The hard but necessary inner work

The past few years have felt like a drastic, yet long-coming evolution of how I show up in the world. I can confidently say that I feel more authentic and honest than any other point in my life. I think it is no coincidence that I also feel more ease, joy, confidence, and connection than ever before, too. 

For a long time I have had a hunch that in order to radiate outward - show up with compassion, care, support, and purpose - I had to start with the inner work. I will admit that this work at many times has felt selfish, self-absorbed, silly, even a waste of time. But a core part of me didn’t let those doubts totally derail the train. A part of me knew that my search for self-understanding was rooted in some important truth. 

I recognize this may feel abstract and in the clouds, and sometimes it feels that way to me, too. There are things in life that we only understand and learn through direct experience. And I largely think that is true with the work it takes to feel more authentic and whole in your life. Luckily, there are key concepts and practices that can bring the experience alive and help you on the journey.

As a coach, my main objective is to support and partner with folks like you to grow in self-understanding and develop or evolve your capacity to trust in yourself, what you want, and how you want to get there. Yes, coaches have techniques and processes to help the work move forward, but I find many physicians are good at making goals, getting things done. Often the harder work is figuring out what you really want, and what's actually most important to you. I know this has been true in my own life, as well. 

An anchor for this work of self understanding has been connecting with my values. Interestingly, I no longer like to start this process by inviting people to look at a list of values and identify which resonate with them. I find that this method can be overwhelming and confusing - how do we narrow when there are so many ‘good’ values?!? I also find that relying only on our logical processes (making lists, trimming them down) limits our ability to really connect to what's most important to us.  

Considering this, I’ve created a Values Reflection guide that I’d like to share with all of you. I hope using this process opens up more curiosity and possibility within you. I suspect it will allow you to connect to parts of yourself that don’t always get as much air time. And mostly, I hope this is a tool in supporting you in living in an authentic and meaningful way.

On Rest

On rest

“You were not just born to center your entire existence on work and labor. You were born to heal, to grow, to be of service to yourself and community, to practice, to experiment, to create, to have space, to dream, and to connect.”

― Tricia Hersey, Rest Is Resistance: A Manifesto

I don’t know if it is serendipity or a slow subconscious pull that has me simultaneously reading two books on rest over the past few months.. After writing my last blog post and getting deeper into Tricia Hersey’s book on rest, I see a resonance that feels like a small tug of the universe saying, ‘see, I told you’. To briefly explain my interpretation of her words, which is no doubt imperfect and seen through my lens as a white woman in America -“ it is a beautiful and convincing plea that rest is about more than our physical bodies. It is an act of preserving the soul.” 

In her book, Tricia lists many types of rest, some active, some passive. The central theme is that all types of rest get us out of the money making and spending loop, the hustle and performance. Rest in the broad sense can open up the freedom for us to be ourselves and with ourselves in both mind and body. Rest allows for creativity, dreaming, and joy. Her words resonate for me in large part because this is what I have experienced, too.

About 7 years ago, when I was deeply burned out (though I was not fully aware of it), I happened to sign up for an introductory meditation course with my best friend. Some people cringe or laugh when stories start this way, but whatever your internal reaction, it is my truth. That class was the beginning of a new life for me. That is no exaggeration. I have been practicing meditation and other contemplative practices ever since, in large part because they have allowed me to rest. When I sit down to meditate, I can see the busy and anxious thoughts in my mind, my to-do list, and not react. Many of us think that the faster we go, the more we get crossed off our list, the better we feel. That has not been my experience. Slowing down, recognizing that many of those to-dos are not life or death, that has been my new power. A space to choose where to spend my time. A space to let some balls drop. This skill and practice has flowed over into my life, to the point that I have more choice in where I pay attention, and the quality of attention I bring to each moment.

But lately, I’ve been trying to explore the other parts of rest that she discusses. Daydreaming. I loved this as a kid. And I’m learning to see daydreaming as a way of understanding what I want in life. It opens up an energy of possibility and gets me out of what can sometimes feel like the stuckness of right now. It can be a place of inspiration and hope. Two things the world needs.

