The Thriving Doctor: How to be more balanced and fulfilled, working in medicine

By Sharee Johnson

How can you protect your right to a balanced life in a profession that demands perfection?

Medical life is challenging. The culture is competitive, the environment intense, the machinery complex and unwieldy, and the expectations high. Under such constant stress, many doctors sacrifice their own wellbeing to try and provide the

• Language: English
• Publisher: Hambone Publishing
• Release date: Nov 22, 2021
• ISBN: 9781922357274

Book preview

Cover.jpg

PRAISE FOR

THE THRIVING DOCTOR

The Thriving Doctor is a must read for any aspiring doctor, doctor, or anyone who interacts with doctors. As a mid-career doctor, I wish I had this book earlier. It explains so eloquently the numerous factors that lead to doctor burnout, and the necessary internal work required to be able to fully show up to do the important work of doctoring. Beyond prose, this book provides helpful exercises to drive reflection and change. It does not blame the victim, rather it addresses the systemic issues in healthcare. This book provides a pragmatic and wholehearted approach to staying as well as possible in our unwell system.

Andrea Austin, MD, FACEP, FAAEM, CHSE

GSACEP Immediate Past President

I have really enjoyed the opportunity to read The Thriving Doctor. I could hear Sharee’s voice talking about concepts that have been part of my personal development, experienced while coaching with her. It was a delight. I am going back to many parts to linger over the descriptions.

For me, Sharee really captured the struggle as well as the magic–the privilege–of being a doctor. Her insight into the tensions that exist, the humanity of being a doctor, and the load that we carry as a result gives her work a credibility that resonates.

The scientist in me is reassured by the evidence she provides. The medical stories are ones to which I can relate. I appreciated the summaries that appeared regularly. The activities and questions challenged me to reflect.

My experience working with Sharee is changing my practice as a doctor and as a woman. My family have noticed that I am less reactive, calmer. I am learning to manage my ‘energy spend’ on my terms. I have a developing vocabulary that includes words like agency, intention, and values. Now my language is around living into my values and bringing my authentic self with kindness and courage, using my voice.

Dr Sarah Wilmot, GP Anaesthetist

My medical degree and specialist training gave me the practical skills I needed to be an excellent doctor. However, I was not well equipped to understand the multiple interpersonal relationships that exist within the health care system that so often wear down and burn out junior and senior medical staff.

Thank you for writing The Thriving Doctor. It provides insight and techniques for all doctors to understand the systems we work within and provides the much needed tools to develop our leadership and interpersonal skills. It also reminds us to lean into our vulnerability and humility, which were the very things that attracted us into medicine in the first place.

This book helps us be the doctors we want to be and our patients need us to be.

Dr Edwina Coghlan, Obstetrician & Gynaecologist, Teacher and Mentor

The Thriving Doctor is a call to arms.

It asks us as doctors to consider who we fundamentally are, and how we can make best use of our best selves in the service of our patients and communities. Sharee deftly and clearly implores us to see that we can’t hide our struggles from others -our fatigue, burnout and cynicism, and living distant from our values impairs us and damages our patients. It’s time for that to stop. No job is worth us dying for. No single doctor’s life needs to be the kind of battleground it’s become for so many of us.

This book is more than just a rationale for self-care. It is a clear guide with strategies we can use for introspection, reflexivity and action. It should be part of every medical student’s required reading. I wish I’d known the powerful value of building skills in mindfulness, emotional intelligence and self-awareness when I’d started my own medical journey.

Sharee’s own experiences, and the experiences of caring for doctors through coaching, shine a powerful light into our profession from the outside and give hope that we can each learn to build more sustainability into our working lives as well as take better care of our colleagues. Our best imagined future MUST be one where both doctors and patients can flourish, and Sharee invites us to try new strategies that have been absent from medical education and culture for far too long.

Dr Elisabeth Wearne, GP and Medical Educator

Sharee’s passion for wellness, for those working in an industry that enables the rest of us to be well, jumps off every page of this comprehensive text. Packed with evidence based, real life examples and practical activities, this is a book that every medical practitioner should have close by. If you live with, or care deeply about a medical practitioner, this book is also for you, as it will deepen your understanding of their reality and give you some great ideas as to how you may provide support to those you love.

