E011 - Quieting Your Inner Critic with Dr. Christina Shenvi

[00:00] Christina: Being a physician. You wanna be very certain of things. You don't just go out on a limb and try things. Whereas being an entrepreneur, that's exactly what you need to do. You need to be able to function with a high degree of uncertainty and, and be willing to go out on a limb and try a lot of different things.So recognizing, Hey, what skills transfer over from what I do as a physician and what skills do I need to learn or become more comfortable with to do something.

[00:33] Pranay: Hi, and welcome to the firm MD to entrepreneur podcast. The podcast that teaches you how to find financial security outside of medicine. I'm Dr. Pranay Parikh. And I started out as a fresh attending with zero business knowledge, despite loving my job and medicine. I didn't feel like I had the financial security or control over my life today.

I am a serial entrepreneur and practice medicine on my own terms. Listen on to learn how I've helped hundreds do the same. Dr Christina. She is a practicing emergency physician, keynote speaker and academic leader. She also teaches and coaches on time management. Her goal is to help high performing professionals do more of what matters with less stress.She says that the key to managing your time is managing your own mind. She writes and blogs@timeforyourlife.org. 

Hey Christina, thanks for joining us. How are you doing?

[01:27] Christina:I am great. Great to see you Pranay.

[01:29] Pranay: Yeah. It's been so long. I'm so super excited to talk. I know we've had a lot of conversations like this, and honestly, I wish that we recorded some of them.

I think a lot of people would've got benefit out of it.

[01:40] Christina: Well, Pranay, I remember when this podcast was just a twinkle in your eye and we were talking about how are you gonna overcome the fears or the other emotions that get in the way of doing it? And so I'm so excited to see that it is out and launched and available to the.

[01:57] Pranay: Yeah. And you know, actually, uh, our emails were sometimes every once in a while we'd connect and you'd be like, so what's going on with this podcast? 

[02:06] Christina: That's why you avoided me for like 6 months. I know she’s gonna ask me about my podcast.

[02:12] Pranay: Yeah, well, it was, we'll get started in a second, but it was funny. It was like, uh, I talked to you. I was like, oh, Hey. Yeah. Would you be interested in doing some videos on procrastination, fear, mission statements? I was like, yeah. I'll reach out to her in like three months, two weeks later, 14 hours of content are a, you are a machine careful what you asked for. I did not. Okay. So Christina, for, for the people that don't know you, could you tell us a little bit about.

[02:41] Christina: Yes. Hello, my name's Christina Shenvi. I am an academic emergency medicine physician and love like many ER docs, getting my fingers into a lot of different things. And one of my, my favorite side gigs or areas that I have pursued outside of medicine is in coaching around time management productivity.

And really the take home is it's not about, craming more into 24 hours. It's not about just finding that perfect app or that perfect calendar that will solve your problems. It's really about asking hard questions about what we wanna do with our lives. What do we wanna be when we grow? Or what are the reasons that we are putting things off.

So really getting at some of the deep thought level and identity level issues around managing our time.

[03:31] Pranay: Yeah. And you know, I get this question a lot. Uh, you're a doctor, do you really need to be productive? You're pretty successful. I mean, look what you do look at your academic career and you were telling me that you're trying to get on more roles. So do, do doctors really need to be more productive? 

[03:45] Christina: You know, it's not about doing more necessarily. It's about. Doing what brings you more meaning? So do we need to do more? Do we need to see more patients in a day or do more charts in a day? Well, I don't know, but I bet we can all say yes, we wanna find and create more meaning or more joy in our lives.

So for me, it's about doing the things that create fulfillment and that make an impact, not necessarily just craming, you know, one more publication in or one more study or one more presentation. Yeah.

[04:19] Pranay: Yeah. A lot of that stuff you get diminishing return. Right. And there's people that like drawing stick figures or starting a podcast, or, you know, we, I think we are the Kings and Queens of delayed gratification.

[04:31] Christina: Yeah, absolutely. You know, we, we go through life saying, oh, I've gotta do a good job on in undergrad so I can get into med school and then med school so I can get into a good residency and then fellowship. And then finally you get a good job and you look around. And you say, well, what now? What am I trying to do now?

And there's nobody there telling you necessarily, oh, you should do this or should do that. And even if they are often, they're putting us on the wrong track, that's not right for us. So we are that's. The great news is we get to be the arbiter of our own Fs. In many ways, we get to be the ones who decides we get to be the captain of our ships.

And that's a great thing, but also it requires a lot of decision making and a lot of soul searching about what really matters to us.

[05:19] Pranay: You know, and one thing that I get a lot, Christina is I'm just a doctor. I can't be a coach. Uh, I can't teach productivity. I can't start a podcast. What would you say to these people?

[05:31] Christina: Well, first of all, maybe that's not the right thing for you. If you're not drawn to it, maybe something else is maybe it's, you know, some other service to your community, or maybe it's some other business venture, but just because you're a doctor certainly does not disqualify you from it. You know, I think about emergency medicine, we love being the Jack of all trades.

You've gotta, you know, ortho problem we can at. Fix it a little bit. You've got, you know, GI problem. We can fix it a little bit and having side gigs or side hustles actually can help prevent you from burnout. Because now you've got some area where you're using a different part of your brain. You're using creativity in different ways than you might during your day job.

You know, if you're an outpatient clinic doctor and you're seeing patients day in, day out, There's probably you get into a groove and you're seeing mostly the same things, but then if you decide, okay, I wanna start an aesthetics business. I'm thinking about a friend of mine who lives in North Carolina, or I want to launch a podcast or I wanna get into real estate investing or coaching.

