Featuring Articles on Resilience for Medical Providers & Parents. 

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Fatigued?

I don’t know about you, but fatigue is real.

As if there wasn’t enough to overwhelm us, it seems like the collective world stress is unrelenting. Are you tired? What kind of tired?

Emotional/Mental exhaustion – feeling “all the feels” and absorbing pain. Emotional exhaustion occurs when we experience fatigue from being emotionally overloaded. Our pain, others’ pain, and collective pain all combine to create an overwhelming feeling of tiredness that has accumulated. Feeling worn out and drained from the totality of emotions.

Here are signs of emotional exhaustion from The Mayo Clinic:

 

Emotional symptoms include:

  • Anxiety
  • Apathy
  • Depression
  • Feeling hopeless
  • Feeling powerless or trapped
  • Irritability
  • Lack of motivation
  • Nervousness
  • Tearfulness

 

Physical symptoms include:

  • Fatigue
  • Headaches
  • Lack of appetite
  • Sore muscles or muscle tension

 

Performance symptoms include:

  • Failing to meet deadlines
  • Lower workplace commitment
  • More absences
  • Performing work duties more slowly

 

Physical exhaustion – our body’s perception of fatigue. Our body feels physically exhausted when the cumulative fatigue and persistent tiredness catches up with us. The physical sensation that our body functioning is compromised.

Here are signs of physical exhaustion from Better Health:

 

Symptoms include: 

  • Chronic tiredness or sleepiness
  • Headache
  • Dizziness
  • Sore or aching muscles
  • Muscle weakness
  • Slowed reflexes and responses
  • Impaired decision-making and judgment
  • Moodiness, such as irritability
  • Impaired hand-to-eye coordination
  • Appetite loss
  • Reduced immune system function
  • Blurry vision
  • Short-term memory problems
  • Poor concentration
  • Hallucinations
  • Reduced ability to pay attention to the situation at hand
  • Low motivation.

 

Values Disconnect Exhaustion – A third type of exhaustion that many providers are experiencing is called “values” exhaustion. Kamal Sarma describes this type of exhaustion, “values disconnect exhaustion,” as more subtle and insidious than other forms of deep tiredness. Values disconnect occurs when a person has to compromise their own character and beliefs in order to meet the expectations placed on them. Over the past two years, there are few other professionals that have been impacted as greatly by values disconnect exhaustion than providers. Moral distress exemplifies values disconnect exhaustion (oh, if you want to learn more about this, sign-up for next week’s free workshop for medical providers!).

 

Symptoms of Values Disconnect Exhaustion:

  • Lack of purpose
  • Feeling disconnected and detached
  • Uncomfortable
  • Covering or masking feelings
  • Pretending to be well

Regardless of whether you’re physically exhausted, mentally/emotionally exhausted, or disconnected from values (or a combination of several), the first step is to recognize what’s happening in your body. Because the last two years have created constant demands, pressure, and isolation, we often overlook symptoms of fatigue because we become accustomed to overwhelm. We have consistently felt like we “can’t go on” only to be pressed into continuing for days, weeks, and months more than we should endure.

The second step is to figure out how to rest. In our westernized view of rest, we hold a myopic view: rest equals sleep. But sleep is not the only way to rest. In fact, our bodies and minds require different forms of rest. And morally, we need rest as well. For a great reflection on rest, watch this Ted Talk: https://youtu.be/ZGNN4EPJzGk

I want you to begin to ask yourself – what kind of fatigue am I experiencing and what type of rest is my body asking of me?

Tell me. I’d like to hear what you’re experiencing and what’s helping.

 

-Dr. Amy

Hey friends,

Have you heard of the term “pacesetter?” If you’ve entered running races, swimming events, biking races, or the like, you’ve probably heard about pacesetters in that context. A pacesetter is a person who does exactly that: sets the pace for others. In a moment, I’m going to make the argument that I can be your pacesetter for navigating stress and decreasing burnout, but more on that later. In a large race, you’ll find a person holding a sign or leading a group with a paced time on it. Before high-tech gear, a pacesetter would have one of those sandwich board that said “10 min mile” and would encourage others who aspired to run a 10-minute mile to run with them, assuring a finishing time that met their goals. See where I’m going here? And, by the way, don’t judge me for running a 10-minute mile as a reference point. 10 minute miles get the job done! But I digress…

What we’re all going through as helpers during the middle of the pandemic is nothing short of an ultra-marathon. Not a 5K or 10K as we initially thought. Heck, this pandemic isn’t even a marathon…but an ultra-marathon. We’re going to need more than good sneakers, Gu and some inspirational beats to get through all of this. We need a pacesetter. May I be your pacesetter?

