Episode 10.10 Habits That Help Doctors Thrive

Antonia and special guest Kristi Angevine explore how physicians can rethink habits beyond routines to include default thoughts, feelings, and reactions, and how that shift relieves burnout and restores purpose. Practical micro-habits, internal validation, and redefining productivity help us lead better and live better.

• habits as automatic thoughts, feelings, reactions
• perfectionism, people pleasing, catastrophizing as learned solutions
• survival seasons and low‑friction wins
• two micro‑habits: emotional check‑ins and box breathing
• escaping all‑or‑nothing with iterative learning
• redefining productivity around alignment, not to‑do lists
• internal validation and making yourself make sense
• training culture, criticism, and choosing supportive mentors
• identity beyond “doctor first” to include rest and health
• coaching options: group community and private work

Be sure to check out Thinking about obgyn.com for more information, and be sure to follow us on Instagram

0:01 Setting The Stage: Habits In Medicine

0:32 Introducing Dr. Kristi Angevine

2:05 Redefining What A Habit Really Is

4:20 Perfectionism, People Pleasing, Catastrophizing

7:12 Coping Gone Sideways And Burnout Risk

11:21 Unrealistic Standards And The Inner Critic

15:54 When Work Ethic Becomes Self-Neglect

19:30 Why Simple Routines Aren’t Easy

23:12 Survival Seasons And Low-Hanging Fruit

26:12 Two Five-Minute Habits That Stick

30:45 Escaping All-Or-Nothing Thinking

36:05 Internal Validation As A Mental Habit

41:05 Success Beyond The To-Do List

48:39 Burnout’s Roots And Moral Injury

52:42 Training Culture, Criticism, And Resilience

Follow us on Instagram @thinkingaboutobgyn.

Chapters

• 0:01 Setting The Stage: Habits In Medicine
• 0:32 Introducing Dr. Kristi Angevine
• 2:05 Redefining What A Habit Really Is
• 4:20 Perfectionism, People Pleasing, Catastrophizing
• 7:12 Coping Gone Sideways And Burnout Risk
• 11:21 Unrealistic Standards And The Inner Critic
• 15:54 When Work Ethic Becomes Self-Neglect
• 19:30 Why Simple Routines Aren’t Easy
• 23:12 Survival Seasons And Low-Hanging Fruit
• 26:12 Two Five-Minute Habits That Stick
• 30:45 Escaping All-Or-Nothing Thinking
• 36:05 Internal Validation As A Mental Habit
• 41:05 Success Beyond The To-Do List
• 48:39 Burnout’s Roots And Moral Injury
• 52:42 Training Culture, Criticism, And Resilience
• 57:05 Coaching Options And Community

Transcript

Speaker 1: 0:01

Welcome to Thinking About OBGYN. Today's episode features Antonia Roberts and Kristi Angevine discussing habits on purpose.

Kristi: 0:15

Antonia. Christy. So have you seen Howard? Where is he?

Antonia: 0:19

I think he's giving us the episode off. It's just me and you this time.

Kristi: 0:24

Okay. Well, I as much space as I have in Howard, I think we can handle it. What do you think?

Antonia: 0:30

Yeah, that sounds good. Let's try.

Kristi: 0:31

Perfect.

Antonia: 0:32

We're talking about on this episode the habits that we need to make our lives and careers better. And so for our listeners, I'm going to introduce Christy Angevine, who's an OBGYN by training and practiced for about 10 years or so as an OB, but now focuses on helping physicians, especially female physicians, as a life coach. And specifically, this I'm just stealing from your website. So I'm going to quote it. Keep your high standards and bold goals, ditch perfectionism, keep your fierce kindness, quit the people pleasing, learn to compassionately direct your mind on purpose and trust yourself completely. Because at the end of the day, who matters most in your one wild and precious life?

Kristi: 1:24

So that last bit is from a Mary Oliver poem.

Antonia: 1:28

Yes. And apparently Howard loves that poet. And that quote is from a poem called Summer Day. And so then I'll just start this whole conversation with some more lines from that poem. So if Howard were on with us here, he'd probably read the entire thing ad nauseum. But the listeners may, you guys can Google it. The Summer Day by Mary Oliver. But here's the last four lines of it. Tell me what else should I have done? Doesn't everything die at last and too soon? Tell me what is it you plan to do with your one wild and precious life?

Kristi: 2:02

Yeah, those are good questions, right?

Antonia: 2:05

Well, so you are a physician as well. What was the specific challenge or moment in your medical career that made you realize that understanding how habits work wasn't just maybe a side interest, but an essential survival tool?

Kristi: 2:22

Yeah. So the short answer is I became interested in this when I realized that I wasn't being as I wasn't being as efficient in the clinic as I wanted to be. And some of my ways of just like coping with stress weren't really supporting me. That's a short answer. But the longer answer is I think to answer this, I have to describe what I consider to be a habit because I think there's a misconception about what that word means when it comes to actually addressing them. And so the way I think of habits is that they're not just our morning routine. Our habits, they're the sort of almost default or automatic ways that we think, feel, and act and react. And I think you can go as far as to say that our habits are even things that we like habitually believe and might even include uh the goals we pursue and the things that we value. So the important thing to note here, and this will all connect, is that our habits are things that we learn. And in that way, they are solutions in the sense that they solve for something and they're usually really adaptive and protective strategies. So in that way, our habits they come from our lived experiences, and they also come from the way that we've been socialized, either by our family of origin or our peer group, or like for your audience, like our medical training. And some of our habits are really beneficial and they're useful and they serve us, right? And all of them made sense and were really effective, either for survival or whatever, when they developed in whatever season of life they were in. But some of our habits can have some negative consequences, or they might just be outdated and not really serve us today. And what I found in my own life is that many of our habits just we don't even think to examine them or question them or consider them carefully, because we don't even notice them as habits. And for me and for many of my clients, and I would imagine, yeah, a lot of your listeners, the habits that I noticed really plagued me were things like perfectionism that I didn't name as perfectionism, all or none thinking, second-guessing, catastrophizing, people pleasing, that I didn't even know as people pleasing, saying yes when you want to say no. Um, maybe things like letting your own opinion of yourself be really shaped by other people's opinion of you. And so for physicians, some of these habits, they come from what we learned in our training. And they're great for getting through training, but they can have an underbelly. So I started recognizing this myself and having an understanding that like what I was doing with taking forever to get through my notes, was connected to worrying about what people would think of me if I left the appointment without answering every single question. And then I was also realizing I was coming home completely haggard and empty. Like I just felt afraid. And so all my ways of coping with that were just counterproductive because I was exercising as an escape. I was staying out scrolling or eating or escapist reading or overworking. Oh, I'll just bury myself in more work. And they weren't really helping. And as I learned about coaching and started coaching physicians, I also realized that a lot of my clients, they were coming to me wanting to do things like eliminate their emotional eating, stop their drinking to wind down at the end of the day, stop what felt like compulsive shopping or scrolling. And when I did that work, not just with myself but with others, I realized that these habits, they were never really about the vice or the thing. They were always about whatever was three layers deep that the habit was solving for. And that's when things crystallized, maybe a year or so after I started coaching physicians, that I realized that if you don't understand why you do what you do habitually, you're probably going to be at higher risk for things like burnout and career disenchantment. And by understanding habits of physicians, I feel like we're going to really help with retention and career happiness and therefore keep more people in medicine and be able to do just do right by our own purpose and by just understanding ourselves in a different way. So that's a long answer to your short question, but I hope that makes sense.

