The Key to Improving Physician Wellness and Fulfillment
Episode 539

Gail Gazelle, Assistant Professor at Harvard Medical School

The Key to Improving Physician Wellness and Fulfillment

In this episode, we are thrilled to feature Gail Gazelle, a leading physician in wellness, leadership, and mindfulness coaching. She discusses how she helps physicians take care of themselves, improve resilience, overcome burnout, and become a role model of well-being. She shares insights on the source of physician burnout, getting to know the backstory, anecdotes, and more. We’ve really enjoyed our conversation with Gail, and we hope you’ll do, too.

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The Key to Improving Physician Wellness and Fulfillment

Episode 539

About Gail Gazelle

Gail Gazelle, MD, FACP, FAAHPM, is a part-time Assistant Professor of Medicine at Harvard Medical School, a practicing physician and a certified professional coach for physicians and physician leaders. She is the author of Building Your Resilient Self: 52 Tips to Move From Physician Burnout to Balance, and a new one that’s coming soon.

Dr. Gazelle is the solo author of two narratives in The New England Journal of Medicine. In addition to teaching a cutting edge resilience curriculum for Brigham and Women’s Hospital Internal Medicine residents, Dr. Gazelle is a national speaker on physician wellness, burnout, and resilience. She is known for her dynamic, engaging, insightful, and down-to-earth presentation style.

 

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Intro:
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Saul Marquez:
Welcome back to the Outcomes Rocket saw Marquez’s here, and today I have the privilege of hosting Dr. Gail Gazelle. She’s a faculty at Harvard Medical School, a 30 year practicing hospice physician and a master’s certified coach for physicians and physician leaders. In addition to publications in the New England Journal of Medicine O, The Oprah Magazine and the Journal of American Association for Physician Leadership, Dr. Gizelle is a certified mindfulness teacher, a former consultant for the United States Department of Justice and one of the nation’s pre-eminent physician coaches, having coached over 500 physicians. She’s the author of Everyday Resilience, slated to release August of 20 20. And in these times, with a lot of the challenges that we have around the pandemic. But even before the pandemic, we’ve been plagued with issues around physician wellness and and burnout, the opioid epidemic. There’s there’s there’s issues all around that require expertise in guidance. And so today, it’s just such a privilege to have you here today, Gail. And we’re going to focus in on the work that you do to help care for the people that care for us. Such a privilege to have you on the on the podcast today.

Thank you. Saw. So it’s really a pleasure and a privilege to join you today.

Absolutely. And so before we we take a step toward, you know, exploring the work that you do, the outstanding work that you do. I want to learn a little bit more about what inspires your work in health care.

Great question. I would have to say that it is making a difference in the lives of vulnerable individuals. That has always inspired me. And when I say back on my career, I was drawn to the practice of medicine because I wanted to help individuals. At the end of life and hospice and end of life care was not really a field. When I finished medical training in 1998, there was so much pain and suffering physically, emotionally on a psychosocial level, obviously for the individual who was terminally ill, but also for their families. And furthermore, for people working with them on health care. And so I was drawn to that vulnerable population and wanted to be able to make a difference as I cared for patients to the end of life. I began to notice that I myself was burning house. I was doubting my judgment. I was experiencing some criticism. I was feeling guilty, guilty when I was home, that I wasn’t working. And when I was working guilty, that I wasn’t with my son and my family. And I began checking in with colleagues around the country. This is really in the late 90s, 2000s and understanding that it wasn’t just me and beginning to understand how our training really didn’t teach us how to manage all the stresses of health care. And so that’s when I became more inspired to do what I was doing with End-Of-Life Care, helping those vulnerable individuals and shifting it, debiting a sounds over to those working in health care. And so that’s what I’ve spent the last decade doing, really helping physicians and physician leaders deal with their own bar ability in what we all acknowledge now is a very dysfunctional health care system.

Wow, what a great story. Gail and you know, I just I’m inspired. I got goose bumps, actually, when you were telling me that, you know, you you shifted from from hospice to physician leaders needing this help. And there’s no doubt that our physicians and physician leaders need support. There’s no way you could drive on an empty, you know, empty tank of gas.

