Part 2: Going from Reacting to Responding

Episode Introduction and Heartline Mission 0:00

Welcome to a special Heartline Echoes episode where we revisit some of the most impactful conversations from Heartline changemaking in healthcare. This rerun isn't just a replay. It's an opportunity to reflect, reconnect, and reignite the ideas that continue to shape the future of healthcare. Whether you're hearing this for the first time or returning for some fresh insights, let's dive back into this powerful discussion. Enjoy! Welcome to Heartline, Changemaking in Healthcare. I'm your host, Dr.

Andrea Austin, a board-certified emergency physician, physician development coach, and educator. After years on the front lines, I've learned that real change in healthcare starts within. Each episode invites you to explore the inner work that unlocks clarity and bold leadership, because healing systems through changemaking begins with following our heartlines. Welcome to part two of my interview with Dr. Leslie Koenig. If you missed part one, I'd highly encourage you to go back and listen to that.

We get into her journey to be a more well-physician mom and wife. Dr. Koenig is a board-certified emergency physician, Afghanistan combat veteran, and creator of the Stress Relief Survival Guide, a workbook that is available on Amazon and that I highly recommend. In part two of my episode, we're going to jump into a conversation about how we can make the system of healthcare more friendly to physician wellbeing.

Healthcare Staffing, Culture Change, and Burnout 1:32

I so enjoyed this conversation and I'm really happy you're here. Thanks for being a listener. I hope there's some hospital administrators listening or we can forward this to them. Everybody's talking about the staffing shortage right now. And all I see is quick fixes. And we are beyond quick fixes. The other day we had a call out for a shift and they put a substantial bonus on it. And it was a day shift. And, you know, if you're not a shift worker, usually day shifts, especially with a pretty sizable bonus, people want to pick those up.

and they're going unfilled because people are tired. So I think now is the time, you know, you can keep bringing in travel nurses, you can keep dumping bonuses on, or you can actually invest in making your hospital, your clinic a more sustainable place to work. What's your thoughts on that? That is absolutely so key for the future of medicine is to have that long eye or that long term view about how to take care of your people. It comes into having good leadership. It comes into being knowledgeable about how to truly motivate your employees.

And as an employee, that just goes to show that money isn't everything and that really your health and well-being is so important. And I've seen the same thing with administration fixes where it is a quick fix. You and I know both know TeamSTEPPS and how wonderful that has been. And my hospital, when I first came on, wanted to talk to me about it as I was a TeamSTEPPS champion. And I tried to impress on them that this needs to be a culture shift. And they said, well, that's too expensive. That's too much training.

We just want to do this tiny little bit of team steps. And I have not seen any changes. They wanted to do just implement a small little quick fix and not do a culture change. And it went nowhere. So really, the money was wasted. And they thought that this tiny step would do it, but it just doesn't. You need to have huge shifts in culture to make lasting positive change. But in the same way, we need to look at the same way in our own lives. We can't do these little quick fixes like vacation. We can't do these little quick fixes like I'm just going to get a massage.

We need to do a culture change in our own lives to have that lasting positive change as well. So it's almost like looking outwards at administration and the culture of medicine. Look at yourself in the same way. And that's the quickest fix that you can do is with yourself. Looking outwards at administration, I know that they're doing the absolute best they could or best they can. And I know COVID was incredibly difficult, but it is time for physicians to come together and speak out, speak loudly, and we can make our own positive change as well.

So a question that's been resurfacing a lot with many of my guests, and I'm truly interested in your thoughts. Is emergency medicine full-time clinical practice a sustainable option? Do you think people can do emergency medicine exclusively for a full career? It's such a personal question. I think it depends on every individual. There needs to be a balance. I personally absolutely love emergency medicine and I don't see myself ever leaving. However, because of the circadian rhythm changes, it's not on my terms.

