"Eternally Optimistic Staff of Asclepius" by Poppy Jasper Arts

VOLUME 8 | 2021

2021: THE YEAR WE OVERCOME

P H Y S I C I A N P o

OUTLOOK MAGAZINE

WWW.PHYSICIANOUTLOOK.COM PUBLICATION DEDICATED SOLELY TO PHYSICIANS AND THEIR PATIENTS Cover art by physician artist Poppy Jasper Arts WWW.PHYSICIANOUTLOOK.COM | 1

From the Publisher. . . .

Metamorphosis

“When she transformed into a butterfly , the caterpillars spoke not of her beauty, but of her weirdness.

They wanted her to change back into what she always had been. But she had wings.”-Dean Jackson

2019

2020

2021

Even I can recognize that (at least outwardly) I have indeed molted from an earth-bound caterpillar into a monarch with beautifully colorful and powerful wings over the past few years.

ready to venture out into the world and actually “practice” Medicine.

promising. We know that only a fraction of us will survive the chrysalis stage, as being a caterpillar is the most dangerous in our life cycle. In nature, the dangers are predators and parasites, disease, and unfavorable weather conditions. In medicine, the threats are surprisingly similar. The predators and parasites in OUR world, however, are camouflaged in fancy suits, dictating how we care for patients with their never ending bureaucratic rules and algorithms.

My wings are the pages of Physician Outlook Magazine.

It is no secret that physicians are an endangered species.

The physician-patient relationship is on the brink of extinction.

Those of us who aspire to become physicians spend the first three to four decades of our lives in a pre-larval, sheltered existence. When we first hatch, our first meal is the fragile thin exoskeleton provided by our parents and the village that raised us.

We then voraciously feed on the leaves of the Asclepias syriaca on which we are carefully laid. For those of us destined to become Doctors of Medicine or Osteopathy our “milkweed” consists of medical school, residency and the fellowship programs that prepare us to take care of patients. Like the tiny caterpillar that hatches from the egg, our knowledge increases its body mass thousands of times before we are finally 2 | 2021 VOLUME 8

We know that only a fraction of us will survive into “adulthood” but yet we persevere. We do what we do because it is part of nature’s cycle. Not all of us will get the opportunity to use our wings to complete the transcontinental journey, but we nevertheless spread our wings in flight. We purposely and deliberately cross-pollinate the flowers in our gardens.

We know that we play a vital role in our globe and in humanity’s survival.

By the time we realize that forces greater than ourselves are plummeting us toward potential extinction, many of us find ourselves flapping our wings without purpose. The monarch butterfly faces landscape-scale threats from global climate change, poorly planned urbanization and development, and pesticides. The threats we physicians and patients are challenged with are much more insidious--they come in the form of thinly veiled special interests that pretend to control healthcare costs and make our jobs ‘safer’ by inserting themselves as intermediaries.

Many of us in medicine are still in our pupal stage, our most vulnerable time in terms of survival, but also our most

I spent many years of my career in the pupal stage, spinning silk to form my protective exoskeleton, sometimes curling up into a ball to protect myself from the elements.

I shed my skin one last time when I founded Physician Outlook. My wings are dry and powerful.

I am ready to take flight and make the long journey with the other monarchs who are truly committed to preserving our profession.

It was an inspirational physician coach who helped me to recapture my joy in medicine.

Written by Marlene J. Wüst-Smith, MD

Table of Contents

Metamorphosis

by Marlene J. Wüst-Smith, MD /p.2

The Path to Coaching

by Dael Waxman, MD /p.22

JUST GET A COACH ALREADY!

by Catherine Woodhouse, MD /p.4-5

Physician Coaching: Explained

by Desmond Bell, DPM, CWS /p.24

An Unexpected Gift

by Cecilia Cruz, MD, MPH /p.6-7

Simply and Positively Transformative

by Rachel Miller, MD /p.25

Origin Story of Physician Coaching Alliance

by Errin Weisman, DO & Sinéad O’Kelly /p.8-9

Perspective

by Alyssa S. Jenkins, RN /p.26

The Question

by Scott Abramson, MD /p.10

The Value of Coaching

by Adam Harrison, MD /p.28-29

My Transition from Physician to Physician Marriage Advocate & Coach

by George P. Naum, MD and Vanessa Naum /p.11

The Key to Sustainable Change

by Susan Wilson MD, CPC /p.30-31

How Coaching Helped Me

by Marion Mull McCrary, MD, FACP, NBC-HWC /p.14-15

Inclusive Leadership

by Teresa Malcolm, MD, FACOG, MBA, CPE, CPXP, ACC /p.32-33

Emotional Freedom Techniques

by Melissa Hankins, MD /p.16-17

The Missing Link in Pediatric Obesity

by Wendy Schofer, MD, FAAP, DipABLM and Erin Schofer /p.34-35

Expectations and Outcomes

by Randy Cook, MD, FACS /p.18-19

Reflections on Becoming a Running Coach

by Michelle Quirk MD, FAAP /p.36

Learning to Practice Medicine on My Terms

by Nahille Natour, MD, FACOG /p.20-21

Compassionate Coaching

by Robyn Alley-Hay, MD /p.38

Art by Kaitlin Walsh

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Image by Pete Linforth

JUST GET A COACH ALREADY!

Just get a coach already.

Okay, that was unsolicited advice, which we coaches are traditionally loath to give.

But it’s excellent advice, nonetheless.

If you’ve been thinking about getting a physician coach, thoughtfully consider these questions: Do you have a pulse?

Is there more that you want to do, or to be?

Could you use a professionallytrained ally totally committed to your progress and well-being?

Yes, yes, and yes, right?

Physician coaching is now a necessity, not a nicety.

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There are at least three reasons why.

First, nearly half of us physicians are job stressed. And not just from burnout either.

New work-related syndromes such as moral injury, work-life imbalance, second victimsyndrome, and plain old ennui are being recognized as separate stress entities.

If you’re job stressed, working with a coach can help give you clarity about where you are in your work, discover your real desires for your work and life, create a personalized plan for your next steps, and hold you accountable for getting them done.

Bam! Second, the future of the healthcare industry is fiercely uncertain. We physicians are weathering the onslaught of breakneck devolution. We’re increasingly compressed by the

fragmentation of care delivery, venture capitalist encroachment, and neverending administrative burdens. The scope of practice of APP’s continues to evolve and deepen; physicians are increasingly deemed as less necessary.

If you’re reeling from occupational instability, working with a coach can help you rediscover your personal power despite systemic powerlessness.

Coaching helps you understand your unique value. Armed with this knowledge, you can maximize your participation in the healthcare marketplace, or decide to jettison it altogether for other work that better aligns with your personhood.

Thirdly, practicing medicine can be a particularly lonely endeavor. Many of us were taught that standing alone is a marker of strength, that being independent is the ideal physician state.

We’re cloistered away in office pods,

physically siloed away from colleagues who might otherwise provide peer support. Some of us don’t have colleagues who care about us. And even when we do, they’re afraid to ask how we’re doing, because they wouldn’t know how to handle a less rosy answer. And if we are asked, we don’t fully share for fear of being seen as weak or even being ‘ratted out’ to Admin.

If you’re tired of trying to figure it out alone, working with a coach gives you a safe, private, and confidential space to be your true self. You don’t have to pretend you have it all together because none of us do.

In relationship with your coach, you are free to be imperfect, authentic, and glorious. Warts and all. Fears and all. Your coach is your staunch ally who accepts you as you are yet holds you accountable to the desires and values you profess.

As a busy physician, you spend the precious moments of your life listening to others, but rarely get listened to. You are a human being. You deserve the same abundant compassion and companionship on your life’s journey as anyone else.

What’s a coaching session like?

Coaches come in all flavors, so it really does depend on his or her style. But generally, there is a recap since the last session, what you experienced and learned in the interim.

The coach may next ask what you’d like to address today, and then the coaching begins. The coach asks questions, you reflect and answer, and your coach listens and summarizes what he or she heard.

Then in an amazing way, powerful insights are co-generated from your two minds working together in harmony.

With new insight, you joyfully choose which action steps towards your goal

you want to accomplish before your next session, knowing that your coach will hold you accountable for their completion.

How do I know coaching is working?

Once you begin coaching, your progress toward that stubborn goal will likely be much more tangible than you’ve ever been able to induce alone. That’s fantastic! But most importantly, you’re on a journey of self-discovery. You’re becoming more self-aware, learning priceless lessons about you and how you operate. And usually once you start such a journey, you never want to stop.

hard work both you and your coach put into the process, but the quality of your relationship that truly drives change.

Now’s the time to get a coach!

Just get a coach already.

Physician coaching is now more necessary than ever. Coaching can give you clarity, help you reclaim your power, and give you much-needed support and encouragement as you do so. It can improve your work, and your life, for the better!

Why? Because you finally realize how truly fabulous you are.

How do I find a good coach?

Coaches don’t currently need to be credentialed to provide coaching services.

Many people calling themselves coaches are functionally consultants or mentors instead.

Written by Catherine Woodhouse, MD, BCC © 2021 For more information, head to www.physicianoutlook.com

Look for titles and letters. Titles and letters after a coach’s name signify that coach has been officially trained in a coaching methodology and practices under formal ethical coaching guidelines.

Different certifications and credentials correspond to differing lengths of training and practice hours.

Research your coaches. The Physician Coaching Alliance offers a helpful database of their coach members. Most coaches have a complimentary Discovery call. Talk to them; find out what their training and experience have been.

