EP 22: Befriending the Inner Critic and Learning Self-Compassion

Episode Description:
In this week’s episode of the Hope4Med podcast, we have an in-depth conversation with Dr. Omar Shaker about burnout, practicing self-compassion, and finding fulfillment. Dr. Shaker discusses his journey of overcoming burnout through befriending his inner critic and learning self-compassion. He shares evidence-based methods and tools to help battle burnout and measure fulfillment.

Connect with our guest, Dr. Omar Shaker
Email: omar@shaker.health
Website: https://gumption.ink/

Transcript:
[00:00:00] Dr. JB: For us, by us, and just for us. This is Hope4Med, med.

[00:00:06] Dr. JB: Hi everyone, welcome back to the Hope4Med podcast. I am your host, Dr. JB, and today’s featured guest is Dr. Omar Shaker. After burning out as a physician and later as an entrepreneur, Dr. Shaker embarked on a journey to unveil what drives our professional and personal fulfillment. In this talk, he will share the latest evidence-based methods and tools that we have at our disposal to measure fulfillment and battle the shadows of burnout. His latest project, The Search of Gumption, is about healing himself and those around him through the power of storytelling. Welcome, Dr. Shaker.

[00:00:49] Dr. Shaker: Thank you, Dr. JB, pleasure being here.

[00:00:53] Dr. JB: Yeah, we’re so happy to have you and to be able to have a very fulfilling conversation today.

[00:01:01] Dr. Shaker: That’s the word, I hope so too.

[00:01:04] Dr. JB: So Dr. Shaker, where are you currently located?

[00:01:07] Dr. Shaker: I am currently based in Cairo, Egypt, where I grew up. And I, I spent seven years of my life in the U.S., so I practiced medicine in both Egypt and the U.S., and then I switched careers into healthcare technology and data analytics, practicing also in the U.S. and came back only a few months before COVID. And I’ve been based in Cairo for most of the time, but more recently my wife and I moved to Sinai, which is this tiny piece of land between Africa and Asia, and it’s beautiful living by the beach now and mountains, so I’m really happy about that switch.

[00:01:45] Dr. JB: Wow, that sounds like paradise.

[00:01:47] Dr. Shaker: It has its moments for sure.

[00:01:51] Dr. JB: So let’s, let’s learn a little bit more about you and your background. So Dr. Shaker, what made you decide to become a physician?

[00:01:58] Dr. Shaker: Well, I’d like to say that I loved studying the human body when I was young and biology was by far my favorite subject, but really I think it was because my father, he was a surgeon and I spent most of my childhood in like a waiting room with patients. And so I think it’s, it must have gotten to my subconscious somehow. I knew that that was his plan all along, but I, I remember being fascinated by the science of our bodies and how they work at a very young age.

[00:02:29] Dr. JB: You said that was his plan all along, that was your dad’s plan to seep the desire to become a physician in you?

[00:02:37] Dr. Shaker: Yes. Yes, so my dad’s a surgeon and he always had this plan for me to take over parts of his practice. I remember closer to graduating from high school, I wanted to be a computer scientist, like I got interested in computers. And also my mom is an IT director, so the second half of my childhood when I was not a patient waiting room, I was in the mainframe room, which is a giant room full of computers that have the computing power of like an iPhone now that’s in our pockets. So I remember like always being kind of between both worlds, but I remember when I was in last year of high school, I started thinking about computer science and my dad told me, “you need to be able to do something with your hands,” because his professional skill he’s, he’s always about that. And I think it’s in Egypt, and like many other places in the world, you, if you’re not either an engineer or a doctor, then you’re a failure, right? So my dad, he didn’t really ever stop me from getting into computer science, but he, I think was great at that, that convincing me medicine was a good thing to start off with. And, and so, yeah, I remember that first day of medical school walking in, buying the books, and going into like these huge lectures. I studied in Ain Shams University, which is one of the biggest public hospitals in Egypt, and so it was a very overwhelming experience from day one, because it’s a huge class and you feel like you’re just a speck in the sand. I remember seeing like all these students and being in disbelief that I’m about to spend the next seven years in this place. And in Egypt, you don’t go through, undergrads or you don’t go through pre-med and then med school, it’s just a straight shot of like seven years. So a lot of people realize midway also that maybe that, maybe that wasn’t the right choice, it wasn’t the right move. But I stuck through it and then decided to start changing my mind. Another great thing about something in Egypt is that because it was a public hospital or a public university, so I didn’t graduate with a lot of debt afterwards, which is, I think, one of the huge problems that cause burnout that I’ve seen affect people’s lives, after you go to med school in the States where you graduate with a huge amount of debt. So luckily I didn’t have that, but it was still a gruesome experience just to get to it.