And that is one reason why I'm looking at other options. Long-term, it's not a very good option because of that one issue, in my opinion. All else being equal, where you love where you were, you're satisfied, your administration is supportive. It still gets down to as you age, you know, because our human bodies do. It's just not sustainable to have that circadian rhythm change, in my opinion. So I think it's very possible with the right mindset, the right constitution and the right balance.

Can Emergency Medicine Be a Full Career? 5:33

But often you need to bring in some kind of side gig or one more vacation. Just have an understanding of how it's going to change in time. Does that answer your question? Absolutely. I think that's a great response. And I think it's what I'm telling my residents is I would highly recommend that you have something else professionally an income generator besides exclusively emergency medicine. One pattern we've seen on the show is there's a lot of people that have a clinic practice that allows for more normal hours.

And the way I've restructured my professional time is I have a lot more work that I can do from home. again, during normal hours. So right now I'm working probably on average one night shift every couple of months, and that's not a big deal. I don't think that's really gonna contribute to my mortality in any significant way. But when you start getting up to some of the other shift configurations, I think that's something we have to grapple with in a more real way. than we've been doing in emergency medicine.

Yeah, totally agree. Yeah. I mean, that is the trajectory of my career has been. And again, that's where the heart variability made me recognize what I was doing to myself with doing only emergency medicine. I did read a book called Rich Dad Poor Dad, which I actually have a copy of at work and a handout to anybody who brings this up. You know, what can I do aside from medicine? Because if you get into something like real estate or investing, it gives you a lot more options to continue this job that I love.

But not worry about income some kind of passive income sometime investing because it is a financial decision sometimes whether we stay in emergency medicine or not but you know between financial and mental health. And physical health as well so having that secondary side gig or. Plan B back up. I totally agree as an emergency medicine because it's going to be difficult to have it be your entire career. If it is your entire career, you're probably going to end up working less simply to have the rest that you need.

Yeah, and I think the interesting thing is once you diversify your career, my emergency medicine shifts now are a choice. I don't feel like I have to, and I feel like if my emergency medicine job went away tomorrow, it would have an impact on my income. but I have enough other things going on that I would be okay. So now the mindset has shift from I have to go to my shift to I want to go to my shift because I have other options. So that's a huge thing. And I would really, you know, the listeners that are struggling with burnout and I would encourage you to have another option and you may start to notice that as you do other things, you're like, you know, actually, there are some aspects that I underappreciated that I actually do about emergency medicine.

But again, going from I have to, to I want to, or I get to. And that's such a huge shift for how you live your life. Imagine wanting to go to work every time you go to work. That's kind of living the dream, right? And formulating your life and planning so that you can do that for yourself is one of the best gifts you can give yourself. So that's an amazing outlook. And it comes down to us creating it for ourselves. And it's really our responsibility to make that happen.

Diversifying Work and Creating Career Flexibility 9:13

So I know for years that you have been an extremely fit person and fitness has been a big part of your life. And I'm curious about why that is, what, you know, if you're an athlete in high school and how your fitness journey has changed over the years. Oh, thank you so much. I was not really an athlete in high school. I was a diver, which is not highly athletic. It's more mental really. You basically jump off a diving board into the pool and do some flips and stuff. So it takes a lot of mind dedication.

Through college, I got into running. And that, I think, helped me recognize how fitness helps me de-stress. For a long time, I thought, I don't need to meditate. I'll just go for a run, which works in a way. It does help to calm down the body. You know, I do an intense pre-med study session, and then I'd go for a run. I also felt highly accomplished again type a person who wants to accomplish things, you know, finishing a race and getting a medal was, you know, kind of a great way to make me feel like it was I was being productive.

Right. But the fact of the matter is that fitness in whatever form works is beneficial to the mind and body. And I just got into so many different things noticing how it made me feel between running, doing races. I just got finished hiking in Colorado, kayaking, and I do weightlifting as well. I got into weightlifting through my husband, but I found that was more of a group program for me that I like. It's CrossFit-like. with just heavy lifting and then at high intensity. Having a community of people who's really supportive, it just ends up being a really positive environment and you can start tracking progress.