Well, now you have to use entirely new skill sets and it's almost like growing another area of your brain. I wanna, you know, use this new area of my brain and these skills, so it helps with burnout, but it also can help your day job. The skills that I've learned in coaching? Well, I started learning them in my day job and my academic work, but then I brought that out to my entrepreneurial ventures.

And then I've also brought skills that I've learned. Oh, so many things that I've learned from coaching faculty and coaching physicians around the world. I've had clients, you know, in England, South Africa, all over the place. And I've brought that back to how I work with other colleagues or how I work with students.So it's definitely bidirectional.

[07:24] Pranay: So Christina, you do a lot of mentoring or, uh, teaching to, uh, students. Could you, could you gimme an example, uh, of how you're able to take some of these skills that you learned from your coaching and really kind of help provide them direction and, uh, focus.

[07:42] Christina: So a lot of the skills are similar in terms of coaching or mentoring students or faculty, which is getting at what is the underlying challenge that's going on?

What are the thoughts and feelings that are going on behind the challenge that you're having? So for example, I've worked with a number of faculty who talk about, they come to me when they're kind of at their wits end and they say, I've just got so much on my. I just can't focus. I, I don't know what to do next.

I can't fit it all in. And what they come to me for is a solution for here's how to pack 30 hours worth of work into 24 hours and also create balance and sleep. But really, you know, that's not something any of us can do. Instead, the question is, well, what were you feeling when you decided to take on all of these things?

What are the motivations? What are the goals? And sometimes it's, well, I feel like this is what I have to do to be successful. I have to have a clinical practice and I have to do research as an academic, or I have to, you know, other people are publishing more than me and there's this constant treadmill and worry that you're getting behind.

And so looking at some of the assumptions that we make, that I assume. To have value. I have to be successful academically, or I assume that in order to get promoted, even I have to, I have to do these things, or I assume that I will feel more fulfilled if I'm doing all these things. When actually often the opposite can be true.

[09:13] Pranay: Could you dig in a little bit deeper? What do you mean the opposite could be true for that?

[09:17] Christina: For example, if you are having the thought of. I have to do all these things in order to be successful and fulfilled. How do you feel? You feel overwhelmed, you feel, um, maybe motivated, but also you feel a sense you may feel a sense of helplessness that I am just at the mercy of this giant academic machine.

And I have no control. I have no agency. Whereas, if you choose different thoughts or if you examine really what is true for you, and it may be that thoughts, like I have full control over what I do. I don't have to do this. I don't have to jump on this hamster wheel. I don't have to choose this pathway. I can choose a different pathway.

That mindset shift going from, I am a victim. I have no control over what I do to Nope. I have full control. I'm a grownup. I am a captain of my own ship. That mindset shift can then help you make better choices. So maybe that means for some people cutting down to part-time or maybe ha have a friend who recently made the decision.

To leave clinical medicine altogether and pursue leadership development, um, training, uh, as a leadership developer. So that mindset shift can help you think more clearly and more creatively because you are not in that state of learned helplessness, where your blinders are all the way in, and you really aren't seeing other solutions.

[10:48] Pranay: We're not good at being able to gauge how we felt at a certain time or what something is going to make us feel. Right. When we were working together, you had me do a pretty interesting kind of journaling exercise about emotions. Do you mind going over

that a little bit?

[11:02] Christina:  Yes. And this has been something that's so helpful to me.

I remember years ago, my husband would say, oh, you're upset about something what's going on. Why are you upset? And I would say, no, I'm. Because I was just so out of tune with what was going on. And of course, three days later I would be like, Ugh. Yes, I'm so upset. And, and I would figure it out. So forcing yourself to stop and write down what you're thinking.

So whether it's on a good day, cuz it's, you know, good to write those things down too, or whether it's on a day, when you find yourself constantly reaching for your phone or reaching for your email or Instagram or whatever your digital toxin of choice is instead of doing the work that really matters to you.

So writing down your thoughts and maybe it's. Thoughts can be as simple as this is so boring. I don't wanna do this. And in which case you can say, okay, interesting. I'm avoiding doing this important work that matters to me because it's boring. Well, how can I subjugate the boredom to the strength of my purpose, which is yes, I can do an hour of boring work in order to accomplish this thing that matters to me.

So reminding yourself of your vision or your mission or your values. That allow you to tolerate boredom or maybe even just noticing like, oh, yep. This is boredom. Now is the time when I feel the boredom or maybe it's not boredom. Maybe it's, you know, you mentioned in your podcast, uh, a few episodes ago about how you had delayed putting out the podcast because of fear of failure.

And that's a huge one. If I, you know, don't submit this paper, then it can't get rejected. Or if I don't submit my abstract as a speaker, then I can't get rejected. Or if I don't apply for this position, I can't get turned down. And fear of failure is something that holds us back all the time. So being honest with ourselves and writing down.

Like, I am afraid, you know, in my heart of hearts, I am afraid that this will get rejected or that I'll do this. And people will think it's terrible. I'll do this podcast episode. And everyone will say, Ugh, that was the worst. Why did Renee invite her? So being honest with ourselves about our thoughts allows us to then first of all, it diffuses them, just the act of writing it down.

I'm like, okay, good, done with those thoughts and it, they have a little bit less power. But then the other thing you can do is choose thoughts intentionally that will create more positive feelings that will help you be motivated to do the work. So for example, if I come at something with curiosity, oh, I'm curious.

