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“Allow yourself a moment to focus on yourself, not the next patient. Take a drink of cold water, go to the bathroom, and maybe take a lap around the room. Physically relax those tensed muscles.

This will allow you to start the journey of healing.

Instead of just pushing yourself deeper until the bottle of unprocessed emotions causes an explosion, notice each moment. The more that we are aware of what we are experiencing, the easier it is each time to ground yourself and process before moving on. This is not easy and requires practice, but we can do hard things. We graduated from medical school and residency! We spend so much time healing other people. It is time we heal ourselves too.”

Mallory Salentine is a pediatrician and leadership coach.

She shares her story and discusses her KevinMD article, “Allow yourself a moment to focus on yourself, not the next patient.”

This episode is sponsored by the American College of Lifestyle Medicine (ACLM). 

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Mallory Salentine. She is a pediatrician and a leadership coach. Her KevinMD article is titled “Allow yourself a moment to focus on yourself, not the next patient.” Mallory, welcome to the show.

Mallory Salentine: Thank you, Kevin, so much for having me. I love what you’re doing and giving physicians a voice when we often feel like we don’t have one, so thank you for that.

Kevin Pho: Well, thank you so much for being on the show and writing the piece, because obviously I couldn’t do what I do without guests like yourself. We’ll get into your article in a little bit, but first off, briefly share your story and journey to where we are today.

Mallory Salentine: Yeah, so thank you. My story really started in medical school and residency, in that I had some events that really caused me to have a lot of stress and really caused me to focus really deeply on my patients and kind of forget about myself. Throughout residency and throughout medical school, I really spent a lot of time focusing solely on the patient and not really thinking about what I needed at that time. So by the time I started in my first role as a general pediatrician, I was burned out, and I didn’t know it, because I was so, so focused on my patients that I didn’t have the awareness of where I was, who I was, and what I was feeling.

It actually took one of my colleagues stopping me and telling me, “You can’t do this anymore. You’re up all night, you’re charting, you’re calling your patients, you’re doing all these things, and you have to stop,” for me to realize and have the awareness of what was happening for me. After that happened, I spent the rest of my time in my role really looking at how I can find joy in what I’m doing, in my life, and for myself. So that’s kind of where my journey started.

Now I am leading the physician well-being initiatives at my organization. I spent a lot of time focusing on myself while still providing really excellent care for my patients, and I started coaching. I actually hired a coach who really helped me figure out what was going on deep inside that was really causing me to do this, and with that, I was able to change my life at work. I still work full time as a pediatrician, and I’ve found a lot more joy in that. So in my coaching practice, my hope is to be able to help other people do this as well: find what really brings them joy, help them focus on themselves and not just on their patients, and then also help leaders to be able to inspire their teams and their physicians to do this as well.

Kevin Pho: Now, you mentioned that you’re the leader of the well-being initiative at your group. Do you find that the other clinicians that you work with are going through similar stories to what you described?

Mallory Salentine: I’d say a lot of physicians are going through similar experiences. I think in our training, we spend so much time focused on our patients, our number one, “First, do no harm,” all of these things that we are really trained on, that we have to spend all of this time and all of our energy on our patients. We bring all of our energy to work, and we spend, you know, 80 hours at least a week as a resident at work, so we really do spend so much time there. We spend so much time learning. We come out of residency, and we’re afraid of making a mistake, we’re afraid of missing something, we’re afraid of all of these things, because we’re trained so deeply to just really be there for our patients that we kind of stop thinking about ourselves. So I see that all the time.

I think the other thing that I see a lot of too is feeling like we’re not in control, right? In medical school and residency, it feels like someone else is dictating everything for us. They’re dictating our schedule, they’re telling us when we have to be there, they’re telling us when we can eat lunch, they’re telling us what lunch we eat, right? So we feel like we don’t have control over what we’re able to do and really who we are. And so once you start in that first job, you feel like you just have to keep doing what you’re doing, because that’s who you are now, when in reality it’s not. It’s what was kind of put on you, and so now it’s time to kind of find your control again. So I’d say those are the two big things that I see with physicians.