And I think taking an easy approach to it though, not super intense to the point that you get injured is a key thing to have lifelong fitness and longevity to go along with it. So having the right trainer and the right recovery, which is where the Oura Ring is also helpful. Absolutely. I mean, there's a lot of physicians that are runners and I think running's great. There's been periods in my life I've done half marathons. Right now, I've kind of decided I'm not really into running right now. We're very fortunate to have a pool and I'm doing a lot of swimming laps.

But my question is, with all the reading and research you've done on well-being and mindfulness and needing that recovery, do you think people should take a look at their fitness routine and see if they're adding in anything that is more in line with a parasympathetic response like stretching or yoga. I've just got a lot of friends that only do running and that in particular, you know, I'm actually working with a functional medicine physician and we're trying to kind of regulate some of my cortisol surges.

And, you know, her advice for now was like, I actually don't want you running. There's a lot of cortisol. surges with that and she wasn't real hip on me doing a half marathon right now just kind of looking at my overall goals. What are your thoughts on that? That's actually a really great idea to have that guidance to help you so that you can better ascertain what's better for your body because sometimes we don't listen to our bodies and we should.

Fitness, Recovery, and Sustainable Wellness 12:40

And if our body's telling us you need to stop running and focus on swimming or something more low intensity. A lot of us just don't pay attention because the mindset is I want to go I want to do this is what I've been doing, but it can be detrimental unless you pay attention. I am totally guilty of not doing what you're doing. I think yoga is one of those kind of highly touted parasympathetic boosters. And I am so bad about doing it. What I have done to try and improve my activity level on that is I simply do seven sun salutations every morning.

It gets me out of the guilt of not doing yoga as much as I should. But it's also a good morning stretch. It starts my day off right. It takes about seven to 10 minutes depending on how much I do the stretching. But it's a way to ease into my day. And it gets me ready for a cold shower. I'll put it that way too. Are you doing cold showers? Yeah, yeah, we're actually looking at getting a cold plunge as well. My husband just did a program where he was doing sauna cold plunge combo. And so the health benefits out there about doing cold exposure are huge.

So it's something that is mental discipline, but also is backed by research. So I do that as much as I can. It's hard in the winter. I mean, here in Nebraska, let me tell you, it's hard to do it in the winter. However, just when you look at the research behind these things that we're talking about, it's really undeniable. And to ignore the research is to do yourself a disservice. So meditation is good for you. Cold plunges are good for you. Parasympathetic, you know, practices are good for you and lays to longevity and better health, better mindset, better life.

So there's probably a listener right now that's gripping the steering wheel, driving into a shift and just feeling frazzled. Maybe they've got a small child at home or they've got an older parent they're caring for and they've listened to the last a little bit of this conversation. You're like, you know, that's nice, Andrea. That's nice, Leslie. Good for you. But that's just not practical for me. I don't even know where to begin. What would your small step be towards? I mean, clearly, like you said it, you've been meditating for seven years.

This has been a journey. I feel like I'm just starting to hit my stride and it's definitely been a journey. So how do you even begin? I would say to that person who was listening saying, yeah, that's good for you guys. Good for you. I can't do that. I would say, take a deep breath. and really notice what a great job you're doing. Whatever you're doing right now, you are doing the absolute best you can and you just give yourself a pat on the back. You know, maybe put your hand on your heart and say, thank you.

Really thank yourself for all of the hard work you're doing. It really matters. What you're doing really matters. The downside of that is sometimes we don't see that about ourselves and what we're doing is making any lasting change or any lasting benefit. and you feel like you're starting to spin off the wheels, you are grasping at straws, you don't know what to do. It feels like everything is out of reach. When I say taking a vacation, that may be hard to do. A vacation can be five minutes of sitting with yourself and doing the battery technique.

