EP22 - From Burnout to Breakthrough: Dr. Michael Hersh on Coaching Physicians to Thrive

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations behind modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power. You've spent years making careful decisions with lasting impact. When it comes to investing, the same principle applies. Lightstone Direct gives you access to institutional quality real estate investments. With decades of proven experience behind them. Invest directly, no middlemen, and a $12 billion plus AUM real estate firm in your corner. Visit lightstonedirect.com. All investments involve risk. Please visit lightstonedirect.com for a full list of disclosures. Hello, my peaceful warriors. Welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst, and I am thrilled to have on the podcast today Dr. Michael Hirsch. Dr. Hirsch is a full-time practicing gastroenterologist, husband, and father. He is also a physician coach at Better Physician Life Coaching. He is also the creator and host of Better Physician Life. How to Get Unstuck in Your Medical Career. He is passionate about helping doctors not feeling trapped in medicine so they can finally enjoy the life that we have worked so hard to build. Dr. Hirsch, welcome to the show.

Oh my goodness. Thank you so much. It is great to be here and I'm really looking forward to chatting with you.

I know, me too. I was on your website and one of the things that you talk about as we're sort of getting into, you know, your site. Is that we all have a story, that we all have something that resonates with us that we recognize in other people. And part of you being a physician coach and now a podcaster is telling your story. What got you into physician coaching?

I think living a physician life got me into physician coaching, I think is the easiest way to say it. So, you know, I had a pretty traditional path. Straight through college, medical school, residency, fellowship, and hit the ground running in my clinical practice. I just started my 17th year out of training and joined a very small multi-specialty group. But if I'm thinking back on my journey, I would say I was probably burned out from go. And I know we're all as physicians a little burned out on the word burnout. And, um, if I look back on what my life was like, even then, clearly there were signs that I was just kind of pushing through. But as doctors, that's what we do, right? We signed up for the challenges. And so I just kept pushing, built up a very busy clinical practice, got married, had kids, got a house, all the things. And then life started getting more challenging. I negotiated a medical malpractice lawsuit that really Just destroyed my trust and confidence in the healthcare system, led me to want to just get out and escape as fast as possible. I fell headfirst into the financial independence, retirement early movement because I thought if I could just save enough money fast enough and get out of medicine, that I could finally be happy and live life. And then COVID happened.

Yeah.

And so all of these things compounded. Probably what was already a life of just kind of always doing, always trying to achieve. And then I stumbled upon physician coaching. Now, when I first found coaching back in 2020, it was largely something that only female physicians were doing. There were several programs for women physicians, but really nothing existed for men before that point. And I saw a co-ed coaching program advertised and I signed in just to listen. With no intention of signing up. I was incredibly skeptical. I didn't need a coaching program. I needed to retire from medicine.

Yes.

And I got home that evening, listened to this coaching call on my commute home, and I came in the house and I was talking to my wife about having listened to this call on the drive home. And she just told me, she was like, you have to do this because this can't continue the way that it is, right? Like you can't just keep putting your head down and trying to slog through. It's not working for you.

Yeah.

And, uh, so with a little bit of push from my wife and a push from, uh, the coaching program, I signed up and the experience for me was transformative. And so, uh, that's kind of what got me at least to there.

That is so cool. I love the fact that, you know, it was something that, uh, you happened upon this. It was something that intrigued you. It was something I think somewhere in here you knew you needed, but I also love that you got, you know, the encouragement from your spouse, just like, you You need to do this because sometimes when we're in this situation, like you said, we're just putting our head down. We're just getting it done. It's the people around us that really witness what we're going through, and sometimes they're better able to see what we're needing. I think it's interesting that your push to get in physician coaching was very similar to my push to do my conflict resolution training. I had been in private practice for you know two to three years just out of residency. I hated it. I thought there was something wrong with me. It's like I've spent twelve years of my life learning to do something that I don't want to do. This is And I came across an ad for this conflict resolution master's. It was a distance program and realized after going through the program and learning how to work with conflict, it wasn't that I didn't like practicing medicine, not at all. It was that I didn't have the tools to manage what I was dealing with while I was at work. And it had nothing to do with the clinical practice. It had to do with me as a human being. And physicians, so often we are human doing and not human being. And I think the fact that you were able to see that and then do something so proactive. I think that's incredible. As you're telling the story and as you're telling that, you're getting other people to open up to you as well. Was becoming vulnerable a big part of that process for you?