I wonder where this podcast will go. Curiosity is a great positive emotion that drives kind of approach behavior rather than retreat behavior. So bringing curiosity or bringing an openness, I'm open to feeling fear. I'm open to feeling boredom. I wonder what fear will feel like to me when I go feel it while I'm, you know, getting ready to do this task, depending on what the thought is, there's all sorts of ways to dig into it.

But those are the, some of the common ways that I've seen, uh, seen those thought patterns play out for people.

[14:12] Pranay: And when you talk about kind of changing the emotions, is it, uh, like fake it till you make it kind of thing? Like I'm excited and I'm not nervous. Uh, you kind of hear that one a lot, um, where you kind of change your kind of jitteryness to excitement.

Like you're excited. You're happy that this is happening. So is it, is it in that sense or is it something deeper?

[14:32] Christina: I think it's something deeper, cuz I think our brains are really smart. And you can't very easily fool them. You know, if I have a fear of public speaking, that's another really common one. And I tell myself, I just, you know, stand backstage and at power pose and I'm.

I am the world's best public speaker and I try to repeat that to myself. It doesn't work. There's no world in which I'm convincing myself of something that is untrue. And I don't like to be that feels a little bit disingenuous. I wanna be honest with myself. So I try to pick things that will be believable.

I actually have this printed above my desk. It is a Latin phrase. That says essay Cumari and it turns out that that is actually the state motto who knew states have a motto. Like what else do they add? We've got birds, we've got flags. Apparently we have mottos. And it means in Latin to be rather than to seem.

So the goal for me is not to try to believe something that's untrue or to seem like something to try to be something that we're not, but try to be what we are to be rather than to seem. Now, there are some. Mental tricks that we can play that will help us believe things that are challenging for us. So you mentioned, for example, seeing a, something is excitement rather than anxiety.

And I just finished a book called the upside of stress. I don't know if you've read that it's a great book. You would love it. And I was inspired to go do a deeper dive into the psychology literature around stress. So let's use that example since you brought that one up, let's say you're feeling stressed about an exam or, you know, For students or, or a public speaking gig that you're doing or whatever it is that you're feeling anxious about.

There are a lot of studies from the psychology literature that say, if you reappraise that stress as excitement that you actually perform better. So they've done this, for example, with the GRE or with other performance measures where they say, Hey, that racing heart, those sweaty palms, that is your body, preparing you to perform optimally.

And just creating that mindset shift actually changes the biology of your response. You have different stress, hormone levels, you have different cardiac contractility, vari variations in terms of whether you see something as a challenge or a threat. So we are constantly scanning our environments and seeing, you know, okay, this car barreling towards me.

Is that a threat? If I'm like two feet away from it? Yeah. That's a threat or is it. A challenge, you know, I'm far enough away that it's not gonna harm me or this standing up on stage. Is this truly a threat? Our body likes to tell us that a lot of things are threats when really they're just challenges. So I see that challenging situation more as like, okay, I'm an athlete preparing to run a race.

I'm not a victim running away from a lion that might kill me. And that's, my body is telling me that I need to run away from this, but really I can run towards it. And so seeing yourself in that light, you know, if you look at athletes preparing for a game or a race, their hearts are racing, they're pumped up, but they're using that to their advantage to help them perform better.

Whereas if you see someone who truly is in a threat situation, let's go back to that lion and their heart is racing, but they are in a situation where there truly is peril and where they are, are going to run away from not towards that challenge. So one, there are different ways to increase. Your ability to see something is a challenge.

One, if we go back to our, you know, public speaking example is to prepare well, if I've prepared well, then now I don't see this as a threat. I am just excited about it. I'm excited to show all the work that I've done to prepare another is to desensitize yourself to it, by doing it over and over and over.

You know, when I was a resident, I remember just in her residency conference with like 20 people who were mostly half asleep because they'd worked late. I would get so nervous when I had to give just a, a presentation on, you know, hyperemia or something, I would be like sweating and getting so claming and nervous.

And now, you know, I've done this so many times I've spoken in so many places you just get used to it. You're like, oh yeah, that's my that's myself being excited almost to the point that now I have to. Actively work on feeling a little bit nervous, just so that I can like perform better. So it's like, you know, those athletes in the locker room, like pumping themselves up high fiving, like they're doing that to actively increase their level of arousal and their level of, you know, uh, uh, epinephrine and, and all those hormones that are gonna help them work better.

So preparation. Desensitization. And then third is just that mindset, mindset shift of saying this feeling is my body preparing me to perform optimally. I don't have to be afraid of the feeling of nervousness, just like the fear of boredom or the fear of fear itself. We do more harm to ourselves when we push it away rather than accepting it.

If we accept it and we're like, oh yeah, that's a little nervousness. I'm feeling cool. There it is. Hey nervousness. I'm Christina. How's it going? Whereas if we try to push it away, ironically, we just end up creating more barriers to allowing it to go through us and allowing ourselves to perform optimal.

[19:55] Pranay: Yeah. And it kind of goes back to what you were saying, right. To technology your emotion. Like, you know, I am scared, right. And like, Hey, this is what fear feels like, and this is, you know, so next time I know what to do or, you know, I know to do breathing or something else to be able to handle that.

[20:13] Christina: Yeah, exactly.Or kind of make something funny out of it. Uh, I have a, a friend who I worked with. She took my time management. And we were talking about that negative voice in your head. That's like, Renee, no, one's gonna listen to your podcast. It's just gonna be terrible. It's gonna be a flop. Right. You've heard that voice.