It can be five minutes of trying meditation one more time. It's five minutes. It just maybe I would say first thing, delete Facebook off your phone. Delete Instagram off your phone. or put it on some kind of timer because look at your screen time if you're driving right now when you park look at your phone and look at how much screen time you're using that is probably the number one place that you can create some time and space and if you create five minutes for yourself to just say thank you to yourself i know that sounds woo i know that sounds a little hokey give it a try if it doesn't work fine it doesn't work for you But give yourself five minutes.

And if you want to try just taking slow deep breaths, just noticing the breath at the nostrils noticing how it fills your chest, envisioning how each breath is a breath you will never have again, and having that appreciation for the life you have. So as that's, I would say probably the number one and number two things, look at your screen time, put limits on your apps and take five minutes. If you're, especially in your car, that is a great place to do this. If you're listening and you're on, you know, on your phone in a car, when you park five minutes.

Everybody's got about five minutes to spare. And your car is a great place to do meditation. That's one of the number one recommendations I have is someone says, I don't have time for meditation. The minute you park your car, turn it off, like in those transition times between walking into work, getting from work, you know, you from work in your car before you start it, or even when you arrive in your driveway or in your garage, turn it off. And there's five minutes right there in that transition time.

You'll be amazed once you start giving this to yourself. the changes that will happen i really like that because five minutes even if you're running a little bit late is the five minutes really going to make a big difference really like just take the five minutes if you can show up and be more present and more kind during that shift I'm pretty sure your colleagues going to be happy. I mean, try to get there early that you can do the five minutes. But honestly, I think do the five minutes regardless because there's such a huge difference.

I mean, we've all shown up to the shift where you're just like running through the door and like your hair and you just can tell that. And, you know, I think we do need to spend more time on getting into the right mindset.

Mindfulness, Five-Minute Reset, and Screen Time 18:30

If you think about how much time we waste with a bad mindset, it's astounding. And that's what meditation really showed me was how much my mind was really just sabotaging my life. One thing I noticed that helped me a lot with burnout was how judgmental I was of people who would come in simply because I was just angry. I was just upset about the patient volumes. I was upset about that I didn't get enough sleep last night. And when I had that mindset of judgment is not in the job description, that changed a lot for me because I would see, you know, I would see, say, a frequent flyer come in and I'd be like, oh, oh, so and so is back.

And I would just have that like down feeling and that that's just and then you spend five minutes complaining about it with your nurses. Right. That's five minutes right there of complaining that you can just cut out your life. You don't need that time. All that time spent complaining, all that time spent judging, all that time spent worrying. If you are able to notice that amount of time, being mindful of your thoughts. you will be able to shift that negative mind state of judgment, anger, frustration.

And in those five minutes, you'll see that and you can cut it out of your life. And by replacing that negative mindset, that negative judgment towards this person, you can, you know, as with the positive battery technique, oh gosh, I'm going really negative right now. I'm going to look at this patient and I am going to what I've done also, and not only is thinking that judgment is on in the job description, but looking at each person almost like with an x-ray vision of their cardiac heart. If you just see someone's like just look at their chest, maybe you're like upset looking at their face, you just need a minute to just calm down.

Just look at their heart and envision this is a person with a beating heart. This is a person who is a warm-blooded, loving person just trying to make their way in this world too. And just having that vision, I think for me, just to just take a moment, see them as a person, not see them as a patient, not see them as a frequent flyer. But this is a person with wants and needs and desires. And they're just here for your help. And remembering this is a privilege to take care of this person. And really having that I'm not here to judge.

I'm here because I have a privilege to take care of a human person. That changes so much and it really opens up to the compassion you can put back in your life. Yeah, it really also reminds me of a conversation I had with my coach about six months ago. It was during a COVID surge and I was so angry about the continual onslaught of people that were unvaccinated exposing me. And then I got COVID and I was sicker than I had anticipated and just angry. And it sounds contrite, but acceptance was what changed my life.

