Gail Gazelle: 00:00 And the surgeon lost it. "How dare you come into my OR and not know how to do this."
Intro: 00:07 From Spaugh Dameron Tenny, it's The Prosperous Doc podcast. Real stories, real inspiration, real growth, a show for doctors who are ready to improve their overall wellness in every aspect of life. Now here's your host, Shane Tenny.
Shane Tenny: 00:26 Welcome to The Prosperous Doc podcast, where we talk with your colleagues around the country to educate, inspire, and motivate you. And I can't think of a better time in history or at least the history of this podcast and in the midst of 2020, the year of the global pandemic and everything else going crazy to be talking about professional, relational, emotional, and financial wellness. Today, we are joined by Dr. Gail Gazelle. Dr. Gazelle is an assistant professor at Harvard medical school. She's a master certified coach through the International Coach Federation, has coached over 500 physicians on mindfulness, resilience, growth. She teaches a resilience curriculum to medicine residents at the Brigham and Women's Hospital outside Boston. Dr. Gazelle's been published in the New England Journal of Medicine, Oprah's magazine, The Journal of the American Association For Physician Leadership and is a recently or a newly published author releasing Every Day Resilience her book that came out last month. So Dr. Gazelle, thanks so much for being with us today.
Gail Gazelle: 01:35 Oh, it's a pleasure, Shane. Thank you for having me.
Shane Tenny: 01:38 Well, let's start maybe by just laying a little foundation. I've shared your pedigree here, rewind a little bit. How did you move from clinical medicine into now coaching people in clinical medicine?
Gail Gazelle: 01:52 Right. It's a great question. So I started my career as a hospice physician. I actually went to medical school because I was really interested in end of life care and it wasn't actually a field back then. So I did my residency in internal medicine. Then I did a medical ethics fellowships thinking, "Oh, maybe that'll get me into the field of end of life care", which it did. I was actually asked to develop an end of life care, palliative care program for a large HMO in Boston, where I was working. So that's what I did for most of my professional career. And now along the way, I, like many physicians struggled with burnout and it was all too much, frankly, not just the time demands, but the guilt. I'd be home with my son and I'd feel guilty that I wasn't catching up on journal articles.
Gail Gazelle: 02:36 I'd be at work and I'd feel guilty that I wasn't home with my family. And I had so many kind of interior tapes about my worth, about being an imposter, inner critical voices that really wore me down. I stumbled into coaching myself and found it life changing. It really helped me work with kind of my inner workings, a little bit, getting to know them more. And I felt a sense of almost leapfrogging forward with some of the things that had held me back. So I was inspired to become a coach. So I did my coach training in 2011 and with the sole purpose of helping colleagues across North America cope with burnout and learn the skills that we just don't learn in our training that can help us run this marathon of a medical or even a dental career.
Shane Tenny: 03:27 It's interesting that it sounds like you were well into your career as a physician when the symptoms of burnout began to kind of manifest in you, what helped you identify the symptoms and say, this is something that I really need help with as opposed to just something that I need to stuff in a box and keep grinding it out?
Gail Gazelle: 03:48 Well, I'll be honest. I did that kind of head down, grinding it out for a long time. And I think that's what we learned to do in healthcare is just put our needs last, take care of everybody else. Kind of ignore some of these issues. And I guess it just wore me down so much the fatigue from it, that sense of running on empty that made me think I need some help here and it's okay to ask for help. I don't have to go this alone. I had done a lot of work in mindfulness. I developed my own kind of meditation practice, then got training in mindfulness as well. And I think that also helped me have a greater awareness of what was going on for myself and a realization that I had a choice. I could stay locked into some of that burnout, or I could invest in myself, so to speak and really get the tools that I needed to move forward and be the best I could be both at work and at home.
Shane Tenny: 04:39 Now you mentioned you felt like an imposter. There's a word for this. I think imposter syndrome, maybe you could talk a little bit about what imposter syndrome is.
Gail Gazelle: 04:50 It's important to talk about because a lot of us well-functioning people who were well-respected actually walk around feeling like an imposter. So it's the belief that what we know is minuscule and what our peers know is massive. And that it's only a matter of time until we're found out. And once we are, we will be the laughing stock of our institution. So it's this high stakes inner belief that questions our own worth, questions our own validity as a professional, as a physician in my case, and for many physicians. We don't have really good data on the imposter syndrome, but my best guess is that well over 75% of physicians chronically walk around feeling like an imposter. And what is that based on? Well, it's based on the hundreds of physicians that I've coached. It's a rare one who doesn't feel like an impostor. The hundreds of residents that I've worked with at a major Harvard teaching hospital, where you might think, wow, they're the cream of the crop.