[00:05:00] Dr. JB: Yeah, that’s true. In the U.S., we graduate with like a mortgage amount of debt, like 200 plus thousand dollars of debt, plus or minus. And so you did seven years of schooling in Egypt completed undergraduate and medical school, and then what happened after that?

[00:05:20] Dr. Shaker: So I started, well, I did, I got an internship position at Tufts New England Medical Center in Boston, and I considered myself one of the lucky few, especially around the world where we’re all competing for spots to be a doctor in the States. And when I got this, I remember wanting to be a transplant surgeon, I was obsessed by the idea of transplants, and so I got to work with one of the top physicians there and it was in the year of 2011. So between 2010, 2011, and electronic medical records were just starting to become a thing or become a thing that’s being adopted because the High-Tech Act with Obamacare was just fast, right? So there was a lot of hospitals implementing these HIS systems, and I remember being at Tufts and starting to see my senior doctors act like– to me, they were threatening, but later on I realized that they were feeling threatened and overwhelmed, and there was just a scene of doctors hunched over their computers and trying to figure out what this electronic medical record is and how to use it. And so there was a lot of frustration in my normal day and a lot of fear, I remember a lot of fear in my system, which had started to manifest itself in more of a story that I started telling myself– of course, I didn’t know that it was a story back then– but it was this idea that I’m not enough. I’m really not enough. I’m not smart enough, I haven’t studied enough, I need to do more, I need to learn more, and the basic feeling of it was that I’m not supported by my seniors because they’re so frustrated and angry and I had to tiptoe around them if I needed to ask about a diagnosis that I didn’t know, or a routine procedure that I haven’t done before yet. And so, I think back to like, generally just it was a very self-conscious time. And also just with my accent, so I’m speaking differently, even the way I pronounce a lot of the medical terms was different, so it just felt really out of place. And the funny thing is that I felt that in Egypt too. Like I thought when I would leave Egypt, I would flourish in America with all the research and all the incredible opportunities for doctors, but I realized really quickly that that’s not the case and that there are other stressors and sometimes even more stress. You know, we’re just talking about the debt and electronic medical records, those two factors weren’t in Egypt, but I realized that it’s my idea of the promised land of America wasn’t exactly true, especially when it came to healthcare. So I quickly needed to make a decision about, do I want to continue practicing medicine that way or do I want something different and I, I just made that realization that I need to choose my own life, otherwise there’s going to be a lot of suffering in my new future. And so I spent a few years trying to figure out what that’s going to look like, and I moved from Boston to San Francisco, and I started immersing myself in digital health specifically.

[00:08:50] Dr. JB: So Dr. Shaker, I apologize to interrupt you, but I did have a quick question for you. So you mentioned this promised land. What was your, what did you envision before you came to the U.S.?

[00:09:04] Dr. Shaker: I envisioned a healthcare system that is top notch, that respects doctors and rewards doctors for their efforts and that it would be a learning environment that was safe, and that, this idea of flourishing was really on my mind and I expected advanced research, which I found, but I didn’t find any of the other things that I just mentioned.

[00:09:30] Dr. JB: And, and what was it like practicing in Egypt?

[00:09:34] Dr. Shaker: Practicing in Egypt was exhausting. It was definitely a problem of the overwhelming demand for healthcare services so as a doctor, I had to constantly be on the lookout. So, you’re talking about really long shifts, a lot of problems that you’ve probably, other guests on your show have talked about, like just the, the kind of seniority complex slash hazing slash abuse that happens between residents, so it wasn’t like a safe environment by any means. You always had to be grinding and putting in long, long hours and I was being paid close to nothing as a medical intern. And, and even if I had done residency in Egypt, I would have barely been making it. So a lot of, a lot of my friends that continued in the system were still needing to get financial support from their parents until after their residency. And so it was, it was mixed feelings of like really high workload, very low reward, almost non-existing comradery. And, and then just like low resources in general. With the U.S. it was, there was a higher, higher number of resources. We have technology, we have nice cafeterias, like the hospitals were clean. It wasn’t like that incredible workload that I was used to, it was actually less, but still more than a normal job, but I noticed that there, like I said, there was, there were new challenges and there wasn’t that incredible amount of learning, and especially not like the supportive environment that I had hoped for that I would find in the developed world, so it was disappointing for sure.