I had to make a decision that if I was going to keep being an emergency physician, I had to accept the reality that a large number of people are never going to be vaccinated in this country. I wish it was different. I can do things. I can have one-on-one conversations. I can use my status as a physician in different ways to try to change that. In that moment, when I have to walk into a room and someone's unvaccinated, that is the reality. And being angry about it, I've always associated anger with change.

And in some ways I can see why. Social justice movements are largely fueled by anger. But in the moment when you still have to do a task, you still have to interact with somebody, that anger is very counterproductive. Stay tuned, we'll be right back. Are you a physician mom with school-aged children feeling utterly exhausted? My friend Dr. Sheeta Shafi invites you to take a little time this summer to join her in a small, intimate group for meaningful conversations. Dr. Shafi is an emergency physician, coach, and mom to eight-year-old twins.

She understands firsthand what you're going through. This isn't a pizza party or a yoga class. You'll meet for two one-hour sessions twice a month starting in July to help you move out of exhaustion, Let go of mom guilt and live a life you're not only proud of but can truly enjoy. Connect with her on LinkedIn or Instagram at Shida Shafi to learn more. Shida is spelled S-H-I-D-E-H and Shafi is spelled S-H-A-F-I-E. You can also check the show notes for a link so you can connect with her there as well.

I also suffer a huge amount with anger. And that's the thing about the world is you can't control it. And that's what emergency medicine is. It's taking care of other people. And sometimes they're bad decisions. And that's the job. And you can fight it, but you're fighting reality, which you're always going to lose there. You're just going to suffer and you're going to lose. And so either reality can change or mindset about it can change. for me and I hate and when I was doing it I thought compassion practice was the lamest stupidest thing and I never wanted to admit to anybody that I'm doing this whole compassion loving kindness thing but I found that it was honestly the best thing that I had ever done in meditation.

Acceptance, Compassion, and Managing Anger 24:10

was a loving kindness practice. I followed someone called Sharon Salzberg. I have the practice in my book and it's there for a reason. I'm a person who's still suffering. I mean, I'm still a person who has a lot of anger. That's just my conditioning and that is the way that I have been for the last number of years. However, I now see it better and doing this practice truly does change the way that I relate to my job and relate to patients. I'm just recognizing what needs to change reality or me.

One's going to win, one's going to lose. And I don't want to lose. Right. And I think what you said there was so important that you recognize that still many of these things are base traits. They're very hard to completely change. I mean, these are hardwired neural circuits. So honestly, bringing it full circle back to Victor Frankel, it's more about creating that space. You may always have that reaction. For me, somebody unvaccinated in the year 2022 with all we know, I'm going to have a reaction to that.

It's really my choice if I'm going to pour gasoline on that reaction. That is such a great way to put it. Yeah. And I don't think we should fault ourselves for our reactions. You know, they're there, but it doesn't mean that we have to pour gasoline on it. Like you said, you know, you can still have that reaction, but meditation helps you notice that reaction quicker and meditation helps you create that space behind that initial like, oh, and then you can be like, you know what, I can respond to this.

I'm not here to judge, I'm here to respond, and I'm here to treat. And meditation, even though five minutes a day in the car, whatever helps, will help you notice that. And that way you keep that anger to a minimum, and you don't expand on it, negative cycle it, turn it into this bigger thing than it needs to be. And that's okay. We can have those reactions. Meditation is not about cutting out the anger or shaming you for your anger. I still have it. There's just less of it. And whatever you struggle with, it's going to be there.

It just minimizes and minimizes and minimizes. And as it minimizes, your happiness starts to maximize. Yeah, one of our good mentors, Dr. Kerry King. Yeah, I love Kerry. I always think he's like the Zen master of the emergency department. And he told me very, very, very long time ago that throughout your career, it's like waves in the ocean. And at first, you just have these huge waves, these huge surges. And over time, they just become much, much smaller. I'm beginning to be able to see that, that my responses to things, they're just not so heightened.