Gail Gazelle: 05:49 Why would they feel like an imposter? And yet they do. And we can talk a little bit more about why, and then I've been very fortunate to speak to physicians across the country. I do a lot of public speaking, keynotes, workshops, etcetera. And I often poll the audience. If you'd be comfortable, just share if you feel like an imposter. And when we do that as a poll question, it's typically nine out of 10 audience members, nine out a 10 physicians who are hearing that talk, who fess up to the fact that they walk around with the sense that it's only a matter of time until they'll be found out. And the cost of that is really high.
Shane Tenny: 06:24 What causes this to develop in the physician? And I'm curious to your knowledge, is imposter syndrome unique just to medical and healthcare professionals, or does it show up in other areas of society as well?
Gail Gazelle: 06:37 It definitely shows up in other areas of society. Michelle Obama has talked about feeling like an imposter, many celebrities. I think it was Jodie Foster who said something like when she won the Oscar, she thought, "Oh, they didn't mean me. They met Meryl Streep." So they're all kinds of quotes from famous people about feeling like an imposter. So it's common in high functioning professionals. I think the reason it's perhaps as much or more common in physicians has something to do with our training. Our training is about perfectionism and we are taught very sadly that if we're not perfect, we're actually a failure. It's very kind of black and white. It's a fixed type of belief. You're this, or you're that as opposed to you have a lot of strengths, you may not be perfect. And that's okay. You bring a lot to the profession of medicine and let's foster your strengths.
Gail Gazelle: 07:27 Let's harness them to help you in areas where you're not as strong. The other thing in our medical training is lots and lots of comparisons. We're always being compared to some other physician. There's what's called the hierarchy. There's this idea that the neurosurgeon and the cardiac surgeon, or the tippy top and down at the bottom, it's ridiculous, but family docs, pediatricians, people are shamed sometimes for going into those specialties. It's really, it doesn't make any sense, given the worth that all physicians bring to vulnerable patients. We need all of these specialties to function as a population. But those comparisons also set us up for these kind of false views of who we are. There's something that I've kind of claimed and called the cycle of perceived inadequacy. And let me just say what that is, that we're hyper-focused on things we perceive we didn't do well.
Gail Gazelle: 08:22 I didn't sound very smart. I didn't give a good presentation, something like that. And then we compare ourselves to others, but what are we hyper-focused on them. We're hyper-focused on the things we perceive they did well. Oh, that one's so smart. That one. Wow. So articulate. So we kind of create this false Delta, this false kind of gap between where we perceive we are and where we perceive they are. It's an incredibly subjective process. You can hear that. I can sit here, you're chuckling Shane, and you can see it for what it is. And yet many of us get very caught up in it. I'll be honest. I've gotten caught up in it. And I work with a lot of clients who really feel this very heavy burden. This thing that they're carrying around, like a big bag of rocks, almost that contributes to being drained and being burnt out.
Shane Tenny: 09:10 I'm smiling because I think your description is so apt. My sister eloquently described the impact of that from social media, by saying that we compare our Monday to everybody else's week.
Gail Gazelle: 09:24 Well put.
Shane Tenny: 09:25 I thought, yeah, that's exactly what happens. I'm comparing my every day to somebody else's vacation or success. And my failure to somebody else's win and victory and then feel unworth it. Really. I was also thinking Dr. Gazelle, I remember in a coaching environment that I was able to be in a number of years ago, similar to what you're describing there was ... they were talking about the difference between our role and how we perform, and then that connection to our identity. And sometimes we unhealthily connect our performance to our identity. And when we make a mistake or when we fail, "Oh, well now I didn't just fail, but I am a failure." And learning how to distinguish those. And I think that's a little bit of what you're kind of describing here. Yeah.
Gail Gazelle: 10:09 It's very important to distinguish this. And frankly, to realize that the impostor syndrome is simply a thought process, it's all it is. It's a thought process. And sometimes I think about our mind, almost like a garden, Shane, that there's weeds. And then there are things that we want to thrive, but we kind of water them equally. And sometimes we water the seeds that become weeds more than we water the healthy things that we really want to sustain and grow.
Gail Gazelle: 10:38 So what I mean by that is we can begin to become more aware of when we're accusing ourselves of being an imposter and really tune our awareness into that. And then we can decide, well, how much attention am I going to give that thought? I can water that thought. I can give it lots of water, so it'll thrive. And I'll walk around with my head hung low, not being able to see my strengths and all the good that I do, or I can pay attention and realize when that imposter belief kind of negative message comes out in my mind and I can work with it. I don't have to give it all that watering, all that attention. That's such a critical part of resilience and it's a critical part of what I help people do as a coach. And I think that's what you're saying in the experience when you got coached as well.
