since the field’s inception in 1998, the notion of human flourishing is still mostly absent from mainstream medical practice. Similar to the “medical model” which emphasizes disease treatment and prevention, most solutions to improve physician well-being focus on reducing distress and alleviating burnout. By applying positive psychology principles to the practice of medicine, Positive Medicine offers us a new paradigm that teaches us how to live with more meaning, joy, and fulfillment and ultimately to flourish not just function. 

As physicians, we are often too busy to worry about our own happiness. Many people depend on us. We are used to dealing with stress. But the healthcare system will only be as healthy as we are. We owe it to our patients, families and most of all ourselves to prioritize our own well-being. Positive Medicine can help. Over the next several newsletters, we will present some core principles and exercises in Positive Medicine that you can try at home.

Now on to this week’s ideas…but first a brief note – given the feedback from our readers, please see our new physician spotlight section at the end of this newsletter. This allows us to highlight the work of physicians and medical students making a difference in the world. This week, we are featuring David Fessell, MD who is an executive coach, professor of radiology and prior director of the leadership curriculum at the University of Michigan Medical School. 


“Focusing on what’s in your zone of control can help – the patient in front you, the key decisions you need to make today. By narrowing the scope of your attention and focus, you can replace seemingly unsolvable issues with doable items. You’ll feel relief and satisfaction as you accomplish them.”


Drawing on their combined 29 years of research in the world of emotional intelligence, best-selling author Daniel Goleman and executive coach David Fessell discuss why it’s critical for healthcare professionals to pay attention to their emotional lives in order to remain effective and healthy themselves – especially in times of crisis. 


2. How Marcus Aurelius Conquered Stress (and the Rest of Us Can Too)

“Stress is an inevitable part of life. It is the friction of the plates of our responsibility rubbing against each other. But if stress is inevitable, anxiety and anger and worry are not. Marcus believed that these things were a choice. That we could work past them, through them, that we could discard them, as he said, because they are within us, or at least up to us”

To say that Marcus Aurelius had a stressful life would be an understatement. Running the largest empire in the world while facing coups, plagues, an unfaithful wife and troublesome son, Marcus talks openly about his daily struggles and strategies with anxiety, anger and virtue in his private journal Meditations. In this post, best-selling author Ryan Holiday shows us how we can use these lessons learned over 2000 years ago to improve our own ability to effectively deal with stress and manage our emotions. 


3. Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being | NEJM


“We have a brief window of opportunity to get ahead of two pandemics, the spread of the virus today and the harm to clinician well-being tomorrow. If we fail, we will pay the price for years to come. In the race to respond to the Covid-19 crisis, we must not neglect to care for those who care for us.”

In this NEJM article, Drs Dzau, Kirch, and Nasca from the Collaborative on Clinician Well-Being and Resilience discuss 5 high priority organizational and national actions to protect the well-being of our workforce during and after the Covid-19 pandemic. 


Physicians Helping Physicians Spotlight

Michelle Mudge-Riley, DO, MHA, RDN
Founder and CEO, Physicians Helping Physicians

1. Can you tell us a little about your career path and what led you to your current role running Physicians helping physicians?

How long do you have?  :).  Just kidding – it’s just been a long journey.  18 years ago I would have told you I’d be a seasoned pathologist in clinical practice…it’s interesting how life can go in unexpected directions.  Instead, I ended up working at a medical device company, followed by hospital administration and then at a brokerage firm as Director of Employee Wellness. I started telling my story before Facebook or these other forms of social media existed and began speaking at conferences because people were intrigued by a physician doing something other than clinical medicine.  Other physicians started reaching out to me to ask how I left clinical practice because they wanted to do the same thing but weren’t sure how.  One thing led to another and suddenly I’m running a company, helping other doctors who want a non-clinical career.

2. Given the state of mental health in medicine, how can physicians (trained as lone wolves in a culture that often pits us against each other) form a cohesive community that can help to support each other?

That has been one of the most interesting things about what I’ve seen over the past 15 years.  As physicians, sometimes we can really be mean to each other!  That hasn’t helped us as a profession.  Although burnout, moral injury and stress for physicians in clinical practice has increased more and more, I’ve seen something awesome within parts of the physician community.  We are starting to come together and help each other.  I think the support starts and gets stronger when we are nonjudgmental towards each other because it then becomes safe for us to be ourselves and ask for help.  That’s why I built the Physicians Helping Physicians Non-clinical Community. It’s a safe and non-judgemental place to talk about and get help if you are interested in a non-clinical career or side hustle.

3. What do you enjoy most about the work you do? What are you most excited about now?

I enjoy the relationships that are built through the community.  We really help each other!  When I see someone I helped get a non-clinical job a couple years ago who is now in a position to hire another physician who wants to work in a non-clinical job, it is the best feeling!  That’s why I’m so excited about the 2020 virtual conference.  It’s virtual so it’s very accessible (and cheaper than other conferences) and a great way for physicians to learn about their options for non-clinical work and meet other physicians who may be able to help them get into their next job.

4. What do you wish you had known as a young physician?

I wish I had known the importance of relationship building with professional colleagues.  We don’t get taught that in medical school and I’m not sure why.  Although we are trained to serve patients and build relationships with them, our mental health and wellbeing often suffers because we don’t have professional colleagues to ask questions and advice from, or just commiserate with.  That was the value of the “Doctor’s Lounge” that we lost when it was taken away.  But we can still build those relationships we just need to be purposeful about it.  Physicians Helping Physicians gives physicians a safe place to build those relationships. 

Registration now open for the 2020 Virtual Conference: