EP151: The Hidden Struggles of Physicians: Dr. Jessie Mahoney's Mindful Solutions

Transforming Physician Well-being: Mindfulness and Awareness with Dr. Jessie Mahoney

In this episode, Dr. Jessie Mahoney, a pediatrician turned physician wellness expert, shares her extensive experience and practical wisdom on how doctors can move from merely surviving to thriving in their practice. Dr. Mahoney discusses common, yet often unrecognized, detrimental mindsets such as self-sacrifice, over-responsibility, toxic independence, catastrophizing, and self-doubt. She emphasizes the importance of mindfulness and self-compassion in overcoming these patterns and improving overall well-being. The episode also delves into actionable mindfulness practices and self-compassion techniques aimed at helping physicians address these ingrained behaviors, reduce burnout, and enhance their personal and professional lives.

00:00 Introduction and Guest Welcome

00:25 Common Patterns in Physician Struggles

01:30 The Impact of Medical Training

04:18 Recognizing and Addressing Harmful Patterns

08:27 Mindfulness and Self-Compassion

16:22 Practical Tips for Self-Compassion

21:10 Final Thoughts and Conclusion

Transcript

Christine Ko: [00:00:00] Welcome to this episode. I am excited to be with Dr. Jessie Mahoney. As a pediatrician turned physician wellness expert, Jessie has helped over a thousand doctors transform their lives through mindfulness and coaching. She's here to share her practical wisdom on moving from surviving to thriving in medicine. Welcome to Jessie.

Jessie Mahoney: Thanks so much for having me. 

Christine Ko: Thank you for being here. You've coached over 1000 physicians. What's the most surprising pattern you've seen in outwardly successful doctors who might be struggling?

Jessie Mahoney: We have all the achievements. I always say, successful on the surface, but struggling underneath. I have been doing physician wellness since 2002. One of the key things is, and maybe this is the most surprising thing, that we have all these patterns, challenges, and so many of the same, what I like to call, mindsets; but we aren't aware of them. We just think they're normal. We live in a culture where they're normal. My [00:01:00] philosophy has really become that most of these we were trained to have. It's helpful for the medical system. It serves the system. If we are, I like to call it, over responsible, taking responsibility for things that aren't ours. And we take responsibility for, not just our patients, but our departments, and our colleagues, and the world. That is really helpful for a system that needs us to work over capacity all the time. It's perpetuated because it helps the system. It helps us get through our training, and because we learn these patterns during what I call times of trauma, because medical training is trauma, they're stickier. So they're harder to get rid of. And for a lot of us, many of them originated even before we went to medical school. And then they just got sealed in as we went through medical school and training. We become adept at being chameleons to make everyone happy and giving way more than we have. And so it's [00:02:00] no surprise that we continue to do that by the time we get to our practice of medicine. Many of us carry these same thought patterns that cause us so much pain and discomfort. 

Christine Ko: You're saying that really anyone who's "made it in medicine" has learned a certain pattern, and it's to really work harder than really, in some ways, is humanly possible. When we're on call as an intern, and, I didn't know enough just because I'm an intern, I'm a first year. 

Jessie Mahoney: You're not supposed to know enough. 

Christine Ko: Exactly. 

Jessie Mahoney: Expectations are so high. 

Christine Ko: Yeah. When I was an intern, there's this phrase, it's see one, do one, teach one. Now when I think about it, it's crazy. I'm supposed to see something one time, and then be able to do it myself. And then the third time, be able to teach someone else, as if expertise can be achieved that easily. And if I can't, then there's something wrong with [00:03:00] me. But that's just crazy, actually, to think three times. And already you're just so good at it, you're teaching someone else. 

Jessie Mahoney: Exactly. And then if you don't do it, or if you fail, the trauma is so significant. We're terrified. That's what I call the shame, blame, guilt, or making decisions from fear. I was working with a neurosurgeon recently, and we were talking about this idea of hiding in plain sight. Like we're there, but we're like hiding inside and not wanting to be discovered, even though none of us really has anything to be discovered, but we're worried that someone will find some place that we aren't measuring up. And that was very much taught to us. And so it's really hard when you get to attending hood to let go of any of that. And to recognize that it's actually not sustainable. And part of the problem is that we come into attending hood, and we've set these expectations. So we expect them of everyone behind us because we think it's normal. And we keep following along [00:04:00] because we're afraid. And so that becomes the standard. 

I often say for primary care, I'm a pediatrician; we just do more and more. Because they ask us to, and we don't want to get into trouble. And then they're like, look, they're doing it all. We'll just ask them to do more. And then there's double the work, and it's even more of a burden. 

Christine Ko: Yeah. So, you just said that we aren't even really aware of these patterns. You said, you see these patterns over and over again, in common to maybe every one of us.

Jessie Mahoney: Everyone in medicine, and as women, I always say we specialize in certain ones. In fact, I have a joke that we specialize in PEDS or DERM, but we also specialize maybe in self sacrificing, or being a martyr, or we're a specialist in people pleasing. Most of us have a few specialties in the realms of these patterns.

Christine Ko: Since we're unaware of them, so I'm probably unaware, can you define maybe like the top five? 

Jessie Mahoney: There's too many to even go over, but really the biggest ones I [00:05:00] think are self sacrifice/ martyrdom. Like, we're trained that if we're a martyr, when I graduated, that was glorified. You were a better doctor. The more you martyred yourself, the more tired you were, the less sleep you got, the more your patients needed you, you were a better doctor. In our culture today, the other one is the over responsibility. So many people take on responsibility for things that is not their responsibility. And If you happen to have a leadership role, so I was a former chief, I took responsibility for how every single person in the department was doing, which is not possible, right? It's really exhausting. The other one that I see is what I call toxic independence. So, we don't ask for help. We just do it ourselves because we can do it faster and more efficiently. We just do it, and then we get frustrated when other people don't help us, like our nurses, or staff, or spouses, or whoever; when we actually set ourselves up for that. We worry if we don't do it, [00:06:00] nobody will do it or it won't get done right.

Catastrophizing, which is one of the other most common, where we focus on the absolute worst case scenario, and we worry about that And then we tend to take what we learned at work, and we do it at home. So if you have kids, you catastrophize about your kids, or if this one thing doesn't work out, or I'm in the midst of aging parent dilemmas, and we immediately go to what's the worst case scenario? And never, like, what if this isn't a big deal? Or, what if it works out? And it's very expensive is what I like to say: emotionally, energetically, and on our career. It keeps you out of, as you mentioned, thriving, right? You just barely get to surviving, if that. I see a lot of people so stuck. They can't make a change for the fear of making a mistake, which would be another one. So many people are paralyzed in, is it wrong to work part time? Is it wrong to not take that leadership role? Is it wrong to...? Whatever it might be... [00:07:00] and and then we catastrophize and go down that path. These patterns are there. Once you start to tease them apart and begin to talk about them, you have so much clarity.

Self doubt would be another one. We are full of self doubt; we're actually trained to doubt ourselves. Because if we doubt ourselves, we go into that hyper vigilance and read and do more. It works for the whole system, but it doesn't work for us. And, I like to point out that in the longterm, it doesn't work for the system. So many women, in particular, are leaving medicine. And so if you can learn more about these patterns and understand them, that's the first step. It's actually probably about 80 percent of the solution. Cause once you identify, Oh, we are being a martyr again. Oh, I'm catastrophizing. Like it's lost its power, if that makes sense. And then there's lots of other tools you can use to step out of them. But the biggest bang for your buck is being aware of them because then you're onto yourself. Once you begin that, it's a journey to stop. I often just poke fun [00:08:00] at myself Oh, there I go again, I'm falling back into that old pattern. But again, it's not as exhausting when you identify it as a pattern, if that makes sense.