But ultimately the best coach for you is the one you resonate with, with whom AVAILABLE AT you can see yourself having a happy and AMAZON.COM engaging relationship. It’s not simply the WWW.PHYSICIANOUTLOOK.COM | 5

Physician, Heal Thyself

AN UNEXPECTED GIFT IN JUNE OF 2018 I was diagnosed with breast cancer. I was shocked to say the least. Even though as a physician I was well aware that cancer was on the differential when I required a biopsy of the lump in my breast, it never actually occurred to me that the result would be positive. In that one moment when my PCP called me with the biopsy results, my life as I knew it fell apart. I was angry at the world, angry at my body, and angry at God. How could this have happened to me?

I HAD ZERO RISK FACTORS - no family history, I don’t smoke, I’m not overweight, I barely drink any alcohol, and I nursed four kids.

Little did I know, however, that this would turn out to be one of the greatest gifts in my life. It was, in fact, the turning point in reclaiming my life.

YOU SEE, at that time my life from the perspective of society seemed to be perfect. I “had it all”. I had an active career as an ER physician, I was part of a great group, I had some administrative responsibilities that allowed me to further contribute in a useful way, and I was wellliked by my peers. On the home front I had four healthy children, a loving husband, a mother who lived nearby and helped out, and a group of amazing women who I have the honor of calling friends. Yet, I was not happy. Every day as I woke up and set my feet on the floor, I dreamt about the moment when the day would be over. I felt like nothing I did was ever enough. I felt like I was always running to just “catch up”, and as I neared the finish line, 6 | 2021 VOLUME 8

something else would come up and once again make it unattainable. I lived waiting for my next vacation - an opportunity to slow down, to leave some of my responsibilities behind, and to just be.

However, even during vacations I found it difficult to simply enjoy the moments. I set expectations of how the vacation “should” be that kept me trapped and didn’t allow me to live what was. And, of course, within half a day of being back from vacation, I was back to the same point where I had started, if not actually worse.

MY CANCER DIAGNOSIS and the required treatment threw me off the hamster wheel. I physically and mentally could no longer place all the same expectations and “shoulds” upon myself that I had

lived with until then. My chemotherapy treatments made sure of that. So, I found myself with some time to just “be” and consider how I was living my life. When one’s health and mortality are challenged, priorities shift and it is much easier to achieve clarity around what it is that truly matters to one’s being.

THE CLARITY that I achieved while undergoing the treatment allowed me to appreciate many details I had previously taken for granted. It created a path for me to bring gratitude into most of my interactions and experiences and detach myself from specific outcomes. It made it possible for me to enjoy the life that I was living (in spite of the discomforts associated with my treatments), instead of constantly wishing for the life that “should” be. And, it helped me come to a place where I was much more comfortable with who I was, and did not feel the need to prove myself to anyone. .

I was enough.

HOWEVER, as I got through my chemo treatments, surgery, and radiation, and closer to returning to my baseline state of health, I noted that maintaining the clarity I had achieved became harder.

Life and society were pulling me back into the vortex of my prior way of being, and I was terrified. As crazy as it may sound, there were moments when I wished for my cancer to recur because I did not ever want to lose myself in the merry-go-round of an unintentionally lived life again. So, I promised myself that I would do whatever I needed to develop my ability to maintain focus on my deepest values and live my life with clear purpose.

IT IS THIS endeavor that solidified my belief in coaching. At that point I had already participated in a few coach training programs, and had definitely found the coaching beneficial. But, I was unsure as to whether or not the skills I had learned would hold up as I reentered “normal” life. I committed to continue coach training and obtain my certification, while maintaining a relationship with my personal coach. Three years later, I can wholeheartedly say that was the best decision I have EVER made.

NOW I WAKE UP every day with curiosity and excitement for what the day may bring. Are there moments when I take things for granted and complain, or get angry, or frustrated, or anxious? Of course there are. Many of them. But, I am able to recognize these reactions as that, and no longer blindly accept them as the truth. I am able to intentionally shift my mind and heart to a place where my

values and passions are tethered and I can find empathy, curiosity, gratitude and joy. And, as I continue my practice, this becomes the slightly bit easier every day.

their lives. It is within your power to begin living the life you have always wanted TODAY.

MAKE A COMMITMENT TO YOURSELF I WISH this intentional living for everyone, and seek a coach with whom you can partner. You are certainly smart enough but most especially for my fellow and capable enough to do this for yourself. physicians. I believe that most of us Imagine how it would be if you could entered medicine because we have love fully love yourself, and bring empathy, and compassion for others in our hearts.

However, the stressors of our careers and curiosity, patience, intention, and clearthe pressure for perfection over time take headed action into every interaction.

This is what coaching will help you work a toll and force us to hide our hearts. We towards. No greater gift can you give to believe that in hiding our hearts we will be protected from the pain of loss, failure, yourself and to all whom you touch on a uncertainty, etc. The problem is that as we daily basis! try to keep these negative emotions out, we keep ALL emotions out. It becomes more difficult to experience connection, joy, gratitude, and love as well.

I URGE all physicians to not wait for illness, or a fractured relationship, or a tragic loss to reclaim their hearts and

Written by Cecilia Cruz, MD, MPH For more information, head to www.physicianoutlook.com

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different people in very different places, who, apart from the fact that they were coaches, had very little in common. And so, the Coaching Circle was born.

Origin Story of Physician Coaching Alliance It was late 2018, and Errin Weisman, DO had an idea.

Her podcast, ‘Doctor Me First’ was starting to go places, and with each new episode she recorded, she connected with yet another amazing person in the field who was making a difference. Dr. Weisman herself had already been on a rollercoaster of a life journey and now she was really hitting her stride as a physician life coach. But she had a nagging feeling that something was not quite right.

Growing up, Dr. Weisman’s grandmother participated in a quilting circle at her local church. Every week, women in the community would come and together the group would make a quilt from scratch.

Age and ability did not matter: if someone wanted to be in the group, they were in the group. There was Betty, the snackbringing old sage who refused to quilt, but also refused to quit. And that was okay.

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who had her own little corner of the quilt, and she just got on with her patterns as best she could, slow and steady. And that was okay too. The group was a democracy, learning from and sharing with one another, and one of Dr. Weisman’s favorite life memories.

It’s fascinating to think that even in the niche world of physician life coaches there is a hierarchy, an unspoken “you can’t sit with us” mentality, but Dr. Weisman says she felt it, and felt excluded by it.

Despite her ostensible success, and her open, honest nature, she still felt like she was on the outside looking in, and she didn’t like it. She wanted to create an environment where everyone could feel welcome: cool kids and science nerds and art geeks alike. She wanted to recreate the sense of belonging and community that her grandmother had recounted with such fondness. So, she reached out to six coaches that she knew. Although all women, these were six very

It was immediately clear to the first few in the Coaching Circle that what they had was very special. Each of them recalls that it was unlike anything they had encountered in their various coaching endeavors up to that point. It was making a huge difference to their coaching practice, to teach and be guided by other coaches in an open, supportive, and non-judgmental space. Each month, they would meet, and the metaphorical quilt would grow and become more elaborate and decorated as people invited their friends and colleagues, who each brought with them their own wealth of knowledge and experience, and their own questions and ideas.

By November 2019, the group had expanded from just doctors to people from all facets of the healthcare system: dentists, nurses and lawyers being just a few examples. Now, men were joining too. Both of these expansions were met with some initial apprehension, but Dr. Weisman found herself revisiting the original purpose and aims of the group: a safe space where all are welcome and included. Through all of this change and growth, it was important to Dr. Weisman that this mantra remained at the center of the group’s purpose.

Finally, the time had come to ‘professional’ up, and, armed with a clear mission statement and a faith in creating something greater than the sum of its parts, the Coaching Circle became the Physician Coaching Alliance.

The Alliance was growing at a steady pace, but it was in 2020 that the full potential and power of the PCA came to light. There is no need here, to recount the worldwide events that took place as 2020

began, that would impact every minute detail and microscopic element of life as we knew it to be. What quickly became apparent to Dr. Weisman and the founding members of the Physician Coaching Alliance though, was that they were uniquely positioned, by virtue of their now-established community, to help and support those who were some of the most affected by the pandemic: the people working in healthcare, and the people who were helping the people working in healthcare.

They developed a community calendar, with multiple events every week, where members could link up virtually to talk things out, share advice, and belong somewhere that other people understood the gravity of what they were going through.

They could tackle their fear and uncertainty head-on, and rely on each other with their combined years of

training and experience, and a broad spectrum of educations, specialties, and coaching styles. In the swirling, unpredictable tornado of Covid-19, the PCA was a hatch-battened bunker for its members. At a time of complete chaos, they showed what true collaboration could look like.

Since then, the PCA has continued to grow and evolve into something unparalleled in the field. They’ve developed a leadership team. There’s a very active Slack Group where they build each other up and celebrate each others’ wins.

Where once they had a monthly meeting, now they meet four times a month, with extra bonuses always being added to the agenda: Coaching 101 lessons for those who are thinking about becoming a coach or just starting out, Podcasting workshops, Business and Leadership mentoring, and group retreats. Their

membership is now 60-strong and growing every day.

The core values of the PCA? Community over Competition. Transparency.

Vulnerability. Open Coach Approach.

Growth Mindset. Transformation. They want to fundamentally change the culture of a broken healthcare system and herald in a new approach: one that champions the wellbeing of its healthcare professionals.