You see, as medical providers, you’re trained to put on a brave face and help others, even during the most trying times. But the last year and a half have been exhausting. Am I right? And it’s difficult to find respite, purpose, and sift through all of the messages of self-care. How are you supposed to do that while running a clinic, seeing patients, taking care of your staff, and rolling out vaccines? I’m here to help.

I am hosting a workshop this week– to give you practical tools to feel less burned out so you can practice meaningful medicine. As soon as the pandemic hit, I began reaching out to medical providers, clinics, and hospitals about how I might help. I spoke with medical directors in tears, providers in panic, and distraught colleagues. I knew we had to focus on practical tools to mitigate the effects of the pandemic and see this as an ultra-marathon if we were going to make it through intact.

Earlier in this newsletter series, we began with acknowledgment. Acknowledgment begins a healing process. Then we moved into support and resources. And now, as we begin to reconcile with what we’ve been through (and still have curveballs thrown at us) and what we continue to go through, we need ways to navigate the uncertainty of primary care. We need practical tools and actionable next steps to make sense of what’s happening and clear the way for a meaningful path forward.

Here’s exactly what we’ll be covering in the webinar if you join me:

  • Recognizing the signs of burnout
  • Understanding compounding stress and its effect on us
  • Practical tools to address overwhelm
  • Actionable tools to deal with uncertainty
  • Ways to find purpose
  • Moving into community

 

The workshop will take place this Wednesday, November 10th at 6:00 pm PST. Register at https://doctoramyllc.mykajabi.com/registration-page

Come and run a 10-minute mile with me! Or just come, drink wine and listen. It’s better in company!

With compassion,

Dr. Amy

Friends and Colleagues,

If you read last week’s newsletter, you know that burnout is a critical theme to address in primary care. And yet, it’s quite complicated and multi-layered as well. If you haven’t read it, you can do so here.

You may be asking yourself, “If I’ve identified that I’m burned out and overwhelmed, now what? What can I do? Is there even hope? Or, do I just put my head down and keep forging on with no end in sight?” Please don’t do that – do not continue to forge ahead in isolation. I want to offer a few key insights into what addresses burnout and what we can begin to do.

First, know that it’s not entirely on you. Too many well-intentioned consultants, therapists and coaches suggest that the key to burnout is self-care. While addressing self-care is important, it’s only ONE PART of addressing burnout. In fact, I’ve consulted with hundreds of health care professionals who are doing ALL.OF.THE.RIGHT.THINGS when it comes to self-care – eating, sleeping and exercising – and they’re still overwhelmed and burned out. No amount of healthy eating can address things like organizational stress or marginalization, poor work environments or an ongoing pandemic. Recognizing that addressing burnout is bigger than you represents a critical step.

Second, you have to name it – the burn out. The overwhelm. The feeling of hopelessness and resignation. That pit in your stomach that realizes you are lacking purpose or passion in your practice. I know it seems terrifying, right? Naming the overwhelm? But I’ve actually never seen a time where acknowledging hurt made it worse in the long-term. It’s painful, sure. And it can be scary. You might worry you’re all alone and that no one else can relate. Or worse, that others will judge you as incompetent. But, only if we name it can we begin to address the chronic fatigue and burden we’re experiencing.

Finally, we need to embrace a bit of vulnerability. We need to find a person (or many people). Next week, we’ll discuss finding your pacesetter. If you’re not sure what that is, stay tuned. But in the meantime, I want you to try something. Acknowledge overwhelm to one other person – maybe it’s a colleague, your partner, your life coach, a friend, or your dog. Find the courage to say, “I’m not sure how long I can go on like this…” Or, recognize overwhelm or fatigue in a friend or colleague and say, “I see you.” Then watch. Watch what happens when we say it out loud.

Perfection is not what people need from us. They need to know we’re entirely human. Humanness builds connection. It heals loneliness and isolation. Connection builds a bridge to others that says, “I’m with you, you’re not alone in this.” 

The only way to begin to “cure” burnout is to recognize 1. It’s not entirely on you. 2. You must name it. 3. Embrace being vulnerable for a bit with one other person – for yourself and for the other person.