Christine Ko: Absolutely. When I first started this podcast, I started off talking about emotional intelligence because I had never really learned about it in any of my training. And when I came across it, I think just as you said, the awareness that there's this concept out there, it has a name, there are steps you can do to become more aware of my own emotions, and be able to name them, and be able to use them properly instead of being overwhelmed. That was one of my first things. It was just, as you said, it's awareness. So I appreciate what you're saying about these patterns. To just go over some of the things you said, you said being a martyr, toxic responsibility, catastrophizing.... 

Jessie Mahoney: It's over responsibility and what I call toxic independence. They're slightly different. Once we can understand the way we were trained, it doesn't mean that these are all bad because, honestly, in a code situation or in certain situations, they're [00:09:00] still useful. So it's really being aware of them and being discerning about when they're helpful and when they're not helpful, because sometimes catastrophizing is helpful, but not on your vacation, and not with your children, and not with the call schedule, for example.

Christine Ko: What you're saying is reminding me of the conversation that I had with Chrissy Cammarata, who studies perfectionism. And I had never quite thought about perfectionism in that way, but it's just, as you just said, that it's actually also a skill that is quite important. It's very useful to be a perfectionist until it's not.

Sometimes it is really good to catastrophize and really think, what's the worst case thing here? And, taking responsibility is not a bad thing. But then if we overdo it, then that can be bad. And self blame. It's not necessarily all bad, if we do something wrong.

Jessie Mahoney: It really does come down to noticing and awareness. And, that really comes down to mindfulness, right? Because you have to slow down, and you have to pause, and you have to choose to be aware. Most of us don't do that [00:10:00] because we have an urgency bias, right? We're always moving and doing all the things. We don't slow down and pause and breathe and say, wow, why am I spinning? Mindfulness is such an important thing for doctors, and many of us think of it as like this woo thing. And the other thing is that many of our institutions used it against us. If you go to this mindfulness class, your job will be fine. Or, maybe you should learn how to do MBSR, mindfulness based stress reduction, and then you won't be so nervous. It's really not designed to be that way. It's really a way of thinking and a way of working with your nervous system. It's really physiologic, and it's upregulating your parasympathetic nervous system, so you can pause and, I like to say, respond rather than react. And that's where that discernment comes in, right? It's, Oh, wait a minute. I'm just thinking that it's this, but that's just my habit.  It helps your patients if you can practice mindfulness. Mindful parents are better. Mindful partners are more attuned. And it really helps the system at large because when [00:11:00] we are, say, in reactivity or fight or flight, or we're showing up as a victim, which is another one we're taught to do in medicine, we don't advocate well. And so then we're not getting any of the changes that we want. So when we're strategic with both our physiology and being thoughtful and practicing some of these tenets of mindfulness, then all of a sudden we can advocate better. But we're not taught any of this. 

Christine Ko: Yeah, so we tend to have these patterns in common because they've helped us, right? So in some ways, they are positives ,but we're unaware of them to a certain degree. How did you become aware of them?

Jessie Mahoney: For my entire career in medicine, I worked in physician wellness. I worked in physician wellness for a big institution. Now, nobody has taught you these. There's not like a list out there. A lot of it is just learned experience and working with physicians in distress. And then, I am trained as a yoga and mindfulness teacher. So part of that really gets at a lot of this philosophic stuff. And I've now done, I think, I've done three coach trainings because I'm one of [00:12:00] those lifelong learners. I'm also someone who was a psych major in college. And so I love the brain and I love all of that stuff. And so I'm getting back to my roots as it were. I find different tools work together. None of the tools out there were specific for people coaching physicians, and the people who lead the coach trainings, they don't understand physicians at all. So it really takes this fun, creative, curious approach to sort of weave the physician mindset and what you know from all of the different places and spaces that you've worked in medicine with these coaching tools. So taking all of that and weaving it together. It's really just piecing together different things that I've learned in different spaces. I don't think someone outside of medicine has any idea how we think. I don't think you have to be in the same specialty, but you have to understand the culture, and the mindset, and the training that got us here if you want to understand how that's influencing our experience of practice. And really, [00:13:00] if we leave it to all these other people who are not in medicine, they're not doing a good job. So we need to become whole and healthy so we can be part of that solution. 