Written by Errin Weisman, DO and Sinéad O’Kelly For more information, head to www.physicianoutlook.com

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The Question

On hospital call duty for neurology, I had a particularly intense and hectic 3 nights. I didn’t get home till maybe 9pm or 10pm each night. When I finally got home Sunday night, my wife hit me with The Question: “Who do you love better,” Pamela demanded, “Your patients or me?”

Now I am no dummy. I responded immediately: “It is you, my beautiful bride, that I love the most.”

“I don’t believe you,” Pamela uttered as she turned and walked away. That night my sleep home was the guest bedroom. However, with some Ghirardelli Chocolates and with some apologetic sweet talkin’, by the next night, I was back in our master bedroom. And of course, Pamela is no stranger to these kind of work weekends. She knew this when she married into the medical profession 41 years ago. But sometimes, I guess, it still gets to her. I suspect that many doctors have at one time or another been on the receiving end of the “Who do you love better,” Question.

Now it is one thing when one’s spouse or partner asks “The Question,” but what about when our kids ask? And what may be even more disheartening is when they don’t ask. What if they silently presume the answer?

Written by Scott Abramson, MD For more information, head to www.physicianoutlook.com

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hours on call during those training years. She was raised in a family-owned business. She was used to hard work and had a WIT (whatever it takes) attitude.

We were both equally determined to make our relationship work. We used concepts and tools that have not only allowed us to survive, but thrive. We want that for you too.

My Transition from Physician to Physician Marriage Advocate & Coach

Since the tender age of five, being a physician is all I ever wanted to do with my life. I thought of little else from that time forward. Until, I was eventually accepted into medical school in 1986 at the age of 27. I started into family practice in 1993 when I was 34. My story is an interesting one and will be told, I promise, at another time. Though I have been a physician for 31 years, I have been a marriage advocate for much longer.

Today, the practice of medicine is not the same practice of medicine I knew back in 1993. That year, I finished my Family Practice residency and returned to my home area of Wheeling, WV. I settled into a small-town family practice in McMechen, WV not far from my home in Wheeling. Treating patients in my office was not only how I dreamed it would be, it was better!

I went on house calls and enjoyed being the “old time family doc”. Getting to know families through multiple generations from birth-to-death was not only a joy, but a privilege. Spending quality time with patients without quotas to fill and administrators to please seems like centuries ago. Those were the “good ole days.” I was living the dream! MY dream.

Years went by as well as the “good ole

days”. As we have watched the erosion of the doctor-patient relationship, we have watched it become corporatized, replaced with cookie cutter treatments where one size mostly fits all, and where third-party controllers reign supreme. We spend less face-to-face time with the patient, and sadly, more time with EMR and the computer screen.

A random google search leads us to believe that physician marriages are on par, if not better, than the average marriage in society today. I’m not convinced. While they may have some merit, one must question whether the right questions were asked. I saw in my parent’s marriage. I come a family of physicians, where my own dad was a doctor, and I saw in my parents’ marriage years of infidelity, lying, narcissism, and abuse in multiple forms. I saw it among the other physicians he associated with, and it was abhorrent to me. I wanted something different.

My own marriage has been fraught with challenges and many obstacles that could have broken a weaker marriage. My wife, Vanessa, knew what we were in for when we dated and later married. We met in the middle of my first year of internship.

Vanessa was understanding of the long

For the past 25 years, our life’s work has been supporting the institution of marriage by volunteer coaching for nonprofits. And, though being a physician was first and foremost my career of choice, I was called in a different direction.

Transitioning from a physician to a marriage coach has been a very natural one.

It is both rewarding and challenging, very much like a marriage. The rewards come from spending more face-to-face time with people. It is great being my own boss again and working with my wife. The challenges come with my steep learning curve with technology. Gratefully, I have Vanessa helping me with that. Supporting and helping physician marriages is equally rewarding and fulfilling and make the challenges worth it.

It is really hard to put into words the passion we have making a difference in our colleagues’ marriages. The concepts, tools and the coaching program we have has been life changing. It has been for so many, and can be for you too. We believe our proprietary marriage, sex and relationship coaching program is not only life-affirming, it is also life-saving, and most of all life-transforming. We are dedicated to teaching our colleagues how to transform their marriages and relationships.

Written by George P. Naum, MD and Vanessa Naum For more information, head to www.physicianoutlook.com

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FEATURED SHOWS...

Podcasts are a useful and entertaining way of dispensing information related to all kinds of topics. In fact, this technology has made it easier for content creators to talk on any niche of their choosing. It’s no wonder that the popularity of podcasts in general keeps increasing.

Over the last year or so, it has been especially exciting to see physicians create more and more podcasts addressing various aspects of physician life.

That’s where Doctor Podcast Network comes in...

Founded in June 2020 by Dr. David Draghinas, a Dallas-based anesthesiologist, Ryan Inman, a fee-only financial planner for physicians, and Desiree Leos, a sole proprietor of her own content development and podcast production company, Doctor Podcast Network was created for the purpose of helping physicians feel supported throughout their podcast journeys.

Simultaneously, “DPN” brings together in one location many quality podcasts that are essential listening to physicians and their families.

Dr. Draghinas and Ryan are both podcasters. Desiree built their teams to help support them and others to consistently produce content. All three knew how challenging that was to do in the midst of busy schedules, competing priorities, unpredictable monetary compensation, and fluctuating motivation.

Physician podcasters are there for the doctors and healthcare providers that make up their podcasting audience. But “this can be a tough and lonely journey for the podcast creator.”

Doctor Podcast Network is there for the physician podcaster. It’s a place where they can come together, learn from, collaborate, and confide in one another, as well as facilitate the monetization of their shows.

Having soft launched with 15 founding members in October 2020 and formally launching in January 2021 with 17 shows, the network has shown its capability of creating the community and environment that podcasters need to thrive.

Doctors Unbound is a podcast created for doctors who are busy with unique side passions outside of their normal schedule. Dr. David Draghinas shares their stories of triumph, learned lessons, and, ultimately, their humanity.

Financial Residency is geared toward early-careered physicians looking for practical ways to manage their finances.

Ryan Inman is usually found nerding out over phoned-in questions by his listeners asking about student debt, investing, insurance, and balancing budgets.

The Physicians Guide to Doctoring is hosted by Dr. Bradley B. Block where he seeks to answer the question, "what should we have been learning while we were memorizing Kreb's cycle?" His podcast is a practical guide for practicing physicians and other healthcare practitioners looking to improve in any and all aspects of their lives and practices.

AMPLIFYING PHYSICIAN VOICES

VISIT US TODAY AT WWW.DOCTORPODCASTNETWORK.COM Find other physician-hosted shows on Doctor Podcast Network’s website, www.doctorpodcastnetwork.com. You’ll find a list of amazing shows, focused on various aspects of physician life. They’d appreciate your support by subscribing to (for free) and sharing their shows.

If you’re a doctor who is either wanting to launch your own podcast or join with your existing show, the network is accepting submissions. If you are a physician that enjoys listening to podcasts, check out DPN for new shows that will bring value into your life.

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How Coaching Helped Me Are you just a little curious about coaching? Everyone is talking about it! Well, let me tell you how being coached, and coaching others has helped me. I first heard about health and wellness coaching at an American College of Preventative Medicine Conference.

I came to Chicago that year wanting to recharge my excitement in my medical career - some way to change it up. I was burned out from several years of administrative roles, transitioning EMRs, and the frustrations of medical practice. I had patients who needed and wanted to make health changes but just me telling them to do it was not the solution. I didn’t know the answer for them! I decided to train as a health and wellness coach to help. Turns out, this was not the first step in realizing the benefits of coaching.

In hindsight prior to being a coach, I was coached in a group setting before I had a name for it. At the time, it was disguised as leadership training, and was instrumental in starting a journey for me. Then, during my coaching course, we coached each other to hone our skills. It was so valuable, I continued to seek coaching after I was certified as a coach.

Here are 10 specific ways coaching has helped me, and may help you: Coaching helped me see I had options.

I was feeling stuck without a way out. “This is how it has to be” was my mindset before I knew differently. Realizing I had choices when I did not think I did was very freeing.

Coaching helped me get clear on my priorities.

I learned through the coaching process that there are superficial goals and then there are the true goals. I dug deep to identify what truly mattered to me and how that could shape my future.

Coaching helped me realize I can start with small changes.

I thought I had to be perfect the first time and that led to procrastination and inaction. Being able to start with small but impactful changes I could go slowly and deliberately. I could build on small wins to get me to where I wanted to be.

Coaching helped me ask for what I needed, and what I wanted.

I would often sacrifice what I wanted or needed to make sure someone else was not inconvenienced because I thought that is what I should do. This, in turn made me frustrated, jealous, and unhappy. I learned that I could advocate for myself and that could benefit more than just me.

Coaching helped me form a different mindset or soundtrack in my head.

My mind was filled with a vocabulary of “I can’t” or “I shouldn’t” often. With coaching I could identify limiting beliefs that kept me from trying something new. I was able to bust out from “playing small.”

Coaching helped me realize I am not alone.

When I felt burnout, I was disengaged from others. I also thought that I was the only one who did not have it together. I have learned that many of us suffer in silence or out of shame. Now I know that having a conversation with someone else who has experienced the same as me, is so cleansing and helpful.

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Coaching helped me feel more comfortable having difficult conversations.

I developed a new language along with a new mindset with coaching. I was able to use the skills my coach modeled to help me in communication with others. I learned to listen and answer in a different manner.

Coaching helped me have more confidence.