[00:11:14] Dr. JB: And so you said you left Boston and moved to California?

[00:11:19] Dr. Shaker: Yes. Yeah. So in 2013, I, I just packed my bags and I decided to take a year off to think about what I’m going to do next, because maybe going through, like climbing through the ladder and trying to become, go all the way to become an attending was going to take away too much of my life. And I was also, going back to my story, I wanted to study computer science, so it was always, there was always this itch of technology at the back of my head. And there was a lot of talk about healthcare technology at that specific moment because of Obamacare and so it opened up a channel for me to explore that.

[00:11:56] Dr. JB: So walk me through that process though, of ever since you were a child, your father was a surgeon, he essentially groomed you to become a surgeon, and you were going down this path and then you went into transplant surgery, and you encountered your experiences, and so that transition though, between finally– or the transition from realizing, “oh, this isn’t really in line with what I want or thought,” and then finally deciding to leave. Can you talk with me a little bit more about what that was like?

[00:12:31] Dr. Shaker: Well, it was in one word, that’s one of my favorite words, it was very discombobulating and disorienting for sure. I felt like I was definitely taking a road less traveled and there was almost no one that could help me or help me pave the way. So everyone from my family to my friends and my coworkers and colleagues were surprised by that because they saw me as a successful doctor, right? Because I always had good grades, I had made it to the U.S., I made it to Tufts, and so it was– everyone was kind of jarred by my choice of going to something new. And for me, there was a lot of self doubt because I didn’t know what I was doing. I had to trust my gut, that there was something for me in San Francisco and that there was not much left for me in a typical medical career. And so the, the process involved moving, which our bodies react to in a very particular manner. I’m in the process of moving as well now, and even though I have all these tools and a lot more security, financial and other, I still can feel it in my body. Like, Hey, we’re moving, we’re going to the unknown. What’s going on? Where are you taking us? Are you sure? Like, this comfort was really nice over here. What are you doing? And I can still feel it now and, and this is ten years later. But during that time, I think what kept me going was that how terrible I felt while I was in that internship year. And it was just my immediate experience was really gruesome and so I think that gave me the motivation to keep going. And then I had to find my own like spirit guides, if you will. So, someone like Dr. Daniel Kraft and his Ted Talks and just Singularity University and hearing people talk about digital health and how things are going to move, where I needed to find my own heroes in a way that would keep me believing that this move is right for me. And so moving away from Boston– and I went back to Egypt also, so I had to explain myself to my family and my mother was like, “you just spent nine years of your life pursuing something and now you’re going to leave?” So there was also like this idea of “don’t be a quitter” and so people are making me second guess myself, and it wasn’t the best, it didn’t help a lot, but I had to, I had to believe in myself and I had to find new heroes that would help me figure out the way, even if it’s not paved yet.

[00:15:04] Dr. JB: And so in terms of resources available to you to just help you process what you were experiencing, did you find those resources at Tufts or in your residency program? Was there somebody you could, you were able to like talk to?

[00:15:17] Dr. Shaker: No. And I honestly don’t know if the resources were there, but from speaking to doctors right now after I know what burnout is, cause back then I didn’t even know that there’s this thing called burnout. I diagnosed myself as depression because I have been through psychiatry rounds, I know the symptoms of depression and so I generalized it. And what I was feeling is a, was a deep sense of exhaustion. I couldn’t muster the courage to get out of bed even though I kept getting out of bed at four in the morning every day and walking in the Boston snow, but I still can feel that exhaustion in my bones getting there, and it was like an emotionally draining experience. And also I couldn’t, I felt like I was locked in a glass box, which I’m, I’m isolated from everyone, so I also felt like my connection to people had been severed, and that’s because I saw myself as an other. And so, again, coming from a different country didn’t help, but it’s also like an experience that now I know everyone is going through at the same time, but I felt that that was my own unique experience. And then finally I felt like I wasn’t doing enough so I felt like I haven’t accomplished enough things, and that I’m becoming like this weak person, so there was just this like enmeshed shame of like who I am and what I am, and so I did not reach out for help, even my friends, I was, I was really ashamed to talk about it because to me that meant that I’m weak and my whole training had been about “you gotta be strong” and “medicine isn’t easy,” and that’s been just my M.O. for like eight or nine years at that point. So even, even like admitting that I’m feeling all these things was really tough. And I certainly I wasn’t talking about this to my friends, let alone some psychologist or psychiatrist that might also put a, put a mark on you for having depression or whatever, and that’s a huge problem that a lot of doctors are now going through.