Antonia: 6:37

Yeah, that's fantastic. I'm sure that among the listeners, probably a lot of people can relate to those struggles you just described. And yeah, that sounds like a really empowering way to look at all of those patterns as just habits that you can learn and relearn. So that's great. And it yeah, that kind of that I think that probably answers anyone's questions a little bit of how you transitioned over. So this is now your full-time career, is that right?

Kristi: 7:09

It is, yeah. And I to say that this was not anywhere on my radar is an understatement. I'm never I love being an OBGYN. There are parts about it that I miss. And I didn't leave because I didn't love it. I had a great practice, great patient panel. It was amazing. I just found something else that I loved as much, and sometimes just in a very different way that felt like I needed to pursue it.

Antonia: 7:34

I I am curious, like, because I imagine you have some OBGYN clients and maybe probably some that are not OBGYNs. Do you see a lot of similar issues that people come to you with, or does there seem to be patterns within certain specialties?

Kristi: 7:52

What a great question. I don't know that I would have to think about if I see like a particular unique pattern in a specific specialty, because I haven't noticed that. I do, I mean, I just I think birds of feather flock together. I do have a lot of OBGYNs that I work with. There's a niceness, no offense to any of my non-OBGYN clients, but there's a niceness to having that sort of shared lexicon and shared philosophy of approaching things. But I don't know that I see that much that is unique to a particular field. I think there are some things that are unique to high achievers in general and people who maybe pursue things that require a lot of delayed gratification and training that is has nothing to do with specific field. So yeah.

Antonia: 8:42

Okay. Yeah, that's interesting. So you've worked with a lot of physicians now on mindset and habit transformation. What would you say is maybe one of the most common habits that you see holding doctors back from feeling fulfilled or balanced?

Kristi: 9:00

Oof, yeah. Probably the most common habit that I see that keeps them from feeling balanced is holding themselves to an unrealistic standard concurrent with a really sharp inner critic.

Antonia: 9:13

Yeah, that brings a lot of. So it's kind of like you're damned if you do, you're damned if you don't.

Kristi: 9:17

Which is we can see just for anybody here who's, I don't hold myself to a high standard. What are you talking about? That's almost a telltale sign when we think that our standards aren't quite high. And if we're constantly trying to feel satisfied or feel whole or feel worthy by meeting what other people would consider like an unrealistic standard. Like, you know what, I can do it. I don't really need any sleep. It's totally fine. I should be able to get everything done and do all the things just right. But we don't see that as really, really like a steep challenge. And then we make ourselves wrong when we don't miss the mark. And then we feel discouraged and bad. Sometimes it can feel really just unavailable to even acknowledge that our standards is too high because we're coming at it from a place of I couldn't meet the mark because there's something wrong with me. So if I admit that my mark was too high, that further reinforces there's something bad about me, which nobody, we don't want to risk being excluded by the tribe and say there's something wrong. So we stay in the loop and don't realize it. So what I hear a lot is people will say mean things they would never say to a friend about themselves, and they won't recognize that it's harsh for a long time. And then finally they'll go, oof, wow, I do talk to myself meanly and push myself in ways that aren't kind. That would never do to someone I actually cared about.

Antonia: 10:35

Wow. Yeah, because people don't want to feel like they're just lowering their standards because that's how they would have not got through med school or residency if they did that. Well, and a lot of doctors do pride themselves on discipline and work ethic. And if nothing else, I show up and just grind through. So why is it that I think patients want to depend on us, but why is it that those same traits can sometimes fuel the burnout or the emotional exhaustion?

Kristi: 11:03

Oh my gosh. So again, another great question. I do, I, and I want to just say that for anybody listening here, by talking about some of these topics, I am in no way suggesting that there's something bad about discipline or bad about hard work or bad about having a really strong work ethic, but those things are great. It's just when they start slipping into an approach that does things that are like almost get in the way of the goal. So if your goal is to have a really strong work ethic to be able to support people, but you do it in ways that are really harmful to yourself or to your peers, you're not actually able to show up as good as you'd like. So what sometimes happens is people won't realize that their really strong work ethic has them not taking care of themselves. So they're prioritizing others. That trope we hear, patients come first. It's hard to argue that without feeling like you're a jerk or like you don't care, especially publicly. But if you always prioritize others at your own expense, and then you take that to, well, I need to make sure everybody else is not just taken care of appropriately, but is happy with me and is pleased with me and sees me as a team player, then and you pair that with some of the things we learn in residency. Well, you'll sleep when you're dead. Good doctors never want to go home. Then, and you put that with some perfectionism of I need to know everything all the time, and I need to be perfect and I cannot make mistakes. Then you've got a like a scenario which is really ripe for having exhaustion. So you're just not taking care of yourself, you're exhausted, you feel like you need to always be right. So you have an unrealistic expectation of yourself. And you won't ask for help or say, hey, I think I need to, instead of working 80 hours, I think maybe I would like to work 60, or I'd like to work 40, or I'd like to work 20, because that could be a sign of weakness. So you can start feeling really isolated and alone, which can lead to all sorts of maladaptive coping, just help you feel better, which exacerbates isolation and can ultimately all this stuff. I mean, anybody who's into mental health listening can go, oh, well, that's just a recipe for really deeply entrenched depression or anxiety or career disenchantment, as well as just a feeling of I have no locus of control, definitely not internal, and I feel powerless and I don't like my job, so I'm out. Whatever that means. So all those things can start off as really useful, help you get through training, help you work really hard, learn a lot of stuff, and then they can end up just coming back and being less productive ways of getting through.