Through my experience with coaching, I started to see the things that moved toward my goals as experiments that I could learn from rather than opportunities for failure. I used these wins as evidence that I could do hard things. Each step reinforced that I could continue to march forward successfully.

Coaching helped me be happier.

When I came to coaching, I wanted to be a happier person. I wanted to find that zest in my life that I had lost in many ways. By learning about what my vision was for the future, what motivated me, and what supported me, I was able to decide I controlled my happiness. I could create environments and situations that gave me a sense of joy.

Coaching helped me be more curious.

I was afraid to step out of my comfort zone. When I was brave enough, I felt guilty that my new interests took me away from the list of overwhelming responsibilities that was weighing me down. The guilt would follow. Now I can explore ideas and topics and apply new ideas.

Coaching continues to be helpful daily for me, whether it is self-coaching or group coaching.

My coach does not tell me what to do or give me the answers. My coach helps me figure this out for myself. My coach listens, skillfully reflects, and guides me. My coach holds space for me to cultivate what I need. In all these ways, coaching has helped me be the me that I want to be.

Written by Marion Mull McCrary, MD, FACP, NBC-HWC For more information, head to www.physicianoutlook.com

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Emotional Freedom Techniques FOR A LONG TIME, I was in hiding. I was truly terrified of losing my reputation, my credibility, and everything I had worked so hard for professionally. I was afraid of being labeled “a kook,” “off the deep end,” “a nut,” or “crazy,” and being blacklisted within the Harvard community (where I trained and worked; I’d heard of this happening before, so there was precedent) and within the scientific community, at large. I allowed the fears to keep me quiet, even when I wanted to share with so many what I had discovered. I had come across a technique that really impacted people’s lives in many amazing ways—physically, emotionally, in past and present relationships, with work-related situations, and with issues involving self-worth, confidence, selfcompassion, acceptance, and self-love. However, there wasn’t much evidence (at the time) to support it beyond anecdotal reports, it involved energy meridians, and doing it looked pretty strange. So, except for telling a handful of non-medical friends, I stayed silent until a few years before I began my transition from clinical work to full-time coaching.

IT WAS 11 YEARS AGO that I first learned about Emotional Freedom Techniques (also known as EFT or “tapping”), and it forever changed the way I worked with others. I don’t remember exactly how I came across it, except that I was very interested in and seeking out more holistic ways to help people really transform their lives. I was working as an adult psychiatrist, and I was dissatisfied with the ways I was taught and told how I was “supposed” to be helping people to heal. I was bringing into sessions techniques such as mindfulness and meditation (when they were much less mainstream than they are now) to help patients connect with themselves and their truth--not someone else’s version of it they these methods to help people change their lives for the better that I first discovered EFT, and attended my first 3-day training, with many more in the years that followed. had been taught to believe—to become more empowered to create and live a life on their own terms. It was a product of this natural growth towards understanding and using SEVERAL THINGS DREW ME TO EFT from the very beginning. I knew the key to really helping people have the life that they wanted was to help them get to a place of greater selfacceptance, self-compassion, and self-love because from there, all else would follow. I knew the importance of helping others to release the negative emotions weighing them down and open up the limited 16 | 2021 VOLUME 8

tunnel vision for what they thought was possible for them. I knew that negative emotions were entwined with the beliefs that were anchoring in thought and behavior patterns that were no longer serving those I was working to help, preventing them from living the life they truly wanted to create and experience. I knew that strong emotions could override conscious thought processes (even when we are working to change them), and result in unhelpful behaviors (including those that are unconscious) and the, oftentimes, unwanted or unintended outcomes wrought from those behaviors. EFT helped with ALL of that and more (including helping me overcome my own burnout as a physician, as well as many of my clients).

EMOTIONAL FREEDOM TECHNIQUES is, at its most basic, is a stress-reduction technique that is similar to acupuncture, though without the needles. EFT involves tapping on specific acupressure points (associated with the same energy meridians used

EFT using fMRI. A recent study showed that EFT significantly reduced measures of “stress” and “anxiety” in nurses during the COVID pandemic.

WHILE I APPRECIATE THE RESEARCH that is now available supporting the efficacy of EFT, the real reason I use EFT with my coaching clients is because IT WORKS! EFT meets people where they are in the present moment with all the messiness of their thoughts and feelings, and with that acknowledgement combined with tapping, those messy, unpleasant thoughts and feelings easily, naturally, and gently shift—no heavy lifting involved.

Image by Alexandr Ivanov

AS THOSE COGNITIVE AND EMOTIONAL SHIFTS begin to happen, and the negative emotions (like anger, frustration, sadness, fear, guilt, shame, unworthiness, etc.) are organically released along with the thoughts associated with those feelings, there now is space for new, more empowering, more compassionate, more loving thoughts, feelings, and beliefs to fill the void. And, from that place of greater self-compassion, greater empowerment, greater self-acceptance, my clients make decisions and take actions that actually support the life they truly want and deserve, both professionally and personally.

in acupuncture) on the hands, head, and upper body while focusing on an emotion (most often, one that is unpleasant) and the specific situation associated with that emotion. In this way, EFT combines a cognitive process with emotional and energetic components, as well as often adding in a somatic component when asking the person tapping to localize the emotion they are feeling to a place within the body. So, EFT is the epitome of an holistic approach, in that it truly is a mind-body-emotion-energy technique.

SINCE I DISCOVERED EFT over a decade ago, there have been numerous randomized controlled trials and several metaanalyses conducted to support its efficacy in areas including anxiety, PTSD, physical pain, food cravings and weight loss, depression, and enhanced peak performance. EFT has been shown in at least two studies to significantly reduce cortisol (the “stress hormone”) levels (24% EFT vs 14% controls; 43% EFT vs 20% controls). Neural changes in the brain have been seen with

Written by Melissa Hankins, MD Photo courtesy of Melissa Hankins, MD For more information, head to www.physicianoutlook.com

WWW.PHYSICIANOUTLOOK.COM | 17

Expectations and Outcomes Whether you’re discussing a surgical treatment plan or reviewing the schedule of pending diagnostic tests with a patient, he or she will always want to know two things: What can I expect? What are possible outcomes? Expectations and outcomes are two cornerstone elements of healthcare vernacular.

Sometimes these two words are used interchangeably. However, when you break down the definition for each, you discover expectation is “assumed” or “presumed” while outcome is a definitive result.

Clients often arrive at the virtual physician coaching door without expectation. They are curious about possible outcomes, but this is defined during the first coaching session. While there are many types of coaches out there, the entire concept of “professional coaching” is a remarkably new phenomenon. There is disagreement about the true origins, but Thomas Leonard frequently gets credit for originating the idea in the early 1990s.

Leonard was a personal financial planner who transformed himself into a “coach” after realizing that his clients were asking for much more than investment advice. Having recognized the need for the service, he attempted to organize and codify the coach training process but was ultimately thwarted in that effort and tragically died at the age of 49. Although 18 | 2021 VOLUME 8

the discipline of executive coaching has progressed substantially beyond its infancy, it is currently in a period of adolescence, and one should take care when selecting a coach.

Your first coaching session must give a space for expectations and outcomes to come to light. Be certain that goals and methods are fully understood and agreed upon by both coach and client. With that preamble, here are three important benefits that one should expect to gain within the coaching framework.

Awareness of Values and Goals: When Alice was lost in Wonderland, she inquired of the Cheshire Cat, “would you tell me, please, which way I ought to go from here?” When the cat replied, “that depends a good deal on where you want get to,” Alice admitted that she “didn’t much care where.” To which the cat correctly offered, “then it doesn’t much matter which way you go.”

When we are at a point of confusion and indecision in our lives (and we all go there occasionally) it’s critical to reflect deeply on the personal values we’re trying to satisfy. In those moments, it can be unbearably tempting to just throw up our hands and do anything that seems “different” in hopes that we’ll end up in the right place. With thoughtful coaching, we are more likely to correctly identify meaningful goals based on solid values.

Heightened Sense of Perspective: Even if we can identify and enumerate a list of very worthwhile goals, the achievement of those goals can be easily thwarted if pursued with reckless abandon. By taking advantage of a deliberate, thoughtful coaching experience, goals can be organized and prioritized in a way that dramatically improves the probability of successful achievement. Pursuit of goals becomes orderly and the stress of too many “balls in the air” vanishes. We find it much easier to keep track of the values and goals we mentioned above.

Focus on Skill Set Development: No one has ALL the skills. Each of us has certain skills that seem effortless to us, whereas others seem completely beyond our grasp. This is another key area of self-awareness that requires careful consideration and honest self-evaluation.

The effective coach will offer thoughtful questions to help the client objectively evaluate their various skill sets. Such honest assessment creates an opportunity to consider areas where known strengths can be exploited. Equally as important is the process of identifying areas in which certain skills are lacking. To repeat, no one has all the skills. But identifying areas where particular skill sets are suboptimal invites the opportunity to seek out and associate with people whose skills are complementary to our own.

The relationships that grow out of such collaborative arrangements is often the fuel that powers the most successful organizations.

Like the Cheshire Cat, an effective coach will continue to encourage the client to say where they want to go but will never suggest a particular direction. The coach will encourage the client to stay near a familiar path but to cautiously explore interesting new territory. Above all, an

effective coach will encourage the client to believe in themselves. Sometimes the expectation changes, but the ability to overcome obstacles and adversity is always within us. The coach is there to remind us that we are in control and we hold the power to determine our own outcomes.

