Physician Burnout and Chronic Stress: How Doctors Can Feel Better

I usually start by teaching very simple and effective stress relief tools to help get the body back into homeostasis, into balance, so then we can start working with mindset tools and working Welcome to another episode of Doctor Talks.

I'm your host, Brett Gregory, and I am really excited to have Dr. Robin Tiger with us today for another edition. She is the author of Feeling Stressed is Optional and the host of the Stress-Free MD podcast.

So this is going to be a different kind of topic today that is really near and dear to my heart. And so I m really exited about it. Dr Robin tiger, welcome to the program.

Thanks for having me. Thanks so much. Really excited to have you here. So tell us a little bit about your journey, how you got to where you are today.

Yeah, well, as I say, Brett, make your mess your message. And so I, you know, about 15, 20 years ago, if I'm honest, started recognizing that I had a bunch of symptoms that nobody could really figure out.

They got worse and worse, and well, I figured it out myself and I learned how to feel better. Everything kind of was under the umbrella of what we're calling burnout now and then some.

And so I have spent the last, yeah, 15 years or so really focused on helping our colleagues and educating them on what I learned on how to feel better all by themselves.

And tell us about your journey. Tell us a little bit about you practice and then where you are now. Yeah, so I started out as a diagnostic radiologist, board-certified, fellowship-trained diagnostic, radiologists, and, you know, people joke and said, You're a recovering radiology.

And so when I start to learn about the things that were helping me physically, emotionally, psychologically, spiritually, I started to study them more deeply and became certified in many different disciplines to build what is now, what has now become stress-free MD.

And that continues to evolve and grow. That started out understanding that most of what I was experiencing was under the umbrella of chronic stress. It wasn't anything I needed a pill for or procedure for, or anything other than learning how to prevent and relieve my stress.

And so that started with learning things like yoga and meditation, working from body-based tools, and then mindset through life coaching and learning more and more about the fastest growing field of medicine called lifestyle medicine.

where instead of managing symptoms, illnesses, and diseases, we actually say, what's the root cause of what is going on? Where is this actually coming from?

And when we can figure that out and focus on our behaviors, things like relieving our stress, thing like what we're eating, moving our body, sleeping as we were just recently talking about a bit before we popped on, connecting with other people, watching out for all of those escapes, which can come in the form of drinking and recreational drugs and anything else you're doing to not feel the things you don't want to feel, even getting outside in nature.

When we start focusing on our behaviors, we can actually change everything. And so I dove deeper into this field of medicine, became board certified, and actually became faculty.

So I wrote the board review manual for the emotional health component where stress is located. And I'm so happy that thousands of other healthcare professionals are actually studying this to become certified in their boards.

So all of these pieces together have just been under the umbrella of this growing practice of stress-free MD. Amazing. So, okay, you often say that stress isn't just an emotional issue, it's a whole body health issue.

What's happening inside our bodies when stress becomes chronic? Why do so many people underestimate its impact? Well, I think that, you know, particularly in the U. S., more is thought as better.

The busy you are, the better, The more you're doing, and the truth is, it's sometimes less is more. And what we've come to understand is that although some stress is good, so people say, well I need stress to help me get things done.

I'm like, yeah, get it. Right? And so there's you stress, which is the good stress. That's the falling in love stress that's coming on this podcast stress And then there's the new stress of just like the neutral stress.

Something's happening over there. I know it's not good, but it is not affecting me. Then there is the chronic stress, which is frequently what we just call stress and that's distress.

And that which is over time causing the whole stress response in our body, the HBA, hypothalamic, pituitary axis, cascade of events that causes our heart to beat fast, that our muscles to tense up, causes these hormones to be chronically secreted, cortisol and initially epinephrine, that over time wreaks havoc on our entire body, physically and then emotionally and psychologically and ultimately spiritually or whatever you want to call that actual self inside.

And chronic stress is the number one cause of chronic disease. So ultimately, even if you're saying, I can deal with all the symptoms that the stress has causing.

By the way, 90% of these symptoms are what people report to their primary care physician with. the stress-related symptoms. It's not the symptoms, it's what the systems ultimately turn into, such as hypertension, diabetes, stroke, heart attacks, dementia, and cancer progression and growth.