Antonia: 13:33

All right. Well, I I hope Howard's out there listening too. I'm sure he is. Yeah. So so we have, as physicians now, especially with like evidence-based medicine, we talk about that all the time. We're following guidelines and complex protocols. We're not just making stuff up as the experts anymore. But a lot of times we struggle to even implement even really basic habits for our own well-being, like you're saying, even just going to sleep at a decent time. Like it's beyond us a lot of times. So what is the single biggest misconception that doctors seem to have about why they can't stick to routines like that?

Kristi: 14:19

Yeah. So I think there's I don't know that I know one thing I noticed in myself is that when it comes to distilling things down to the single most thing or the top thing, some I have a part of me that struggles a little bit because sometimes things have more components than one. But for this question, I think there's a couple like misconceptions that kind of collapse into one. And I think it all relates to, as physicians, many, if not most physicians, are really intellectual, really smart, really good at synthesizing masses and mass amounts of information really quickly and are really great at taking complex protocols and memorizing every single one, but also using clinical intuition to practice that art. And so sometimes when it comes to something really simple, there will be a presumption that this simple thing should be easy. And when the simple thing is not easy, they will quickly conclude that there's something wrong with them. They can't do the simple thing, or they'll blame themselves or feel terrible or feel embarrassed. And when we feel terrible and embarrassed, it's very easy to shrink or hide. And when we do that, it's hard to start things, like overcoming the inertia to actually initiate a task is difficult when you feel awful. I, if Howard were here, I would, if Howard are here, I would ask him to go into his brilliant brains of this. But my understanding of the root of the word shame is that it comes from a word, I think it's an old European word that means to cover. And so whenever we have shame and we want to pollute and cover, it's hard to do simple things. So what physicians will do because of this is they will sometimes have, they're like, okay, I want to support myself, take care of myself. And they'll have this grandiose idea. I'll take on this unrealistic approach, a lot of all earned unthinking. I'm gonna eat perfectly, get to bed every night at 9:30. I'm gonna put my phone in a locked box, I'm not gonna do anything. And it's too big of a plan for all the stuff they've got going in their lives with whether they've got kids or dizzy practice. And because it's unrealistic, it doesn't work, so they stop. And then they unfavorably compare themselves to other people who look like they've got it all together. They think they should be able to figure this out, and then they just they are in the hamster wheel. What is wrong with me? I'm I should be able to figure this out. I can't, there must be something wrong. And then they're not very patient with themselves. And all of this gets back to that harsh self-criticism thing I mentioned. It's hard to be patient with yourself, to give yourself the time it takes to start with something really fundamentally small, like, all right, instead of saying I'm gonna go to bed at 9 30, I'm gonna be realistic and I'm gonna get to bed instead of at midnight, I'm gonna aim for 1140. And I'm gonna try that for a month and see how that goes. It's hard to be patient and kind and soft with yourself if you think there's something wrong with you. But is that kind of good at what you're asking?

Antonia: 17:08

Yeah. So it's yeah, I'm seeing the connections where someone can say, what's wrong with me? Because I can't get through a whole clinic day on one hour of sleep, but then also then on the flip side, like, why can't I go to sleep? So at work and at home, it's it's just a cycle. And I also think that if we're not really patient with ourselves, then it that will turn outward and we won't be as patient with like other people messing up at work.

Kristi: 17:37

100%. Yeah, very smart of you to connect that. I agree.

Antonia: 17:42

So so you have this podcast, and I think it's pretty great. I've I'm still in the beginnings of it, but it's called Habits on Purpose. And so hopefully, all of our listeners will check that out too. Pretty nice, like digestible episodes that you can just listen to, like on your drive or whatever. But in there, you talk about you your audience, I think, is high achievers, physicians, mainly, and maybe other professionals that I might hopefully I'm getting that right.

Kristi: 18:12

So you're absolutely correct.

Antonia: 18:13

Okay. So professions like that that are defined really unfortunately by burnout and all these to-do lists that never end. How would a physician who's just frazzled begin to connect their small daily actions back to their larger sense of purpose, like why they went into medicine, for example, especially when they feel like they're just trying to stay above the water?

Kristi: 18:41

Yeah. The question is so great because it's got many sort of really important features into it. So the first thing I always recommend is that is just to realize that there is a season for survival. And if somebody listening is like realizing that they are just getting through the day, that naming where they are as a season sometimes helps you wrap your head around the fact that, okay, it's not gonna always feel like this, even if you don't necessarily believe that for the most part, there are seasons to struggles and seasons to, you know, when things are easy. But when you're in a season of survival, and just like you're just trying to get through, trying to get through the morning clinic or the day or the week, or just trying to get through your discharge summaries, whatever is the case, in those situations, you really are will be wise to go for low-hanging fruit. What I mean by that is go for the easy things in terms of concrete, tangible, realistic things. Because if you don't go for something that is really accessible, it's gonna be really hard to go for anything else. And so if you're trying to connect to your larger purpose, sometimes you'll think, well, so why do I go into medicine? Well, I want to help people, I want to contribute, I want to do something like that. It's so silly just to focus on maybe leaving work, leaving the office at five o'clock. That's just silly. Or it's silly to work on this small thing, like and you'll just not do anything. So, whatever your larger purpose is, and if you want to do anything for that, you have to start at like the foundational base of the pyramid, so to speak. And you have to be willing to do really basic fundamental things and realize that those do connect to your larger purpose because you're not going to do anything if you're just burnt out and afraid. Right. And then the other part that that question that I love that how it's phrased is that sometimes as physicians, we will we'll think, well, like I had this really big life purpose that I had 15 years ago. And I it doesn't feel like this maybe isn't the life that I expected based on that purpose. And I don't know how that purpose fits with what I see and what I now know. And therefore, I don't even know who I am, I don't even know what my purpose is. And sometimes we can just say, that's okay if that's the case. Sometimes you just have to meet yourself where you are and recognize that even if you're not sure if that original purpose still stands today, you can let yourself off the hook. And it's not going to be the end of the world. Just to be like, my survival skills that I'm gonna have to implement for right now, they may not necessarily have to create connect to a larger purpose. That might be a thing high achievers do where they're like, this must connect to my higher purpose. And if it doesn't, and we'd be like, or not, and it eventually will connect to your higher purpose, but like sometimes that can put a lot of pressure on us, and then it makes it hard to do anything. And again, that might be just me thinking for myself and my clients, but I do see that.