We're like, oh my gosh. How did you know? Yeah. So she gave that voice a name. I think she called it Shannon. And so, so whenever it happens, she could be like, oh yeah, that's Shannon. I, you know, don't have to choose to listen to her. She can have her opinion, but then she can, you know, she's voiced it now she can go.

So kind of making something funny about it or seeing that. Um, anxiety kind of personifying it or making it into like, um, a funny image in your head. Like your anxiety has like a funny face or a clown nose or something. It's almost like that. How my kids remember, there's some, um, spell in Harry Potter where you take something that's really scary looking and you make it into something funny.

And so that is something that we can do just mentally, that will then, um, disempower it and give us the power.

[21:24] Pranay: Yeah. For people that watch comedy, you know, a lot of times the funniest things are when someone mix misses up and they make a joke out of it. Right. As opposed to like, just pretending it doesn't happen.

And then it's just super awkward. Right? Everyone's like, wishing they weren't there. But if you acknowledge it and you make a joke out of it, everyone's like, yeah, this funny, this is life. Yeah. It's human.

[21:44] Christina: It humanizes you and you know, fundamentally, why are we afraid of failure? Why are we afraid? Why have we connected our sense, our deep sense of self worth to our success. And, and that's another thing that, you know, that is something we can't solve here in a 30 minute podcast, but that, that is an ongoing, uh, kind of way to look at our assumptions. Oh yeah. I'm fear. I'm feeling fear because I don't want the podcast to fail, but really I'm feeling fear because I've tied my sense of worth to the success of this podcast.

Whereas if I viewed it purely as something I could do for joy, for meaning for fun, for personal development, well then there's no risk involved and then there's no fear.

[22:36] Pranay: Yeah, there's a quote, uh, or a saying that says, you know, uh, I can tell you how successful someone's going to be by how afraid they are of being, uh, having failure, you know, or having, um, success.

So if they're, if they're totally tied to the outcome, then you know, you're just not gonna be able to take as many risks, you know? And, uh, a lot of times for doctors, we actually are. We're in such a good place to start a business, to start a side gig, right? Because we are not, we have, uh, pretty decent living, right.

We we're able to pay all the bills. We can even take a month or two off if you want right. To work on whatever you want or work on weekends. Um, so we have that safety net, um, but, uh, we've been conditioned right. To not fail at anything like to don't take that class. If you're not gonna get an a . Uh, don't do that extracurricular if you're not going, uh, get that award or whatever.

Um, so, uh, it's, it's so built into our psyche that I think even as an adult, it's hard to, um, take that off. And a lot of times, like that gets even carried on to our kids.

[23:42] Christina: Yeah. You know, the other side of it though, is that we, we do have to, when we're entering a new field, Avoid the hubris that, oh, because I'm good at being a doctor, therefore I will be good at something else because the skills are different.

I'm actually reading a book called, um, what got you here? Won't get you there. And the idea is that often the very things that made you successful in one area are actually things that will harm you in others. So for example,

[24:36] Pranay: If anyone ever talks to Christina or listens to one of her talks, she is. Best and well sight person outside. It's like, uh, it's like, yeah, this book in that book, but it's, it's amazing. I love it. So she she's so well read and she's able to take insights from really the last couple thousand years. I know a lot of times you talked about Seneca and the soak philosophy.

Uh, so it's great. And it's one of my favorite things about you. Yeah. Um, you know, and, uh, you did talk about burnout, um, in the past and that's something I really wanted to, um, dig in a little bit about

[25:12] Christina: One thing I do wanna preface about burnout is that it is not an individual failing. If we are in a situation where 50% of physicians in the us are feeling burnout.

Well, it's not a problem with them. It is clearly a problem with the. I think about electronic medical records. You know, it's only been in the last 15, even 10 to 20 years that those have been implemented. And before that, there really wasn't this going home and charting for hours and hours at home, you would write your handwritten notes quickly.

There were pretty brief. There wasn't a lot of, you know, metrics that were tied to them and things like that. And now, because charting is so tied to the metrics that you have to hit. Charting becomes a much bigger deal and a huge source of burnout. We know that the number one cause of burnout among physicians is administrative tasks.

So when we think about fixing burnout, really it's about fixing the system. We should continue to work to do that, whether it's through factors that mitigate some of the stress, like having a scribe can reduce the, the workload and the burden of taking notes or whether it's really through healthcare transformation, working at the level of CMS or other payers that are determining a lot of these metrics that we have to meet and making sure that they are things that are patient centered, and that will work in a, you know, busy hospital in a, or in a busy emergency department.

Now at some point, we reach a state where we don't have control over those outside entities. We can't control the metrics. We can't control a lot of the external factors. The only things that we can then control are ourselves. In fact, Frankel, Victor Frankel says when we are no longer able to change a situation, we are challenged to change ourselves.

So, yes, continue to work, to fight the factors that are contributing to burnout and to change the system, to make it more safe and more, uh, tolerable. But if we decide, yes, I want to stay in medicine. That's of course the other decision we can decide. Nope, I'm done. I'm leaving or I'm cutting down to part-time.

But if we decide, yes, I want to stay in medicine, then it becomes about how do we create the mental models or frameworks that'll allow us to thrive and patch. 

[27:34] Pranay: A lot of people say, and a lot of people come to you and I, and say, you know, I'm burned out, right? Insurances, companies, all this other stuff. Uh, and a lot of times we talk about maybe do something outside of medicine.