Huge. And, um, you know, if I could go into the Wayback Machine and I could not have imagined my current life, right? I guess that would've been like going back to the future. I don't know. But I could not imagine that I would be here talking to you about all of these struggles that I was experiencing. At that point in my life, because I think as physicians, we are trained very early on to armor up, to never let ourselves be fully seen. And that's part of the training. And it was that distance that was creating so much challenge for me in my day-to-day life. I was spending so much time hiding behind a veneer and not allowing myself to be seen.

Yeah.

I was missing out on all of these relationships and experiences because I had such a hard time allowing myself to be seen for me. Afraid, right, of what other people might think. And I think so much of medicine and medical training relies on external validation. It starts with like a gold star in kindergarten, and then it just like explodes from there. And we see all of the accolades that we get as we continue to accomplish things. And it's like, well, I can't let anybody see me quote unquote not succeeding. And so I think vulnerability is something that is challenging for all doctors, but in particular for men who are socialized that vulnerability is an incredible weakness. And so that has been probably the biggest part of my growth edge over the last 5 years is noticing how much I benefited.

Yeah.

From other people being vulnerable with me and how much other people then can benefit when I allow myself to be seen as well.

Wow. That is so powerful. This idea that you really recognize that there is this identity that we create and sometimes is created for us as physicians. And we get told that these are the things that make a good doctor, that this identity of being good and bad or being good and not as good, or maybe not as good as the guy next to me. These are things that become very ingrained in us, and it's very hard because they're so ingrained in us for us to recognize them. If we can't recognize them, that we can actually do something that's going to be productive to realize that, okay, this is getting in the way of me being effective and happy in my life, and I need to learn how to deal with this. So there's a lot of discovery and self-reflection, I'm sure, that goes into that process as you're working with physicians to understand that this is an identity that in many ways may have been constructed for you. And so let's figure out how this has affected you and let's figure out how we can actually make it something that's more authentic. This concept of physician identity, I think, is also interesting because it plays into conflict so much that when we are fighting about things or when we're getting in conflict situations, is it really what we are as human beings or is it because we believe this is what we should be? And I'm sure as you work with physicians, you're seeing a lot of people carrying into this idea of what they should be. They're trying to live up to something. How do you get physicians to sort of look at themselves as something separate from a physician identity, to actually see themselves as who they are and not who they are with a title in front of their name?

Yeah, I guess it starts with an invitation, right? Because we as physicians, we spend at least a decade of our lives allowing medicine to become a part of who we are. And probably more. It's probably a journey that begins from the moment we decide that this is our career trajectory. And there are some physicians that are totally fine with a physician identity. And I have a feeling, this is me just speaking off the cuff here, that probably I'm a Gen X physician. It probably more applies to us and older than the younger physicians who I think are already coming into medicine with an understanding that They are more than their physician identity. Um, but I think for us, we were raised in a health system that where we were, it was demonstrated for us. I will never forget being an internal medicine resident and watching the internal medicine physicians who were in their 80s, still practicing medicine, hobbling down the stairs at grand rounds to learn the latest things that were going on in healthcare.

Mm-hmm.

And I think we are starting to see that there are other ways of doing this modeled for us. So this is a long roundabout way of saying, at first we have to invite people into this work because not everybody wants something different. Some people are okay with having their physician career and that being the bulk of who and what they are. And there's nothing wrong with that.