Jane Porter, MCC GAICD

The Thriving Doctor is a gift to doctors everywhere, whether they are already thriving in their life or they are struggling with burnout. This is more than a book on thriving — it is a complete how-to guide for self-awareness and mindset mastery. In language that is approachable and easy to read, without unnecessary academic minutiae, Sharee’s writing respects the time pressures we are all under in healthcare.

Sharee makes a powerful case for devoting energy to developing self-awareness, and providing the tools to develop that life-changing skill. The Thriving Doctor is written from Sharee’s vast real-world experience with doctors in every stage of their career and along the stress-well-being spectrum. She writes with a deep and palpable sense of compassion and care for doctors.

There is practical wisdom here that we never got as medical students or at any time during our career. I enjoyed the introduction to the power of coaching for physicians, many of whom may be resistant or uncertain. The section on the culture of medicine and the roots of imposter syndrome during medical training spoke to me directly. Emotional intelligence was covered beautifully. I especially appreciated the brief case studies that serve as real-world examples.

This book and the practices it contains will make me a more effective doctor, colleague, and leader. I’m also certain any physician taking the time to work through this book will reap benefits outside of healthcare, as spouses, parents, and friends.

Brava!!!!

Jonathan Fisher, MD FACC Cardiologist,

Organizational Well-Being & Resiliency Leader

I would highly recommend this book to all doctors, and to medical students, especially those in their final year. Plain and simple, the book is an engaging read with lots of aha moments. The Thriving Doctor connects the reader to the stories of doctors who have encountered and effectively managed issues in the clinical workplace. The book provides insights into the processes underpinning coaching. It shows the reader the tried and trusted steps to build skills for more effective and satisfying engagement with the whole clinical workplace.

This book also works as a manual to build adaptive behaviours step by step to move from surviving or enduring to flourishing and thriving. That this is not an easy task is acknowledged, the book is grounded in reality. Sharee highlights that thriving does not mean an absence of distress. Like any skill, engagement and practice is key. When the focus shifts to effectively prioritise self, it will feel right!

Associate Professor Catherine Haigh,

Director, Monash Rural Health Gippsland

The Thriving Doctor has amazing depth, so much so that it is not possible to absorb all in one read. It is relevant to both medical and non-medical practitioners, with valuable pearls that challenge our way of thinking. Previously assumed terms are redefined into relevant and useful practical solutions to the challenges our modern day workforce, and life, presents.

Sharee structures her book in a logical sequence, with practical ‘to do’ tasks that allow us to pause and reflect, and indeed self-discover. This book complements the workshops and courses run by Sharee and allows us to explore these concepts in further depth, almost like a core textbook and reference.

I would urge all junior doctors to read this to pick up a few learning points. It will also be worth revisiting later, as new challenges in your career or new situations arise or new levels of maturity are reached. I know if I had discovered this earlier I would have avoided a fair amount of hurt and distress, and be much further along the path to thriving.

Dr Antony Wong, GP Anaesthetist

This book doesn’t need a critique or a review. It’s complete. It’s a gift to our profession, one for every medical student and doctor, junior and senior.

First Sharee articulated the way that I feel.

Then she gave me permission to acknowledge my feelings.

She made me feel valued. She made me realise that I mattered.

Sharee encouraged me to confront my emotions, and to challenge my existing paradigm, and told me that was ok.

…and then she gave me the tools with which to make a change.

Dr Vijay Roach, Obstetrician and Gynaecologist, Past President RANZCOG

I am so grateful for Sharee and the work she does. Sharee’s teaching is another curriculum, too often not easily accessible and vital for all doctors’ professional development. Her teachings and practical advice can salvage careers and save lives.

Dr Bree Wyeth, Psychiatrist

An evidenced based guidebook for preventing or recovering from burnout to leading an intentional and meaningful life.

This is a book that we can all benefit from, starting from where we are right now, to be more effective as doctors and more engaged with life. A recommended read for all doctors, I’ll be giving it to all of my colleagues.

Thank you Sharee for writing this book. Your clear writing, the evidence based content, and practical exercises have challenged and supported me to evolve how I think about my identity as a doctor. I feel better equipped to balance this with my other needs to live a meaningful and thriving life.

Dr Louise Sterling, GP and Practice Owner

Sharee is an extraordinary human being, and a kind and compassionate coach. Over the many years we’ve worked together on patient centred care, communication, and patient safety, Sharee has made connections between concepts, people, and communities where it was most needed.