It's important for me to not overlook the deep premise of Tricias message, even though it may not land comfortably for everyone. Much of her writing describes how rest resists the violence that can come with capitalism. I can’t say I know enough about capitalism or its alternatives to write about it intelligently here. But what I observe that we have and continue to extract and destroy nature, take land and resources away from people who are not in power, and use these steps to grow wealth for certain people. And I have always known that that doesn’t seem like the way I want to be in the world. For over ten years I have worried about how my role as a consumer indirectly causes harm to humans, animals and the planet. It's an ongoing struggle in this world that is riddled with injustice and inhumane practices that are normalized. But her book reminds me that that dream, to not have to buy clothes or food that directly harms someone else, is not lost. It may be difficult, or even impossible, to do perfectly. But it doesn’t make it futile and it doesn’t make me wrong for trying. 

In healthcare, we have created a system that doesn’t always take great care of patients, and sometimes makes healthcare workers sick, burned out, etc. We know that physicians who cut back to part time and take their vacation decrease their likelihood of burnout. I also know physicians who love their work, they don’t want to do less of what they love, but maybe they can do less of what they don’t love and have time for rest, too. And while many things contribute to clinician burnout and other types of ill-being, I think one of the major problems is that our system doesn’t value rest. 

Yes, sleep and sleep schedules are clearly a challenge when taking care of sick folks. Someone has to be up at night. But beyond the circadian clock, our current system makes rest so hard. Once again, this is not about just physical rest, but also the rest of getting to think quietly about a problem, be present with patients, be present with our own emotions related to this important and challenging work. A quiet moment to reflect on what we appreciate, the impact we can have for our patients, the ways they have touched our hearts. These are all types of rest.

Something I really appreciate in Tricia’s book is that she advocates for folks to rest now. Not waiting for systems or institutions to change. Starting small. Looking out the window for 5 minutes. Closing your eyes in a brief meditation. A couple minutes of daydreaming. A brief nap after work. Sipping warm tea. A break from social media. These sound trite when we write them down, but I, like Tricia, think they can be powerful.

And yet, how many of us have or make time for this in our days at work? One could argue that there isn’t time for these things. I don't doubt that there are people whose practices and workflows make it feel impossible to slow down. AND. As I’ve been exploring rest and space for the past few years, I have found that often there is more space and time than I see on first glance. More than I let myself do. It requires setting down my phone, and closing my computer. It requires knowing which balls are safe to drop. For me, sometimes it also means just being alone for a few minutes. Getting some quiet. Not being productive. 

Our bodies and minds are not machines and they are not meant to be going all the time. I worry that the pace and cadence that we have normalized within medicine is in itself harmful to our mental and physical well-being. I also know that some are so used to it, slowing down literally hurts. I’ve been there, too. When I first started meditating, at times it was excruciating. I would think of something undone and would have to literally hold my body back from getting up to do it. It felt like something inside me would explode. The energy and normative habit of doing, doing, doing was a strong physical and psychological pull. It was like I had no choice. I still feel that way sometimes.

I sense this is what some of my friends and colleagues feel when they say they don’t like relaxing or don’t know what to do with downtime. I’m not in their bodies so I can’t know for sure. But I think its possible that when we’ve been conditioned to go, go, go, it can feel extremely uncomfortable to do something different. I say all this, because I know that rest doesn’t feel good to everyone. And maybe we are wired differently. Or, maybe we are conditioned to feel bad when we rest. If that is the case, then perhaps a part of our work is to rest, despite the discomfort. Learn how to rest. And see if it offers something we have lost or are missing.

In considering and writing all of this, it feels important and in my integrity to get serious about ways that I can intentionally lean more into rest, imagination, and creativity. Taking a page out of Tricia’s book, I’m taking a social media sabbatical. I’m not sure how long, probably a few months. I realize that social media is a way to connect my work with those looking for coaching or well-being resources, but I also am aware that time on social media interferes with other priorities in my life. So we will see how it goes and what comes of it. I’d love to connect in other spaces - my website, via email, or through my group or 1:1 offerings. 