Written by Randy Cook, MD, FACS For more information, head to www.physicianoutlook.com

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Learning to Practice Medicine on My Terms I’m curious to know if your training looked like mine in regards to your future medical practice. We learned there are two ways to practice medicine – as an academician or as a private practice physician. I trained at a community program, so the guidance was biased towards private practices, and my goal at the end of residency was to join an established group and serve my community as the best obstetrician/ gynecologist I could be.

For me, it was part of the prescribed pathway to being a physician, directing me as early on as when I was a premed student. Work hard to get into a good college. Now, work hard to get into medical school, etc. It made sense. After completing residency, I couldn’t imagine that before the decade would end, I would find myself searching for something new.

Everything changed for me in 2012. I was part of a busy, successful practice with kind and caring partners, and it should have been wonderful, but it wasn’t for me.

At the time, I didn’t have words to

20 | 2021 VOLUME 8

describe what was going on; all I could tell you was that I was exhausted. I didn’t enjoy my work, and when I reflected on my days, I didn’t like the person I was becoming. I knew I needed to make a change, but I didn’t know what or how.

It took almost everything I had to turn things around. I almost left medicine, but I didn’t know what I would do, and I couldn’t be without an income for more than a few months, so I transitioned to a position that helped me create boundaries and work/life balance. I found a way to practice medicine on my terms, and I am still practicing as an OB/Gyn hospitalist almost 10 years later.

As a result, I’ve learned a few things that weren’t taught in school or in residency.

I became a life coach so that I can help others who are struggling like I was. I can see the stress in my colleagues’ eyes, but I know from experience: when you are in the thick of it, you just can’t see it.

Physicians are naturally hard workers. We know how to put in long hours, and we’ve

been successful because of it. For me, the busier I got, the more I worked. My values got lost in that work, and until I stopped, took inventory, and made some changes, I was miserable.

Here’s what I wish I learned about myself earlier in my career – I gain my energy through my time alone. I need strict delineations between time working and time off. I need very clear boundaries.

I rediscovered my values, including the values of creativity and growth. I made time to learn and improve hobbies and time to create.

As I’ve worked with clients, I’ve learned a few lessons about medicine. First, everyone deserves to practice medicine on their terms. Second, everyone’s terms are different. Last, there are multiple ways to practice medicine, and one way is not better than another.

Here are a few actionable items you can incorporate for yourself, remembering that YOU are the expert, both regarding

your field of medicine and regarding what you need for a successful career.

You do not have to follow a prescribed path. You can influence your patient panel and see more patients with conditions you are passionate about treating. You’ll be a better doctor for your patients and more satisfied in the long run. Your dream career won’t emerge overnight; it will take work, but it can be done!

First, identify and get to know your referral base. Go out and meet other doctors in your area; both the doctors who will refer to you and those to whom you will refer patients. Get to know their staff.

When you introduce yourself, make sure you share what type of patients you’d like to see. An easy way to incorporate this into your conversation could be: “I specialize in the nonpharmacologic management of obesity,”

or “In my practice, we take care of women who are perimenopausal and menopausal.”

Make sure the office has plenty of business cards, and if there’s a referral process, make it easy!

Second, include in your marketing campaigns the diseases that you are passionate about treating. Your business card is your most important marketing tool. Can you add a statement on the back of your card? For example: “Specializing in minimally invasive surgery” Another marketing tool is your website.

Most websites include information on the physician, including their areas of practice and/or what they are passionate about in medicine. Use this to your advantage.

milestone or when you attend a conference that highlights your expertise.

The last action item is to get your patients talking. When you make a meaningful connection with a patient or when they compliment your care, ask them to complete a Google review or a review on your practice website. You can even purchase a cheap tablet to have them do this before they leave the exam room. Imagine how positive reviews will enhance your practice both in the number of patients you see and in the type of patients seen.

My sincerest wish for you, and for all physicians, is to practice medicine in a way that brings you joy and satisfaction. I hope this article helps you customize your Another way to use your website is clinical practice. Remember, YOU are the to write a blog post for your practice expert, and with a little work, you can do regarding an interesting topic. So, a family more of what you love (and less of what physician who likes sports medicine you don’t). may write articles about common sports injuries in high school students.

A final low-cost marketing idea is to send a letter to your referral base (once this is well established) when you celebrate a Written by Nahille Natour, MD, FACOG For more information, head to www.physicianoutlook.com

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The Path to Coaching So, you’re in the middle of a dilemma and you’ve heard about this thing called coaching that some people engage in to work through their quandaries. But you’re not sure about it. What is it going to be like to be in coaching? Several images come to mind when you contemplate the term: a basketball coach cheering from the sidelines, the scholarly coach of a college debate team forwarding readings, or the literal vehicle – a coach - that transports tourists from site to site.

Coaching has elements of all of these.

The common feature: forward movement toward a goal.

Succinctly, coaching takes clients from their present state to a future state through: 1) defining the outcome that the client wishes to get from coaching, 2) illuminating the barriers that prevent them from attaining that goal, 3) determining steps to take to overcome those barriers, 4) taking those steps, and throughout 5) developing insight with the goal of sustaining gains made in the process.

A coach does all the above through reflective inquiry – a process of questioning, reflecting back your responses, then further questioning to 22 | 2021 VOLUME 8

allow you to see yourself in a new light.

Reflective inquiry uncovers beliefs, perceptions and values that function either as roadblocks or promoters of your progress. The insight you develop from this process allows you to see a way out of your dilemma. Next, the coach facilitates a discussion to develop a plan for achieving your goals and, most importantly, to sustain that growth. Note that coaching does not involve diagnosing problems or giving advice. A coach is a thought partner and insight facilitator.

While the description of coaching above sounds linear, like most growth and development that sticks, it is actually more serpentine, iterative, and contemplative. As these states can, at times feel unsettling – especially for physicians, the coaches job is to create an environment where you feel safe and can trust that solutions will emerge, through insight that is developed from coaching, for you to be successful.

Here is a case example to illustrate: Dr. B., a general internist in a healthcare system outpatient practice, turned to coaching because she was burning out from the way she was expected to practice medicine in that system. Seeing 25+ complex patients per day required at

least 2 hours of work per night after clinical hours. While she loved the patients, she saw the way that she had to practice as unsustainable for her health and her relationships with her spouse and children. In coaching she uncovered a limiting belief that financial security could only be achieved if she worked as an employed physician. Further, she came to realize that what really, really mattered to her professionally was to engage meaningfully with patients – which meant taking the time they needed, not the time she was given. With these and other insights gained, she determined that she needed to explore other models of practice that could provide both reassurance that she would be okay financially as well as be able to practice in a more fulfilling manner. After said exploration, meeting with a financial adviser, and processing all of it with her spouse, she decided to join a direct primary care practice where her income is less, yet adequate and her satisfaction with her professional life--exceeding her expectations!

While Dr. B.’s coaching story sounds tidy, she would tell you that there were days and weeks of discomfort, anxiety, and second guessing. However, she would also share that, through coaching, she implicitly trusted the process because she learned to trust herself and what she valued.

Coaching is often described by clients as a journey of self-discovery. While not always comfortable to come face-to-face with ourselves, with the awareness that develops conscious decisions are made towards aligning one’s self with their unique path. Ultimately, that is what allows us to thrive. And, when we are thriving so are those around us – our patients, families, and our colleagues.

Written by Dael Waxman, MD For more information, head to www.physicianoutlook.com

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Physician Coaching: Explained Coaching has no definitive definition, but the concepts it entails are empowering.

Thinking, listening, and verbalizing with a trusted partner can be therapeutic at its most basic. Coaching is not one partner asking a series of questions. It is a process of inquiry. Such inquiry is part of a process toward progress that can provoke critical thinking and a greater awareness within the coaching client.

Each client’s reasons for enlisting coaching are certainly varied, but there is some inciting issue or situation that prompted them to first consider, and then seek out a coach. The reasons may not be clear to the client, nor may their expectations be of their outcome.

What gets the client in the door (or on the phone) is far less important than the initial coaching conversation.

Why? Simply because the outcome of a coaching conversation must be clear, and it may often evolve as coaching progresses.

Changing behaviors is never easy, especially if those behaviors are limiting our growth, learning, and overall potential.

Humans are social creatures and need the presence of others to enrich our lives. Attempting to “go it alone” can work in some situations, but not all. The objective approach a coach employs can be both enriching and profoundly transformational.

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Part of our greatest challenge in life is realizing our strengths, weaknesses, and talents. It can be a struggle filled with trial and error, frustration, and at times, a seemingly overwhelming quest to understand if the path we have taken is the “right one.”

What does any of this have to do with coaching?

Quite a bit, actually.

We often follow our gut, or the inner voice that guides us as we make countless decisions each day, many of which do not It is easy to admire those who have require much thinking. Most of the time, seemingly reached the pinnacle of their there is not second guessing or concern professions, as they often make their that such decisions were incorrect (think accomplishments seem simple. Observing driving home from the supermarket). the success of others from afar can lead It’s those other times that seem to hold to the perception that those of such a higher level of uncertainty, due to the status have a charmed life, one without stakes involved, or the underlying fear of hardship or struggle, and that their lives what a “wrong choice” can lead to. are somehow better than our own. They Even though coaching lacks a definitive certainly have discovered the keys to definition, a one-size fits all approach, it happiness as a result. can be gleaned that at its core, coaching is the opportunity to seek wisdom, Or have they? guidance, and objective support from a like-minded, expert individual. The One does not have to search far for stories benefits are abundant at any stage of your of those who seemingly had it all, only career. All you need is a willingness to to follow their success with often selfgive it a try and start the conversation. inflicted destructive behaviors that reveal anything but an exceptional life. It’s easy to wonder, “how could someone with the world in the palm of their hand, throw it all away?” You might even feel better, at least momentarily, learning about another’s misfortune when compared to your own situation. That is, until reality Written by Desmond Bell, DPM, CWS sets in and you are pulled back to the For more information, head to reality that you are still “stuck” in your www.physicianoutlook.com own personal hell.