Absolutely.

And If there is a part of you that is wondering, as I was, is this it? Is this all I do every day for the rest of my life until I retire or die?

Mm-hmm.

Then we get to invite people into a conversation of what do you want it to be? And I would say that we never have to fully separate from our physician identity, right? Like, that's not required. We can allow ourselves to be more than our physician identity. We can allow ourselves to see the parts of ourselves that exist now, but maybe we've kind of stuffed down and haven't really let that part of us out to breathe fully. Yeah.

I love that phrase that let, let it out to breathe. Actually let it be out there. Let it become something that's more exposed. When you were talking about like the 80-year-old physician shuffling down the stairs, going to ground rounds. That resonated so hard with me because I know some of these people that are in their 70s and they're still going to clinic every day. And I do look at those people and I go, I respect you. That was your life choice, but that's not going to be mine. There are so many other things that I do want to do with my life. And there's so many other facets to me that are not the physician. And I want to let those out. I want people to see those. One of the things I think that's happened to me, and I want to circle back to this because you had mentioned that men sometimes have a harder time doing this than women is that as a female physician, I still don't think I was really letting that part of me out to breathe as much until about 2 and a half years ago when I had another female physician who approached me. It's like, would you like to go out to dinner occasionally just so we can hang out and chill? I'm like, yeah, I'd love that. That'd be great. And then we invited another doctor and another doctor. And now there's 8 of us in this group that we all get together and we celebrate birthdays and we, you know, go hang out. But in that space, and it takes all of probably 30 seconds when we all sit down to dinner that we're all talking about, did this happen? What do you think about this? This happened to me at work today. Did you have this problem? And we become vulnerable in that space because we have permission to do that. But what was really cool, I saw my husband start doing it. He's also a physician, pulmonary critical care. And then one night he says, hey, this doctor and this doctor want to go out and have a beer. Can I go? Go, absolutely go, go. And he says, well, we're only going to be gone for a couple hours. I'm like, oh, you do what you want. 6 hours later, they're still out. And it's like, we're still having a really good time and we're just chilling and hanging out. And I'm like, this is what you need. But I think it was really interesting. I mean, we started doing it and these were both spouses of women who are in our group. So it took a little longer, but once they started to see what the women were doing, And how much it benefited us, they started to do this as well. So I think as maybe male physicians start to see the benefits of female physicians kind of sharing that vulnerability, maybe they'll want to be invited into that space as well.

I have so much to say about this.

Okay, cool. Let's go.

So yeah, I will say the first part here is number one, I think we separate ourselves frequently into these like male and female physician distinctions. And I just want to offer that we probably all have so much more in common than we allow ourselves, than we give ourselves credit for, because the job is the job. Um, regardless of gender identity and how we see our roles, there's so much frustration with the system and kind of everything that we all have so much more in common. Number one. Number two, even though I just said we're going to look beyond gender roles and gender identity, I want to name something else here is that Women very often are the caretakers, right? And as I started to explore physician coaching for myself and saw all of these female physicians doing this work, I started to see the female physicians as actually the caretakers of our profession, demonstrating, showing the rest of us, like, this is how we do it. In so many ways, we as a profession have lost our community. Right. The community was there in our training, and then we get out into the world and where did it go? You're just practicing in your silo and you lose the connection in the community. Where did the community used to be? It used to be in the doctor's lounge where physicians could get together in the middle of the day and just like hang out and eat lunch together and complain and joke. And by and large, a lot of those physician lounges are gone. And the ones that are still there, most of us don't have time to sit and spend any time there, even if they do still exist. And a lot of them are not solely for physicians anymore. There are executives in and out, and it maybe doesn't feel as safe as it once did. And so in order to have that community, we have to make these efforts. We have to create these communities. And that is something that I didn't realize or understand until I found coaching. I didn't realize how much I was missing community. And I love that you and the other female physicians have now demonstrated to your husbands that like you can do this. And in a lot of ways it makes the day-to-day so much better knowing that you have this group that you can go and confide in and rely on.