Wishing you a moment of rest, 

Sarah

On escape

I recently returned from a beautiful and therapeutic trip to Puerto Rico with my husband. This was our first long trip without kids in about 10 years. And while there are many wonderful things to say about the opportunity to be in sunshine and warmth, experience the sea and beaches, and enjoy the privilege of having food prepared and served to you, the thing that has carried with me most strongly is the relationship between escape and my deep urge for space and ease. 

Let's start with the latter, my deep desire for space and ease. I, like many people in medicine and larger society, have been conditioned to obtain much of my worth from my work, output, productivity, status, titles, and accomplishments. It feels a little embarrassing to admit that outloud; it doesn’t sound humble or altruistic. But it's true, and I know I’m not alone. And I know that it would be a mistake to over-simplify these truths and conclude that these motivations are antithetical to humility or altruism. I went into medicine to serve others, to make a difference, to heal. I love caring for my patients through difficult moments. But I also know that in the process of getting there (here), I became conditioned to work for the approval of others, to seek advancement for the sake of advancement, to hustle, to prove I am worthy. 

However, over the last several years, as I have crept my way out of burnout, exhaustion, insecurity, etc, I have found that a part of me deeply desires something that medicine left out: space and ease. Practically, for me this means time for unrushed walks, looking around my yard at the first signs of spring, imagining and thinking, moving my body, being present rather than always thinking about the next thing. Implementing this, committing to this, has been a hard and difficult practice full of false starts and steps backward.

Enter, vacation. Most people probably see vacation as a place for ease and space. Those people don’t have children. I kid, but really, most of my time off in the past 10 years has been with my wonderful, yet developmentally appropriately loud and busy children. I love them. And also, I have not necessarily seen vacation as a place for space or ease, which is why some people call traveling with kids a trip. 

My husband really wanted us to spend some of our vacation on the island of Vieques. I was hesitant, as it took extra effort to get there. I knew I wanted ease on this trip. An escape. We went to Vieques, and it was, in fact, extra effort to get there. But wow, it was beautiful, with beaches unaltered by development. Warm sand and sunshine. As the days went on, I felt a growing ease. That tightness that can settle in my chest on a regular work day was gone, and I wasn’t thinking about all the things that were left un-done at home. It didn't matter what my title was or what accomplishment I had made the week before. I was present, at ease. 

During this awareness, I read an article on Substack by Kristin Powers. She was describing a recent choice to move to a rural area of Italy. I want to start by saying that I have no judgment about her choice, and in fact many of the challenges that led to her decision resonated with me. While the reasons for her move are many and likely surpass what she shared, the article centered around her feeling fed up with the general sense of rush, hurry, workplace culture, consumerism, and lack of social safety net.

In many ways, she was listing the same things I’ve been trying to escape over the past few years in big and small ways. The things I escaped while on vacation. The conditioning of culture and medicine that orients my attention toward my productivity and output. My to-do’s. How I measure up to others. Whether I’m doing enough. On vacation, I felt the tight pressure of those expectations literally leave my body and mind, and experienced the ease and presence I yearn for at home.

But, her own personal choice to somewhat permanently employ the escape hatch left me with many questions and feelings. When we escape, what happens to the people who can’t? Is it ok to utilize our privilege to escape to maintain our own well-being? Physicians considering leaving medicine probably ask these questions, too. These questions are important, and are worthy of deep contemplation, but the question that has stuck with me most is this: Can I, can we, experience ease, space, and presence in the midst of this culture? Do we have the capacity to create spaces and habits where we can slow down, to feel emotion, to connect, to dream, and be creative amidst our American  lives, AND while working in medicine?