[00:17:21] Dr. JB: That’s so true.

[00:17:22] Dr. Shaker: So I only we learned about all these, a lot of resources, many years later, and I’m still learning now about how to deal with burnout, but I had no idea that it was even called burnout back then.

[00:17:33] Dr. JB: And another interesting thing that you mentioned was when you decided that you were going to transition out, then explore digital health, et cetera, that your friends and colleagues were surprised because externally you had it all together.

[00:17:49] Dr. Shaker: Yeah. Yeah. And that’s a really interesting point. And even when I started opening up about my experience with people and be like, I just, I just can’t do it anymore or, or I’m tired, they’d be like, “no, but you’re fine, you’re talking to us, you go out every now and then like, you’re, you’re fine.” There were, there was no validation on my experience whatsoever, so I just feel like I was, was going crazy for some time.

[00:18:13] Dr. JB: And you mentioned this word shame a couple times.

[00:18:19] Dr. Shaker: Yeah.

[00:18:19] Dr. JB: Let’s explore that a little bit more in terms of the feelings of shame and how that affected you.

[00:18:25] Dr. Shaker: Yeah. I’m glad you’re allowing us to explore that on a deeper level, because I think it’s a fundamental word and experience for anyone that’s going through burnout, but most for anyone, period. I think because– so if you define it first, the difference between shame and guilt, with guilt, there is something wrong or I did something wrong. With shame, on the other hand, it’s there’s something wrong with me, there’s something wrong with who I am, my I– it’s this connection between our selves and our identity in a way. And so one of the most powerful learnings for me was listening to the audio series, Power of Vulnerability by Brittany Brown, who is a shame researcher, and what she looked at in her cohort is– she was on a quest to understand what is the major difference between people who live wholeheartedly, that are satisfied and fulfilled and fulfilled in their lives versus those who aren’t– and the number one thing that came up from her research repeatedly, over and over again, was how we react to shame, how we deal with shame. And to me that did not make a lot of sense in the beginning because I, again, coming from that space of “I have to be strong and I have to withstand the pressures that medicine will want to force upon me and stand up against all these obstacles and crush them and keep on going,” which I think is part of the appeal of being in medicine, like we want to just keep on crushing through these walls one after the other. And part, I think, part of me was enjoying that so this idea that I am, oh, I just have some shame around this or I’m experiencing shame right now did not register until I really like heard these series of lectures, which I recommend to anyone. So Power of Vulnerability is an audiobook, but she also has a lot of Ted Talks, and one of the most profound points that she summarizes is that there are three things about shame. The first thing is that we all have it, every human being has shame. The second thing is that we don’t like talking about it and we try to avoid that. The third thing and the most important piece of the puzzle is that once we start talking about shame, it goes away. That’s the cure, is to talk about it, because if, if you come to me and you’re like, “Omar, I don’t feel like I’m doing a great job as a podcast host, can you tell me– oh, like there’s all these things that I needed to do and wanted to do, but I, I don’t feel like I’m putting in like that or I’m not a good host.” Obviously, the first thing I will tell you is that Dr. JB, you’re amazing, you’re doing so much and you’re impacting people’s lives by listening to it, and you’ll get to do all these things in due time, and, and as soon as you let it out, then someone can, can support you or show you that. She calls them shame gremlins, that they’re there tipping in the dark and they love the dark, and they love gnawing at our psyche, and some of us learn about this through the concept of the inner critic. There’s this little shame gremlin that lives inside us and just festers in the dark, and then, and as soon as we shine a bright light by either practicing something like self-compassion, which has a whole lot of evidence around it, or just talking to our friends about it and giving it some air and changing, ultimately, the way we talk to ourselves is the name of the game here, I think. And it is a key into so many mental problems and struggles that we may have, but especially burnout, I think it’s huge. And even when you look at something like addiction, which is also related to burnout in some way, addiction and shame are so intertwined with one another, it’s like just one cycle that keeps feeding itself over and over again, and the only way to break that is to let that gremlin free and shine some light on it, and trust in someone and tell them how you’re feeling.