Shane Tenny: 11:26 For sure. Now, in your experience, is there a common denominator among people, among physicians and practitioners who are more prone to imposter syndrome or is there a subset of people by specialty as you point out or gender or ethnicity or stage in practice where it manifests?
Gail Gazelle: 11:47 It's so interesting. I have seen the imposter syndrome in medical students, residents, as I said, even at Harvard medical school, people kind of call it the Harvard Olympics. Well, how can I compare to this person who has all of these credentials and accomplishments? And similarly, while we might think with the medical hierarchy, that people who are kind of put at the bottom of that might feel like an imposter more. I think the problem is that everybody walks around feeling like an imposter when there's kind of the setup of that we're not equal.
Gail Gazelle: 12:20 So for example, I was coaching a cardiac surgeon, wonderful guy, very well respected, and he's had such bad imposter syndrome. He just, his mindset was, "Somehow I got here. Nobody found out what a fake I was, but it's only a matter of time now. And every time I go into the OR Gail, I think my number is going to be called." And I've heard that from a lot of surgeons when they go into the OR the sense, like, okay, now that foot is going to drop and everybody is going to see that it was all a sham. You can imagine the burden of it.
Shane Tenny: 12:56 For sure. Yeah. Just that feeling of going to work and forming a noble service throughout the, maybe not perfectly but noble work and yet feeling the weight of being a fake. Now I know a lot of your work and talk is on overcoming imposter syndrome and clearing the noise in your head. So I'm going to ask you about that right after this break.
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Shane Tenny: 15:14 All right, Dr. Gazelle, we were talking about imposter syndrome before the break, and I'm curious, what do you tell people who are struggling with this and just have a cloud in between their ears when they go to work every day?
Gail Gazelle: 15:29 There's a few things. The first is realizing that everybody experiences this. We feel so isolated and this voice of you're an imposter. You're not as good as others leaves us feeling like it's just us. So very, very important that we can remind ourselves, this is not just me. For every person that I'm comparing myself to and believing that I come up short, that same person probably is comparing themselves to other people and hyper-focused on their perception of their inadequacy. So that's the first part really reminding ourselves, this is universal. This is not just me. That alone decreases the burden. The second is getting to know our thought patterns and that's why mindfulness is so important. When people hear the word mindfulness, they think about monks sitting on the mountain top sitting and meditating in an uncomfortable position for hours upon hours.
Gail Gazelle: 16:26 Yeah, that's true. But for the masses and for you and I, it's really more this awareness, this getting to know what our mind is up to because our minds are so productive obviously. And yet they also take us down a lot of dark alleys, don't they? And we need to get to know that so that we can work with it, as I said, so we can decide which thoughts we pay attention to and which ones we don't. So mindfulness is another thing that is critically important, just being aware, "Oh, there goes my mind again, telling me that I'm an imposter." Just we can externalize it a little bit as opposed to this is the truth. That also helps us work with it a little more. The other thing that's really important is when we have that thought that we're an imposter to actually push ourselves to look for objective data.
Gail Gazelle: 17:17 In other words, look for the data points. When I gave that talk last week, and I thought that I was just a complete fake and didn't know anything about it. Actually, some people asked some questions that really showed that they valued my expertise and oh, that one really thanked me for how much I helped them in the talk. So kind of looking for that objective data. What about those patients that I help? Maybe I couldn't cure their COVID, but I did do a lot to alleviate their suffering. So it's trying to apply the same objective lens that we apply as healthcare professionals. We're in the business of doing is being objective, applying that same lens to our own mind, because we can really benefit from a little bit more objectivity with our own minds.
Shane Tenny: 18:04 Is working through these things, the process that you call resilience and working with folks, or what's the connection there between the imposter syndrome and resilience?
Gail Gazelle: 18:15 Well, the impostor syndrome so erodes our resilience and just to make it very specific. I'm coaching a lot of physicians, obviously during the pandemic. And so many physicians have a heightened sense of being an imposter during the pandemic. So the examples are I was coaching a family physician who was doing tele-health, wasn't in-person with her patients. And when she was in-person had to have her mask, her face shield, her gowns, etcetera and she felt like a total imposter. I'm not a real doctor. I'm not even in the room with patients. I can't even put a hand over the shoulder to comfort somebody in need. I'm not a real doctor. That same week I was coaching a couple of physicians on the front lines in New York City and this was in April and May when numbers were really high, it was really unreal what was going on in New York.