Simply and Positively

Transformative

Dynamic change. Measurable change. Tangible outcomes. The coaching experience I provide is designed to provide more than just temporary clarity. It is designed to help you use that clarity, along with the tools I give you, as a framework which you can apply to your personal and professional life.

Recently, I had an amazing opportunity to work with a physician who initially engaged my services because she was feeling several real-world constraints in most aspects of her life. At work, she was experiencing a period of high turnover within her organization and felt unsatisfied in her leadership role as defined.

At both work and home, she had limited free time and felt overwhelmed. We all have these seasonal phases in life where we feel the walls are closing in from every direction and in every room we go to. This was my client, whom for the purpose of this transformation story we will call Dr. Jane.

After my initial exploratory call with Dr. Jane and taking the time to digest her situation, and what was the underlying need, I recommended that a four-month long engagement was the minimum amount of time needed to make significant strides for her transformation. Again, my goal was to provide her with the tools she needed to initiate and expect change. As part of Dr. Jane’s customized plan, we did 3 things: (1) a 360-degree assessment; (2) a Genos emotional intelligence assessment; (3) identify areas of opportunity at her job. Each area of focus has a specific purpose.

In between each session there were exercises designed to create a series of small wins and new habits. Within a couple of weeks, she noticed changes. Some of these exercises focused on increasing emotional intelligence, seeking continuous feedback, and learning to be direct with communicating her transformation goals to others. As with many leaders, Dr. Jane was very goal oriented and worked extremely hard to achieve them. Good leaders know how to achieve goals, focus on the people behind them, and share the success.

With each successive session I had with Dr. Jane, we went through my cycle of success model to (1) find out what did you do since the last time we met (2) how was it received or did you accomplish it (3) determine the next set of actionable/ tangible tasks for the next session. There are several frameworks which have similar feedback loops. The key with my coaching (and the coaching concept in general) is the guiding versus consulting aspects. This was a key point that I repeated to Dr. Jane throughout our journey. She needed to understand that as her executive coach, there will always be more guiding than consulting. This was part of giving her the tools needed to create long-term results.

The results? Simply and positively transformative. Dr. Jane received a 10% out of band performance raise. Her employee retention and satisfaction rates/scores increased from the previous quarter. She had more confidence in her role by better leveraging her strengths and of her coworkers. Outside of work, Dr. Jane was able to find the time to learn the piano and exercise enough to exceed her weight loss goal of 10 pounds! By no means were all of these changes overnight. It took time. Dr. Jane needed to invest herself and time into the process. We worked together so that she could see herself on the other side of this even before we began. It is possible. The better you is possible.

I would love to be your trusted executive coach that will help make that happen for you, just as I did with Dr. Jane.

Written by Rachel Miller, MD For more information, head to www.physicianoutlook.com

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“Hang on for me, don’t give up”

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Because hope lives in us.

26 | 2021 VOLUME 8

Written by Alyssa S. Jenkins, RN Photos courtesy of Alyssa S. Jenkins, RN For more information, head to www.physicianoutlook.com

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The Value of

Coaching In early September 2020, a little over a year since I started my training, I certified as a life, leadership and executive coach through the Australian Institute of Professional Coaches. But why did a British Family Physician, residing in Australia at that time, embark on this journey and why is it relevant to you, the physician reader?

While I was working as an Associate Medical Director in the UK’s National Health Service in 2018, I was not the best leader. To be fair on myself, I had never held such a lofty position before, nor one with such responsibility where the spotlight is on you more than it is in your clinical job. Call me naïve, but I didn’t realise my less-senior colleagues, clinical and non-clinical alike, would be looking to me for strength and as a good example of how to conduct one’s self. I genuinely had no notion that I was being ‘observed’; not in a bad way, but that my actions and I were so visible. And why would I? I had actually been appointed to this position because I was both a practising physician and a qualified lawyer, not because I had previous stellar form as a medical leader.

And therein lies the problem, there is no leadership training at medical school, certainly not in the UK anyway. The curriculum is so packed with basic medical sciences and clinical subject matter that there is no room for ‘softer subjects’ like leadership, even though arguably it is as essential as anatomy and physiology, just not as immediately. We simply have to pick it up as we go along, learning ‘on the 28 | 2021 VOLUME 8

job’ so to speak, often from seeing how our seniors lead and modelling our behaviour on their examples.

So, when my tenure in that role came to an end (it was a fixed-term contract), I asked my employer to fund some leadership coaching for me and thankfully they agreed. This was when my visual fields began to expand beyond the blinkered view that the medical profession offers physicians. All of a sudden, I was exposed to concepts like values, beliefs, mindset, emotional intelligence, wellbeing models, leadership styles, circles of concern / influence / remoteness etc.

So much of who I was, how I was living my life and why I made certain choices all began to become much clearer and everything changed for me as I quickly came to understand the power of coaching.

I then began to live my life, not just my work-life but my whole life, by my values, which I now had a deeper knowledge of and appreciation for. It was liberating and empowering to try, wherever possible, to only engage in activities which were in alignment with my values.

I started thinking about my life and what I wanted from it. What kind of a person I wanted to be, not only with my colleagues

but also as a husband, and father, and how I could achieve those wants and desires. I reframed those wants as ‘goals’ and, with the help of my own coach acting as both a strong supporter and accountability partner, I set about achieving those bigger picture five-year goals through more readily achievable monthly and three-monthly goals. It was like a switch had been flicked in my brain.

I decided that I personally could make more of a lasting and valuable impact in the world as a coach than as a physician, and so my transition from doctor to fulltime coach began. I undertook my coach training and set about helping doctors work out things like: How do I want my life to look in five years’ time? How can I achieve that in the shortest possible time?

What are my values and how can I use them to guide me down a pathway that I truly want to go down?

What do I really want from my career and how can I make that happen as quickly as possible?

What kind of a leader am I and what kind do I want to be? How can I create that outcome?

And as I have coached my clients,

predominantly US-based attending physicians from all specialties, I have come to realise that coaching not only helps us achieve our goals in a shorter timeframe than if we tried to achieve them on our own, but it helps us maintain a standard of personal and professional excellence beyond the attainment of those goals, long into the future. In other words, it helps us become and stay our ‘best selves’. Dr. Jim Kim, President of the World Bank and former physician, put it much better than I ever could when explaining why every leader needs a coach: “… anyone can get better. And if the best people in the world at what they’re doing [e.g. Tiger Woods and Atul Gawande] are getting coaching, then everyone should.

And just the notion that anyone can get better, including me, might be the first and maybe most important step you take in actually being a better leader.”

So, in summary, if you want to achieve personal, career and leadership goals, much more quickly than you would if you tried to do so on your own, and then maintain and improve upon the position you get to once you have attained those goals, instruct a coach and start your own personal journey toward transforming your life.

Written by Adam Harrison, MD For more information, head to www.physicianoutlook.com

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The Key to Sustainable Change Peer Coaching for physicians has been shown to be an effective wellness tool, and has many different variations. One particular coaching strategy is that of showing clients how to strengthen their mental fitness.

This powerful technique allows one to gain control over thoughts, and shift mindset from negative to positive. Based on the program “Positive Intelligence” by Shirzad Chamine, the idea is that through the use of mindfulness exercises, one is able to command themselves to shift from defeatist, cynical thoughts to those of optimism and enthusiasm.

This concept is based on research in areas of positive and cognitive psychology, performance science (think elite athletes), and neuroscience (neuroplasticity). For physicians, the concept of neuroplasticity is very compelling; the ability to modify neural pathways with repeated thought processes is how we can strengthen our positive thought patterns while simultaneously weakening the negative patterns.

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“Positive Intelligence” model of mental fitness personifies these thought patterns by referring to the “saboteurs” (negative) and the “sage” (positive). The saboteurs consist of our judge (which is universal; our inner critic), and a host of accomplice saboteurs, whose strength is based on our personality.

For those of us in medicine, the predominant saboteurs are often “hyperachiever”, “controller”, hyper-rational”, “hyper-vigilant”, “stickler”, and “pleaser”.

These characters generate all the stress, anxiety, frustration, anger, and sadness that we feel. Conversely, we all have a sage. This character represents our authentic self; this is one’s pure, inner, true essence. Our sage is the origin of all the sensations of love, calm, creativity, passion, and optimism that we feel.

The saboteurs reside in areas of the brain stem, limbic system, amygdala, and parts of the left brain, while the sage is found in the middle prefrontal cortex and areas of the right brain. Through the years, we have come to rely on our saboteurs to guide our decisions and actions (as part of our survival mechanism), and

consequently our sage has been overshadowed and buried by these overbearing negative thought patterns.

By strengthening mental fitness, we cause atrophy of the saboteur pathway and hypertrophy of the sage pathway.

The “muscles” of mental fitness that we build with this process are self-command, saboteur interceptor, and sage. The process is as follows: recognize when a negative thought (saboteur) is happening, STOP, do 10-20 seconds of some kind of mindfulness exercise in the moment, then commit to moving forward in a positive (sage) manner.