Oh my gosh. That's so beautiful. There was actually a hospital about 45 minutes north of us, tiny, tiny community hospital that back about 15, 20 years ago, they only had about 10 doctors on staff. But every day those doctors had lunch together. Every day they would meet in the doctor's lounge. They had a standing lunch date. They would have a dining room. They all got to sit. They all got to eat together. And when you were talking about that, it made me reflect back to thinking about how important that experience was to them. I think about my parents when both my parents are physicians. When they first moved to my little county, that every month they would have the county medical society meeting. And so every month my parents would get me a babysitter. They would dress up. They'd go to this meeting. And mom used to come back and say, "Look, the only people that are on this meeting are people who are on call. You don't miss this meeting. You go." But that sense of community, that sense of connection, that sense that you're going to have. A way to connect with this person that may not necessarily happen in the clinical sphere. I'm willing to bet you that when those doctors did get in conflict, because it is inevitable, that they had a back way. They had another channel that they could connect to that was not as threatening and maybe not as formal as having to deal with it. And also too, you had your colleagues there. You had other people there. You were not alone. Like you said, you're not in the silo where it feels like it's me against this other person. You actually have a community of people that are like, you know what, stuff happens and we'll work through it and it will be fine and we'll get the patients taken care of. And in that sphere of connection and community, conflicts will still arise, but they will be less impactful or more quickly resolved when we have that community. So I 100% agree with you. The fact that we've lost that. And unfortunately COVID just made that worse, has been a big part of the reason why we're seeing physicians having difficulty work through that and how it's so often negatively impacting professionally. One of the things I think you also, and I, I would, when I look at what you do and when I look at what coaching does, helping people become more aware of those identities and those limiting beliefs, those are things that we carry with us. But like you said, when we armor up, sometimes that armor is not something we're necessarily aware of. So you really have to raise people's awareness to the fact that they're putting that on. What kind of limiting beliefs do you really find that physicians have to work through?

Yeah, I think you touched a little bit on it earlier. The one that I like to use as an umbrella example is a good doctor doesn't do that, right? So we have in our minds what a good doctor does and does not do, in particular, does not do. Right.

Yeah.

And if I think back on me and my own journey, a good doctor doesn't do anything other than wake up in the morning, go to the office, do their— go do clinic, do their procedures, maybe eat, maybe there's no time to eat. And so you just keep taking care of your patients. And then at the end of the day, after all the calls are done and all the patients are seen and everybody is tucked in, then and only then Um, do you go to the bathroom? I mean, do you go home?

But it's true, right?

Like we sacrifice even the tiniest things like going to the bathroom and eating a meal because a good doctor keeps going, stays on schedule, all of the things. And again, I'm exaggerating a bit for illustrative purposes, but there is this running dialogue and it's not the same for all of us about what we can and cannot do based on what has been modeled for us or what we have And that can be our mentors. That can be things that we saw in our medical training. It can also just be things that we see in toxic Facebook groups about, you know, when we see physicians getting mocked or gaslit for the work that they're doing. And so it's really important for all of us to take a step back. And if there is something that you want to do, To take a step back and figure out why am I not doing it? And to see if you like the reason that you're not doing the thing that you want to do. Because I have found that even when I'm doing uncomfortable things, it can feel really uncomfortable. But as long as it aligns with what I ultimately want in my life, I can push through it. But if I'm not doing the uncomfortable things because I think somebody else thinks I shouldn't, that feels so much worse.