Kevin Pho: All right, and we’re going to talk more about solutions and next steps in your KevinMD article that’s titled “Allow yourself a moment to focus on yourself, not the next patient.” Now, for those of you who get a chance to read your article, just walk my audience through it and share the story of why you decided to write it.

Mallory Salentine: Absolutely. So I think there are two big pieces of this article. The first one is that with what we witness as physicians, all of the pain and suffering and illness and trauma, we kind of just move on to the next patient after we see that, right? We just think that it’s normal, and it’s not normal.

So what kind of helped lead me to that is, for one, I have a family member who, every time I see them, asks me, “What’s the craziest thing that you saw since I saw you last?” And I always think, “Well, I’m a general pediatrician. I don’t see anything that’s really crazy,” you know, and everything seems very normal to me. But when I think about this family member, you know, they’re not in the medical field. They don’t see these things that we’re seeing every day. So all of this pain and suffering, and, you know, the kids screaming in the patient rooms, to them would be crazy, but to me it just feels so normal, and it takes so much for me to feel like it’s not normal. So it has to be a very significant event for it to feel crazy or not normal.

I actually really noticed this a couple weeks ago when I was at a friend’s house and we were having dinner. I actually picked up dinner, and I thought I did a really good job getting a meal that her child would like. When he sat down at the dinner table and saw the meal, he started screaming, and he was not happy, and he didn’t want the meal. He went to the other room, and he, you know, kept screaming the whole time. My friend and I were just kind of like, “OK, he doesn’t want the meal,” right? He’s doing what a kid normally does. We’re OK with that. But her husband, and you know, my friend is a pediatrician also, her husband was totally upset about the screaming that was happening and the tantrum that was being thrown, and he was trying to attend to his child. My friend and I were just kind of like, “Yeah, we deal with this all day long,” right?

Our patients all day long are screaming, and they’re fighting, and their parents are always freaked out, but we’re always just like, “Oh, this is normal,” you know? An 18-month-old comes in for a checkup and screams the entire time, right? Eighteen-month-olds are terrified of people, and so they just scream and scream, and the parents are so scared and so upset, but for us, we’re just like, “This is normal.” We just kind of go through our day, and in reality, this is not normal. We’ve been trained, we’ve been conditioned, we’ve been desensitized to all of this that is really not normal. So I’d say that’s the first piece of the article.

The second piece is that even though we’re trained that this is normal, we still likely have some subconscious fight-or-flight response happening underneath all of that feeling of “this is normal.” So whenever we hear kids scream in the room next door, or we have someone who’s unhappy, we’re likely always having this chronic fight-or-flight response. Our amygdala is responding all day long at our work. So whenever we’re at work and we’re hearing all these things and we’re seeing all this pain and suffering, we’re likely having this low-level amygdala response that we’re completely deconditioned to. I know we’ll talk a little bit about what we can do about that, but I think those are the two big pieces of this article: One, what we see is not normal, and two, we likely are always having this fight-or-flight response at kind of a subconscious level.

Kevin Pho: So before we get into next steps and solutions, tell us why those feelings of desensitization and those feelings of a constant fight-or-flight response, why is that detrimental for physicians?

Mallory Salentine: So I think for a lot of people kind of out in the world, out in the community, they don’t tolerate as much as we do. We tolerate a lot, and because of that, we burn out, right? We’re constantly having this chronic low-level stress that has to be so high for us to realize what is going on in our bodies and what is going on in our brains, and for us to burn out. So this kind of repetitive vicarious trauma, the fight-or-flight response, all the pain and suffering, is likely contributing to our burnout in this slow-burn kind of way. And when you think about people that are outside of medicine that aren’t witnessing these things, when they start to witness that initial piece, they’re leaving their jobs, they’re, you know, trying to find something better, they’re maybe starting coaching earlier, starting therapy earlier, because they’re starting to see these not-normal things that we witness every day affecting them. Whereas as physicians, we don’t notice that until it gets really significant.

Kevin Pho: So what can physicians do to combat some of these feelings?

Mallory Salentine: So I think the very first step is actually similar to what I went through in my journey, which is the self-awareness, so understanding what is happening in your body. We need to rewire our brains to understand that this is not normal and that we need to focus on ourselves just as much as we focus on our patients.