One of Sharee’s greatest strengths is in how well she listens to our stories. It is this attention that has enabled her to truly capture the essence of other people’s lived experiences, in particular in a medical context. I have seen the skill with which she facilitates panels in person, and she has carried this sensitivity and perception into her writing of this book. This clarity of thought is why she is so perfectly qualified to work with Doctors to find their own balance.

With gentle expertise she has woven these lessons into a wise and enduring resource that will change the lives of doctors everywhere. It is strengthened by beautiful illustrations that showcase the intersection between arts and medicine. Through challenging and joyful examples, Sharee continues to advocate for doctors to advocate for themselves.

Prof Catherine Crock AM, Founder, Hush Foundation

Acknowledgement

I would like to respectfully acknowledge the First Nation people of Country throughout Australia, especially the traditional owners of the land where I live and wrote this book, the Gunaikurnai people.

I acknowledge the cultural and spiritual connection that Aboriginal and Torres Strait Islander peoples have with the land and sea. I remain committed to listening, learning, growing, and being together on what was, and always will be, Aboriginal land that has never been ceded.

Copyright © 2021 Sharee Johnson

All rights reserved, except as permitted under the Australian Copyright Act 1968. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

This book uses case studies to enforce the meaning behind its relevant chapter. Names have been omitted or changed to protect privacy.

Every effort has been made to trace (and seek permission) for the use of the original source material used within this book. Where the attempt has been unsuccessful, the publisher would be pleased to hear from the author/publisher to rectify any omission.

First published in 2021 by Hambone Publishing

Melbourne, Australia

Illustrations by Glenn Finlay

Edited by Mish Phillips, Danielle Upshall and Emily Stephenson

Interior Design by David W. Edelstein

Cover design by Andrea Hall, Gio Abarquez, Russell Caras and Daniela Florez

Cover photo of Sharee by Lisa Baker

For information about this title, contact:

Sharee Johnson

[e-mail]

www.coachingfordoctors.net.au

ISBN 978-1-922357-26-7 (paperback)

ISBN 978-1-922357-27-4 (eBook)

ISBN 978-1-922357-33-5 (audiobook)

Remembering Tim

To my awesome teachers Will, Ella and Tess

and

Dedicated to every doctor, thank you

Gratitude

In my roles as psychologist, coach, and meditation teacher, I do a lot of listening to what is said and what is unsaid. There is often a lot of emotion present when I sit with another person, a doctor. In my practice and in this book, I have tried to bear testimony to what I see and hear from doctors, to hold safe space for you to explore your experiences, and to offer practical psychological responses that you can use in your day-to-day life to maintain your wellbeing and prevent burnout in the face of many wicked challenges.

To support, encourage, and occasionally guide you while you experiment and learn is one of my life’s privileges. I have learnt so much from every doctor I have sat with. I am humbled by your commitment to your endlessly challenging work, your willing service to our community, and the trust you have offered me. Thank you doctors for taking care of us.

Before I worked with doctors, I worked with people from all walks of life as a therapist and in many other roles. My deep gratitude to everyone who has ever consulted me as client, colleague, or student participant, your trust and partnership over the past 30 years have allowed me to learn how to take psychological theory and research into real living. Thank you for all the lived wisdom you have shared with me. Remember, you are already more than you think you are.

A deep bow of gratitude and thanks to my mentors and coaches over the years: Elizabeth Roylance, Kerry Brydon, Angela Forbes, Jeanette Gibson, Debra Smith, Nick Thurbon, Uli Kimler, Nick Petrucco, Justine Anderson, Pam Newton, Rasmus Hougaard, Gillian Coutes, Mike Allen, Lindel Greggory, Sabina Vitacca, Jo Klap, Fuyuko Toyota, Karen Soltes, Vicki Crabb, Elisabeth Wearne, Catherine Crock, Lucy Mayes, Vijay Roach, John Matthews, Jane Porter and Andrew Green. And all my colleagues along the way who have been willing to dig deep into life with me, sometimes digging around in a lot of dirt to find a tiny speck of gold. Thank you for your patience and respect, your willingness to share and, most of all, your belief in me. Thank you also to those who may not realise how key their mentorship from afar has been in my development: Ian Gawler, Munjed Al Muderis, Richard Miller, Mehrdad Nikfarjam and David Clutterbuck.

I cannot really remember a time in my life without books. I often joke I will die drowning in them. Books have provided me with adventure, challenge, solace, and a continuous stream of learning. This book stands on the shoulders of giants in psychology, neuroscience, leadership coaching, philosophy, and spirituality. Thank you to all the authors and researchers who have asked what seemed like impossible questions and found ways for us to understand them, progressing our understanding of the human condition.