And so, what else? Well, it actually cuts our longevity. It decreases the number of years we live on this earth. So when you think, oh, the more this better, or the More I'm Doing is better or The Busier is Better, and when You realize that all of this stress over time ultimately is shaving years off your life and decreasing your health, your Health span, how long you live healthy as well as your lifespan, How many years you Live on This Earth.

Yeah, that's huge. So as a physician, was there a moment in your life or career when you realized that traditional medicine wasn't fully addressing stress and what changed your perspective?

I think, you know, right after going to so many of our colleagues for help, I was seeing a neurologist for my migraines and for issues that I having, prestigious, bizarre things were happening in my hands and my back and in feet.

I seeing gastroenterologists for all the GI upset that i was experiencing. You know, I was going to chiropractors and massage therapists and physical therapists, an occupational therapist, and acupuncturists for all the pain I'm having in my body.

You now, talking to people about sleep, seeing a therapist for the negative thoughts I have and so on. And I came to realize that all this pile of pills that I've been taking every day, a pill for an ill that was being given as we say, wasn't getting better.

And at some point, you know, I just realized the imaging studies are negative, the blood tests are a negative. The pills aren't working. All the therapy isn't work.

I need to look outside the box of traditional medicine. And I have to say that, losing a few colleagues to suicide, I just kept seeing it over and over again and I started to have dark thoughts myself.

And I looked at my children, I look to my husband and said something's got to change. Yeah. That's where the change happened. Yeah, wow. Okay. Let's zoom out a little bit.

If someone only had 10 minutes a day to invest in reducing stress, how would you recommend they spend those 10 Minutes for the biggest long term return?

Well, as I mentioned earlier, Brett, we need to look at the root cause. So before we can dive into what the behavior is that could help them, We need figure out what's going on that's causing the stress.

And then we could dive in to what behavior would be the most beneficial. And usually when I work with people, I do an assessment, a short assessment a lifestyle medicine assessment where we go through some questions of all the different behaviors and we see where people are feeling like maybe they're actually okay in certain areas and other areas are really depleted.

And then that's where We start. Okay. So when you so let's say somebody has taken that first step and do you have a quiz or is there some questionnaire that somebody can get through to do that?

Yeah, well, I usually send that out for people who want to coach with me, whether we're doing one-on-one coaching, or whether you're in group coaching.

I always send it out and I say, let's take a look at this before we meet so we can both have this bird's eye view of what's going on in your life and then we focus on what matters most and where you need the most help right now.

Okay, so let say then someone has done that initial assessment. What's then the next step? Yeah, so the next step depends on what they filled out. So if they failed out number one to a thousand, and so let's just say stress, for example, they're feeling that their life is just completely, you know, inundated with stress.

Then we start working on, what I call the bottom up top down approach to stress relief. So, lots of times we have thoughts, for example, 60,000 of them a day, which are many times not so nice and most of the time on repeat, but it can be really hard to work with them when our body is dysregulated.

So I usually start by teaching very simple and effective stress-relief tools to help get the body back into homeostasis, into balance. So then we can start working with mindset tools and working thoughts.

Are you able to share some of those tools? Sure. Yeah. So, for example, let's just talk about breath. You know, breath is really accessible. Everyone's breathing, right?

If you're listening, you are breathing. so you can do this with us. And being a nerd with physiology and putting on that left brain, people may have heard about breathe work and they think that's for like, people that are doing all kinds of crazy yoga stuff, I can tell you that when we put our doctor brains on and we actually get down to the physiology, it is really amazing.

So your breath can do four things. It can calm you down. it can wake you up. just based on how you breathe. So we're talking here about calming down. And so when we want to focus on calming, down there's a few different points in our physiology that really help with our breath.

One, for example, is understanding what happens when you inhale and breathe in, and what When you breathe in, your heart rate goes up and your blood pressure goes.

That's a sympathetic response. And every time you breath out, you're heart and you blood are going down, that's your parasympathetic response and so both parts of our nervous system are autonomic or automatic nervous systems are working everytime we breathe.

So when someone says, just take a deep breath and breath in. Well, that doesn't do anything. Your heart rate goes up, your blood pressure goes and you feel awful.