Antonia: 21:32

Yeah, I suppose it's not one size fits all, everyone's a little bit unique. And so I'm wondering, and I would be surprised if you actually had like a universal answer for this, but is it possible for someone to have some kind of less than five minute new habit that they could start with to just to make one change if they're really overwhelmed and they just want to at least at least get on at least get on the right track? And it doesn't even have to be one specific thing, but is it possible that someone could have something like that?

Kristi: 22:11

Yeah, yeah, 100%. So it is 100% possible, and it's actually probably one of the best starting points ever, especially when you're busy and you literally have your day planned out by the three-minute intervals. Because if you start with something too big, you're just not gonna do it. Even if you take a six-month sabbatical, like it's gonna be too big. So I actually create in my practice, I have some like tool kits that are very specific for people that help them recognize that starting small is actually the most effective thing they can do. So, in terms of something that you can start with five minutes a day, I'll there's two things that are like the top two things. People are like, I don't know where to start, what do I do? The top two things are one of these. And you just pick one. You don't have to pick both. It's not like extra credit or you get more. But most people, and I don't want to like exclude anyone here, but most people brush their teeth twice a day for two minutes, right? Some people don't. And if this is not you, I have a friend who has like gorgeous teeth and hates brushing your teeth. And I don't know what she does, but somehow she's fine. But most people, two minutes a day. If you're gonna do that already, this is where you can tag on something to something you're already doing, which is what helps you be more accessible. During your two minutes a day, this is where you just tag on and you do an emotional check-in. You're brushing your teeth. It's automatic enough, you don't really need to focus too much on that. And an emotional check-in is just while you're brushing your teeth, you just ask, How am I? or what am I feeling? How am I? You might just be like bad, awful, terrible, or what am I feeling? Discouraged, exhausted. It doesn't matter what it is. You just want to note. So if twice a day you checked in to be like, what's going on here for me? Just the checking in does a few things. Baked in the check-in is what I'm feeling matters, what I'm feeling might possibly be valid. I'm curious about what's going on for me, even in the incidental moments that aren't like really high or really low. So just those check-ins are the like a first sort of like basic step. And a lot of people will be like, well, that seems silly. I promise. Most of the best things you can do in the beginning seem silly. So that's option A. Option B is doing three box breaths with your hand on your chest. So anybody listening can press pause right now. You put your hand on your chest, whether you on your over your heart, wherever you want to put it, you put your hand there. Just that touch, any sort of self-touch, there can be really useful in terms of calming. And a box breath is where you, if you're able to inhale for about four seconds, hold it at the top of your inhale for four seconds, exhale for four or longer seconds. For exhale can be longer, even better. And then hold your exhale before you inhale again for about four seconds. That's considered a box breath. And that can really help your central nervous system get some calming. And all the neuroscientists out there will know that I'm vasterizing this, but there's a study of science in terms of calming your nervous system that sees that you can have increased oxytocin just from doing that intervention. And you can do that in the car before you walk into your house. You can do that before you go to bed. It doesn't take very long. You can sneak off to the bathroom, do that after you wash your hands. Like whatever you're doing at work, just it can be really a great way to regulate and help you get back to a sense of if you're feeling frazzled, a little bit less frazzled. So those would be the top two things I recommend.

Antonia: 25:26

Okay. Yeah, that I don't think anyone, there's anyone out there that can't do at least one of those if they just have to have have to think about it and remember to do it. So those are really good tips. So I'm gonna keep peppering you with some more questions here. This is great. So medical training, we have a lot of times an all-or-nothing mindset. So it and that gets really just hammered into us. So, how do you coach physicians to overcome this thinking when it comes to habits? So that maybe if we miss a workout session or have a big indulgent meal when we were supposed to be dieting, how do we change our thinking so that doesn't lead to us abandoning our entire goal altogether?