This book would not have happened without Kelly Irving and the incredible community of authors she brings together. Thank you, Kelly, for reminding me that writing is thinking and for being willing to walk through all the early iterations of that thinking with me. Thank you to everyone in the expert author community for inspiring and encouraging me to keep writing.

To everyone at Hambone Publishing, especially editors Michelle Phillips, Danielle Upshall, and Emily Stephenson, who have helped craft what is mostly a private world of coaching in practice, into an accessible resource. Thank you to David Edelstein for his design work, making the book easy to navigate. And to publishing master Ben Phillips, for taking such good care of me and The Thriving Doctor as it enters the world.

To my friend Glenn Finlay for keeping art in our lives, always. Working on this book with you has been such a treat. You have added so much humanity and warmth to the story telling of The Thriving Doctor with your fabulous drawings. Thank you, Glenn.

Thank you to the early readers of this manuscript: Joel Fanning, Elise Ly, Rachel Fanning, Nicola Finlay, Rachel Patton, Cath Crock, Elisabeth Wearne, Cathy Haigh, Lucy Mayes, Tanya Preston, Ziena Al-Obaidi, Sharon Ray, Andrea Hall, Antony Wong, Iris Tung, Robert Anderson, Chris Sellers, Sarah Bass, Adrian Jobson, Vijay Roach, Jane Porter, Bree Wyeth, Jonathan Fisher, Andrea Austin, Edwina Coghlan, Louise Sterling and Sarah Wilmot. Your feedback has made anything I could write so much better.

Thank you to Andrea Hall and Linda Hunt for keeping Coaching for Doctors ticking, from the genesis of early community events in 2014, to what is now a thriving practice serving hundreds of doctors. Andrea, you have kept me sane during the writing of this book; thank you for your organisational expertise, patience, enthusiasm, design ideas, and endless encouragement.

Thank you to Cameron Roberts, Tiffany Jao, and Ethan Brown, who helped me rise to the challenge that was 2020. Tika Reeves, thank you for keeping things moving in 2021. You have all embraced the vision of driving a healthier healthcare system by taking better care of doctors with passion and commitment, and for that I am grateful. Moving mountains is much more fun with company.

To my psychologist colleagues, the coaching community, the meditation teacher community, everyone at Pancare and to the healthcare movement communities I am a part of — Gathering of Kindness, Compassion Revolution, Ending Physician Burnout, and our own Recalibrate Alumni community — keep going! Belonging is central to wellbeing; I know that my wellbeing is enhanced by each of these communities, and I commend their work to everyone. They can help you put your wellbeing first. Together we can all be better and feel better; it takes a village to stay well, and it’s forever work. Together we can transform healthcare.

Anything I have achieved has happened because of the secure, loving family I have been blessed to live in. Thank you, Mum and Dad; you set me up to give it a go, whatever it might be in any given moment, decades ago. Rachel, Dean and Joel, I feel so lucky to share the same orbit with you three; thank you for reading, advising, and talking straight. To Will, Ella and Tess, you three are the stars that light my sky. Thank you for being patient these past two years especially, when work has taken over. It has been a silver lining of the COVID lockdowns to have had extra time with you three. I love you always.

My first village also includes the rest of the Fanning-Oliver clan, especially Noel, Nicki and Elise, who have helped take such good care of us these past 10 years. Thank you to the Johnson-Boyd clan, especially Libby, Johnny, Paul, Rachel, Tony and Nat, for keeping us close. Libby, Paul and Rachel, your ability to anticipate what we need and simply show up is something to behold; thank you. Big tight hugs to our extra family Nicola, Glenn, Tom, and Kate for loving us, taking care of us, and teaching us so many things. To Jo and Chris Jones who have looked out for us and made us laugh. To my beautiful sisterhood, especially Nicola Finlay, Naomi Hatwell, Tanya Preston, Jane Cameron, Nikki Smith, Pam Newton and Donna Rowand, thank you for being my trusty sounding boards. Thank you to Paul Johnson, Andrew Cameron, Nick Cox, Duncan Smith, Mick Hatwell, and Chris Rowand, my go-to guys. Thank you all for the constant acceptance and love you have given me. Thank you to all my glorious friends, I can’t wait to hug you again; you make my life rich. I have so much to savour and be grateful for.