And it's funny now, I can see it in my resonance, I can see when they spike, and I'm able to modulate a little bit. Like, yeah, I know that was frustrating, or actually that happened, but it wasn't your fault. It would have happened regardless of what we had done. Bringing it full circle back to our Navy background and shout out to one of the greats of Navy medicine. Oh, absolutely. I was going to say it's probably all the surfing he does. That helps. And it's funny how surfing does show you just you can't control the waves.

You know, you're sitting on the surfboard and the life will throw you whatever throws at you. The ocean will give you a wave or it won't and you just have to accept it. You have to be patient. And if you are okay with that and you accept that that is what reality is, that is what the ocean is throwing you, you can have more peace. You can have more ease. And then you get the happiness. I think I have so many people chase happiness. You just can't chase happiness. Find peace and ease with what you have and the happiness will come.

Yeah. Final note before we move into wrapping up. So I don't know if it's the same with surfing, but for paddle boarding, you know, if you're standing on your paddle board in a wave's coming, you know, it's very easy to be knocked off your board, especially standing straight up and to stay on your board as a wave is approaching you, you actually need to turn into it. Based on. And that is such a beautiful metaphor for life that, you know, you try to, you can't outrun the wave. It's going to catch you.

And if you try to like do some weird thing from the side, you're definitely going to get knocked off. So you just need to move. right into it. So I hope that metaphor helps our listeners that, you know, you can ride the wave into your next shift and into whatever life is throwing at you right now. I love that. That's amazing. And you have your two feet on your board. You see it. You turn into it. So you're mindful of the ocean. You're aware of things. You're aware of your surroundings. And you've got your two feet on it.

You have your foundation set with your abilities. And so that's, again, another metaphor for just all the self-care techniques that we're talking about. You're not standing on your head on one foot going into the waves. You've got a solid foundation to face whatever adversity comes. So this has been such a treat and I can't wait to have you back on the podcast and follow your integrative medicine journey. How can our listeners connect with you? Probably the best way is through Facebook. I did have, I still have a Facebook group called Stress Relief Survival Guide group.

I minimize my social media time now. However, if you message me on Facebook, Leslie Koenig.

Waves, Resilience, and Closing Resources 30:10

I also have a website where you can see some of my, you can download my products with the Stress Relief Survival Guide and I have a whole video course on YouTube. It's totally free. You can get the book on Amazon and that has almost all that you need. So feel free to find me on YouTube, find me on Facebook. Those are the best ways I would say. Awesome. And we'll put all those links in our show notes. Well, it has been an absolute joy. Thank you so much for being on the podcast. Oh, thank you. Thank you for everything you're doing for physicians and all of the work that you've done.

It's been amazing. And thank you so much for having me. Thanks for listening to Heartline, Changemaking in Healthcare. If you're ready to deepen your own inner work or want to bring these conversations into your organization, visit andreaaustinmd.com. You'll find resources and ways to connect with me for coaching, speaking, or consulting. Don't forget to subscribe, leave a five-star review, and share this episode with a friend or colleague. Until next time, keep following your heartline. This podcast represents the views of the host and guests.

It does not represent the views of any entity we work for or with. It is also for informational use only and does not replace any professional advice, including medical or psychological. If you're interested in unlocking your true potential, reach out to me. If you're an organization interested in supporting the wellbeing of your people, I'd love to connect on innovative solutions. Schedule a strategy session at andreaaustinmd.com. Thanks for listening to Heartline, Changemaking in Healthcare. If you're ready to deepen your own inner work or want to bring these conversations into your organization, visit andreaaustinmd.com.

You'll find resources and ways to connect with me for coaching, speaking, or consulting. Don't forget to subscribe, leave a five-star review, and share this episode with a friend or colleague. Until next time, keep following your heartline.