Self-care is the Rx we were never taught to write [PODCAST]

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“This is our call to action. I have the experience, knowledge, expertise, and deep passion for teaching every medical student these skills. I cannot do it alone. I need you. We need to do this together. I am seeking those of you who are caring, innovative clear thinkers involved in medical school curriculum creation. We owe it to our physician seedlings. We owe it to their future patients. Who out there can now see 20/20? It is time to change the culture of medicine and focus on prevention. I am 100 percent in. Who is with me?”

Robyn Tiger is a radiologist and can be reached at Stress Free MD.

She shares her story and discusses her KevinMD article, “The Rx we were never taught to write.”

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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. Today on the show we have Robyn Tiger. She is a radiologist and a trauma-informed self-care coach for physicians, and she wrote the KevinMD article “The Rx we were never taught to write.” Robyn, welcome to the show.

Robyn Tiger: Thank you. It’s an honor to be here.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you just share your story and your journey to where you are today?

Robyn Tiger: Yes, absolutely. So I had the traditional path of going to college and then medical school, internship, residency, fellowship, and then into practice, into radiology practice as a board-certified, fellowship-trained radiologist. Initially, everything was great, but over time I noticed that I was developing a lot of stress and anxiety. I was imbalanced. I felt my world was upside down, and I developed a lot of physical ailments, a lot of illnesses, which we can get into in a little bit. Through my own search for how to help myself feel better, I was able to do all of that, get rid of all of those symptoms and illnesses, and now I help others do the same.

Kevin Pho: Wonderful. And I understand that you are now a full-time physician coach. How is that transition from being a board-certified radiologist into a coach for physicians?

Robyn Tiger: It’s really, really rewarding to have experienced firsthand burnout and all the symptoms and the mental and physical issues that go along with it, and to improve my own life, and now to help others improve theirs.

Kevin Pho: Excellent. And from all the physicians that you see and that you coach, what are some of the primary drivers of why they’re burning out?

Robyn Tiger: I think that each medical specialty has its own specific issues within it. In radiology, we transitioned from film to PACS. It became very isolating, dictating into a Dictaphone with voice-activated transcription in a darker room nine hours a day without seeing very many individuals. Missing that contact, and having to focus on RVUs more so than quality, really took a turn in how I was practicing for me as a radiologist. I know that more in the primary care setting, there are a lot of issues in terms of electronic medical records, and all of it, again, electronics helping but then hurting at the same time. I think that, again, each individual physician has their own story, but we all come to the same place, however we get there, of being stressed and anxious and depressed and unfulfilled in our lives.

Kevin Pho: Now, did you have any training as a coach while you were a radiologist, or were these new skills that you developed and learned during that transition from clinical medicine?

Robyn Tiger: Yes. So as I mentioned earlier, I developed all of these ailments. I had migraine headaches and vertigo and tinnitus and reflux, body pain, these bizarre paresthesias in my hands and my feet. I thought I had some debilitating neurologic disease. And so I was seeking another way beyond the medications that weren’t working, another way to help with the thought processes. I actually had dark thoughts, suicidal thoughts, which I can’t believe I’m saying at this time, but it was true. And with an amazing husband and two young children, I wanted to figure out how to make myself better.

And so I kept hearing more and more about yoga and meditation, and I was incredibly skeptical, as many physicians are, but I decided to give it a try. After the very first class, I felt incredibly balanced and calm and clear, and I realized that I needed to figure out what was going on through the physiology. So then I went on to study, first as a yoga teacher, then as a yoga therapist, which, actually, a lot of people don’t know, is a three-year certification, over 1,000 hours of training, as well as a meditation teacher, iRest in particular, which was initially created for Walter Reed Army Hospital to help our military, and that was another three years. Those two pieces helped me learn how to regulate my own neurophysiology, learn how to work with our own autonomic nervous system to control the stress response, which was what I was experiencing, because all of my symptoms went away.

And then there’s that life coaching piece. There’s that working with your mind, there’s that mind management piece. And so those two pieces together, self-regulation and mind management, help to create that perfect package of self-care. And so I went on to help others do what I learned to do, not only through these couple of methods but a couple of other things as well. And I created for physicians Stress Free MD, and a now CME-accredited program, Rx Inner Peace. That was created based on the many physicians who asked me over the years to create something that was online, something that was accessible to them 24/7, in a way that they could learn in short, digestible lessons.

Kevin Pho: All right, so let’s talk more about some of these techniques and some of the things that you’ve been talking about in your KevinMD article, and it’s titled “The Rx we were never taught to write.” Now, for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to share it?

Robyn Tiger: Yes. So for years, as I mentioned, I have been teaching physicians. And then last year, when COVID hit, I just had this incredible clarity, this 20/20, in the year 2020, that it was time for me to do what I’ve been asked for years and to create this program for physicians, to put everything in my mind that I’ve been teaching live into an online format. I had the sense of being selfish, that I actually had all of this knowledge and education to share and I wasn’t really reaching the population that I needed to. So I created that program, and physicians started doing really, really well. They’re finding relief from their symptoms.

Physician statistics pre-COVID, which I put in my article, are that 50 percent of physicians are burned out. That’s one-half of all physicians. And the suicide rate is twice the national average. I personally lost three physician colleagues to suicide, three. So I really felt driven to help flatten that curve, to help decrease that curve. And most recently, Medscape put out an article just a few weeks ago saying that one-half has jumped to two-thirds, so now two-thirds of all physicians are burned out.