Mm-hmm. Yep. And there's a resentment that starts to build up when we feel like we're, like you said, we get in toxic groups or, you know, this is what good doctors do. And I think that's unfortunately a phrase that can resonate with all of us because we have that little voice in our head that's telling us this is what good doctors do. And so, like you said, you put your head down, you skip lunch, you don't pee when you need to, you wait. All these things that we do because we think it's what good doctors do, but But what's brewing inside of us when we do that is the fact that we resent having to fill a role that somebody else built for us. And one of the things, when we build up that resentment to this identity that's been constructed around us, you know, sometimes not even of our own doing, but sometimes because we're complicit, because we do want to please the other people in profession, we want other people to think that we're good, right? It goes back to the gold star thing you were talking about in kindergarten. We've grown up our whole lives wanting that positive information.

Yeah.

And so this is just one more gold star. My colleagues think I'm good. But one of the stories I like to tell in working with people in conflict is there's a monk who's teaching his students and the monk says, okay, there's a guy who's walking down the street and he's holding a cup of coffee and somebody bumps him and the coffee spills. Why did the coffee spill? Why did he have a spill? And the students say, well, the coffee spilled because he got bumped. It's like, no. The coffee spilled because that was what was in his cup. And whatever's in your cup, whatever you're carrying around that day, if that's peaceful water, if that's coffee, if that's resentments, if that's, I really don't want to be at work today, I'd really rather be taking this week off and going and traveling with my family, and somebody bumps you, you know, somebody bumps your case in the OR, you have a patient that's really rude to you, you get into a conflict with a coworker, Or somebody that, you know, you have to deal with a peer-to-peer with an insurance company and you've got that resentment in you, when you get bumped, that is what will come out of you. You will not have the bandwidth to manage that conflict in any constructive way because what's inside of you is not constructive. And so I love the fact that you are helping people understand that is a limiting belief. This idea of this is what you should be, and then having that create that resentment. It's like, no, this is not. What I should be. I want to be what I am. And if that's being a physician author, if that's being a physician surfer, if that's being a physician chef, if that's being, you know, whatever it is that's truly part of your identity. Once we start to understand that, that's going to help us manage the other stressors in our life so much more effectively. One of the things I also loved when I was looking at your website is when people talk about physician coaching, people talking about these processes that we're talking about to make us more aware of ourselves. and give us a happier life. There's data to support that these are beneficial processes.

Yes. Not just data, but randomized controlled clinical trials that compare what is a cohort of physicians and medical students and residents and faculty members. What do they look like before a coaching intervention? What do they look like after? How does that compare to a control? What happens when the control group then goes through a coaching intervention? And study after study shows improvements across the board in things like burnout and flourishing and depersonalization, all of the things that make doctors feel like they have to escape from medicine.

Yeah.

And I guess this is what I always remind people, right? So, you know, I mentioned to you, I just started my 17th year in practice. Um, pre-coaching me versus post-coaching me. I live in the same house. I'm married to the same woman. I have the same children. I commute every day back and forth to the same hospital that I've been going to for the last, again, 16+ years.

Yeah.

Nothing has changed from the outside. You look at my life from the outside, it looks exactly the same. And what I will offer to you is that everything is different. And I think that's an anecdote that supports the evidence. That is available. And, you know, you can see, I know, um, Drs. Adrian Mann and Tyra Feinstadt out of the University of Colorado, they have run studies looking at over 1,100 physicians going through physician coaching programs. And, and the evidence is there.

Yeah, 100%. It also really speaks to the fact that the metrics that we're looking at for being successful in our lives Are not external metrics. Those are internal metrics. The fact that you're looking at, and it's like, you know, you look at my life, my life looks the same, but really and truly what my life is, feels and looks and acts and sounds just more like me. And I'm so joyful in that. It's not that anything's changed externally. It's what's changed is here. And I think that is such a common thing because so often people try to improve situations by changing external things. If I just made more money, I'd be fine. If I just saw fewer patients, I'd be fine. It's like, well, you can do all of those things. And it's true that some of those things might have an impact on your joy and happiness. I mean, not discounting that, but that may not be the whole story. And unless you do that internal work, you're not really going to know if that's the whole story. I also love on your website, you're talking about living with intention, this idea of being very intentional in these things. And I absolutely think that if people are coming to you and getting coaching and getting physician coaching, there's already some level Of, I know that there's something wrong and I know I'm gonna have to do something to really address this. How do you help physicians actually become intentional as they go through their daily processes?