Kristi: 26:16

Yeah. Okay, I love this question. I love all these questions, but this one, I don't know. There's something about this one that's really powerful, especially if you have any all or none thinking. The way I think helps for particularly this audience to think about this is all or non-thinking has a time and a place. And that's great. All or non-thinking can be really great that last hundred yards of a race where it's like I'm either gonna quit or I'm gonna go all out and I'm gonna be dead at the end. And that's fine. Oh, I'm gonna like crawl across the finish line or I'm gonna sprint. Whatever the that's okay. That's a great time for like suck it up, buttercup, push through because it's finite and it can be really effective for motivating and things like that. For life in general, all or none is not the most effective way and can actually get in the way of the all part of the equation. And this is where it's nice to know there's a difference between high achieving thinking and pursuing excellence, and then perfectionism. And all or none is like I've got, in order to do good work, I have to do it all, I have to go all in, go big or go home. Because if I don't do that, I'm gonna suffer the the big M mediocrity and or somebody's gonna get hurt. Something like that. Something terrible is gonna happen if I don't do everything right. So when we have that in our mind, it's useful to think about okay, where does all our nine thinking come from? Well or none, I think that's sort of for all the pediatricians here, again, this can be an oversimplification, but in terms of our development as we go through different stages of the development from being like really young toddlers to being like eight, nine-year-olds to being teenagers to being young adults, to being all or non-thinking is a development, a certain developmental stage that we'll see in a younger age group where it's hard to have nuance and be open to like more things than one can be true. It's not like all boys are bad. Sorry, it's just yes and Aaron's not here to hear this, but that makes sense when you're in fourth grade or seventh grade, right? And sometimes we can learn that at a young developmental stage, and we can carry that same young way of thinking forward and wonder why it doesn't work. So sometimes it's nice to know, okay, all or none thinking, that can be something from my like pre-tween and teenage years, where it's all or none, one or the other. But in reality, if you hold on to that, you're looking at this bifurcation of I either get everything I want or I get nothing I want. And so the question to ask is, okay, so what's the concern if you didn't do all or none? Like, what's the concern if you ate that one big meal, but then you returned back to your eating plan the next day? What's the concern? Oftentimes the concern is that, well, I will fail. If I don't do it right the first time, something bad's gonna happen. And so the irony of all or none is that if you hold yourself to something that's not realistic for most humans, you'll more often than not go backwards. And this is what yo-yo dieting is. People like set an unrealistic diet, and at the end of 12 months, more people have gained more weight than they haven't, and they feel tired and exhausted and they hate diets, and they, as opposed to just being like, okay, life is complex. There are gonna be times where I'm making forward progress, and there are gonna be times where the shit is the fan and I ate that big meal, or I ate three sleeves of Oreos, and I said I was gonna eat two, and so so you know, it's every expletive you can think of, heck with it. I'm not gonna do this. I'm just who cares, I'm gonna do anything. And that can be just very satisfying because it feels terrible to try. And so, this is where it does bring in this idea of what would be possible if instead of all or none, I did something that was more. Nuanced and was the gray zone, where you know, four out of the next seven days, I'm gonna go to bed at this time. And if I'm a little bit late, I'm gonna evaluate what worked, what didn't, what am I learning next time? And that's how we get back to actually learning in a way that's actually more consistent with how humans learn that doesn't keep us in the nun.

Antonia: 30:19

So it's like just being more mature than whatever that developmental stage is, just growing up.

Kristi: 30:26

No, which does take work.

Antonia: 30:27

Yeah. Like it does, it takes effort, and that's okay.

Kristi: 30:29

But it's undoing something that used to work really well that honestly probably served most of us for a long time.

Antonia: 30:35

Yeah. Okay. So beyond physical habits like workouts, exercise, you you focus a lot on internal thought patterns. So, what would be a good crucial mental habit that you think physicians can practice to help better manage all the emotional weight and stress that comes from the job, like from the high-stakes decisions and the patient outcomes that we deal with?

Kristi: 31:04

Yeah, I think probably twofold they intersect here, but probably one of the most important internal mental habits is internal validation, which is just making yourself make sense. And oftentimes people think that's just going to be feeling sorry for yourself or making excuses for how you feel for what's going on. But validation and internal reassurance is more like what I'm feeling in this moment makes sense. I may not understand why, but there's always a good reason for thinking or feeling however I'm thinking or feeling. So what's going on right here makes sense. And we know from lots of psychological research that most humans, they want to feel seen, heard, understood, valued, and validated. And that's an acronym that Leslie Petrick talks about. It's called Shove, S-H-U-B-V, seen, heard, understood, valued, validated. And if that's how most people want to feel, which a lot of us see this for the patients, we're like, wow, if my patient can feel seen and heard, valued, and like what they're coming from, makes good sense. They listen better. They we communicate better. And so when we bring that internally, that looks like validating, which means making ourselves. So anytime you hear yourself being like, oh my God, I'm such an idiot. I can't believe I did that. Or so-and-so has is a single parent and has three academic appointments and they don't yell at their kids, what's their problem? What's my problem? Those are all times where you're making yourselves not make sense. And usually we do that when we do things that they either were embarrassed by or that we don't like about ourselves. And so if we can find ways, and this does require a degree of like intellectual rigor to proactively make ourselves make sense, it can be just a game changer. So internally trying to make yourself make sense is helpful. And I think I'll just mention this was when thinking about if there's almost like a main philosophy that would define my approach to things, it's basically this is realizing that you make sense. There's always a good reason you do what you do. And there's a, I unfortunately can't remember his name right now. There's a a mediator attorney who does a lot of mediation teaching work at Harvard. And when I heard him interviewed once, he almost just offhand said, He's like, you know what? And he does you participate in a lot of like psychotherapeutic teaching with attorneys. And he's like, one of the things that we do a lot of when we're mediating and in therapy is we're looking for reasonable reasons for seemingly unreasonable behavior. Like, how on earth does somebody do this? What's a reasonable reason? And that's what I mean by this is when we can find the reasonable reason for seemingly unreasonable behavior in ourselves, that's when we can go, oh my gosh, it makes so much sense. I'm like trying to perfect this note. I'm worried about the patient. I'm worried about being seen as like not a good doctor. There's so many good reasons why I stayed up late at night. I just want some knee time. This is the only time I can get it to in the morning. Okay, that makes sense. Because as soon as we know we feel like we can make sense, change is easier.

Antonia: 34:06

So be our own defense attorney in a way.

Kristi: 34:10

Yeah, exactly.

Antonia: 34:11

Okay, I like that.

Kristi: 34:13

Yeah, I like that analogy. That's right.

Antonia: 34:15

So, okay, so a lot of doctors are gonna measure a good day by how productive they were and how maybe how many tasks they completed, how many patients they got through, how are their patients doing, or how are their reviews on Google or whatever online system? So, but that obviously is not really like the most fulfilling way to look at things. So what would you suggest as a more sustainable and fulfilling metric, even for maybe productivity, that could help physicians in their careers shift their definition of success away from just like clearing out the inbox?