So I wrote the article not only to bring attention to what’s going on in actively practicing physicians, and the way to help themselves, the way to relieve their symptoms and their suffering through self-care, but can we work now through a preventative means? Medical schools should include these teachings at day one of orientation. That’s when these stresses begin. Back in 2016, a JAMA article reported that one in four medical students are depressed or have depressive symptoms, and 11 percent have suicidal thoughts. Those are very large numbers for medical students. So the problems that we’re experiencing as practicing physicians actually begin in medical school.

Kevin Pho: Now, can you share some of the most actionable self-care tips to my clinician audience who may be listening to this?

Robyn Tiger: Yes. So from the self-regulation standpoint of things, being able to work with your breath, in particular understanding the physiology of breath and how our breath works. Meaning that, for example, when we inhale, our heart rate increases, and when we exhale, our heart rate decreases. So noticing how long our exhale is: Having a nice, long exhale can decrease your heart rate, decrease your blood pressure, and decrease the stress response, and increase the parasympathetic nervous system and the relaxation response.

Also, location of breath: breathing into your belly as opposed to your chest. Chest breathing is stressful breathing; belly breathing is calming breathing. We initiate vagal tone, right? We get that vagus nerve going, which helps us to feel calmer. So the length of your breath and the location of your breath are two very important pieces with respect to how we can use our breath to feel calmer.

There’s also movement. I’m certified in somatic movements. We can move in a certain way to increase the resting length of our muscles. Our muscles are chronically tense from stress. Stretching them doesn’t work, so we can move in specific patterns to increase that resting length of our muscles, to feel calmer in our bodies.

And then life coaching. Learning to separate facts from thoughts is very, very powerful. We think our thoughts are real most of the time, but they’re just thoughts. So in life coaching, we learn how to separate facts from thoughts, and that our thoughts determine how we feel, how we act, and ultimately the results in our lives.

Kevin Pho: So you talk about some of the techniques to relieve stress. How much time should a clinician spend on these techniques per day?

Robyn Tiger: Well, physicians are very busy people. So when I’ve asked the busiest of physicians, “What’s the least amount of time you have on any given day to give to yourself?” I hear 15 minutes. So I say 15 minutes is fine. If you have five minutes, it’s fine. It’s not necessarily just the time that you’re creating for yourself throughout your day, but it’s how you can use these tools when things come up in your life: when certain thoughts are coming up, when you’re feeling stressed, when you’re rushing through work, when you’re having a situation with a patient or their family, or maybe something didn’t go so well. Maybe it’s with your own family, maybe someone cut you off when you’re driving. Life happens. So how can you be calm in the chaos of your life? The tools that I teach happen to work very, very quickly. It’s not only time that you would set aside for yourself, but they’re really life lessons in how you get through your days.

Kevin Pho: We’re talking to Robyn Tiger. She is a radiologist and a physician coach, and she wrote the KevinMD article “The Rx we were never taught to write.” Robyn, one of the reasons why a lot of physicians are burned out is not so much that they’re not as resilient, or some may still be able to take care of themselves, but also it’s because of the systemic problems. Physicians are forced to see more patients, and they have to do more paperwork, do more check boxes, and a lot of these things are out of the physician’s control. Now, do all of your techniques work despite the increasing stresses that are out of a lot of clinicians’ control, and these stresses being increased every day?

Robyn Tiger: Yes, Kevin, this comes up a lot. So we can’t necessarily change the health care system overnight, and I’m not even sure that I’m going to see it change in my lifetime to the way that we all wish it would be, but we can learn to be calm in the chaos. And so, yes. I wouldn’t say that all tools work for everyone. What I teach is a buffet of tools, and I invite our physicians to try them on, see how they feel, take notes as to what’s working for them, and then create their own self-care toolbox. They can pull these things out whenever they need them, so they can feel calmer, they can feel more grounded and more balanced, independent of what’s going on in the workplace.

This is really important for their own health. We know from the medical literature that the chronic stress response is associated with many diseases and illnesses, like diabetes, heart disease, and stroke. It affects cancer growth and progression, and it even affects our longevity. Chronic stress shortens our telomeres by blocking telomerase, blocking the ability for this enzyme to add nucleotides to the ends of our chromosomes, and ultimately decreasing life span. So these tools are really, really important to improve overall health and well-being, as well as feeling calm, grounded, and in control, independent of whatever is going on at the workplace or whatever life brings.

Kevin Pho: And if a clinician wants to research more online about what you’re talking about, where can they go?

Robyn Tiger: Yes, they can find me through my website at stressfreemd.net.

Kevin Pho: All right. And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Robyn Tiger: My take-home message, Kevin, would be that if you are feeling any or all of these symptoms or situations that I described, you’re not alone. You have the innate ability to control how you’re feeling; you just need to learn how, and I’m here to help you. And to all of the residency program directors out there, to all of the individuals who are responsible for creating curriculums for medical students: I am here. I am here to help make this change, to change the culture of medicine with you. We have new medical students and new residents starting this year, new academic years starting. Let’s make 2021 this new year of change.

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

Robyn Tiger: Thank you.

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