Christine Ko: You mentioned that training is trauma because part of medical training is that we ignore our physiology. We're tired, and we don't sleep; we're hungry, and we don't eat; we're thirsty, and we don't drink; and a whole host of other things: you feel lonely, but, no, you can't do anything about that. So you ignore your bodily signals. 

Jessie Mahoney: Many people come to me and they're like I just have no idea what I want. I don't know. Like, we don't even know how we feel about things. And so this mindfulness practice helps you get back in touch with it. One of the reasons that I got into yoga and ultimately became a yoga teacher is that I actually couldn't do mindfulness at first. Even though I'd been in wellness for a long time, the thought of sitting there and just not thinking about anything, that was way too hard. And so in yoga, they had you move and told you things [00:14:00] to do. And so if you do the kinds of yoga where you are mindful amidst it, I could do that because I was busy doing something else, and I could begin to slow down. Now I can do it. 

One of the things that I like to teach is what you practice grows. So you can just practice not showing up automatically, you can practice feeling what you feel, you can practice being aware of how you're thinking, and then you get better and better at it over time. We want to be instant sensations, as you said, see one, do one, teach one. 

Christine Ko: The concept of deliberate practice, which you just touched on. Practice, try it like once, twice, and fail, and try again and figure out what works for you. To just be aware of, oh, I'm doing that again, I'm self blaming when there's really not anything to blame myself about, and you just practice then a different response. 

Jessie Mahoney: If you stop practicing being a martyr, you become, it becomes less and less familiar. Like, for most of us now, it's just the familiar pattern, so much so that we think it's just normal [00:15:00] behavior, when others outside of medicine are like, what? Why would you do that? It does just take this practice of noticing and practicing shifts and changes. 

The other thing that's really key is when you notice that you're doing these things, we tend to go into judgment. We're trained to judge in medicine. And so it's, I can't believe I'm doing that again. Or, why haven't I fixed that? And, the science about showing yourself compassion, or seeing yourself as a human, we call it common humanity, is that releases oxytocin, and that helps you change. Whereas if you are in shame, blame and guilt, you're releasing cortisol, and your brain science shows you're in fight or flight. Nobody changes in fight or flight. But yet that's how we were trained. And so recognizing that to untrain ourselves or to unlearn these habits, we do have to use the physiology there. Most of us think that self compassion, that's a pass. I'll never get anything done. I can't be kind to myself. And yet it's actually [00:16:00] the secret sauce to be able to change. 

Christine Ko: Okay. What are a couple of things that you can do to try to be more self compassionate? 

Jessie Mahoney: My favorite easy one is hand to heart. You literally put your hand on your heart. Most of us don't even remember we have a heart. The top hand on the bottom hand: there's studies that like rubbing that hand to hand or skin to skin decreases cortisol, releases oxytocin. Then I can begin to practice and begin to recognize that I am a human. And then you can start to get to, Oh, humans make mistakes. Women in medicine, self compassion is so hard. We can't get there right away, and we judge ourselves cause we can't get there. 

Christine Ko: Why do you think that self compassion is hard for us? Like, why are we so mean to ourselves? 