Kristi: 35:01

Yeah. So when it comes to that like product, my productivity defines my worst little tricky riddle that a lot of us struggle with. I think it helps first off to just know that to-do list never get to-do list zero. So if we're thinking that if we check off enough boxes that we're gonna feel satisfied, we're outsourcing our sense of success to something outside of ourselves. Because you could one day checking off 10 boxes will make me feel good, but maybe tomorrow it needs to be 11, or maybe yesterday should have been 10 or 11. And it just keeps us chasing. So I like to think, what if productivity actually had nothing to do with your internal sense of contentment and satisfaction? What if it, what if what we're thinking of success and productivity were almost like somebody else's notions, like how much work I get done, all this that makes sense. If you're in a widget factory and you've got to, you're getting paid on how much you do, that makes sense. And there are some ideas from capitalism and from how factories work and how machines work that sometimes we in the world of physicians have internalized I've got to do more, especially when it's the more you do, the better doctor you are, the more you care, the better person you are. So if you have to be really productive, which are in medicine, like our RBUs kind of operationalizes that. So it's not just an internal thing, like this is very much supported externally. If you're in that system and you notice that you're constantly chasing, feeling good by how productive you are, the first thing is just to notice, like, okay, I'm measuring my success of the day based on my productivity. And maybe if that doesn't, if that feels great to somebody, there's no problem. But if it doesn't feel great, then you can just be like noticing I'm doing that. And so then you get to redefine it. And so what if being, quote, productive? And I'm doing air quotes for people listening, what if being productive was just that you were you were living your day in alignment or as close as you could be. Regardless of how much you got done. And this way, your quote, productivity might just be like that you feel nourished and supported, or you got through the week, maybe not the day, you got through the week, like making sure that you took care of yourself. So sometimes I think it's nice to just be like, okay, well, what if we shrunk your to-do list down to just like the two most critical things that you need to do? And that can be a little bit of a like a rebellious move, like when you are in a society that is like that a cult of productivity, like hustle culture, like the more you do, the better you are, you'll sleep and you're dead. And so it does require a bit of courage to do that. I think sometimes just naming it like you did, but sometimes physicians think that their success is based on how much they get done and the system supports that a lot. And if that doesn't feel good to you and you're constantly chasing and comparing, then just naming it and then asking what might feel better can help you start to unravel that a bit.

Antonia: 38:07

Okay, yeah. So that's because I've read about like the whole quiet quitting thing, which is like the opposite extreme of just being like the hamster in the wheel. But that's a third option where you're not just detaching, just saying whatever expletive with it, but also not just not just burning out either. But yeah, slowing down a bit to stay in the game, I guess.

Kristi: 38:33

And to be clear for anybody listening, these are not easy things. It might be easy for you and I to say, oh, just slowing down might be actually a way to be more successful and staying your career longer. It may not be easy to do, even if you're just in a very supportive private practice or a hospital situation, a system that says that they really pride themselves on having physician wellness or healthcare worker wellness. If the truth is you're around a bunch of people or a system that really does actually value overworking and overextending more than anything else, so it can be complex to slow down, even though in the long run that might be the thing that keeps you doing your career for longer.

Antonia: 39:14

Okay. Well, you so you speak also about the power of identity in habit formation. So if someone whose ident who whose identity is wrapped up in being a doctor, how can they cultivate or maybe evolve that into an identity of a person who is healthy and prioritizes rest without feeling like they're just trashing the whole doctor aspect of it?

Kristi: 39:44

Yeah. And I think that harks back to that all or none idea that if I question anything about my doctorally identity, that means I'm throwing the whole thing out. Baby with the bathwater. If I'm not always there 24-7 for my patients, that means who am I? What am I if I'm not that? Right. But I think for me, the kind of the most helpful ideas with approaching this is to recognize that what we do, it can feel like it defines us. It can really support us, especially if our identity maybe is a little bit wobbly before medical school. Maybe we don't really know who we are or we're not sure, but we know we want to be a doctor and we know that that's gonna fit and that can be just gonna like really support us in ways that like help our either sense of self-esteem or sense of worth or sense of gosh, I have solid footing. So just recognizing that sometimes we think that our job is our identity, and it's easy to see in somebody else if somebody like stops being a lawyer and they're like, Who am I? And you're like, Well, you're more than just a lawyer. But when you're inside the fish tank and you're like, it's really yourself, it's harder. So I always like to tell people, even if it feels like your identity is wrapped up in a particular career vocation, it's usually because there's things about your thoughts about that career or things that you actually do get, things that really you love about that career that you are conflating with the job. And so you can look at and be like, well, my identity is somebody who can think of a good one for a physician. I'm a person who really helps and I'm a person who's very generous. Well, that identity doesn't have to go anywhere if your vocation or your job is actually getting in the way of you being able to help and be generous because your job is calling on you to work 100 hours a week and like squish surgeries into small spots on terrible times when you're not going to be at your best and you can't actually give excellent care because your demands on your time are so high that you can't you don't have time to read and to catch up and do all the things you can't be a generous, kind, giving, amazing person in those in those conditions. So sometimes you can be like, the job and the conditions, those are separate from me as a human and the things that I value that I happen to think only exist in this job. So identity and job, like it's a one of those complex things, but for sure you can have things in a job setting that aren't really supportive of you as a human. And when you can disentangle or extricate yourself from that and realize that your identity is who you are, is that sometimes people don't know at 50, they're like, wait a second, who am I? I just I don't even know if I know. But it it's definitely not only defined by whatever you do for your income generating and like peer connections and contributions to society that we call a job.

Antonia: 42:45

Okay. I think I just have a couple more questions and then maybe we can wrap it up. I would like to keep going, but we're gonna try to keep it short. So we I can obviously see how a physician's own habits and especially if they're doing work on their own habits can positively affect their leadership and how they are in a team and maybe even the quality of patient care. Do you have even like maybe some hypothetical examples or even real life examples that you've seen either in your career or in your clients about this?