Like Christina, I'm so busy. Mm-hmm I have zero time. You're telling me to do something outside of medicine. Uh, I'm sure you have people like that all the time. What do you, how, how would that kind of conversation go? 

[28:02] Christina: So burnout is, oh man. Such a big topic. I would love to talk about this for a long time. So burnout, I feel like is not just one feeling.

It's a, it's like a package. It's a package deal of feelings. So let's, let's pursue this a little further. We're gonna make this interactive. Okay. So let's say you come to me and you're like, oh, I'm so burnt out. I don't know what to do. Well, burnout is kind of a syndrome. It's like a meta feeling. It's a, you know, it's a lot of things are in there.

So I would probably start by asking, well, tell me what that feels like. What are some of the feelings that come up for you with burnout?

[28:41] Pranay: Yeah, Christina, I just, you know, it's Monday or it's Sunday and I just dread work. Right. Just going in having to talk to the administration, having them tell me I have to see more patience.

Right. And just not having the time, you know, when I tell people they have cancer, I wanna sit there for 10 minutes right. And talk to them. Um, and I just feel like I'm, I'm a cog, you know? And it just, yeah. The, uh, medical, industrial complex eating me alive. 

[29:15] Christina: Oh man. So I hear from what you're saying, a lot of different feelings, dread powerlessness, undervalued.

Feeling kind of, like you said, like a cog in a, in a giant machine. So then I'd wanna look at, well, are you powerless? You're feeling powerless. That's one of the things, are you really powerless or where could we notice that you actually do have a lot of power? Um, so some of the feelings show us, they're like signposts showing us.

We need to look at this. Okay. Powerlessness. Let's look at what's going on with our power. What do we have control over? We always only have control over our thoughts, our feelings and our actions. There's this stoicism, you know, bleeding into this here. So what thoughts could you think that would make you feel something other than powerlessness?

Let's say you just wanna feel, not even powerful, but you wanna feel neutral. Well, let's look at what thought patterns you could create that would help you at least feel neutral. If not, you know, more in control. And it might be, you know, for me, it's things like I have full control over my time. I choose to go to work.

I don't have to go to work. No, one's like coming to my home and dragging me from my bed. I'm choosing to go to work every day and that at least can get you to neutral because when you're in a state of powerlessness that makes you less likely to take action. It also kind. Colors. It's like a lens for how you see everything.

Whereas if you come out from a, come at it from a, a feeling of, okay, I'm actually in control, then you could decide, well, do I even wanna stay in medicine? Do I wanna cut down to part-time? What things can I control? And let's say you decide, Nope, I still have to work full time or not have to. I still I'm choosing to work full time. then even going into it with that mindset can help. So that's how we would start to think. And it's just a start to think about powerlessness and then some of the other feelings of dread, then my next step would be to say, all right, well, tell me, tell me some of the thoughts that go into that feeling that create that feeling of dread for you.

[31:33] Pranay: Yeah. Uh, Uh, you know, just getting feeling, uh, that I need to, that I'm always thinking about hitting metrics. Right. And how, how long is this patient in the ER, how long did it take notes? Yeah. You know, you forgot to order the stupid A1C on this patient. That's been here a million times, uh, and, uh, Just have, you know, getting kind of talked down to mm

[32:02] Christina: mm-hmm so, yeah. So that's even another one of I'm feeling, you know, talked down to by other people. So let's stick with that. One of, you know, I have a, yeah, I hear you with the metrics. We've got door to doc times. We've got length of stay times. We've got, uh, I can't even keep track of all the metrics. So, how do I wanna feel about metrics?

Well, I'm never, I don't wanna try to trick myself into feeling like I'm the metrics queen. I just love metrics. Cause I don't think that that's ever gonna happen the best I can get to with something like that is a studied and difference. I wanna just feel indifferent metrics don't really matter to me.

They're not really, you know, in terms of like good or evil. So the stoic thinking around this kind of thing is there are things that matter, and that is the pursuit of virtue and, um, you know, justice, courage, those kinds of temperance, those kinds of things. And then everything else is indifferent. So whether I have, you know, a salad or, you know, something else soup for dinner is kind of indifferent.

So I'm not gonna like throw a fit about that. And so seeing things like that as how can I create just a very steady indifference about it? So it's unemotional, so I'm not going in with all of that negative emotion. Now I'm not gonna pretend that we can just, you know, magically think our way in an hour out of burnout but, but the constant practice of intentionally choosing your thoughts can be an amazing asset. And also when you go into your work with that sense of like constant dread powerlessness feeling, rush unvalued, and you know, that's all, that's what was under your umbrella of burnout and someone else's umbrella of burnout might have other things underneath it, but then you end up feeling like you can't do anything about it.

Like you just have to keep working in, in that job, in that same way. Whereas when you come at it, Either from a sense of empowerment or at least from a sense of indifference or neutrality, then you can see more clearly to make better decisions for yourself.

[34:14] Pranay: Yeah. And that, that energy is, you know, you might think you're hiding it, but you know, people can see, people can see pretty obvious.

Um, and it goes the other way. Right. And, uh, a lot of people are like, when they see me, they're like, oh, it must be really good in the, uh, world you live. I was like, yeah, you know, it's pretty happy. Uh I have a funny story that someone came in for an overdose and I. Oh, you know, maybe he unintentionally did that.