So what I would recommend doing is when you hear that child screaming, or you just come out of a room of a patient that is in a lot of pain, or someone that brings to you some type of trauma experience that you’re feeling a reaction to, when you come out of that room, or when you’re, you know, in the hall and you’re hearing this, that you take a moment for yourself and you focus on where you feel that feeling in your body. So if you’re noticing some tension, like for me, I get tension in my jaw. I constantly am punching my jaw, and so when I start to feel that tension in my jaw, I have to take a moment, focus on that, and release that tension. So that could be, you know, you start to feel a headache coming on, or you start to feel something in your stomach, or your chest feels heavy.

I have a client who would tell me all of these different stressors, and I would say, “Well, where do you feel that in your body?” And she would say, “My chest. My chest will start to feel heavy.” And so every time that we would start to talk about stressors, I would remind her. I’d say, “Where do you feel that in your body?” And she would say, “My chest.” And so every time that we have that noticing of where we’re feeling that in our body, the faster that we can get back to healing.

Kevin Pho: So how would this be applied in practice? Give us a story or a case study, maybe one of your clients or something hypothetical, on how they can apply some of these techniques just on a typical day.

Mallory Salentine: I’ll just talk for myself. Oftentimes, you know, we sit in my clinic with all the patient rooms around us, so we hear all of the kids screaming, we hear, you know, people coming in the hall, we hear all of these things. And even when kids are excited, right, like we have Hulk up on the wall, and they walk in and they’re like, “Oh, OK,” they’re just so excited, we hear all of these things, right? So oftentimes kids will be getting vaccines, or they’ll be getting a finger poke or their blood pressure taken, and they’re screaming, and we’ll hear them screaming, and we’ll be like, “Oh, what is my MA doing to my patient now?” You know, we’ll kind of make a joke about it.

That is the time that you need to not make a joke about it, and you need to actually stop and pause and think, “What is happening in this moment, and where am I feeling that in my body?” And when you feel that, or even if you don’t feel it in your body, that’s OK. You might not have that reaction, again, because we’ve conditioned ourselves not to. So if you’re not feeling it in your body, that’s OK. If you are feeling it, take a moment and put your energy toward releasing that muscle. So for me, it’s my jaw, so releasing the clenching of my jaw. It could be taking a deep breath. It could be maybe taking a lap around the clinic. It could be, you know, focusing on something maybe outside, focusing on where you are in that moment and being present in that moment, so that you can then move on to that next patient. So instead of going from patient to patient to patient, it’s taking that moment to really focus on you and where you are before moving on to that next patient.

Kevin Pho: Now, as you know, a lot of physicians are kind of set in their ways. For you personally, how long did it take before you noticed that these techniques started to make a difference?

Mallory Salentine: I mean, it takes a long time. It’s not easy, but we can do hard things, right? We went to medical school, we finished residency, we can do hard things. So I’d say for me, it has probably taken at least a year to really be able to do this, where now I can have the awareness that it’s happening. I think that is the first step. I’m aware that when the patient is screaming, that’s not normal, and then I’m able to bring it back to my present self. And, you know, there are times that I’m not aware of it, right? There are still times that I make that joke, or there are times that I get frustrated and not present. But I think it’s a practice, and so every time that you do it, the easier it gets in the future. And it’s hard. It’s hard to do at first.

Kevin Pho: Absolutely. We’re talking to Mallory Salentine. She’s a pediatrician and leadership coach. Her KevinMD article is titled “Allow yourself a moment to focus on yourself, not the next patient.” Mallory, my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Mallory Salentine: I think my take-home message is that the more you practice this awareness, the easier it will be to ground and process and move on. We can know that this is not normal, and we can be aware of this, and we can help ourselves to heal from all of these little things that we’ve seen in the past. And so I’m going to be doing this with you. Just like Kevin asked me before, how long has it taken me? I’m still practicing it. And so I’m here with you, I’m doing this with you. Feel free to let me know how it’s going for you. But I think that is the biggest thing: practicing that awareness that this is happening and then focusing back on yourself before you move on to that next patient.

Kevin Pho: Mallory, thank you so much for sharing your time and insight. Thanks again for being on the show.

Mallory Salentine: Thank you.