It's actually focusing, for example, on your exhale breath. If you can think of it as your key to your relaxation response. That's the part of your breath that's going to allow you to feel calmer.

So when we lengthen our exhale breathe, we will decrease heart-rate and blood-pressure and allows us to fell better. We can try that on for size. So, when we breathe in through our nostrils, two holes, When we do that, we can think about our physics of breathing out through a smaller hole through an imaginary straw.

Naturally, it'll take longer for that breath to come out to that imaginary star than it took to coming in. So when we inhale through our nostrils and we create this pretend straw and breathe out slowly, we'll naturally lengthen our exhale.

So we're wigging out about something in our brain. We can't start thinking, how am I supposed to length my exhale? The quickest way is to breathe through that imaginary straw.

Do you want to try that on for size? Yeah, let's do it. And just something to think about is when we breathe out, we want to breathe slowly as if a candle's flickering on your birthday cake, but you don't blow it out.

So as you're practicing it and say you are a healthcare professional and you teaching it to someone else, your patients, staff, family, friends, someone who's afraid on the plane, I've done this on a plane and prevented it from having to land prematurely.

It's important to give that cue. So we'll get comfortable in our chairs, you know, or if you're walking somewhere, just be comfortable. And your eyes can be soft or closed.

Then breathe in comfortably through your nose. Purse your lips to that imaginary straw and slowly breathe out. Now, whenever you run out of exhale breath, repeat.

So we may be on a different timing of our breath. Breathing back in through your nose comfortably without force. Pursing your lips and slowly breathing out that imaginary straw as if the candle's flickering, but you don't blow it out.

Maybe we'll just do one more together, breathing in though your I'm pursing your lips in very slowly, breathing it out. So I've heard of the box breathing technique.

It's a similar, I assume, to breathing. Box breathing is imagining that you're breathing around the sides of a box. With box-breathing, you are inhaling, holding, exhaling and holding.

Sometimes Brett holding your breath can be very stressful for people. So that isn't the first breathing tool I teach. I love teaching that, but I usually wait until I teacher a few others.

And when someone feels comfortable with some other tools that they can actually fall back on in case stress breathing is activating for them, then I'll teach that breath.

But I don't teach breath holding right away. That's like part B. Yeah. So in this case, you breathe in for two or three seconds, breathe out for four to six seconds.

For the box breathing? No, no, for this. Yeah, so it really is what feels good for you. for somebody that breathes in, maybe they'll breathe them for a count of three, someone else might breathe him for account of six.

It's really very independent. The thing to think about is you want your out-breath number to be longer than your in-breadth number. So whatever that is for you.

And that could also be different on any given day. I don't usually give a number, I just say what's comfortable for your to breathe in and then what is comfortable to breath out as long as comfortably possible.

Mm-hmm. I love this. So I do have to ask so doctors don't know this No, I can't say that I have met and you know I work with a lot of medical students and it's amazing to me that gosh, i just had my 35th medical school reunion and Yeah, and I could tell you working with medical student 35 years later They're still not learning this.

So some medical schools are progressive and they're starting to incorporate things. But no, we learned about the respiratory system, but we didn't learn how to use it to our own benefit.

Amazing. Wow. All right. Well, so on that note, what are some of the biggest myths that you hear about stress management that could actually prevent people from getting better?

Hmm. What are the myths about stress management? Well, let's go back to, you know, more is better. Right? Let's, go, back, to like, I can sleep on the weekends and on vacation.

Yeah. Sleep when I'm dead. It's like a Bon Jovi song or something. But I think I wrote about that in my book. And so the thing is that sleep, for example, Let, s just talk about, that for a moment.

Nobody taught us about what happens when we're sleeping, that we have, you know, DNA repair, memory encoding, regulation of cortisol and insulin, and wow, so many things are happening when were sleeping.

So when don't sleep, We aren't well, and that sleep deprivation is actually cumulative. So we think I'm just going to make up for it on the weekend or make it up on vacation, but the truth is it's cumulative, it takes a really long time to makeup for that.

And so we do want to prioritize our sleep. We want think about sleep as food. Sleep is food for our bodies at all layers of our being. And that it's not something that we do when we think we have time.