So, you know, talk to us a little bit about what you do and how you do it.

Well, it’s interesting that you say that about running on empty, because I think many physicians do run on empty. We actually don’t learn that it’s important to fill our tank. And, you know, the analogy of a car is a good one. We wouldn’t get in the car if there wasn’t gas. We wouldn’t you know, we wouldn’t be driving around the road. And yet, for many physicians, we just don’t learn how to take care of ourselves. I can’t tell you how many physicians I’ve worked with that don’t even eat breakfast, for example. Such a such a silly thing. But they don’t really stop to think, what do I need to do to be at my best today, whether it’s eating breakfast, whether it’s meditating, whether it’s having sustaining relationships, but really focusing on what is it that I need to be at my best and what I find in the work that I do with physicians and training here at the Personal Women’s Hospital in Boston. Is that our training teaches us in a way to take care of everybody else. Not necessarily to take care of. Ourselves. And so a lot of what I’m doing with resilience and coaching is helping to kind of Right. that and balance helping physicians realize not just what’s in it for them and their patients to take better care of themselves, but really how important it is as a role model really for everyone else in the health care endeavor as well as beyond that. To really understand the importance of personal well-being.

Yeah. You know, and you use the word role model. And I think that’s that’s such a great word to use that when you think about your physician Right. because you think you think, wow, you know, my physician gives me some great recommendations because of what they are able to do or recommend to me, I’m healthier. What are they doing?

Nice. Yes. And we have data now that shows that the more the physician is actually engaged, whether it’s exercise or managing their own weight, then the role model one is powerful because it actually can affect the outcomes for patients. So I think we know that in our own lived experience when we go see health care providers. But there are actually studies to support it as well.

Now, that’s that’s outstanding. And so, Gail, tell us a little bit about how what you do is different than what’s available and how is it making a difference?

Well, again, I trained as a coach about a decade ago with the sole purpose of helping physicians who are struggling with burnout and really struggling to have an authentic and important effect and voice as physician leaders. So coaching has been around for a while. Obviously, it’s relatively new in healthcare and even newer for physicians. And physicians tend to find other physicians more credible, whether they should or not. We could argue, but they often do. So for me, as a physician who’s been through the rigorous training and has worked at a variety of settings, I think there’s some credibility there that helps physicians perhaps be a little bit more vulnerable about their own areas of duress. And you mentioned in the intro that I’m trained as a mindfulness teacher. I’ve had a mindfulness practice for some time. I became trained so that I could really own my skills and add that to what I offer to the physicians that my coach. So proven mindfulness strategies, proven neuroscience based strategies are critically important in any coaching. But I think they’re particularly important for people with a health care background, i.e. physicians ways that we can engage the parasympathetic nervous system, for example, not just to bring calm, but to actually level some of the challenging emotions that we encounter professionally so that they don’t derail us as we work with either patients or, let’s say in workrooms. So I think there is a lot that I can bring to this as a physician. And the feedback that I get is that stuff.

You know, and so I get that, you know, you you go through this training and you’re like, I don’t understand, you know, and you’re showing up and meeting them where they are. And you do understand because you’ve been through it and you suffered through it and you’ve you’ve seen the other side of the mountain. And so talk to us a little bit about how you know or maybe how this this program has made a difference for some of the leaders you’ve worked with.

It’s so interesting because I think it may come as a surprise to the general nonphysician public just how insecure many physicians are and how much self-doubt they have. How many physicians walk around feeling like their imposter. And my belief is that there’s a lot in our training that sets us up to have a lot of self judgment, negative self judgment. For example, we learn in medical training that some doctors are really important doctors, the surgeons, the neurosurgeons in particular, and some doctors really kind of have less than one’s pediatricians, the general practitioners now. And that’s reflected in how doctors are compensated. Obviously, every physician is important and brings different skills and learns different skills. But there’s something about that hierarchy that is embedded in the training of physicians that I think in some ways sets us up for things like feeling like an imposter. So a lot of my work is on what we might call the back story of physician burnout and lack of resilience. What is it? Physicians learn? What is it about the physician mindset that makes it difficult for us to focus on our strengths and accomplishments? For example, I do work right now with a large group of physicians in New York City, which we all know has been hit the hardest in the past.