Yeah, just a couple of things. I just wanna circle back to the one thing that you were just talking about. We were talking about expectations and we were talking about resentment.

Yeah.

And, um, there's a saying that I love, which are expectations are premeditated resentments, right? So anytime we have an expectation, mm-hmm. You can expect there to be some resentment. And the person that we have the most expectations of is ourselves.

Yeah. Right?

And so you can see how quickly we can become resentful of ourselves because of the expectations that we put on ourselves. Right? And so it's a little circular there, but I think you get the point. And this feeds right into the question that you were just asking about intentionality, because all of this stuff Is running in the background, right? We don't notice all of these expectations that are running in the background all the time. And until you take a moment to pause, to take a step back and to look at, well, what's going on? What am I unhappy about? What is going on? Why am I getting the results in my life that I'm currently getting? Then you can become intentional about like, why is this happening and how do I do things differently. And I think that for me, that was one of the things that I noticed. I did not know what was wrong. I had no idea, but what I knew was that something needed to change.

Yeah.

And so I didn't have any awareness about what needed to change. I just knew that I didn't want to keep going the way that things were going, why I was so frustrated and angry all the time. And so that is the intentionality there. Right, is when you can just be aware enough to know that you want things to be different. And then all what physician coaching really does is hold up a mirror. There's a saying that I love about physician coaching, which is you can't read the label from inside the jar. And so it's so hard to know when you're living in these bodies and within your own mind what is going on for you. But to have somebody else hold up a mirror and be like, no, look what it says.

Yeah.

Oh, now I see it. And that's where the intentionality really has come from for me.

Oh, that's beautiful. You know, and this idea that there's sort of this hum in the background, there's this underlying little soundtrack that's playing for all of us that it's been playing for us for such a long time that we don't know it's there. And you literally have to take a mirror and hold it up and you have to sit there and spend time with it and really quiet down and listen to it to actually understand that it's been playing. And the effect that it's had on you has been so detrimental, but you have the ability to recognize it and change it, and it will make your life look different from the inside out. I also love when you're talking about sort of this generational difference with physicians who have been doing this for such a long time. And I think about some of these older doctors. You know, I trained in the '90s. We didn't have work hours and have anything like that, but people used to brag. It's like, oh, I did this many deliveries in this 24-hour period. I did this many. It's like, and that's great, and I'm really proud of you, and I'm glad this worked well, but And on a certain level, it was sort of like a badge that you wore. It's like, I worked my butt off and therefore I'm good. And that became the definition. I had a medical student in my office, I guess this was yesterday, and she's just started. So she just started her first year and she said, so I have a question to ask you, but it's not really a medical question. I'm like, yeah, go ahead. She's like, well, I've just started and I've very quickly in this last couple of months, I'm drinking a lot more caffeine. I'm not getting my sleep. I'm getting my work done, but I can definitely tell this is not the quality of life that I want. What are some things that maybe you think I can do to help to make this better? And I said, okay, let's talk about mindfulness. Let's talk about things you can do to maintain your physical health, your mental health, your spiritual health. I gave her some apps and I gave her some tools and we worked through that. And then after we had this conversation, I told her, first of all, I'm really proud of you for asking the question. Because I look at my generation, my generation would not have done that. My generation would have said, How much Diet Coke can I drink? Because buddy, I did it. How much Diet Coke can I drink to stay awake all night so I can learn neurophysiology so I can go back and take this test in 2 days and ace it? I would not have been asking what mindfulness practices can I engage in so I actually have a healthy life as I'm going through this process. So you have younger people who are already coming into the profession who are asking these questions. But what I think is cool in addition to that, I used to see some of the older doctors Who would kind of not diss it, but just all those younger people. But now I'm not seeing that as much because I think they understand that doing it that way, actually devoting your whole life and having that singular, all I want to be is that good doctor. That's all I want. When you look back at your life experience, it's like, there are other things that I could do and be. And these younger people coming up, and now we are sort of in our middle career. Yeah. Kind of discovering this. There's so much more to me, but the more to me is not only going to make me a happier person, it'll make me a better doctor. These 2 feed on themselves. When I am more intentional, when I'm more aware of who I am truly at my core, that's just going to make me more resonant with other people and it's going to make me a better doctor. So in a weird sort of way, this idea of being a good doctor is actually bolstered By doing this work. Do you ever have people come back and say, you know, this was an unexpected byproduct, but I actually think I'm getting better, giving better care than I was before I started this process?