Because when people say to me, I don't have any time to do any of these things, and then I say, you're right. And then they say to me, what? And I say, you don't have time because by not taking care of yourself, even in these micro moments, your shaving years off your life and you're losing time.

So people then start to actually listen and say wait, wait tell me more. Well, yeah, I mean, and we talked about it right before we got on this podcast.

I just got back from two weeks in Japan, just get back less than 48 hours ago. And you asked, how am I still awake? And I said, because I prioritize sleep, build my whole life around sleep or, you know, manage my life, around asleep.

Um, And. Protect it. Uh, extremely protective over my sleep. You know? Sometimes to my family chagrin, but I don't care. Like, I need to get my sleep.

So what do you tell your coaching students and other doctors about how does sleep help you with stress being optional? Yeah, because when we don't sleep, we're anxious.

Think about how tired, when you wake up and you're counting the number of hours till you get to go back to sleep. Lack of sleep causes anxiety and anxiety causes lack of asleep.

It's hard to fall asleep and stay asleep when your anxious until there's this vicious cycle when when don' sleep And so it's really important that we prioritize it and then learn, you know, tools to help us fall asleep, fall back asleep.

Stay asleep and wake up not tired. I mean, as you mentioned, I actually started prioritizing sleep, in the last few years, because I didn't realize just how important it was.

Yeah. So I understood more about the stress tools. And I understand about exercise. Mm-hmm. You know food creating mood and I really dove into nutrition and start to really understand how food creates mood depending on what we eat and the importance of connection and being with other humans, but I didn't really quite get the whole sleep piece until I dove into it.

And once I started prioritizing sleep, I felt like transformation, like an unbelievable energetic human. I wasn't tired when I woke up in the morning.

My husband kept saying, you're not yawning so much anymore. It's amazing. And why, to answer your other question, why were we never taught about this?

You know, so I too am protective of my sleep and I teach what we call the sleep prescription, which isn't about medication. It's about the things that we can do to help ourselves get nourishing sleep.

And can you just share what a couple of those things are? Yeah, well, we need to actually learn what our body needs and what is that magic number for you.

So you can read all kinds of research articles and they'll say like, oh, I need seven to nine hours of sleep. Everybody's different. and so it's important to figure out first of all like what is your magic number when you are starting to get that sleep like how much you actually need and then creating a sleep cycle so what that means and I usually work backwards When I work with people, we go through your schedule.

Tell me about your morning. What goes on your mornings that's non-negotiable? What is it that you have? For some people it might mean get their kids ready for school or maybe they have to check their inbox in Epic or whatever.

We go though all the things and we work backwards. What else are you doing in the morning? Are we adding movement? are we Adding meditation? or are adding yoga?

Or are You adding a walk outside? Do you have to walk the dog? Like, what are the things? And then we say, okay, well, this is the time that you need to wake up to ensure that You get your morning things done.

And, then, we work backwards and figure out the Time you to be asleep. Not the you get in bed, and not in your bed and scrolling on your phone. This is like a sleep.

We're talking like, What is your sleep time? And then we create that, that you know, you said before, like you're sleeping from nine to, what did you say, five or something like that.

And so creating that for that individual human and then working backwards from the falling asleep time. Okay. An hour before you go to bed, we created a wind down routine, right?

Again, there's no television. There's on your phone, there's no on-your-computer. All that is done, because that blue light is really awful, and it prevents the melatonin in your pineal gland from being secreted, so it makes it so that you can't fall asleep easily.

And there are a whole bunch of other things, depending on when's the latest point in the evening that your eat, Because food actually causes a lot of heat in you body because your digestive system is working, we need to cool the core down.

Before for us to fall asleep at night, you know, when's the last time you had caffeine was the time. You had alcohol turning lights down music, like maybe candle that smells good.

All of these things. There's so many things we can do to transition. ourselves to get ready for that falling asleep. And so we create an individualized prescription for each individual, no medication prescription, but more behavior prescription to really prioritize that sleep.

I love it, yeah. I started using my Apple Watch to score the sleep, which had been great. And I always thought I needed eight hours. Turns out seven is plenty, and I never knew that about myself until I starting measuring it.

and, I'm very, always go to bed at nine o'clock. So the hardest thing for me is making sure that the electronics go off at eight. And so I had to figure out, okay, well, how do I force myself to do that?