[00:22:29] Dr. JB: And talk about it, and that’s what this podcast is about, so I really love the fact that you said that, is this is a place where people can just air it out and just release and share so that others who are listening can realize, oh, this is how I feel. I, I’ve experienced that. Oh, it’s just not me. There’s nothing wrong with me if somebody else is feeling this way too. They may not experience every single thing that you are, but they may connect with bits and pieces of it, which is extremely important in terms of tackling it.

[00:23:05] Dr. Shaker: Yeah, absolutely. And that’s why I truly thank you for this podcast and allowing that conversation to happen, I think is, is a big part of the cure and the way we resonate with each other. I think, especially in the medical field, we’re completely isolated, and that’s one of the, one of the things that have been exacerbated by technology. Where technology can be used to connect people, but it has been used to, again, like I think of this image of residents hunched over a laptop and struggling with this technology while there are human beings sitting next to you, and your job is mainly about compassion, right? We’re compassionate givers, we’re supposed to be healers but this connection is missing severely, and I think it’s [technology] a huge part of the problem. Of the– both the problem and then fostering it is the part of the solution.

[00:23:51] Dr. JB: Yeah. I feel like that’s one of the unfortunate realities of technology and how widespread it is. You see this all the time. You go out to restaurants, people aren’t communicating anymore, they’re on their phones; like you can be in a room full of people and nobody’s having conversations, they’re just texting and, and whatnot. But we as human beings need that interaction with others. We crave for it, many of us, and so it’s a, it’s a big detriment, 100%.

[00:24:22] Dr. Shaker: Yeah, I agree.

[00:24:24] Dr. JB: And so the other thing that you mentioned in terms of shame was finding that confidant that you could talk to, but have you ever experienced speaking with somebody and they go ahead and shower you with praises, but you still don’t believe it?

[00:24:43] Dr. Shaker: Yeah. The first person coming to my mind is my mom. And when I would tell her that I’m feeling all these things about my job, I just want, I want to leave and stuff, she would shower me with a lot of praise about how I’m a good doctor and it’s going to be okay, “you’re, you’re strong, you’re intelligent,” like all of these things, and to me, I’m like, what’s going on? Or what I’m telling myself is that she doesn’t know what she’s talking about, she’s just my mom and that’s why she’s telling me all this. Even though she is like, praising me and showering me with love, like you said, that’s another way to put it, but I just could not accept it, and I interpreted that as her being disconnected from my reality or even doesn’t get me. And so, yeah, even though I had that kind of support, I remained to be in that glass box, the feeling of loneliness. And I think I even in relationships, like when I would be feeling down, I remember a previous, an ex-partner of mine that would also give me like all these loving things, like all these reflections of who she sees on the outside, but it doesn’t match how I’m feeling on the inside, and so I couldn’t believe her. And I think I was never able to overcome that until I changed the way I talked to myself and started being aware of how I feel inside and taking note of it and working with that, like taking my own pulse and seeing what’s going on inside me. And me getting curious about it and then really like revisiting a lot of childhood traumas too. So firstly, it was like, I need to change my environment because I think one of the biggest things we, or one of the biggest fallacies that I see in burnout, and I don’t say that out of judgment, but out of my own experience and my own mistakes, is that we tend to think that we can solve big problems like burnout with only the individual working on ourselves. So just want the audience to make no mistake that even though I’m saying that there’s a lot of things that we can do to explore who we are and as far as our early childhood wounds that may have not healed, or those needs and desires that we might not have incorporated in who we are today, but more importantly, there are these systemic issues.

[00:26:55] And there is Christina Masta, who is arguably the most cited researcher in burnout, has created like this wonderful matrix that, where you can assess like how, how fulfilled you are professionally by your job and if you rank low on these things, the only thing you can do is really leave or, try to change it, but you can’t just work on yourself and expect things to– So, the first thing that I did leave that job, that potential career, and then I started being able to listen to myself, observe myself, and then that’s when I started having the ability to incorporate some tools, including that relationship that I have with myself or the different parts of it. And I think that’s when a change started happening, and then all of a sudden now in my relationship with my wife, or even in many conversations with my parents, I’m able to receive this praise, which I wasn’t able to when I was in that glass box and kind of like disconnected.

[00:27:58] Dr. JB: And tackling that inner critic, because the inner critic is the harshest critic. How did you battle that inner critic?