All the time. And I think that's part of my own story as well, right? I went from the doctor who was running away from his medical career to somebody who is recommitted in all the ways to it. And when we are spinning in the frustration of what healthcare is, Right now and all of the things that we can't control and all of the things that we want to be doing, but we're not allowed to, man, how frustrating is that? And then how do you show up in with the patients when you're spinning on the fact that there's so much you can't control?

Yeah.

And when you allow yourself outside of the medicine silo to explore the other things that light you up and that interest you, you get to re-find your agency. You get to find the parts of your life where that you do have control over. And by the way, here's a not secret. We do continue to have a lot of agency and control, even within our current healthcare systems. We just have to actually use it. But it was impossible for me to see again, when that was the entire world, until I took a step back and started exploring what are the other things. And then I was able to see, oh, I do have control over these things. I do have control over making sure that I eat lunch, like simple things, but we do have some agency and we do have some control. We can't control everything, but there are things that we can control.

That's such a powerful phrase that you found your agency, that you found that there are things you have control over. And I think when you start making lists of things, these are a list of things that I can control. Versus a list of things that I can't control. You know, the list of things I can't control, I have to push that to the side. You know, and I have seen, and I know you have too, I have seen so many physicians that were constantly in conflict. I mean, literally constantly to the point that the staff, you know, you could actually see these physicians were coming to you. It's like, you know, I need to talk to you because I actually got written up by the staff member. And you actually can see, it was like, well, you were frustrated and in conflict about something you had no control over. You have never controlled— if the patient ate 2 hours before their scheduled surgery, you have no control over that. It's just something that happened to you. But when people get frustrated about things they can't control, a lot of the conflict that I see is physicians who are getting into situations of conflict because they haven't yet recognized they can't control them. And so they make themselves crazy about it. It's like, well, let's take a step back. What can you control? You can take a breath and you can respond and not react. You can actually learn how it's like, okay, what can I control? I can, if I need to take a 5-minute break and walk to the other end of the room and breathe or close my eyes or do something before I come back into the situation. And number one, get in conflict with the staff because that means the staff is upset. The patient's going to get less care. I mean, that's just what happens when we get in conflict. But also too, it's made your day worse. You have made yourself crazy over something that you can't do anything about. But when you start teaching people, these are the things you have power and agency over. It all of a sudden gives them a perspective and a place that they can actually sit in. And once they're in that space of recognizing the things I can control, all of a sudden the things they can't control become not necessarily something that's not going to be bothersome to you, but you will find a way to work through it. And all of a sudden people around you are going, hey, that actually wasn't great, but it actually went pretty well because my doctor was not screaming and yelling and getting into fights about it. I think it's really cool that you are giving people tools to do that. It's so beautiful.