Gail Gazelle: 19:09 And a couple of them said to me, "I'm a total fake. I can't help patients. Patients are dying. If I was a real doctor, I would have a cure." So you can see in that juxtaposition that anybody can be prey to this sense of being an imposter. And that gets to another very important way that we can help ourselves work with it, which is to intentionally look at our strengths and accomplishments. In other words, at the end of every day, go through, well, who did I help today? No, maybe I couldn't cure them. Maybe there was COVID or some other incurable disease. There are many incurable diseases that we see in the practice of medicine. Maybe I couldn't cure them, but I was able to help that fellow human being. So we actually push ourselves to actually do an inventory at the end of every day to balance this subjective view that we're not doing enough and then by definition we're some sort of fake.
Shane Tenny: 20:06 You bring up just the experience and in April and May coaching physicians, how has the pandemic and I might even just broaden it to say the overall stress of 2020, is that layering on an extra level of tension for physicians?
Gail Gazelle: 20:23 Without a doubt with the pressures on the healthcare system are perfectly unreal. And healthcare was somewhat under resourced even before COVID sadly and a lot of the infrastructure of healthcare was breaking down. There were a lot of complexities. I don't think anybody really doubts that idea that we have a complex and somewhat broken healthcare system, even in this wonderful country. And with COVID, it's really taken an unbelievable toll on the financial structure of healthcare systems, perfectly unreal that they didn't have the same volume of cases. They had to invest so much in PPE and changes in the physical plant. They had to furlough people. Now they're not just physicians, obviously, but many healthcare employees who haven't just been furloughed, but have had their jobs terminated. So it's unreal the stresses on the system. Then where I come in as a coach and as an author, as you said, my book Everyday Resilience, a practical guy to build inner strength and weather life's challenges is helping people have the tools so that they can ride the waves of difficulty.
Gail Gazelle: 21:34 This is an incredibly difficult year. What if we have difficult years in the future? How do we manage that? What if we, or a loved one is diagnosed with an illness that really changes our life? How do we manage that? That's where resilience comes in because we all have resilience within us. That is my belief. And I talk about that a lot in my book, but we don't always know how to access it. And the imposter syndrome to me is an example of that. We don't learn how to access resilience against these kinds of negative, inner, critical thoughts that we have about ourselves.
Gail Gazelle: 22:09 We don't learn certainly in medical school and residency, we don't learn how to work with our own mind to manage, right, to manage these inner critics that we all have kind of sitting on our shoulder, waiting to pounce on us and that erodes our resilience, but we can learn how to do that. Some of the examples that we've talked about today, we can learn how to do that. And that way we have a little more balance, so to speak to then help us weather the challenges that we face, whether they're COVID or an illness or a difficult teen, pick your poison because we all face them. We all face difficulty in our path. Hopefully that difficulty is not massive, but we just don't know. We don't know what life is going to bring us, do we?
Shane Tenny: 22:54 In your career, have you seen a shift in the medical and the healthcare community in being willing to put the vocabulary to the feelings? I guess I'm wondering if 20 years ago people were feeling this and docs were struggling with this, but either not willing to admit it or not able to, because there wasn't a vocabulary for it. Is that developing into a more healthy blend? And I know you teach a class to residents and those sorts of things.
Gail Gazelle: 23:23 I think it's fair to say that there's much more openness and that might be the silver lining of the burnout epidemic. That now we talk about wellbeing. There're chief wellness officers at many healthcare institutions and elite medical schools. Now residents are free to come and get guidance if they're experiencing burnout. And that's so important because the issue of stigma is really mighty. So many physicians are afraid to seek help because you know what if I have a malpractice case and what if that's used against me? What if I need to go on an antidepressant? I can't do that because they'll get the pharmacy records. And that could really put me in a bad place, terrible stigma that nobody should have to experience.
Gail Gazelle: 24:06 The coaching and the resilience framework is really a stigma free. It's a straights based. You have so much wisdom, strength, and expertise within you. And I want to help you harness that and use that to mount the challenges that you're facing. So it's a very positive forward looking, results, oriented approach, as opposed to you're sick. You have a problem. I need to fix you as opposed to the medical model, frankly, this is a model of wellness and growth and forward momentum that really is invigorating.
Shane Tenny: 24:42 Now you mentioned a minute ago, just your, the book that was released last month, Everyday Resilience, congratulations. And we'll have a link to it in the show notes here, so people can track that down. I guess they can find it on Amazon and wherever you like to buy books.
Gail Gazelle: 24:57 Yes and I offer a free chapter. I'll give you the link on that. They can download a free chapter and get a taste of the book.