Kristi: 43:22

Like in terms of when somebody does their own work, how it can have an effect on their on the people that they're leading or the people around them. I think we are, I think this is a very generalized statement, but I think we are more effective at being leaders and being sturdy leaders, whether it's in our own family unit or at the hospital or in the C-suite, when we are we understand ourselves and we understand the reasons why we do what we do. And so what I see is that when we are not showing up at work or showing up in meetings, carrying a bunch of cloaked self-doubt or agendas to look a certain way or act a certain way because we don't really understand what we're doing. When we don't show up with that, we're usually showing up being curious, being clear, being steady and confident, but being open to others. And that happens when you've done a lot of work on your habits. And when we have them then all the research on like optimal and effective leaders usually boils down to they're people who can really listen well, they can also communicate very concisely, and they help people around them feel empowered and feel valuable. And it's just one of those things that if you haven't done some of this inner work, it's a lot harder to be effective when you're trying to lead teams. And so I can almost say, like without a doubt, anybody who's done, whether it's lots and lots of personal therapy or working with their mentors or working with coaches to really understand why they do what they do and look at their habituated patterns, those are the people that are going to have much more ease doing the difficult things as leaders. So that's not a specific example, but it's just it is so clear that the more you understand yourself, the better you lead. That that's how I can answer that one.

Antonia: 45:27

Okay. Well, this feels like it's been the like a free coaching session, which is which is nice. I hope it's insp like inspiring for a lot of our listeners too, especially if they're struggling with any of the stuff that we've talked about. And so I think we can plug you a little bit because you have the podcast, which is free and some other free stuff. And then you also do you offer a service of, I think, both group and individual coaching. Is that right?

Kristi: 45:56

Okay. I do. Yeah, I do group work with primarily with women physicians, habits on purpose for physicians. It's a small group coaching program for about six to eight months, where we do lots of this unpacking and unraveling these habituated patterns we've talked about on this podcast. And then some people really they like the community aspect and feeling like there's a sense of shared humanity that kind of comes from being in a group and hearing other people put towards things that maybe you're feeling also. And at the same time, sometimes people really value having that privacy of just one-on-one. And so I keep a small panel of private clients and not all of them are physicians, not all of them are women. But most of the things that we work on are they very similar. How do I understand me so I can show up deliberately and intentionally and not blink and go what happened the last 20 years in ways that are practical and not just totally abstract?

Antonia: 46:53

Okay. Well, any final words, if you could just distill one major lesson that could be like a mantra that you would suggest people have at the forefront somewhere. Is there any parting words you'd want to give to our I would yes?

Kristi: 47:08

I would I think sometimes I think, especially for this type of audience that you guys have, I think we have a shared overlap in our audiences with people who are very intelligent. They oftentimes have very demanding careers and they're very, very intellectual, very cerebral. I find that even with that, repetition is really important. You mentioned earlier, well, we just have to remember to do these things. Repetition can help us remember. So I will, at the risk of being a broken record, I will say the number one thing that I think is it's simple, but it's not always easy to internalize or believe, is that you could use as a mantra is the idea that every single thing that you think, feel, or do makes sense in some way. And if you can tap into, I think a lot of our audiences are really naturally very curious. They're very good at interested in learning, very good at asking questions. And so if you just go from that premise, everything I think, feel or do makes sense. And then you can get curious about how it makes sense. How would it make sense that I do this thing that seems counterproductive? At some point in time, it must have worked, it must have helped. How does it make sense for where it came from and how does it make sense today? That can be so fruitful. So just that simple thing of everything I'm doing makes sense. Even if it doesn't seem like it, right? Even if I say it up at three in the morning and I'm tired and I know I shouldn't. How does it make sense that you do? That's the one thing I would say. If everybody like ignores all the other stuff, that's the one thing to take home.

Howard: 48:39

Hey, did you guys start without me? Thank you.

Antonia: 48:42

Oh, how do you think? Did I get the time wrong?

Howard: 48:46

I thought I must be on the wrong time zone.

Antonia: 48:50

Don't worry about it. You yeah, you might just want to manage.

Kristi: 48:56

We did have to suffer through. It was a little bit clunky.

Howard: 49:00

Lots of questions, but I'm sure you guys talked about burnout. And that term burnout, we we've done an episode about burnout before that a lot of people I think people will like this episode too, but you know, it was coined by a psychologist in the 70s. He wrote a paper in 1974, I think, named Freudenberger. Freudenberger? What a name. And he had worked, he had been volunteering at a free clinic or worked at a free clinic as a psychologist in New York City for drug-addicted and homeless folks. And he described a pattern that he saw in a lot of the young, idealistic, very committed volunteer staff that would come to that clinic. And initially they had this high level of idealism, a lot of energy, a lot of dedication, and a strong desire to help. And then he described in the paper a gradual depletion and they became increasingly exhausted and cynical and ineffective. And then he gets to this what he called the burnout state, which is a term he actually got from the addicts who talked about getting burnout on junk essentially. And they had emotional depletion and a loss of motivation and then a reduced commitment. And he saw this as both a mental and physical exhaustion, this extinguishing of your motivation and of your ideals, often due to dedicating yourself to a cause or a way of life that failed to produce the results that you thought would happen. And obviously dealing with homeless people and drug-addicted people can be frustrating if they're not all in homes and sober in six months, which they're not. And so these folks they became burnout. And the ideas developed after that, and Christina Maslock came up with the burnout inventory and things like that later. But I wanted to say we have to do every we have to have papers in every episode. So that was a 1974 paper, but there's a new study from Cornell where psychologists at Cornell they looked at a couple of thousand students and grad fellows and people. It's always all these psychologists are always experimenting on college students. And the experiment was they randomized people, I think, to get $400 or to not get $400. And if they got $400, they were supposed to go spend that money on anything they wanted that was helpful for their community, their tribe, if you will, their people, their themselves, even. There was no real guidance around it other than we wanted you to spend money and by extension some part of your time and commitment to something that is aligned, I heard that word, aligned with your own personal beliefs or your personal whatever. And it was a huge difference in many of the depression and a lot of the little things that they tracked between the two groups. This paper hasn't been published yet, but uh the differences between the two groups are pretty extraordinary. And all they did was they had some people act in a way that was consistent with their own personal beliefs or feelings or just something. They just enabled people to be themselves and to act in a way that they authentically wanted to act. And I think that's what physicians are. We talk about moral injury where as you you talked about chasing the RVUs and their productivity. Well, that's not what we necessarily want to do. We want to make a difference in people's lives and we want to impact their lives. And we're detracted or distracted, both, detracted and distracted from those objectives by so many of this hamster will stuff. So I was just gonna say those things. The other thing I was gonna ask, and then you guys can end, Christy, is if you had specific I'm sure you must work with people who are frustrated with like learners or people who are frustrated with OR. And I think about a lot of our audience or residents who are gotta be beating themselves up every time they do a case and that sort of thing. And that cycle that of how we teach people in the operating room seems to me to be a very unhealthy way of constant criticism and self-questioning and blame and blaming people for stuff that's not their fault or just normal complications of surgery and nitpicking and all that kind of stuff. And I certainly hear from residents and folks who are bombarded by that sort of negativity, and then they start to have self-doubt and their self-efficacy lowers. I don't know. What do you what advice do you have for people who are dealing with that? Because our resident listeners in particular are dealing with that, and I'm sure a lot of our non-resident listeners too.