Jessie Mahoney: I think if we're going back to patterns, we were taught that if you were kind to yourself, it was a pass, right? You had to look at, what's wrong with me? What don't I know that all those other people know? And even in practice, right? It's like you don't [00:17:00] want anyone to know what you don't know. And we were trained to notice in every situation what's wrong and what's different. And so we do that to ourselves. That's our lens on the world. We also do it to our children, by the way, and our spouses, right? We're always looking for what's wrong. That's our lens to the world. And so we look at ourselves the same way. And we were really taught that if you were like, Oh, it's no problem. It doesn't matter that I didn't know that. Imagine what your preceptor would have said. The key is we're trained to do all these things, and we need to begin to untrain ourselves and to recognize that it's not a long term strategy. And I think that's why people burn out, right? If we keep doing these things. 

Christine Ko: I love the hand to heart. Are there some other...?

Jessie Mahoney: The other one would be noticing how often you're mean to yourself and literally keeping track like, wow I was mean to myself 50 times today. That's very common, and it starts to be funny. I see you're laughing, but that's the thing, right? Then you're like, wow, this is ridiculous. I [00:18:00] tend to try to ask good questions. My favorite one is, what would love do? I use love in the sense that love is this sort of positive emotion, and I think it can help you. Like, would love see this late patient? Would love think you should stay till 9 PM to do this stuff? For some people, it's too woo. For some people who grew up in families where love would self sacrifice and be a martyr, it doesn't work. So a lot of women physicians grew up in those families. And so for them, it's sometimes, what would peace do? Or, what would kindness do? Cause I think for most of us saying, Oh, what would self compassion do? We don't even know what that is. And so these are, dip a toe in until you become more of a nice person to yourself. And so I think asking good questions can be really helpful.

Some of the other strategies are acceptance. Most of us aren't very accepting people. What I love is accept and allow, allowing whatever terrible feelings are coming up. You accept the reality. I would say it's [00:19:00] actually a pretty high bar because once you've sort of accepted the reality of whatever, you made a mistake. You can accept and be kind, or you can accept and hate something, or accept and not like it. It gets you much closer to self compassion. 

For those of us who are thinkers, it's being aware that you are not self compassionate and then doing practices that help you. Physical practices or journaling can be really helpful because you notice, wow, I just wrote all these terrible things about myself, right?

Christine Ko: Those things that you said, the hand to heart and journaling and trying to just remember how many times you're mean to yourself. Are those mindfulness techniques? 

Jessie Mahoney: Yes, because technically self compassion is one of the pieces of mindfulness. Or, Kristin Neff actually says that mindfulness is part of self compassion. They are inextricably linked, however you say it. Other practices of mindfulness is really simply like pausing and breathing. Most doctors I know don't even breathe during the day. Like [00:20:00] we breathe in the top 30 percent of our lung volume, and we don't pause. And so just pausing and taking deep breaths is actually a practice of compassion for yourself, but it's also mindfulness because breathing is a form of mindfulness. Journaling is a form of mindfulness because it's noticing. And noticing is mindfulness. Mindfulness, it's really paying attention on purpose and moving forth with intention. If your intention is, I'm going to be more aware, and I'm going to be more self compassionate, that's actually a practice of mindfulness. Yoga counts as mindfulness. And then I often recommend to people just to use a app of any kind, like five minutes, push the button, do what they say, because you have to start somewhere. I think we're such high achievers. We're like, that doesn't count. I'm like, it's better than nothing. And it actually cumulatively makes a really big difference. 

Christine Ko: Yeah. Awesome. You have really covered a lot of ground. Do you have any final thoughts?

Jessie Mahoney: My final thought is: [00:21:00] notice these patterns, be aware of them, and then choose a path forward that is kind, recognizing that we can't change when we are below empty on energy, when we are reactive and in fight or flight. Don't just let wellness be another sort of to do list checkbox. Sometimes we think this is all just fluff, like that mindfulness is fluff. But it's that awareness and that willingness to invest in yourself. 

Christine Ko: I agree. Thank you so much. Thank you so much for your time and your insights and all that you're doing. 

Jessie Mahoney: Oh, you're welcome. Thanks for having me. Appreciate it.