Join me next week as we talk about how to continue to build those bridges of connection by recognizing your pacesetter.

Until then, hopefully I’ll see you in The Provider Lounge – A Community Build Resilience. It’s a special group just for providers that meets the first Thursday of every month at 12:30 PST via zoom. Here’s the link to join us. And just a week after the Provider Lounge meets, I’m hosting a FREE workshop on burnouthere’s the link for you to grab a friend and join us!

With compassion for all you do,

Dr. Amy

Hi Friends,

I know. There’s a lot of information out there regarding burnout and medical providers. As you read it, I’m sure you’re like (read with sarcasm), “No kidding, I’m burned out, thanks for the update.” Have you taken the time to inventory the degree to which you’re experiencing overwhelm? Have you thought about signs of compassion fatigue that you’re experiencing? I think one factor that’s tricky is recognizing when we go from – “yes, I’m really overwhelmed” to “I feel extremely burdened with the lack of work/life balance” to “I can’t do this anymore.” Why is this complicated?

The first reason it’s complicated is because, as healthcare professionals, we’re pretty good at compartmentalizing. We’ve been trained to put off our needs in order to focus on others since the beginning of our training programs. Don’t use the restroom, don’t act tired, don’t ask for a break, don’t eat for periods of time and certainly don’t let ANYONE know you’re uncertain of the next step. Move onto the next case, next patient, next meeting and push the worry, overwhelm, fear, questions and concert aside – you’ve got to move on. But…where does all that stress go?

The second reason it’s complicated is because we’re trained in a model of performance and outcomes. In medicine, training is based on performative outcomes, fee for service, finding answers and fixing problems. There are prescription pads, notes, surgeries, pills, recommendations and solutions. There is NOT slowing down, processing and second guesses. And it can be very isolating. People are looking to you to solve a problem. NOW. But…where are you supposed to collaborate and problem-solve?

The third reason it’s complicated is because it’s really blurry right now. Our worries, fears and concerns – think disease, vaccines, overwhelm, worry for loved ones, overwhelm with kids coming out of distance learning, understaffing, etc. are the same as our patients’ worries, fears, and concerns. So the separation between work, home, and patient presentation feels very blurry and uncertain. It feels like there’s no clear line between difficulties our patients are facing and our own barriers to wellness right now. So…how do we recognize this?

Finally, and this one really hits home for me, we’re trained to be heroes. Selfless, compassionate helpers. Patients, team members, staff, parents, and co-workers are constantly looking to us for confident, refined, definitive answers. We take on the world, solve problems, help others, heal the hurt, find solutions, and shoulder storms of uncertainty. But…what do we do when we’re feeling anxious and uncertain?

Friends, this is what I mean by “Beyond Burnout”. I want you to take an inventory of what’s truly weighing on you and feeling heavy. I often imagine healthcare providers in super-hero capes. But the cape feels heavy, no? It feels smothering at times? And sometimes the burden is too much and quite lonely. There’s no space for uncertainty and validation for what you’re going through which only leads to more overwhelm and feelings of burnout. And if we’re honest, a bit of resentment, angst, and panic can get mixed in there too. That is all normal and expected given what we are going through right now.

I see you. And I want to provide help and direction for where ever you’re at in this honest inventory of overwhelm. I have a few things to help:

  1. Join us in The Provider Lounge: A Community to Build Resilience. We meet on zoom the first Thursday of every month. We chat, share resources and the conversation is guided based on YOUR needs as a provider. Sign up here!
  2. Come to my free workshop on November 10 at 6pm. It’s titled Beyond Burnout: Navigating your way through trying times as a provider. We’ll find purpose and address what’s going on with practical tools. Register here!
  3. Email me. Let me know how this newsletter can be shaped by your needs and topics that would be helpful to have covered or addressed.

 

See you soon.

With compassion,

Dr. Amy

Hello Colleagues,

Wow. The past few weeks have been exhausting. Or, shall we say, even more exhausting? Between returning to school, vaccine mandates and staffing shortages, not to mention increased hospitalizations due to COVID, I know so many of you feel like you’re drowning.

You’re not alone.

Because you’re short on time and a lengthy email is the LAST thing you have time for right now, might I offer you a few reminders to address overwhelm?

1.     Get connected – on any level – in person, online, in a group, with your body, with an incredible friend. Connection is the NUMBER ONE factor that will address burnout.