And there’s a lot of. Concern that physicians are having when people call them a hero, for example. And we’re hearing a lot about the health care heroes. And yet many physicians actually feel like they’re not heroes. Why? Because they don’t have answers to the Koven pandemic. There are patients who go on and die. That those physicians can’t tell. And the difficulty of focusing on what they are doing to help people as opposed to the focus on what they’re not able to do. I think really drives a lot of burnout for frontline physicians and for the physician executives that I work for. So I think there are a lot of factors here. There’s a lot of focus on burnout and the electronic health record. The push to be more and more productive, seeing more patients in less time. All of which erode physicians sense of well-being and really their sense of being there for patients. But there’s also a backstory to that has to do with mindset. That has to do with training. That leaves us as vulnerable to not having emotional intelligence, for example. And coaching can be very helpful in managing the backstory that then helps change the front story. Let’s say it’s efficacy and getting charts done or working well with patients and others.

You know, certainly your your understanding of the. You know, I guess it’s your understanding of just having been there. You know, that that and in particular, I, I like the idea of this backstory of physician burnout. It’s like you’re going to understand how to influence a situation or your attitude. It’s important to know the backstory and stories can make or break us. And so I’m curious about you, about the story more. I mean, you know, I like better understand that story from working with you and then and then the impact and transformation potentially that that could come from owning a news story.

This makes me Sancho’s clients that I coached a couple of years ago, a prominent medical director who also had this many physician leaders to also maintain her clinical practice. And I’ll just call her Debbie. She came to coaching because she was just drowning in the clinical duties and frankly, the administrative duties, the add on simple low grade tasks that physicians are now spending, you know, two hours after every hour that they’re actually working with the patient. So she was struggling because the clinical demands were so great that she really didn’t even have time to fulfill her leadership demands. And it was really interesting because it came down to efficiency. Gayle, how can I be more efficient? But what was really interesting is that when Debbie would sit down to chart, for example, to set up the electronic health record instead of sitting there thinking, I’m going to get this done, then I’m going to move on to all the other priorities that my leadership had when she sat down to chart. Here’s what would go on in her mind. Wow. I’m not as smart as other physicians. I’m not as good at being a diagnostician as the other docs that I work with. I got to tell you, Gayle, I’m not even sure why they let me into medical school. She’d actually sit there and have these thoughts as she was getting at the end of a busy day, as she was sitting there to get her charts done.

So that’s what I mean about the back story, that when you’re that down on yourself and really seeing the cup so half empty, how can you really be motivated to go ahead and get these efficiency tests done? These administrative burdens and tasks? So that’s an example of the backstory. And while it may sound like a stark example, I hear from physicians all the time about these feelings of being an imposter, not as good as not as smart as not as a patient and not as compassionate as the cost of that kind of internal narrative story, as you say. So all I think is exceedingly high. So, you know, we can have all the efficiency tools on the dropdown menus and ethic, et cetera. But until we untangle some of that mindset issues, some of these back story beliefs in a way we don’t really stand a chance of helping people move forward in these challenging situations. So that’s that’s a lot of what I’m doing as a coach. And you can hear it’s immensely fulfilling. You really almost help somebody break out of the present that they’re in. So there’s a lot that I can help people with as a coach. It’s just immensely satisfying for me to be helping people, you know?

And there’s so many physicians that are amazing. And and you folks are giving yourselves enough credit who you are. And you are a hero there. You know, there you’re in the frontlines.

And oftentimes it takes help. You know, it takes help from somebody that’s been there and helped others. You know, I Gayle, you and I talked before before we connected here on the podcast. And I told you I used to have a coach for five years and still have coaches that helped me do what I do because I’ll be the first to admit that, you know, I can’t do it all and you can’t do it all. Well, who? None of us can. None of us can. So. So, Gayle.

Well, you know, in your experience, right. I mean, you’ve coached over 500 physician leaders. That’s impressive. First of all, I mean, that’s just like I mean, you were in coaching before coaching was even cool. What have you learned? Is is one of the most common setbacks or mistakes that you know, that physicians make in finding their fulfillment?