[00:28:07] Dr. Shaker: So I continue to battle him, but the only way that I had a chance was actually to befriend him and understand where he comes from. And there are many tools that you can use to explore that, so I think the first step is, is really just observing these thoughts. We’ve all studied the, the vagus nerve and we know that it’s the 10th cranial nerve, that it has the two branches, has all these afferent and efferent branches, and it pretty much like we know that it supplies almost all of our organs, but most notably, the heart and respiratory system and the gut, and really like this idea of taking a breath doesn’t have to be a meditative practice, you don’t have to like download an app, but just really taking a large inhale and a slower exhale, activates that autonomic nervous system and the parasympathetic system, which gets us in a more of a creative space. And when I started learning that, and I didn’t learn that while I was studying anatomy, I learned that when I started reading into psychology to heal myself, and that connected with this idea, “oh, of course, there’s this vagus nerve I know that runs through my body that can actually help me relax in moments of pressure.” So what I realized is that as long as I’m under this feeling, a feeling of burnout, my sympathetic system is mostly activated and I’m in this tense space where I can’t– and that’s where the inner critic can kind of get the best of me, so I feel like, this, this idea of regulating my nervous system, helped me then create the space to learn what I’m feeling rather than what I’m supposed to be feeling, and that’s really what opened the door to, “okay, so now that I’m feeling that I’m not doing enough, that’s the overwhelming feeling that’s there, so where is that coming from?” And that inner critic, what does he want?

[00:29:59] So it’s really like, sitting in front of a friend or maybe someone that you’ve talked with and starting to shift the constant from he’s right, I mean, “I’m right, he’s wrong,” or the opposite, to ” what is this person trying to protect me from?” And they really are, like our inner critics are our protectors, their fierce, they’ve, they’re there to really support us, in one way or another, and it’s only by befriending them and then almost asking permission for them to let go. Can they, can the inner critic trust us? So this idea that the inner critic is an actual, maybe human being inside us or even as a child, if we think of it as a child, that is, there’s a child walking around in your room and you’re asking– it’s trying to get your attention and you’re just ignoring it, and it’s, like mom, mom, mom, and you’re just like doing your thing? It will start trying to get your attention by something a little dramatic, it’ll start like, maybe it’s gonna open the fridge, maybe your baby’s gonna break your TV, it can escalate it just to like, to try to get your attention because you’re not talking to it. So like, I feel like the inner critic is the same way, if I don’t develop that relationship with them, they will come out when I least expect it. And it’s going to be in the sense of like a depressive episode or anger towards someone or like aggression even towards someone else, so I started using a lot of tools such as journaling, looking at that guide, being in, in like, even in group sessions and going out and realizing that everyone else has an inner critic, like you were talking about before. Recognizing my pain in other people was a huge part of that healing, and now I do that regularly where I sit with my different parts. And most recently I’ve learned about internal family systems, which is a method in psychology based in like family therapy, but essentially looking at the family inside of you. So we actually have like multiple critics inside us and they’ve developed at a certain point to protect us from something or drive us to be successful people. So once you start to lean on them that way, that they’re actually, they’ve got your back, then something opens up and then you start seeing them as an ally that can be used at certain moments, but in other moments might not agree with you and you just have to work it out, like the way you work out any problems about groceries with your roommates, it’s just, it’s about really talking about it. That’s all there is to it.

[00:32:30] Dr. JB: And another word that you had brought up earlier on during this conversation was about self-compassion, and I find that is extremely important, so let’s talk a little bit about how you could incorporate a daily practice of self-compassion to also help you.