I'll just name one other thing here, right? Because there's so many people who look at the system and they're like, why should I have to do coaching or any type of anything when it's the system that's broken? And I want to highlight what you said as the reason, because what do you get out of it? You get to have a better day when you are not frustrated and railing against, in your example, the patient that just ate 2 hours ago. When you can understand that that is a frustrating thing, it would be frustrating to everyone and it's out of your control and you can choose to just move on. Not only does the staff have a better day, but so do you. You get to leave that day. Feeling like you showed up as the physician you always wanted to be. So yes, it is work. Yes, it takes time and effort and energy to get there. And there is a ton of benefit that you get when you show up in that way, right? Because I think the other thing that happens is when we do lose our minds, the patient eats, we get frustrated, we're yelling, whatever. We then start to shame ourselves for being the doctor that yelled and that got upset. And why do I do that? Right? And we just compound the frustration when we do that. And so when you can show up more in the moment, the way that you always wanted to, you bypass all that other frustration and shame that happens afterwards.

Oh my gosh, that is so beautiful. It's so true, right? That people will have those behaviors. They won't really even know why that that's what spilled out of their comfort, their cup when they got bumped. But then afterward, it's like you feel that internal shame, which just compounds on itself. And I love how you talk about the systemic nature of this, you know, that we see ourselves as being separate from the system. American College of Surgeons has done some really cool work on this, that when surgeons get in conflict, part of the problem is they see themselves as above the system. The system exists for them as opposed to being part of the system. And when you see yourself as part of the system, you actually take some active agency in making sure that system works. But sometimes that's hard for us to see. We don't always see that our actions have such a profound impact on other people because we don't think we're part of that system. And yet it's symbiotic. We're inherently in that system. And then as you have a better day, you are going to walk in, other people are going to have a better day. But then also too, even if you just say to yourself, I, and I tell this story, but I was in a case once and it was an emergent case and the patient started to move during the procedure and it was a procedure where we were using hot water. So that's a bad thing. And, ah, hey, my patient's moving. And the nurse anesthetist says, I'm sorry. And after everything was calmed down, it's like, I'm really sorry I raised my voice at you. I'm really sorry I did that. And I've actually told that nurse anesthetist, because I work with him a lot, I've told him, I have told that story so many times of the fact that I yelled at you, but I was sorry. And I knew that what I was doing was wrong. And that was just a reaction in the moment because of what was happening. And you know what he said to me? He's like, I think it's really funny that you tell that story because I know you. I knew that's not how you meant it. And I said, yes, but that doesn't give me an excuse to act that way. You know, I'm part of the system. We're part of this team. And I also did not want to walk around feeling shamed either. I did not want to leave that interaction. I felt like I was inappropriate, even if he didn't feel that way. And I'm glad he didn't, but I didn't want to walk around with that shame either. So rather than carrying it around, it's like, oh my gosh, I probably should say something, but I didn't. It's harder to be vulnerable and actually say, gosh, I'm really sorry I did that. But the team and the patient and everybody's going to benefit from you doing that. And what you're doing with physician coaching and how you're working with these doctors, and I know they're so blessed to have you. I mean, you're just making their lives better and the ripple effect in the system and for the patients. It's just profound. It's incredible what you're doing.

Thank you so much. I really mean so much to me. Thank you.

Absolutely. So Michael, people want to find you and if they're interested in getting coaching, how would they reach out to you?

Yeah. So you can find me at my website, www.betterphysicianlife.com. Tons of resources there, and you can access my podcast, which is also called Better Physician Life: How to Get Unstuck in Your Medical Career. It's on my website and it's everywhere you listen to your favorite podcasts, Apple, Spotify, YouTube, all the places. And I just want to thank you again so very much for having me here today. It's been a great conversation.

I really Oh, Michael, thank you so much for your time. And we will link all of that in show notes. So for all of you peaceful warriors who joined us today, thank you so much for being part of the conversation at the Voices Cure. And we're just so grateful to have you here. So thanks again. And at that point, our peaceful warriors, thank you for joining us on The Scalpel and Sword. And until next time, be at peace. Every episode is an invitation to be at peace. To speak, to negotiate, to choose. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.