I know that I dream the answer is yes. I choose to believe it is yes. I’ve seen it show up as a yes in my own life. This yes is what motivates me to keep making space. To listen to my need for quiet walks. To create spaces for others to self-reflect, dig deep and dream. My hope is that rather than escape entirely, we can see that but rather that moments or weeks of escape remind us what is possible. Remind us of the parts of us that are not valued explicitly in the current cultural norms. Because in that space, we can imagine creating something different, and imagine a world, or a healthcare system where we don’t need to escape.

As an ending note, I 100% advocate for taking your vacation time!

Coaching 101

If you were to ask your colleagues what coaching is, and what it is helpful for, what would they say? As I’ve navigated conversations about the application of coaching within medicine, there have been some common questions and threads that come up. Whether we are talking about developing coaching as institutional approach or resource, or individuals who are seeking out coaching for themselves themselves, there are a few topics that I see as foundational. Read on to see my take on coaching 101; or if you don’t have time, skip ahead to the summary at the end.

What is coaching?

The truth is that there is no universal definition of professional coaching. In my experience, I have seen many applications of coaching within medicine and academia. I’ve seen growth of using a coach-approach to giving feedback and educating. There is performance coaching, which is more similar to a sports coach who gives advice and expertise. Even across coaching styles, there are different niches for coaching, like leadership or transitions coaching.

Many physician coaches are trained to practice in alignment with the International Coaching Federation (ICF) standards. In this model, coaching is a partnership between a skilled professional (coach) and client. The client is assumed to be whole, capable and resourceful. The coach’s priority is to honor the client’s direction and agenda for coaching, and to avoid giving advice. Coaches can use frameworks and topics to help unpack stuck points and challenges, but for the use of providing new insights and awareness, not to dictate next steps. Coaches are excellent listeners who can help clients better understand themselves, uncover things that are getting in the way of progress, identify next steps, and support accountability. 

Why coaching?

There are a plethora of reasons physicians and APPs come to coaching. For me, my first experience with coaching was unplanned. I was in a women’s leadership program through the American Academy of Pediatrics. During the program launch, we spent the first two days with a coach who worked with us in a group setting. This experience, though short and in a group, was life altering. I discovered that I held a limiting belief that I couldn’t be the mother I wanted and find meaning and contribution in my career. I realized that this was not necessarily true, only that I did not have clear examples of this, yet. Instead, I claimed a new belief - that with perseverance and creativity, I could chart my own path to show up with my kids in the way that I wanted, and contribute my skills and energy toward a meaningful purpose outside my home. (If this sounds like I’m saying I’ve figured out how to ‘have it all’ hold that thought, we can explore it a different day. ) This new belief and awareness has been a continual place of growth for me in the years since.

The point is that when you talk to folks who have been coached, very often they have found personal growth, new perspectives, and awareness about themselves. The impacts can be both immediate and unfold over time. Physicians who have been coached often develop new perspectives on problems or a new energy toward their work. Sometimes coaching uncovers transitions or hard choices that need to be made, and other times it validates chosen paths and supports new discoveries for deepening into what is important. Coaching can help us become aware of self-limiting beliefs and ways we are getting in our own way. It can also clarify why certain environments or roles are creating conflict, and support clarity in how to move forward.

Coaching is still new within the medical community and research is ongoing. However, the studies to date clearly show that coaching works, particularly in navigating the current crisis of physician well-being. Across 6 studies, including one randomized control trial, coaching was found to improve a number of well-being outcomes, including burnout, engagement, job satisfaction, self-compassion, and professional fulfillment. All studies included professionally trained coaches. Importantly, the duration and frequency of coaching varied across studies, suggesting that even small doses are impactful. What's even more interesting, is that in the randomized control trial, while the coaching cohort improved in fulfillment and burnout, the control group actually worsened. We know that the systems within healthcare must change to reduce burnout and moral injury, and coaching is a supportive tool that can support clinicians while we work toward better systems.

How do I choose a coach?