And of course, to Tim who trusted me and is still my guiding light.

Choose your attitude and take action; you have but one precious life.

May you all be well! XS

Author’s note

A note on client confidentiality: I have changed names and all identifying particulars to preserve the anonymity of those doctors who trust me as their coach. Where I have written about some part of their story, I have sought their permission, and all have agreed to share their experience in the interests of better wellbeing and care for doctors.

Contents

Introduction

1. The Harsh Reality of Healthcare

2. Stop Surviving and Start Flourishing

3. Regulate Yourself

Clarity of mind

Emotional literacy

Self-awareness

Summary

4. Know Yourself

Meaning and purpose

Beliefs

Your values describe what matters most to you

Your role of doctor is only one part of your self

Summary

5. Relieve stress

Distinguish stress from stressors

Balancing the stress response and the relaxation response

Six habits to help you live more in the green zone

Summary

6. Emotional Intelligence and Agility

Emotional intelligence

How to defuse your emotions

Emotional habits

Manage your emotions effectively by consciously choosing to approach or avoid

Summary

7. Communicate Effectively

What is effective communication?

The qualities of great communication

Skills for effective communication

Does empathy make communication effective?

Feedback

Summary

8. Connect Wisely

Feeling lonely

Belonging to medicine

Asking for help

Summary

9. Sustain Balance

32 skills doctors can practise to help them thrive

10. Epilogue

References

Further Reading

Resources

About the Author

Connect with me

Thriving:  adjective

Prosperous and growing;  flourishing (Oxford)

Someone or something that is doing well

and is successful, healthy, or strong (Collins)

Introduction

The experienced medical director sitting opposite me in coaching said:

"You were the first person to ever ask me: – what do you want?"

He went on to describe the profound impact this simple question had had on him. These four words had given him permission to discover, to imagine, to believe that he could meet some of his own needs once he knew what they were.

These four words had freed him from the straight jacket the culture of medicine had bound him in for 25 years and ultimately allowed him to practise medicine with renewed energy and focus. He felt happier, stronger, and was enjoying his family and his work more than he had for two decades.

i0001-1.jpg

Patients will benefit too

I understand that in your role as doctor you are committed to patient safety and patient health. You are possibly only interested in reading books that impact positively on patient care. On this front the research is very clear. Well doctors are better doctors, and they help their patients achieve better health outcomes.

The Institute of Medicine described the primary determinants of healthcare quality in 2001; one of which was patient-centred care. They described this as Healthcare that establishes a partnership among practitioners, patients and their families. Further to this, they concluded that patient-centred care is nothing less than a Quality and business imperative, and that "In general, most patients feel confident that they will receive competent technical care when they enter a hospital or healthcare centre. Beyond that, What matters most to them is being treated with kindness, compassion and dignity".

A doctor who builds positive relationships with their patients is perceived by them as more empathic and more compassionate. These patients continue with their treatment more consistently and for longer duration. Not surprisingly they have better health outcomes including faster recovery rates and better immune response.

The healing power of positive interactions has been well documented, and often forgotten in the measurement of success in healthcare. For example, Rakel et al (2009 and 2011) compared recovery time and immune responses of three groups of patients with upper respiratory tract infections. Immune response was most vigorous and recovery time shortest in patients with empathic physicians. Recovery time was longest for the group with doctors who lacked empathy – longer than those who saw no doctor at all! Rakel and team concluded that empathy in the therapeutic encounter resulted in faster recovery times for flu patients.

The science of medicine is data-driven, humans may not be. Doctors are humans first; emotional beings like their patients, being asked to ignore the art of medicine to their own and their patients’ detriment.

Raising your capacity to care for yourself improves patient health outcomes, patient experience and patient safety.

As you prioritise taking better care of yourself, you have greater capacity to be empathic, compassionate and patient centred. As you raise the care of your patients by being well yourself and raising your skills, you can build confidence, trust and respect in yourself, and others too will have more confidence, trust and respect in you.

Your state of health and wellbeing must come first. All other healthcare goals ride on this. Only when you have the skills to take care of yourself effectively can you truly take care of anyone else properly.

You can make a difference in your own medical life

There is a great deal every individual doctor can do to improve their own experience at work in the healthcare system and in medicine – for both themselves and their patients. To do so you need to engage your own agency, the same agency you used to get into medicine in the first place.

Personal agency is a sense of control over your own actions and the consequences.

When you