And nurse was like, oh, it must be a good world. I was like, yeah. You know, I just expect the best out of people. Mm-hmm . Um, but it, it is a lot less stressful. Right. Um, just imagining that like, yeah, you choose to go to work. Uh, you, maybe you have control over the shifts you pick, right. Uh, and at whatever control that you can.

Over your life. And, um, maybe it's even taking a step back. I know a lot of times we have to feel, uh, and I get this a lot. People are like, Hey Pranay, like, how do I replace my salary? Right. I can tell you entrepreneurship's great, but you can't replace your salary in six months. Probably not even in a year.

Right. Maybe longer than that, but the difference between your ideal schedule and your current, schedule's not that much. Right. So for example, You know, I work nights. Um, I tried switching at days. I didn't like it , but I, I calculated it right. And to, to switch to a hundred percent days from my a hundred percent nights, it's about 30 grand a year, which, oh, it's not an insignificant amount of money, but that is way more approachable than replacing a doctor's salary.

That's like what? Like one 50 to two 50 ish, one 50 to 400, depending on your specialty. 30,000 that's, that's very doable. Right. And that's replacing a hundred percent of my nights. Maybe I did 50% or 25%, or I stopped working weekends. And it's just that. And I know you've talked about this before is just cutting down, you know, almost like the KA way, right.

1% better. And just cut your goals down because everything feels like a mountain at first, right? You're like, I'm gonna create an online course. Uh, I don't know how to use video. I don't know how to edit. I don't know how to do any of this stuff. And then you just sit there and procrastinate because you have all this fear or just.

There's too much. It's too overwhelming. And I, I think burnout is kind of like that too Christina, where you're like, yeah, you have this learned helplessness. You have dread, you have all this stuff that's going on. You're like, okay, how am I gonna deal with any of this? And then unfortunately, people decide to leave medicine where, um, and you know, that's the right answer for some people.

But I think for a majority of people, they can find a level that is sustainable for them and actually gives. Positive energy instead of the negative energy. 

[37:06] Christina: Yeah, absolutely. And noticing what we complain about can actually be a really. Powerful tool in and of itself. So, okay. I'm sorry. I know I keep sharing books, but it's just like sharing books is my love language.

So one of the others that I'm reading right now, I always have like three or four books going at one time is, is called how the way we talk can change the way we work. And I'm only like part way through it, but there, their concept is like, let's say you are noticing that people are always complaining about.

Um, oh, we don't have the resources to be able to do X, Y, Z, or we don't have the, uh, you know, if only I had somebody who could help me, then I would be able to get my work done better looking at well. What does that demonstrate about what you care about and focusing from there instead of from the problem?

So focusing on. Oh, what matters to me is doing a really good quality job. And so that's why I'm complaining that I don't have the support that I need or what matters to me is really making the patient feel valued and heard so that I that's why I'm complaining that I don't have time to, in your example, talk with that patient about the new diagnosis of cancer.

So coming at it from a place of values, rather than from a place of complaint,

[38:31] Pranay: Yeah. It, you know, to kind of stick to this, uh, burnout, um, a lot of times it's because we're missing that opportunity for growth, right? Mm-hmm so, you know, they've researched and they've found that kind of three things that you need to be satisfied with, uh, your work, you know, and obviously everyone looks at it a little bit different, but autonomy mm-hmm , which a lot of times can be an issue, uh, impact.

And, uh, the last one is growth, right? And that's, I think that's a really big one for us doctors because we've went through college med school, residency fellowship, uh, and then also up the academic ladder like you have, but for, for many of us, like me as a hospitalist, we're kind of at the top. Top of the totem pole for doctors, right?

There's only one medical director and a lot of us necess don't necessarily wanna do that. So where are you gonna find that growth? Right. And a lot of times for us, it's outside of medicine. Um, and that's important for people to see that that is an option.

[39:31] Christina: Yeah, absolutely. And I think, you know, the business world does a better job of this.There's usually a relatively obvious career pathway, you know, you're the director, you're the assistant director. And then you're the regional manager, the assistant to regional manager, whatever it is, there's, there's kind of a pathway. Whereas in medicine it's, , it's often, like you said, there's one or two people.

And then everybody else is on a flat playing field and that's good in some senses that there isn't as much hierarchy and levels, but it means there isn't as much opportunity for growth. And if you look at academic medicine, it's like a spider web, like there's all these different levels. And you're like, what is, how, what is the org?

The org chart looks like a spider web and, and it's so hard to decipher. But it's not just about growth in the title of your position. It's about growth in your learning and your opportunities to have impact. And it is there. It can be very hard to, to find that I, I would add one other thing that I think can really be, be the deal breaker in addition to the ones that you've mentioned, and that is having a strong work network and network and networking.

For a long time, I kind of thought of them like dirty words, like networking was this thing, this unfortunate thing that you had to do occasionally, but really it was about how you could meet other people that would be helpful to you. And so it felt very utilitarian and transactional, but actually the more I've gotten to learn about networking is that it's really about creating connections.

That will foster more meaning. So for example, you are part of my network and that's great. That's a way that we can come together and talk about things or bounce ideas, or I can come beyond your podcast. You can, you know, write something for my blog if you want. And that creates a lot of meaning. So seeing your network as opportunities for growth, especially when we don't have those opportunities in our work day in and day out.

And actually there was a, a great, um, little Harvard business review article. I read recently that said, if employees don't have a best friend at work, there's only a one in 12 chance that they'll be engaged. So there you're much less likely to be engaged at work. If you don't have people that you can really deeply connect with there.