The last important piece of coaching 101 is choosing a coach. In some ways this process is similar to how we think about choosing a residency program. Look at the details for what different coaches offer, consider your needs, and specific areas you want coaching around. After gathering the details, get a sense of the person and in the end, listen to your gut. Coaching is an important, trusting, and vulnerable relationship. It's critical to have someone you connect with, feel seen and heard by. Most coaches offer complimentary introductory calls to help you get to know each other and understand fit. Don’t be afraid to try a few calls to get a feel for different coaches. If that feels like too much time, ask for names from friends and colleagues who have been coached AND who you trust and resonate with.

Do you need a health professional or physician coach? This is highly personal and people have different opinions. One benefit of having peer (similar professional role) coaches, is that someone who practices medicine may ‘get you’ in a way that coaches from other backgrounds may not. That said, there are amazing coaches from all backgrounds!

Too long, Didn’t read summary:

Coaching works to improve a variety of well-being measures

Coaching may prevent worsening well-being

Coaching can be done in small and big doses, in 1:1 and group settings

Find a coach that feels right to you

Harnessing the power of the new year

When I was younger, I never bought into new year resolutions. The way I saw it, any day was the perfect day to do something that was important to me.

I still think this is true, but only part of the story. In fact, through my personal journey from burnout and lack of fulfillment, the days before and after New Years Day have become powerful and important to me. They are possibly some of my favorite days of the year. In reflecting on my personal journey and experience as a coach, I want to offer ideas to those looking for a way to make meaning of this week and yearly time of transition. 

Start with reflection

In general, I see the new year as a time for reflection. In the early years of doing this, I focused on reflecting on my values. That was it, I just intended to explore and better understand my values. As surprising as it may seem, many people have only a superficial understanding of their values, unless they have done intentional work to explore them. This was the case for me. It took probably 3-4 years of coming back to this exercise of identifying my values until I felt I had arrived at a place where they were fairly clear and consistent. 

Now, I start my yearly reflection by looking at my values, seeing if there is any refinement needed after the past year, or whether I feel compelled to further explore my definition of each value and how aligned my actions are with these values. 

Next, I reflect on the past year. What have I learned about myself? What has gone well? What has been a challenge? For me, this includes my inner experiences, my home and professional life and how I see myself within the broader context of the world. 

Setting intentions

Finally, I spend a few days noticing what ideas come up as I reflect on my values and the last year. What do I desire more of in my life? What do I want less of? Notice that I do this over several days, maybe even a week. This is to avoid reactions - being pulled toward something because I feel inadequate, have fear, or want to impress someone. 

When I feel like I’ve arrived at an intention from an authentic place, I write down a few intentions. They can be broad, they can be specific. The point here is definitely not perfection, but thoughtfulness, earnestness, and self-compassion. Sometimes my intentions are questions - “what would it be like to live more in my value of authenticity?”

Regardless of the intention I set, I learn about myself, and that's the true beauty of this reflection-intention cycle. For example, one year I decided to create specific aims that would ‘achieve’ my intention. I planned to go plant based, not drink alcohol, and get up at 5 every morning to meditate. You can imagine how that went. I quickly recognized that I was still very plugged into the mindset of striving and trying to be ‘better’, and by February I had set a more realistic intention - to practice and learn more about self-compassion. 

This year, in reflecting on my values, I want to continue the intention of practicing an abundance mindset. I’m also feeling a call to more authenticity within my professional life. For this, I’m focusing more on a question - what would it look like to be authentic and true to myself in every area of my life, including my professional one? 

TLDR (Too long didn’t read)

• The new year offers an opportunity to set intentions for your life

• Reflecting on your values; what they are and how you are/are not aligned with them is a beautiful place to start

• Intentions do not have to be set on January 1st to be valuable, allow yourself to contemplate for days-weeks 

• Setting the intention is the beginning, and the journey from that place is where the true learning and growth happens

Helpful resources

• Values exercise by Brene Brown

• Living the questions - On Being

Intention stems:

1. This year I aim to bring more ______ into my life

2. Connect to a singular theme: e.g. courage or simplicity

3. I will practice ________. 

4. I aim to cultivate _________.

5. I will explore _________. 

6. What would it look like to be aligned with my value of ________?