Well, again, I think a lot of it has to do with our training. And it strikes me that even if one percent or even quite one percent of our training was around the importance of mindset, how we approach the issues and problems that we face, I think that we would be struggling much less around where now the pressures would be the same. But I think we’d be much better equipped to manage those pressures. So I think physicians come by these challenges honestly. But in terms of your question, I saying physician leaders often being derailed by their own emotions, they all kind of lose it in a meeting. They’ll become irritable with somebody, even sometimes, you know, displaying all kinds of emotions that are out of proportion to the situation that they’re in. And so we can all learn to be more emotionally intelligent. And it’s a tremendous skill. We know this in our personal lives that if we can be a little more emotionally intelligent, we can be a little more present with our own family members and not get triggered or provoked in the way that we might. And I think we’re particularly seeing that in the pandemic when we’re home with family members 24/7. So as much as we may love them. Emotions run high. So I see that as a very pivotal part of the coaching endeavors, equipping physicians with more emotional intelligence, which by definition makes them more resilient to whatever challenges they face, both professionally and personally.

Yeah, that’s wonderful. And so so tell us a little bit about this book that you have coming out in August. You know, the sneak peak right now, but why? Resilience Right.. The title is Resilience. Tell us a little bit more about why you decided to focus there.

Now, the title is Everyday Resilience A Practical Guide to Building Inner Strength and Weathering Life’s Challenges. And I tried to take all the lessons that I’ve learned in health care, both working and hospice for decades, working with colleagues, teaching resilience to residents and attendings across the country, as well as my experience coaching. And I really began to see how parallel a lot of the lessons I learned really were to everyone, to every citizen, not just to those in health care. And what I’ve seen in the thousands of people like work to us, whether hospice physicians, etc., is that resilience actually lies within each and every one of us. We often think of resilience as being the quality of heroes and heroines, Superman and Super Woman, Wonder Woman. But it’s actually a deep well that we each have within us. And what’s key is learning to tap into that well and learning to repeat that well when it becomes dry. And with that lens, what I try to do in the book and what I’m excited about is offering simple strategies. The book is full of practical strategies. I think we have about 15 or 20 exercises in there that are very easy to do that can actually help people get in touch with their inner strength, their inner goodness actually help them work with patterns of self-criticism and rigidity so that they can become more resilient even as they’re reading the book. So I it’s my offering. I hope it can be helpful.

And it sounds like it could be a nice, like, desktop reference manual.

Well, that’s my hope that it’s a guide and that it’s a very practical guide. This isn’t a big pontification. It’s not a 500 page tome, but it’s really a very practical guide, as all of us face challenges small and large.

And Gail, as you’ve approached coaching as as as a core offering for four physicians, what’s what’s a setback you’ve had that you learned from?

What a great question so. Well, about my son is twenty three now. And when he was. 16, 17. He became very sick and it turned out that he had Crohn’s disease, which is a fairly significant disease. He’s doing beautifully now. Is it robust is the picture of health. But I really had to take my own advice about slowing things down, about being clear about priorities. Life became very medicalized and I actually couldn’t continue going to a workplace, a hospice that I was working out at that time. So I guess some of my own advice about flexibility and resilience. I really had to do a very major pivot and I was already working as a coach.

Coaching provided a bit more flexibility on the workplace I was in, and so I had to demonstrate the same agility, have the same shifts in my own mind, set the same expectations of myself leaving my clinical career and actually leading into my coaching. So that’s sort of the ripple effect of that. Learning to take my own advice had its own ripples of learning. I’m really prioritizing my son, my family. What’s most important to me here? And so it was really a learning curve.

And so, I mean, major, kudos to you for that. And Gail like it in retrospect. Like what? What. From that experience has. I mean, the answer to me is clear. But I’d love to hear from you. Is has been the biggest benefit from everything that happened.

I would say it’s a greater ability to focus on what’s truly important.