[41:49] Pranay: Yeah. And for, for a lot of people, networking is like, oh, I need to go talk to this sleazy salesman. I need to go talk to like this person that we have zero in common, but no, it's basically making friends, right? Yeah, exactly. This is an adult version of making friends, right? Yeah. Like, like you and I, you know, I reached out to you and you know, maybe we could have just connected for the video course, but we've stayed in touch because we have a lot of common things.

And we've even worked together. Right. And, um, I love hearing about what you're doing. I tell you about my podcast. That's finally out, thankfully. Now I'm not shameful when I talk to you, but uh, yeah. And it's, it's, it's nice. It's like, think about meeting people you like to talk to. Right. And that's, that's networking.

That's the right way of networking. And a lot of times people will be like, okay, I need to get 10 business cards, right? No, no, you need, anytime you go somewhere, I'm like, I need to make one meaningful connection. Right. That's it that's it. And that, that just just takes distress off. And we were talking about like overwhelm right earlier.

We could probably talk a whole hour on overwhelm and the feeling of overwhelm and how that always gets in our way where you're like, there's just so much to go on. You're gonna just sit and watch TV instead.

[43:05] Christina: Right. Right. Cause you, you give up when you're, when your brain is like, okay, I'm full now. Then it, it decides, okay, let me go do something easy.

And, um, yeah. Having other people who can inspire us helps us see what's possible. And also it kind of sh gives us a shared experience of, oh yeah, you struggle with this, but look how you've overcome or look how you've found other ways. And so it allows us to kind of try on other identities so I can look at you and be like, huh, do I wanna be a, a real estate entrepreneur?

And I'm like, well, maybe. Maybe I wanna do something else. And I can look at other people who do, you know, coaching or motivational speaking, and kind of try on that provisional identity and say, do I wanna do that? Is this what I wanna do? And then you, you get to, once you decide, yes, I do wanna do this.

Then you have a network of people you can reach out to and say, Hey, how did you start your podcast? How did you start this? And now you have kind of the inroads.

[44:07] Pranay: Yeah. And, uh, Christina, you know, people are gonna want me to ask, how do you do all this outside of medicine while still being an academic physician?

[44:17] Christina: So the great part about academics and also about having shift work is kind of fitting things in wherever they fit. So I don't have a nine to five Workday. Some days, some days I might have a, you know, 11:00 PM to 7:00 AM work. Or, you know, a three to 11 Workday. So trying to find creative ways to fit things in seeing it kind of like a puzzle, not just a, a stack of here's the hours that I spend.

And then in, in the last year, I have really focused and tried to call things that, you know, I was doing and they were great for a while, but now they're not really creating as much meaning or enjoyment. And, um, and then while you're doing things, being really efficient in how you're doing them, which for me, and today has been a little bit of a tough day.

I haven't done as good a job as I would like, but for me means like when I'm working on something, putting all my attention on that and silencing the distractions, turning off my email, putting my phone away, taking my watch off so that nothing can distract me from really focusing on that one thing. And it, you know, I keep a lot of little motivational notes around.

But one of them that I have on a PostIt on my screen is what do you need to move, do to move the needle? So I can, you know, we can tread water all day long, just like checking emails or checking websites, but how do I really move forward with something and trying to spend my time focusing on those things?

[45:51] Pranay: Now I'm gonna quote a book. Yes. But, uh, there's, , there's a book called, uh, eat the frog. Yeah. Uh, right. And, uh, he talks about basically the whole book is just say that in the morning is eat that frog. Right? Whatever you need to get done, whatever you're gonna push away. Cuz the first thing you're gonna wanna do, as soon as things get difficult is you're gonna try to do something else and it's productive procrastination.

Right? Always emails that need to be checked. You know, you should always go check on your kids. You always need to go make food. You go, you need to go grocery shopping. Right. You need to go. Uh, and then reading is actually the worst where you feel like you're being productive, cuz you're reading a book.

Right. And that's cool. And you can say you read a lot of books, but isn't necessarily moving the needle. Right? So you just cook the frog, you eat the frog first thing in the morning, first thing you do. Um, and then the rest of the day is successful. So a lot of people. Work out, right. Mm-hmm especially, um, in the morning, cuz by the end of the day, you're exhausted.

Right? Uh, you're gonna start tomorrow and tomorrow, tomorrow, but if you get it over with, no matter what you do the rest of the day, it's a success.

[46:58] Christina: Yep. But that my, uh, one of my best friends and I, we would sometimes we'll have days where we work together. And, uh, and we'll always talk about how all right, what's the frog we need to eat this morning.what is, what is the, the worst thing that we really don't wanna do that we need to just get over with before we go onto other things that we're excited about and that, you know, there's different ways. There's no one answer you could also say, well, Hey, what am I really excited about? That's gonna really get me going today and let me work on that for a while first.

So there's, it's, it's a matter of being aware of you. How am I feeling checking in with yourself? What's gonna work well today and what do I really want to accomplish in doing those things?

[47:41] Pranay: Awesome. Christina, could you tell me what a day in one of your entrepreneurial days looks like?

[47:48] Christina: So it's, I don't usually have like a full day for that.I would say usually that's fit in kind of in the evenings. So my day job, I work in the ER or I'm in my office, you know, meeting with people, working on curriculum or other sorts of things. And then mostly I fit my other. Work into the evening. So I run a, a workshop and course on time management and I coach on that.