The sage perspective is that every circumstance and interaction can be seen as a gift and opportunity, therefore allowing us to reframe and see the positivity in all situations. Furthermore, our sage possesses 5 powers— empathy, curiosity, innovation, navigation, and activation.

In particular, the power of empathy is vital for those of us in medicine; not only does this refer to empathy for others and circumstances, but also empathy for OURSELVES.

Physicians are notorious for being hard on themselves, thinking they should be perfect and infallible (all thoughts of our judge and accomplice saboteurs). Being able to recruit the power of empathy instills compassion, both for ourselves and others.

Developing mental fitness allows for growth and strength in many areas of life.

Indeed, there are multiple applications for this work, both personally and professionally. When we think of our roles as physicians, we often think about the challenges of work/life balance, job satisfaction, and burnout. In addition, issues around communication skills, leadership, and self-actualization are important areas for improvement.

As an example, I want to highlight a physician client of mine, and his use of mental fitness training to overcome challenges in his work environment.

The client is an EM physician who was motivated to improve his interpersonal skills, both with colleagues and patients.

After discussing the concept of mental fitness, he committed to this work, and went so far as to have a “pause button” tattooed on his wrist.

The client got into a routine at work wherein he identified when a negative thought was about to hijack him. He would STOP, look at his tattoo for 10-20 seconds, then proceed in the situation with his sage mentality.

Practicing this routine faithfully led to improved interactions, both with patients and staff, and not only did he feel much happier, but his colleagues noticed a difference in his attitude and behavior.

He was now able to reframe challenging situations, and see the opportunity to recruit his sage powers, whether that be empathy, curiosity, or innovation.

Medicine today brings with it many issues; we all are familiar with the challenges that make this profession so difficult. Physicians need to be in touch with self-care strategies that mitigate the stress; coaching is a perfect wellness tool to accomplish this goal. Similar to having a personal trainer at the gym for physical fitness, a peer coach serves as a personal trainer for mental fitness. Maximizing mental fitness is not about changing who you are, but getting back in touch with who you REALLY are. This is the way to sustainable change!

Written by Susan Wilson MD, CPC For more information, head to www.physicianoutlook.com

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Inclusive Leadership I pulled my car into the parking lot at 7:02 am. I tried to quiet the butterflies in my stomach walking from my car to the hospital, but I was too excited. It was my first day and I was eager to begin. I was intent on meeting other team members and the medical staff. These would be the people with whom I would work side by side.

What will we accomplish here together?

What do we want to amplify going forward? I didn’t have the answer to those questions, but I reminded myself that not every question has an answer on day one.

All good things would be revealed, and soon, I would find my way.

The executive assistant greeted me when I entered the administrative office. Neither of us was clear about what was to happen next, so I was politely escorted to my colleague’s office, where I was invited to make myself comfortable.

A few minutes later, my new leader arrived. Following morning pleasantries and a little casual conversation, we spoke about the agenda for the morning. I

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learned that no one was aware that I was going to be working at the hospital as a member of the C-Suite—not the staff and certainly not the members of the medical staff.

I learned the announcement explaining my transfer and my predecessor’s transfer would take place at a town hall meeting scheduled for that morning. And I learned that until news of the reorganization had been broadly communicated, it was suggested that I stay in the office with the door closed and wait.

Wait for what exactly? I didn’t know. An invitation to attend the town hall? Wait for insight into how this unexpected overnight transition from one hospital to another was going to work for our mutual betterment?

What I did know, however, was that my leader didn’t initiate a conversation about what my role could be. There were no words of welcome to my new work home, no “it’s nice to have you here.” Instead, I sat alone in the office, less than one hour into my first day, questioning if I belonged there.

Unfortunately, my experience of feeling excluded is not a unique phenomenon.

Every last one of us knows what it feels like to be excluded. We all have an outsider story to draw from - an experience of feeling different and wanting to be part of the “in-group.”

Similarly, we have fundamental needs and wants as humans that are the same. We all want to be seen, heard, valued, and welcomed. If we share the same basic needs and can relate on a personal level regarding the absence of belonging at work, why isn’t inclusion cultivated in the walls of today’s healthcare organizations?

What if inclusion was as commonplace throughout an organization as daily huddle discussions focused on quality and safety? I’ve personally experienced what a difference inclusion and belonging can make in someone’s life. Because I’ve had my own struggle of working in an environment where inclusion felt like it was an afterthought, I’m inspired to create a space where everyone hears messages that say “we see you,” “you’re important,” and “we’re delighted that you are here.”

Accepting, Valuing, and Welcoming Differences as the Norm As a physician who self-identifies as female and African-American and is unapologetically passionate about physician leadership, I am all too familiar with being the only one in certain spaces - the medical team, the C-suite, or the board room. And as an executive coach to minority and majority physicians who are at all stages in their leadership journey, I hear the challenges that arise when unconscious bias, microaggressions, and disempowering beliefs invade these spaces, interfering with people feeling valued and bringing more of their varied skills to their work.

There are numerous benefits of inclusion.

My clients express the greatest impact in their professional life is being comfortable expressing and being themselves without fear or embarrassment or retribution.

When they feel their uniqueness is known and appreciated, it improves collaboration and that drives better patient outcomes.

Leadership does matter. Our movements do matter - more than we remember and more than we know. In the example that I shared at the beginning, I received a

message that I was not welcome. Even if that was not the intention, it was the impact. The smallest things can make people feel more or less included, valued, and respected in our healthcare systems and organizations.

Intention is one ingredient necessary to achieve an environment where everyone can thrive and contribute fully toward success. But I contend intention must be combined with self-awareness, courage, accountability, radical empathy, and respect. When the ingredients come together correctly, a transformative environment is created.

Like any dessert relies heavily on the quality of its ingredients to create a decadent experience for the consumer, inclusive environments rely heavily on the sincerity of its people to make real progress toward connectedness. If we are to transcend solving complex problems (i.e., healthcare disparities, excellence in safety and quality, physician engagement, and more), we must develop inclusive leaders.

Inclusive leadership is how we’ll design and ultimately achieve a space where diverse people are able to participate fully in the decision-making processes within a group or organization. I am committed to helping healthcare organizations promote inclusion as a leadership skill, thereby advancing it as more than “a nice to have,” but rather a “must-have” to be competitive in the marketplace.

Think about your first day at work. Or think about the best group to which you ever belonged. What made you feel welcome? How did other members show that you were valued as part of the group? Inclusion is the magic ingredient to achieve innovation among diverse group members. Inclusive leaders value who people are and what they offer, and they are mindful of their impact.

“When everyone is included, everyone wins.” - Jesse Jackson Written by Teresa Malcolm, MD, FACOG, MBA, CPE, CPXP, ACC For more information, head to www.physicianoutlook.com

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The Missing Link When we are running away, fear leads us to have a singular focus - to get away - but yet we keep looking back over our shoulders at what we fear. We are expending all of our energy trying to get away, and never know when we have truly succeeded in escaping. And I have to tell you, we can’t run away from the fear of our own bodies.

Instead, what can we run towards?

Having a destination creates a goal.

What do you want to create? Where do you want to go? It’s not necessarily the absence or opposite of what you don’t want. Instead of being skinny or having a certain weight, consider: what would healthy habits look like for you and your family? What do you want to think about yourself? What would a positive body image feel like? What would it be like to focus on what is going well, and celebrating steps forward as a family?

When we look at what we can change our thoughts, our feelings, our actions; we create a very different outcome than arguing with the circumstances of our bodies.

As you look towards your goals, what will it feel like to be there? This is the magic of coaching: You can create that feeling now. And we can help our patients find that feeling too. As physicians, instead of advocating for our patients to lose a number of pounds, start a particular diet, or restrict the number of calories to be eaten each day, we can advocate for their wholeness. We can help them focus on what brings them joy, celebrate their body’s capabilities, and help them grow.

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Instead of looking at what needs to be fixed, the process of seeing what we want to create is changing the dialogue around what it means to be healthy. Health is not a number on the scale or a particular diet - it is celebrating the whole person, and what it will feel like when we create and achieve goals.

I want to feel strong.

I want to feel amazing in my body.

I want to feel free.

As a certified life & wellness coach for parents of overweight children, and a pediatrician, I am learning what works: reframing obesity, removing the fear and shame to embrace the body as it is, right now. And then creating what you want: freedom, empowerment, acceptance, love -- and yes, health, at any weight.

My clients look at their existing routines and then create healthy habits for the whole family. Those habits are not all about eating or movement or portion sizes. The habits are the beliefs they have about themselves and their bodies, how to fuel themselves physically, mentally, emotionally, and spiritually.

The habits are cultivating the emotions of self-acceptance, peace, calmness, and love. The habits are getting restful sleep, prioritizing self-care, and listening to the body. Every client’s journey is different. But it’s amazing how they have such similar results: a feeling of freedom, empowerment, self-confidence, connection, and becoming a role model for their family’s health.

Let’s stop focusing on the weight and instead focus on what makes us amazing, beautiful, unstoppable, perfectly imperfect humans.

Art by Alexandra Haynak

“You can’t run away from something, you have to run towards something.”

in Pediatric Obesity Pediatric obesity: we see evidence of it everywhere. According to the CDC, over 35% of American children are either overweight or obese, and American adults are experiencing obesity at even higher levels. News headlines, medical journals, and commercials for weight loss medications/programs all insist that we have something to fear, and it’s time to take action now, before it’s too late.

Fear has been our medical approach to obesity over the past generation. As parents, physicians, and patients, we fear and focus upon obesity and its health consequences. Internalized thoughts about our weight are reflected in our self-identity (I am obese, I am overweight, I am the parent of an obese child, etc.).