Well, I could force my self to take a jacuzzi around that time. And that forces me off the electronics. So there's all those little things. You're exactly right.

It's totally individualized. But creating that ritual and that behavior routine is so valuable and critical. And in our last little bit here, what role does mindfulness, meditation, and your breathing exercises really play?

And are there solid science behind those practices? Yeah, there's so much research. So when we were talking earlier about like, what was your pivotal moment?

When I started to learn these tools and I start to feel better and the symptoms I was experiencing, which were so many, started decrease my doctor brain, my left brain my cynical brain start dove into the medical literature.

And that was when I to see that there is an unbelievable amount of research that is out there documenting the benefits of all these tools. And so it isn't just woo woo weird stuff.

It's actually our own physiology, our anatomy, and a decrease in chronic disease and illness in addition to just us feeling better. Amazing. So, and last question.

Imagine somebody listening today, some doctor listening to us right now feels overwhelmed, exhausted. They believe they waited too long to make a change.

What would you tell them and what are the first three steps you'd encourage them to take this week? Well, first I would say, it's never too late. That your age is not a cage, which I love to share because sometimes, you know, I'll be 61 this year and people are usually surprised.

So these things work. I actually did my telomere test. Did you measure your telomerase? I have not measured my Telomeres. As I've done other age, biological, chronological age tests, but not my Telemeres, Well, it's pretty interesting, whatever test you're doing.

And I found out that I'm 16 years younger at the cellular age than the chronologic age. Yeah, you look great. Oh, thank you. But I feel great, which is even more important.

Yes. So when people say that, I am like, It's not too late. I've worked with people that are in their 80s. For the first time, they're deciding they want to make changes, right?

So it is never too later and always 1% better every day. So I learned that by working, you know, I present for our military and firefighters, police officers, Navy SEALs, and so on.

And I learn this from them, 1% better every day. So when you hear me talking about all these things, it could be really overwhelming. When we're overwhelmed, we end up doing nothing.

We come back to these tiny little micro changes, really make a difference. It's also in the literature. Little things are the big things. And so I would say also, if you're shutting yourself, I should have known this stuff already, should've been doing this already.

The answer is don't shut yourself. Wipe that shut off, right? Wip it off. Be kind to yourself today is a new day. Yeah, today's a day and every day is new.

Day. When you were asking me about, you know, all of this, the mindfulness and so on, presence is the presence. Really. And, you know, this is the only thing we have.

You and me right now, whoever's listening right, now this, is, the, only, thing, we actually have this very moment. The past has already passed. the future hasn't happened.

and so all of this brings us to right here, right. Now, and to remember that there is nothing more important than what you are doing right? Now. I love it.

Dr. Robin Tiger, how can people get ahold of you if they want to work with you? Yeah, the easiest way would be through the website. So the web site is stressfreeMD.net.

That's stressfreemd. net. And it's there that you'll find a lot of the things you mentioned already, The podcast, you will find online streaming programs, You'll fine information about my retreats.

Um, and my book. The next retreat is in Africa. So I'm heading back to Africa in January to Rwanda and Kenya. We were in Uganda last year. Amazing. And we're heading for our next revive retreat in Africa where we get to see animals in their natural habitat, meet the incredible communities, and we give well-being talks.

So you can get CME credit. Amazing. I was fortunate enough to spend a month in Africa. Went to Kenya, hiked Mount Kilimanjaro, and that was definitely my most memorable trip of my lifetime.

If you get a chance, if you're listening to this, go to Africa with Dr. Tiger. It's going to be great. We'd love to have you come. Friends and family are welcome as well.

Love it. Your book, Feeling Stress, is optional. How can they get to copy that? Yeah, that's available on Amazon. So you can go straight on amazon or you go to my website and the link is there as well.

All right. And we'll put all those links in the description of the podcast. Dr. Robin Tigre, thank you so much. This has been a real pleasure and honor.

It is a pleasure to be here. Thanks for having me. That wraps another edition of Dr Talks. I'm your host, Brett Gregory. We will see you on the next one.

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