Kristi: 53:29

Yeah, no, that's a good one. I love that you use the word nitpicking because I feel like that really encompasses a lot of what happens during trainings where like minutia is harped on and the general vibe is, like you said, lots of criticism and not just criticism that's constructive, but criticism that's based in not just this this particular technique could be approached differently and you could do something better with your left-handed knots. But there's something wrong with you. Your identity is problematic because of how you approach this thing in the OR. I do think residents are particularly at risk for dealing with this as and new attendings. And then if you think of the more privilege and power you have. So if you are marginalized in any of your identities and a resident, you're going to be even more exposed to a lot of this the difficulty there. So, in terms of the advice, is I think sometimes just being able to name is the hugest thing. Meaning you're going to work every single day, and the climate is one with lots, it's peppered with lots of criticism. Nobody learns great in that. And just being able to say, this is what I'm walking into, you can almost create this might sound silly, but like a mental force field around yourself where you're like, all right, I know that I know what I'm going into. I know I'm going into OR so-and-so with Dr. So-and-so, who always will say nice things to the patient and then just completely rein the residents and have all the people around them be like, aren't they great? Oh, so lucky that you got to come in here and scrub in with them when they have just done a bunch of like really egregious things that are not appropriate even professionally, much less interpersonally. And if you just know that you're like, this is the Petri dish in which I'm going, it is very difficult to learn under these conditions. And it's not that there's something wrong with me that I'm getting criticized. I just need to realize this is what's coming. And I need to be able to remind myself and ideally have a tribe of people that I can touch base with who can remind me that just because people are being jerks doesn't mean, you know, that you're not going to get through, that you're not going to be an excellent doctor. Sometimes just knowing that and naming that can really help. And that doesn't, for anybody listening here, he's like, but you've got to be able to point out your deficits to learn that's not what I'm talking about. Yes, we all need to know what we can do to improve, how to be thorough, be competent, be excellent. But that's not what we're referring to here. So just knowing that's what you're getting into and recognizing, yeah, it shouldn't be this way, but it is, I think can be the most basic thing. And then ideally, we we stop and change this and we have a different culture of learning, which is going to be much more effective, PS, than what we're doing now. But until that time changes, having a community around you and then just knowing what you're getting into, as opposed to being like, oh my gosh, here I am, criticized again, can really actually be a little bit empowering or a lot empowering. I'm curious what you two think about that time permitting, like what you recommend for residents or like new attendings who are still in that climate where it's it's not one of the things.

Howard: 56:31

I think it's the same thing. You just have to recognize, you have to pick your mentors and realize the people that are there to build you up and the people who are there to build you down. And you have to be careful with that. You need to take good advice from people in in introspect on it, but just recognize that there are people we have to work with, especially a resident has to work with that that attending an OR seven, and they're not there to build you up. And so you do have to somehow, you know, and it's not getting a thick skin either, because I think that's bad advice. It's realizing that a snake's a snake and don't walk when a snake bites you, don't be expected by it. The real hurt comes when you thought the snake was a dove and then and they get you. And so I think it is exactly what you said, and just not taking it as a personal reflection of your abilities because that's the way that person always acts, and not tolerating abuse, which is hard to do as a resident to report abusive people or things like that. There's a lot of pressures not to do it. But there's a line, and there has to be a line, and there are some people who shouldn't be teaching residents, and they need to be out of academic medicine.

Antonia: 57:37

Yeah, I'm not in an academic setting right now, so but I hear stuff, and I've I vaguely remember most of my attendings were really great and patient and constructive. But we could recognize the ones that weren't, and sometimes even the great ones had some bad days. But yeah, I think having at least having some good ones to contrast those kind of more toxic ones does help. And hopefully it's a rare scenario where someone is just a trainee, is completely surrounded by nothing but toxicity and just constant hateful teaching. I think maybe in that case, that that may be a time where they either have to explore their avenues for reporting something if it really is abuse, or maybe changing programs or something drastic. Because that does sound like a pretty drastic scenario. But hopefully, yeah, hopefully in the mo in most cases, it's there's that one that's really bad, and then there's the good one. So just take examples of both. Take that as a negative example, take the other one as a positive.

Howard: 58:48

We all deal with that on some microcosm. It may not be a surgical case in an attending, but we all have those things in our lives and we have to put them in perspective, I guess. So well, I'll try to be on time next time, guys. I'm sorry I was late. Hopefully you all talk about my bad habits behind my back.

Kristi: 59:07

Well, no, not at all.

Howard: 59:12

Thank you for being on. And thanks for not making me stay the whole hour. I was doing my to-do list and trying to get all my charts done and checking my RVUs for the week.

Antonia: 59:22

Okay. Good. Great. Well, you might I should listen. Yeah.

Howard: 59:28

Okay.

Antonia: 59:29

Yeah. Okay. Well, Howard, normally you normally wrap this up, don't you?

Howard: 59:34

We'll be back in a couple of weeks with something exciting. How's that?

Antonia: 59:38

Sounds great.

Howard: 59:39

We'll put links to Christy's stuff and everything on the webpage eventually.

Kristi: 59:43

All right. Well, thank you for the work that both of you do. This is just amazing that this resource exists, and it's really a privilege that you invited me to chat with you.

Howard: 59:52

We're the privileged ones.

Speaker 1: 59:54

Yeah. Thank you. Thanks for listening. Be sure to check out Thinking about obgyn.com for more information, and be sure to follow us on Instagram. We'll be back in two weeks.