[00:32:50] Dr. Shaker: Yeah, so I had the, the pleasure and the opportunity to speak with a renowned psychiatrist, Dr. Mark Goulston, he wrote a book called “Why Cope When You Can Heal,” and it came out during the pandemic and he specializes in working with people that are suicidal, and he told me that he has never lost a patient for suicide. And I was like, well, okay, what’s the secret sauce? And what he said really wrangled me, he said that he speaks to patients in a way that only, only death listens to them that way. So basically what he was saying is that the people that are suicidal have lost their own conversation with themselves, so they don’t, there, there’s nothing kind of giving this internal love or internal compassion anymore, and so they look out to others, if they can’t get it from others because they’re so blocked, then death becomes the only option. And so what he does is like, he tries to, to give them a different option by really hearing them out, even if it is hearing them talking about their pain. So going back to my example, with my family and friends, when I’m telling them I’m in pain, they’re like, ” no, you’re not, you’re fine.” And that’s the opposite of compassion. So I think the critical piece when it comes to like talking to ourselves is first identifying the pain that we have, and like Dr. Goulston was explaining to me, validating that pain, and not letting that person, which is you, get to a point where the inner critic is so loud that I can’t even feel my pain. And so the other person I want to mention is Dr. Kristin Neff, and she has created most of the body of research around self-compassion, she also breaks it into three. It seems like everyone brings things into three. She– and it’s a great tactic– but so she says like the three aspects of self-compassion are as follows, and that has been validated and there’s a lot of randomized control trials that show that when people go through like the process and mindful self-compassion exercises, the symptoms of burnout do accrue, and so, so these three steps are really important. The first one is, again, identifying the feeling, like taking your pulse. Identifying that I am struggling as a fact, and that it’s okay that I’m struggling. And then the second part is she calls, what she calls common humanity, which is basically, I’m not the only one that’s struggling, everyone is struggling on some certain level, and therefore it’s not a lonely experience. It’s not that glass box experience anymore, right? It’s yeah, I’m struggling, you’re struggling, maybe you’re struggling in a different way, but again, just like what you’re doing with this podcast, you’re really allowing me to unleash the fact that I’m struggling so that others that are listening to it can feel that common humanity with me and with you and be like, “oh, okay, I’m not alone in this.” And then the third piece of the puzzle of like self-compassion here and the third action step is to actually then identify what it is that you need and give it to yourself. And you can do that in so many ways. So for instance, I’ve been talking for an hour now, I feel thirsty and the biggest act of self-compassion I can give myself right now is to have a sip of water, and it can be as simple as that. Like, I feel hungry and I need to eat. I feel sore, and therefore I’m going to take a hot shower. These are all like acts of self-compassion.

[00:36:22] And when we’re– part of like the road to burnout and the symptoms of burnout is depersonalization and including depersonalization of ourselves, like we don’t give ourselves what we need because, again, with the shame experience of not thinking that we deserve it, but these like basic things are important. How we can create a practice, there is a wonderful app that I use and love and I have no incentives from them, but they’re just like the app that I love the most, it’s called Insight Timer and it has a lot of Kristin Neff’s meditations on there, and there you’ll find a lot of self-compassion meditation. Essentially, it’s like, it walks you through these three steps. You, you start, first understanding that you are going through some tough time and bringing a certain situation there, understanding that others go through tough times and remembering that, just remembering that, already relieves some of the pressure, but then giving yourself what you need in that moment. So frequently in these meditations, there’ll be even like hand gestures, like putting your, your head, or your hand on your chest or your head, especially the hand on head, like that’s something that moms do instinctively I feel, right? Like just like this calming effect of a hand on my head, this tactile stimulation can go a long way. And so in these meditations that you have to figure out where the frustration or the pain is coming from and then do something to change it. And the last thing I want to say about self-compassion is that it’s frequently misinterpreted or misunderstood as running away from accountability, like, “oh, I messed up the thing with the patient charts or I messed up the thing with my medication, so it’s okay.” But on the contrary actually, it’s actually a tool for accountability because it allows you to see that pain and then do something about it. And frequently it’s about having a conversation with someone or fixing something that you are particularly feeling bad about, so it’s actually a process towards accountability, not away from it. And that’s a really important distinction to make. Once you start realizing how you’re feeling about something, you can change it, but if you start keeping that brave face, which we are taught to do through the medical school experience I feel, you don’t even have the chance to identify what is wrong. So that’s my take on self compassion. Oh, and I would love to add as one last thing is that there’s a, there are many actually validated tools to measure it. So it’s not like just some kind of soft topic, like the concept of love and compassion in our heads or just like these scary things, but there’s actually hard science and there’s, there’s a tool called the self-compassion scale that Dr. Kristin Neff has developed and it’s a series of 22 questions or 24 questions that gives you a score out of five and explains exactly what is going on in different dimensions of self-isolation and, and self-compassion and all these. So if you’re, if you’re interested in learning more, I would go to Kristin Neff’s website and you will, you’ll find the self-compassion score there.