Shane Tenny: 25:04 Super. Well, we'll include the link to the free chapter in the show notes here. I want to ask you, as we wrap up here, is there a favorite story or account from your book that just exemplifies a journey to resilience?
Gail Gazelle: 25:17 Yeah. I give a lot of pace vignettes of physicians and students and people just walking through their life, business people. But one that comes to mind is I talk about a surgeon and I won't give him any name, but a surgeon who came to coaching because of anger management and angry outbursts, particularly in the OR, and one day in a particularly challenging case, there was a nurse who was struggling to find the instrument that the surgeon needed and the surgeon lost it and started screaming. "How dare you come into my OR and not know how to do this?" Well, the nurse who had always wanted a career in the OR and was pretty early in their career, started crying and actually ran out of the room. So this surgeon was sent for coaching and you might hear this story and think, oh, he was just the stereotypical kind of angry blank, blank, blank.
Gail Gazelle: 26:11 But he wasn't, he was actually a really impressive, respectful, and kind individual who had never learned how to work with his anger and frustration. He'd never learned anything. In fact, in his training, it was all about manning up and being tough, right? And always being the captain of the team, nothing about managing emotions, which is not that hard to learn. So he came to coaching and he was very receptive. He was really interested. He wasn't happy about his behavior, but he didn't know how to do anything different. And he didn't know to not go from zero to 90, which is what happened that day, that I'm telling you about in the OR. He was so receptive. So we worked with, what were his values? How could he really link to his values, which had to do with kindness and respect? How could he get to know his own emotional temperature and taking his own emotional temperature?
Gail Gazelle: 27:04 What were his early warning signs? He began to realize there was like almost a constriction in his chest before he exploded. So just like we treat early warning signs with a stroke, we intervene. Once he identified his early warning signs, then I could work with him to intervene, to take some slow, deep breaths, to regulate his emotional temperature and cool off, so to speak. And then we could work on what would be a professional response in that situation that would be respectful. He ended the coaching engagement really so appreciative because not only was his professional life improved, not only did he have the same sense of mastery that he had as a surgeon, but actually his personal relationships improved as well. His relationship with his teenage son in particular. Those are skills we can learn.
Shane Tenny: 27:55 There's hope. For folks that are listening and thinking. Hmm. Maybe I know someone who should talk to Dr. Gazelle. I have a friend who needs them or someone who recognizes in themselves, a picture of the story you just shared. How long does the process typically take? What do you see? Is this years of consultations and meetings? What should someone expect?
Gail Gazelle: 28:17 I think orienting around six months is realistic. On the one hand, people hear six months and they think, well, I want to change tomorrow, but six months on the other hand goes by very quickly and change takes time. We're talking about deep seeded patterns and ways that we've learned, like the surgeon that I'm talking about. He had learned to be a bully. That's what was fostered in his training. So there's some relearning here, but the good news is that many people in healthcare and physicians, dentists in particular, they love to learn, but they don't typically have that opportunity to turn the lens of learning on themselves. So this is a way to invest in yourself, invest in your future and invest in your ability to thrive no matter what the difficulties are that you face.
Shane Tenny: 29:01 Yeah. Excellent. Well, Gail, how can folks track you down? How can they find you online?
Gail Gazelle: 29:07 The easiest way is my website, www.gailgazelle.com. I love to hear from people and my email is firstname.lastname@example.org. Maybe we can include that in the notes, but I learn every time I connect with somebody, whether my approach is the right approach for them or not, but I really enjoy hearing from people.
Shane Tenny: 29:28 Excellent. Yeah. We'll definitely put the link to your website in there, the link to the free chapter of your book. So people can learn more, connect with you as they'll find it helpful. And I, for one am very grateful for your time today. And so glad we had you on the show.
Gail Gazelle: 29:41 Oh, thank you Shane. It's been a total pleasure.
Shane Tenny: 29:43 And thank you for joining us today for this episode of The Prosperous Doc podcast, we've got more great episodes queued up coming out every other Monday. So don't forget to subscribe. That way you'll know when the latest episode is released. You can find us on of course, iTunes and Google Play or on a number of social media channels too. And as always, if you have suggestions for a colleague or a friend with a story that is worth sharing, would you please email me directly, Shane@whitecoatwell.com. Thanks so much. We'll see you back here next time.
Outro: 30:16 This episode of The Prosperous Doc podcast is over, but you're not alone on your journey. Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years. To connect with us, visit SDTplanning.com today and take your financial wellness to new levels. Join us on the next episode of The Prosperous Doc podcast.