We all get very caught up in the weeds, the small stuff. And to quote from that famous book, Don’t sweat the small stuff. And it’s all small stuff. I think we often have life lessons that help us zoom out. You know, for me, working in hospice, for people walking along in their lives, everything going fine. Plans for a wonderful long life and then finding out, oh, wow. Now I have that diagnosis that I never thought would happen to me. And how that helps people shift from, again, a small self for small perspective into something bigger. What’s truly important here? How can I really lean into the relationships that are deeply important to me personally and professionally? And what’s the legacy that I want to leave when my time comes? So I don’t always follow that. But I think the experience with my son’s illness helped me and certainly my work in mindfulness as well helped me to really pay attention to what’s most important here. And how can I leave that smaller vantage point that, again, we all get caught up in? And how can I really move further than that in terms of how can I be of service to others? And again, what’s the most important segment I can be applying myself to?

That’s so powerful. Thanks for sharing that, Gayle. Thank you. Thank you for asking. And you know, and I look at the work that you’re up to now and I mean all the lives that these physician leaders touch. I mean, your work. Now, I would even say isn’t that much more powerful. You know, I’m that much more widespread.

Wow. I think that physicians are at the core of a healthy health care system and obviously a healthy health care system is at the core of the health and well-being of the population.

So whatever any of us can do to support physicians and other health care providers as well as physician leaders, I think is critically important. We have to really face and bolster the well-being of those on the front lines and those who are leading the ones on the front lines. So I’m grateful to have the opportunity to do what I do.

And so what are you most excited about today?

Well, I’m excited about resilience and helping people see that it is not just the stuff of the people that will read about, you know, the heroes and heroines out there that helping people see that it really is something that is within us. Because I think the more we shine the light on that, we kind of elevate ourselves and we can help people move forward. What I like to think about as positive upward spirals of growth, of efficacy, of development, of really being of service in a powerful way. So I’m just excited about understanding resilience and again, being able to share more widely.

It’s certainly exciting. And the hope that you’re creating Gail and the inspiration that you’re creating with every life that you touch, including this interview Right.. You’re touching many people through this podcast. Folks, I. I strongly encourage that. If you are a physician and or a physician leader, Right. leading physicians or even have a physician friend, you know, we’ve got to spread the word around resources like Gail and the work that she does because, you know, if we don’t, who is, you know, and we have to take ownership as as leaders of communities, leaders of people, leaders of organizations. If we’re going to make a difference. So as we bring this this interview to a close. Gail, I love if you could just share us a closing thought. And then the best place where the listeners could continue the conversation with you.

One, one closing thought, and this has been so stimulating in talking with you today, Saul, and it it helps me really see how important it is for all of us to prioritize our own well-being. We see in a pandemic and we see in other times just how interconnected we are.

And that by taking care of ourselves, almost by elevating ourselves, we really elevate everybody in what could be more important in health care and more broadly as a society. So that’s my closing thought that for each and every listener to really think about, the more you take care of yourself, the more you can take care of others. So that’s my hope for all of your listeners and in terms of reaching me, my sight. Gayle Gazelle dot com, I’m happy to offer your listeners a complimentary 30 minute coaching sessions. For those who are curious about coaching, they can get a sample of coaching amazing, but are struggling with whatever obstacle in their past if they can get a little complimentary coaching about it so that you go to my side, the scheduler is very easy. It just pops right up. So I just want to encourage your listeners to reach out. I’m always happy to to meet more people.

Amazing. So, folks, they have it. She’s offering you a free 30 minutes. I mean, that’s just incredibly generous of you. First of all, Gayle. So thank you for for offering that to to all of the physician listener base that we have here. Thank you. And listeners, take action. If you’re if you’re in a place where you feel like you need some help. Reach out if you feel like you’re on the top of your game. This is probably the best time to reach out because the best at what they do have coaches. And I’m a firm believer in that. And I do believe that if you explore this opportunity, great things will come. Gayle, certainly thankful for for your work and and sharing it with us today. And I’m definitely looking forward to staying in touch and even reconnecting when your book Everyday Resilience gets out there.

Thank you. Saw. This has been such a complete pleasure.

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Things You’ll Learn

  • Physicians and physician leaders must deal with their vulnerabilities and be models of well-being.
  • Know what you need to do to be your best every day.
  • Coachings help physicians be better equipped to manage pressure.
  • We can all learn to be emotionally intelligent.

 

References

https://www.gailgazelle.com/