[00:39:21] Dr. JB: Yeah, I think this conversation about self-compassion is so important, especially as you go down the process of trying to befriend this inner critic, the inner critic can be very harsh at times, and I think really having these tools, these self-compassion tools, could really help you kind of combat that inner critic as you slowly learn more about the inner critic and the reasons behind your having these particular thoughts, and the protective reasons why your inner critic is saying what it is saying to you. Because it just, it just allows you to not feel like you have to be perfect all the time. I think that’s one of the things that really drives burnout in healthcare professionals, is this feeling like we aim for perfection. We have to have A+ on everything, from schooling and to our day-to-day lives. And sometimes you’re not going to get that A+, and what do you do if you don’t? What are those tools that can help you cope with getting an A- or a B? It’s not that you shouldn’t strive for that A+, of course, always strive for it, but if you don’t get there, what can you do to not beat yourself up?

[00:40:37] Dr. Shaker: Yeah. And ironically like, not beating yourself up may be the reason you get an A+ in the end. It’s like, you don’t have to, if you try to work really hard at, at the end of the day medicine, whether it’s studying for it or working it, it’s always a marathon, so you got to pace yourself. So this idea of, of, burning out is also so intertwined with self-compassion since that it’s not just about when you don’t get the grades, which I, I agree with you, there’s a lot of value there, but then also, maybe if you have been pacing yourself and understanding where your limits are, you would actually end up performing better. And what we’re seeing now is that burnout isn’t just something that you experience over a weekend, it’s like something that lasts for months, it could be even years. Certainly my experience burning out, like I burnt out two times and each one took a good few months, almost a year to recover from and figure out the next step. And so thinking of it that way, there’s also, when you think of performance in general, even as physicians, that self-compassion can help us be more sustainable in how we approach our work. Provided that the, again, the structural issues aren’t crushing them, and that seems to be, the norm I feel.

[00:41:58] Dr. JB: So Dr. Shaker, I do feel like we did have quite a fulfilling conversation. I feel very fulfilled. But if my listener wanted to get in touch with you, wanted to find out more about what it is that you’re doing, how could they do so?

[00:42:14] Dr. Shaker: Yeah. So I am available to chat and connect at Omar, O M A R @ Shaker, my last name, S H A K E R dot health. And I’m also, I’ve been putting a lot of these ideas into a novel, just part of my own creative outlet to deal with burnout and create more meaningful conversations, and I called the novel In Search of Gumption, and to me, gumption is really the opposite of burnout. Have you heard of, about that word before? Just curious.

[00:42:46] Dr. JB: Yes, I have, but go ahead and explore it more for my, for my listener.

[00:42:50] Dr. Shaker: Yeah. So Gumption is a Scottish word, it’s a fun one, it means spirited, resourceful, or lively. It’s kind of like being aligned or in flow, but I love the word gumption, a Scottish word, and in Yiddish it’s chutspah, they’re both like really strong and make me want to like get up and jump. And so In Search of Gumption is a novel that currently still in progress, we’re recording this in August 2021, so I’ve written half of the book and I’m engaging with people, trying to open a conversation, and I also have a podcast about the stories that inspired the book. So, it’s mostly with a lot of like childhood friends, and a little bit there are also like physicians and people that have tried to figure it out some of this stuff so, you can follow this project on gumption.ink, so G U M P T I O N dot ink, I N K, not I N C, I N K. And if you subscribe, you’ll get our posts every Sunday. We’re doing that consistently. It’s been a fun, like all do and, and writing project and I hope to connect with you guys if you, if you want to reach out through email, or get your feedback on In Search of Gumption, if you, if you go to gumption.ink and subscribe and let me know what you think.

[00:44:10] Dr. JB: Perfect. So we’ll be making that information available in the description of this podcast. And now that we are nearing the end of our time together, do you have any final words for my listener?

[00:44:23] Dr. Shaker: What I would like to stay in closure after we explored all these tools and stories is first of all, let your story be heard. Come on this podcast, talk to people about the story, whether it’s good or bad. In the end we all have enough resourcefulness in us to go out in search of our own gumption and you deserve it. So don’t let your work, or anyone for that matter, take it from you because it’s available to you. It’s just one step away from a more fulfilled life, and so take that step and don’t let others tell you how you can live your life if you’re not satisfied. And the tools are available for you, you just have to go out searching for them.

[00:45:09] Dr. JB: Yeah. Who says a doc can’t wrap? D O C T O R J B. The greatest doctor to ever touch the mic, the greatest podcast ever broadcasted or prerecorded. Come learn some, each one, teach one. I’m done.

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