And so I'll fit that in, you know, wherever it fits. Um, or if I'm writing a blog post about something or an article about something, you know, often those ideas come to me while I'm driving, unfortunately. Um, but sometimes I'll dictate to my phone what, what I'm thinking about and then kind of bring it together another time.

Some, some of it is capturing the inspiration that comes at random times, but then sitting down and hammering it out and making it happen usually for me is in the evenings or weekends,

[48:44] Pranay: You know, that reminds me of one trick that I've been using. Uh, so every once in a while I'll have to write something and I, I hate writing.

That's why I like canceled my blog and you're just staring at this blank screen. Right. Cuz most of us. But you have a thought in your brain. Right? So what I did, um, have you heard of auto.ai? No. Yeah, it's awesome. Check it. It's free. Um, so it's a transcribing service. Mm. Um, and it works great. Uh, so, uh, I just will open that up and I'll just start talking and it makes zero sense.

There's run on sentences fragments, but by the time I'm done, I'll have like thousand words. Right. And then it just takes some editing. Um, and you gotta do it as soon as you have the idea, you have the idea. Right. It just, it takes like three minutes where normally a blog post would take me like an hour or two. Uh, and it there's an app as well. So, um, and it's free for the most part. Um, so it works really well. It's kind of really, uh, been beneficial for me.

[48:43] Christina: Yeah. It's that's great. Those kinds of tricks can really help reduce that activation barrier. If you're feeling that intimidation of, oh, what am I gonna write?

Nobody's gonna read it then. If you're like, well, I can just dictate it into my phone or my computer. They're done. Awesome.

[49:58] Pranay: Awesome. Well, Christina, I'm sure some people are gonna wanna know, um, what kind of coaching you do, how you help doctors. Could you tell us a little bit about the type of people you work with and what you kind of help them through?

[50:11] Christina: Yes, mostly the people that I work with are, um, Professionals, mostly physicians, although some lawyers or other types of professions and working through whatever it is for them. Um, you know, the time management is really a syndrome of whatever else is going on underneath. So it may come up as burnout, or it may come up as, you know, procrastination, or it may come up as overcommitment.

And so we use that as an entry point to work in and say, well, what is it that matters to you first, defining your vision, defining your goals, and then understanding your priorities and creating a system. So decide plan, and then doing, how do you do things? Well, how do you focus so that you're not.

Constantly thinking about 25 other things, or constantly being tempted to do your email or do Instagram when you're trying to work. And then so decide plan do, and then fourth, reflecting on how are things going? How did this change, how you felt when you were doing this work? And we really go pretty deeply into the thought work and the motivation and the assumptions that underlie the, the challenges that we're.

[51:24] Pranay: Yeah, it's kind of like overeating or money, right? Is it's not cuz you love food or mm-hmm you like spending money, right. There's just, there's something underneath and you gotta, if you don't fix that, then the, the symptom or syndrome is still gonna keep going on.

 [51:37] Christina: Absolutely. A lot of similarities to things like eating or not exercising or all those things that we say to ourselves, I should do this.

Just like, I should not binge watch Netflix at 2:00 AM and then be tired at 7:00 AM. And that's why I'm not feeling productive is cuz I'm tired at seven, you know, I was up till 4:00 AM. Well, okay, well let's get it. Like what were you looking for in the binge watching or what were you looking for in the surfing?

You know, Instagram or Facebook and, oh, I was doing that cuz I was lonely or I was. Frustrated or I was feeling that sense of dread. And if I don't go to sleep, then I still have a little bit of time to myself. Actually, one of my favorite phrases I learned this year from an article was, um, revenge, bedtime procrastination.

And the idea is, I dunno if you've heard that, but when you, when you hear that you can, if you know, you can immediately relate to it. It's that feeling that when you work so hard or you're dreading the next day, you feel like, oh, if I just stay up a little longer, I have a little bit more time to myself.

Whereas if I go to sleep, then it's basically the next day and then I have to get up and work. And so you stay up way later than you really want to taking those few precious hours to yourself as kind of a revenge against your Workday. So getting at all of those underlying things is what really helps people gain freedom.

[53:00] Pranay: Yeah. So the people, uh, listening, can't see this book, but there's this book called the dictionary of obscures sorrows. I love it. And it is full of it. That's in there too, but it's full of like all these like little sayings, uh, that I love, uh, yeah. Revenge, bedtime procrastination. Yeah. It's uh, it, it's funny.

It's, you know, it's and it, it kind of just goes back to that locus of control. Right? Mm-hmm . That's all you can control in your life is the time you go to sleep. And even if it hurts you, you're gonna, you're gonna take control of that part. Right?

[53:35] Christina: Yeah. And understanding what you're looking for, understanding, you know, it's, it's different for different people what's going on in, in our minds.

Um, but it's, we're always looking for something. And so recognizing that and recognizing what's driving our behaviors can then help us create new habits and new patterns.

[53:54] Pranay: Awesome. What a great place to stop. Well, Christina, if people wanna reach out to you, uh, maybe for coaching for your course, what would be the best way for them to do

that?

[54:03] Christina: You can reach me on my blogtimeforyourlifeorg. There's a contact there. And there's also my video series that you mentioned Pernet that is up there. And, uh, just lots of other resources and thoughts. If this kind of thing resonates with you, um, go check me out.

[54:21] Pranay: Well, thank you so much, Christina. I'm sure you have a lot to do today.

[54:24] Christina: Thank Pranay. Great to see you.

[54:26] Pranay: Bye. Thank you for listening to this episode. If you have any questions or would like to follow me, please sign up for my newsletter at  frommd.com.