We restrict junk food, we count calories, we teach our children good and bad foods.

As physicians, we refer to endocrinology, therapy, and nutrition and weight loss centers, looking for the fix.

And yet pediatric overweight and obesity are continuing to increase in severity and the percentage of children affected.

This is a story of how coaching parents can create a much different outcome, starting with the moment my approach to pediatric overweight changed: At the beginning of every visit, I would plot the child’s growth on a chart, and look at the curve. Parents would wait with baited breath... What’s the news? I could hear it in their anxious voices, “What kind of parent am I being?” Emily’s mom asked me why I wasn’t having the “BMI chat” with her. I asked, “Why? What is your concern?”

BMI. We had already covered that she ate a variety of whole foods at meals with her family, and enjoyed lots of activity over the course of the day. There were no “red flags.” Emily’s mom came to tears.

“You’re the first doctor who hasn’t told me I was doing it all wrong because she’s still ‘overweight’.”

Shame is a painful feeling that emerges when we think we have done something wrong, and feel that we are flawed, and it is what Emily’s mom was freed from. It impacts our sense of self and worthiness, and I have seen parents set their worthiness on whether kids are going up or down on the growth curves.

As humans, our emotions drive us to take action, or avoid it. When we are feeling joy and hope and other positive emotions, we lean in and engage. In the discomfort of shame, we tend to withdraw, hide, and seek comfort, which often looks like consuming food or media. Shame does not produce meaningful “corrective” change. Shame and fear of long-term consequences become potent partners in the experience of childhood obesity.

Written by Wendy Schofer, MD, FAAP, DipABLM and Erin Schofer For more information, head to www.physicianoutlook.com

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Reflections on Becoming a

Running Coach Running has saved me from burnout more than once.

I wasn’t always a runner. In fact, I was the kid who huffed and puffed her way around the track to complete the mile run.

I found running, or maybe it found me. About nine years ago, I had just completed my residency, moved to a new place, and started my first attending job. I was a newlywed, and while I thought I would be spending my time enjoying a new home, a new career, and newfound wedded bliss, my world turned upside down when my wonderful dad was diagnosed with cancer. It was a period of great unease and stress. And yes, it was a period of burnout, though I didn’t recognize it back then.

Feeling like a bit of fraud, I would tell my patients and families to eat healthfully, to exercise, to make sure they were resting and getting enough sleep. But, there I was, not taking my own advice.

I decided that something needed to change.

I laced up my sneakers and jogged around the block for just five minutes. I did that for a few days in a row. Five minutes became ten minutes and then fifteen minutes.

on a never ending treadmill, heading aimlessly forward without knowing how to step off, hit pause, or change direction.

Also at this time, I was training for my first marathon. I spent many hours with myself, deep in the calm, trying to figure out where I was headed. In my free time, I was reading about running, taking a deeper dive into run physiology, researching how to structure training plans and training cycles, engaging in discussions with my running coach, and answering the running questions of friends and family.

A dear friend, colleague, and physician coach, provided the question that stopped me in my tracks and forced me to pause.

“What if you became a run coach...?” The seed which became Mindful Marathon began to grow.

And yet, I thought that somehow, I had to choose who I was going to be: pediatrician OR run coach? My identity felt tied to the profession, until I realized that it didn’t have to be an “or.” I had the power to make it an “and.”

I am a pediatrician AND a run coach. I help make running easy and fun for busy professionals. Through Mindful Marathon, I What kept me lacing up my sneakers? When I was jogging have helped newer runners to first race distances from 5k to around the block, I found that all of the thoughts in my head grew quiet. What seemed like chaos before the run, became calm the marathon, to train smarter and not harder, to experience the during the run, and I loved that feeling. From my first 5k race to joy of running, and to achieve confidence that spills over into multiple half marathons, I kept going. aspects of their lives that they never thought possible.

Six years after lacing up my sneakers for the first time, I found myself struggling through burnout in medicine. I felt like I was

We have the power to choose who we are going to be. What would it look like, if you allowed there to be an “AND”?

Written by Michelle Quirk, MD, FAAP For more information, head to www.physicianoutlook.com

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Compassionate Coaching Dr. Robyn Alley-Hay’s wake-up call happened 10 years ago.

After divorce, she was living between Montana, where her kids lived, and Illinois, where she worked. She discovered her son was battling an addiction to drugs and alcohol, so she left her job to be closer to him and her other kids.

Studies show that this state increases openness to learning, creates a higher incidence of sustained change, and increases the overall sense of physical and mental well-being. Dr. AlleyHay creates resonance and rapport with her coachee, and anchors the conversation always in positive emotions.

To clear her contract, she had to declare bankruptcy. In her own words, “I had pretty much f*cked up my life.” She had been putting her heart and soul into her work as a clinical physician for 25 years and now she felt totally destroyed by it. She was completely at sea, and she didn’t know where to turn. She knew it was time to make some serious changes when a longtime friend and ED doctor took one look at her and told her, “You need resuscitation.”

Throughout the coaching process, the coachee discovers their ‘ideal self’ and articulates an overall vision for the future.

They take a deep dive into their strengths and weaknesses by comparing their current self with their ideal self. They work with Dr. Alley-Hay to use this knowledge to create a framework, and learn to leverage the strengths they already have to create sustained change and wellbeing.

This is when she found coaching. After working with her own coach for a while, and seeing its transformative power in action in her own life, Dr. Alley-Hay decided to train as a coach herself. She wanted to help her colleagues that were going through hardship. While she trained, she returned to locums practice. Fast-forward to today.

Dr. Alley-Hay is now an international women’s empowerment coach, author, speaker, educator, and longtime feminist, who is committed to helping women master their inner power and vision, taking them from anxious to powerful.

At the invitation and special blessing of His Holiness the 14th Dalai Lama, Dr. Alley-Hay started a cervical cancer screening clinic in 2016 and continues to provide medical education and training to the local indigenous healers and midwives. The way she puts it: “I receive so much more than I give.”

As well as being a certified life coach, Dr. Alley-Hay is a master of reiki, meditation, and mindfulness, and this has led her to embrace a holistic approach to medicine and a compassionate coaching style. She spends time every summer working with a non-profit organization that travels to the isolated lands of Tibetan Buddhists in the northern Himalayas. She explains that the premise behind coaching with compassion is to use Intentional Change Theory (ICT) to create a psychophysiological state of positivity.

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Written by Robyn Alley-Hay, MD For more information, head to www.physicianoutlook.com

Publisher: Marlene Wüst-Smith, MD Editor in Chief: Alicia Roselli Managing Editor: Roxanne Bruce, MBA, DrBA, VP of Advertising: Pamela Ferman Director of Art and Production: Tobias Sarrio Marketing/Copyright Editor/ Journalism/Social Media Interns: Samantha Petzold, Riley Snowden, and Madison Smith, Pennsylvania State University and Molly Matthews, Hobart and William Smith Colleges Contributing Authors: Catherine Woodhouse, MD, Cecilia Cruz, MD, MPH, Errin Weisman, DO & Sinéad O’Kelly, Scott Abramson, MD, George P. Naum, MD and Vanessa Naum, Marion Mull McCrary, MD, FACP, NBC-HWC, Melissa Hankins, MD, Randy Cook, MD, FACS, Nahille Natour, MD, FACOG, Dael Waxman, MD, Desmond Bell, DPM, CWS, Rachel Miller, MD, Alyssa S. Jenkins, RN, Adam Harrison, MD, Susan Wilson MD, CPC , Teresa Malcolm, MD, FACOG, MBA, CPE, CPXP, ACC, Wendy Schofer, MD, FAAP, DipABLM and Erin Schofer, Michelle Quirk MD, FAAP, Robyn Alley-Hay, MD Cover Art: Navreet - Poppy Jasper Arts Published by “Physician Outlook Publishing” Editorial policy: Physician Outlook magazine is a national magazine dedicated to empowering physicians and their patients to improve the world of medicine together. Editorial decisions are based on the editor’s judgement of the quality of the writing, the timeliness of the content, and the potential interest to the readers of the Physician Outlook magazine. The magazine may publish articles dealing with controversial issues. The views expressed herein are of the authors and/or those interviewed, and may not reflect the official policy of the magazine. Physician Outlook neither agrees, nor disagrees with those ideas expressed, and no endorsement of those views should be inferred, unless specifically identified as officially endorsed by the magazine.

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Inspired by the Staff wielded by the Greek god Asclepius, the deity associated with Healing and Medicine. The Staff of Asclepius is the true symbol of Medicine. It is often confused with the Caduceus - a short staff with wings and 2 entwined serpents - the symbol of the god Hermes and unrelated to Medicine. The flowers in my Rainbow Garden are ‘hand picked’ for their symbolism.

Blackthorn (small white flowers) - protection, overcoming obstacles for a better future.

HOPE in the midst of devastation. It is a haven for birds such as the nightingale who find protection amongst the tree’s long thorns.

Clematis (purple flowers) - ingenuity and associated with the beauty of mental strength California Poppy - restful sleep, peace in death, consolation for loss Coneflower (red flowers)-strength and healing Daisy - spring and rebirth, joy Red Lily - love, passion Blue Lily - hope and tranquility Blue Bellflower - constancy, humility, gratitude Orange Calla Lily - rebirth, resurrection, faith Blue Lotus, Kamal Flower - the symbol of intelligence, wisdom and knowledge

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ISSN 2768-6019