2.     Breathe – it’s simple but effective. Research has shown that just 90 seconds of deep, belly breathing can reduce your cortisol levels. Take off your mask, find a space, and breathe deeply.

3.     Tap out – take a break, even if it’s for short periods of time. In 90 seconds you can breathe. In 5 minutes you can stretch. In 15 minutes you can eat a meal and try not to rush. In 30 minutes you can watch a sitcom and belly laugh. In an hour you dive into a creative task like knitting, singing, or drawing. In a half-day, you can go for a hike or visit a friend. In a day you can get out of town and disconnect from work. You get the picture…

4.     Feel your feelings – I know, you’ve stopped reading… “If I feel my feelings, I’ll go into a black hole and never come out.” It’s not true. Acknowledging feelings actually help them subside because they’re recognized. Once a feeling is recognized, you can decide what to do with it – cry? Set it aside for now? Write it down? Talk to someone? Run? Share it? That feeling needs to be felt all the way through, or it will pile up and come out in other spaces.

5.     Focus on what you can do now. You can’t solve the problem of yesterday and you cannot predict tomorrow (or even later today). But you can be present in the next moment with your patient, your colleague, your MA, or your partner. That’s the only moment we can control.

Gentle reminders friends. This is not an assignment, nor a task to achieve. It is how you will survive through this mess. Simply take an inventory of the ideas and choose one to be more intentional about during your day. Just one small action.

With compassion,

Dr. Amy

Well, hello friends & colleagues,

I thought I might take a moment to reflect on the past few weeks by reaching out to all of you with updates specifically for providers and those in the healthcare field.

If you’re subscribed to my regular newsletter, then you likely hear from me weekly about parenting woes, showing up more vulnerably as a human and ways to create resilience for our kids. But as my work has begun to shift dramatically towards helping the helpers, specifically healthcare workers in primary care, I thought I might begin to send some nuggets to all of you on a more regular basis.

Over the past weeks and months, I’ve talked with hundreds of providers and healthcare leaders. And, wow. There’s so much on our collective plates. I have the pleasure of working with people in different capacities which allows me to ascertain pain points and feel more effective when I help, offer resources, or create content to share. Here are some highlights:

  • Individuals in primary care feeling anxious as people try to figure out “new normal.”
  • Leaders feel frustrated as people refer to “post-pandemic” as if we’re there…
  • Groups of pediatricians who are struggling with vaccine hesitancy and trying to figure out how to have these delicate, often personal, discussions with patients.
  • Leaders who are trying to figure out how to create staff resilience after such long periods of burnout and overwhelm.
  • Providers trying to find meaning as we move back to “regular behavior” …

 

Does any of this sound familiar? You’re not alone. Fatigue, overwhelm, burnout, and exhaustion are words that I am hearing on a daily basis. We have to create space to name these feelings. We must normalize space for people to say, “I’m not okay right now.” And we don’t have to fix it, fade it, or make it go away – listening is a great place to start. And man-oh-man have I listened. And felt tearful. And powerless. And IN IT. How about you?

Here’s something to try right away that can feel pretty powerful: I want you to write down two things that feel opposing but can actually go together. Then bridge the two with AND. For instance, “It’s beautiful outside AND I wish we had rain because it’s so dry.” Or “I love treating patients AND I’m exhausted.” Or “I feel blessed to have had a job through such a tumultuous time AND it’s overwhelming to keep going for so long.” Once we embrace the AND there’s a certain amount of pressure that peels away; or at least, that’s my hope. Acknowledging that two opposing thoughts can co-occur acknowledges the complexity that we all experience. One does not exclude the other, nor diminish pain. BOTH are TRUE.

I’d love to hear from you – so many of you are struggling with fatigue and if you begin to embrace the duality – that it’s ok to feel grateful AND exhausted; inspired AND fearful; acknowledging AND frustrated – the overwhelm will begin to dissipate.

Oh, and another way to decrease the overwhelm – fuel yourself. Here are two ways to join me: The first is FREE and happening within weeks. The second is a retreat that will refuel your mind and spirit.

August 5 at 12:30 – join me for Refresh, A Meaningful Medicine Community.

Or, if you’re ready for more, for a deep dive full of great food, wine, yoga and sharing stories with like-minded professionals….join me for The Most Important Medicine: Transforming Primary Care by Focusing on Relational Health and Connection. 

Where will I see you next?

With compassion,

Dr. Amy

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