• Rob Orman

27. Gail Gazelle on Imposter Syndrome, Either/Or Thinking & a Daily Dose of Goodness

When things are going well, you may not notice how your mind is working. But sometimes, you are overtaken by events and it can feel like the gears are grinding in the worst possible way in both life and work. In this episode, physician coach Gail Gazelle, MD, walks us through the mental processes that happen in those gear grinding moments and how to not only work through them, but also come out the other side with resilience and a better understanding of ourselves.

Guest Bio: Gail Gazelle, MD, MCC is a former hospice physician, part-time Harvard Medical School Assistant Professor, and Master Certified Coach for physicians. One of the leading pioneers in physician coaching, Dr. Gazelle has coached over 500 physicians and physician leaders on leadership development, mindfulness, emotional intelligence, resilience, and moving from burnout to balance. She is the author of Everyday Resilience. A Practical Guide to Build Inner Strength and Weather Life’s Challenges, (Free chapter here).

You can contact Gail through her website and, if so inclined, schedule a complimentary coaching consultation.

Today’s episode is sponsored by Wild Health. More on that below.

Episode Sponsor: Wild Health provides personalized medicine that takes into account DNA, biometrics, microbiome, and lifestyle factors to come up with your ideal diet, supplements, and lifestyle to optimize health and maximize healthspan. They also have a fellowship program to teach physicians, providers, and health coaches how to practice this new paradigm of medicine.

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Listen on:

We discuss:

The fundamentals of mindfulness [02:55];

  • Mindfulness is a practice of being aware of what's going on with your mind and grounding yourself to the present moment.

  • For many, focusing on your breath can be a simple way of returning the wandering mind to the present.

What burnout looked like for Dr. Gazelle before she embarked on a new career path as a physician coach [05:45];

  • Gail lost her sense of purpose. She found herself dragging from one interaction to the next, not fully present. She was exhausted, lost, numb, disconnected, and unengaged.

  • She understood why people call burnout “the erosion of the soul”.

The impact COVID-19 has had on her conversations with physician clients [07:15];

  • Pre-COVID, physicians were already feeling pushed to their limit by case loads, EMR, and productivity concerns.

  • When COVID came along, the added stress of the uncertainties, change, and fears was simply overwhelming for the majority.

  • For many physicians not employed in the ED or ICU, there was a sense of guilt. They were being called heroes, yet didn’t feel their skillset warranted the label.

  • COVID brought a heightened sense of inadequacy. Many felt they were imposters for not working on the front lines.

We can get into that pattern of doubting ourselves. And when we're in burnout, we just can't see the good that we're doing...We lose sight of our accomplishments.”

The response of front-line providers when referred to as a “hero” [10:10];

  • Many find it an unhelpful term, because it’s hard to live up to this label. It carries some weight.

  • Also, healthcare providers are professionals, and heroism has nothing to do with it.

What it’s been like for physicians, trained to be the captain of the ship, when put in the position of managing COVID patients with little guidance from science [12:40];

  • In the beginning of the pandemic, physician concerns were focused on the lack of PPE and protection. There was a sense of frustration, with providers wondering “are we really in this together”?

  • Physicians tend to want to be in control. How do they proceed when they don’t have an answer and aren’t sure what to do next? This uncertainty can have an erosive effect.

  • Gazelle tries to show her physician clients what real success is: to care, show up, do your best. That’s what really fuels people, as opposed to focusing on the things you cannot do.

  • Now, many doctors are facing unemployment, prolonged furloughs, pay cuts. The insecurity and uncertainty about what the future might hold is tremendous.

How Gazelle helps physicians manage uncertainty and weather difficulty [17:30];

  • She validates how difficult things are.

  • She helps them differentiate between the things that they can and cannot control. The goal is to mobilize and direct their energy towards the things they can control and minimize the dissipation of energy towards the things they can’t.

  • She teaches them the importance of “filling their tank” and learning what they need to sustain themselves.

“What's one small thing you can do to fuel yourself? You must give yourself that daily dose of goodness, because you can't run this marathon if you don't fill the tank.”

Tips for ensuring that the “daily dose of goodness” becomes a defined habit [21:30];

  • Make it a routine.

  • Understand that the small act of self care will have a huge benefit and impact on your quality of life (delivering fulfillment, pride, feeding your soul, helping you feel grounded).

  • Start with the end in mind. “You must know what it is that you want in order to begin to get to it.”

How accepting what is/isn’t in your control can help mitigate stress, frustration, and anger [29:50];

  • Understanding what is beyond your control can help you assert yourself in your environment.

  • “There's a wisdom that we can gain when we can look at things with that kind of clarity. And one of those lenses is that lens of, wow, what is beyond my control here?”

“What I'm always doing as a physician coach is trying to help clients get that clarity about where they can mobilize and where they can be most effective.”

Different ways of handling a bad leader [33:00];

  • Too often, we just put up with a bad leader, enduring frustration and accepting the misery they’re causing.

  • Reframing the situation, understanding this person’s challenges but doing your best to help them improve, might lead to a deep sense of empowerment.

The importance of regulating your emotional temperature [38:00];

  • Physicians are often very good at controlling their emotional temperature when talking with patients, but run into problems when dealing with administrators or other interpersonal conflicts.

  • Physicians have a sentiment that they're not being respected or heard. They feel that nobody sees how hard they’re working.

“What are you taking personally here that actually isn't personal to you? It's another game changer question, because we all walk around taking everything personally.”

The problem with either/or thinking [42:00];

  • Physicians seeking help for burnout tend to fixate on how everything in their professional life is horrible.

  • They believe that things are EITHER miserable OR fine, failing to realize that so much of life is both.

  • If we think of life’s events as a mixture of good and bad, that helps us connect with the good things that are happening, which then continues to create those upward spirals of growth and meaning and purpose.

“Either/or thinking leaves us very vulnerable to burnout. It takes us away from our natural resilience of being able to ride the waves of the vicissitudes of our life, relationships, and careers. We need to be able to ride these waves in order to get through a career in medicine.”

The STOP tool for applying mindfulness practice in the heat of an intense moment [45:50];

  • The most important tool is a purposeful pause.

  • Gazelle recommends the STOP protocol: S (stop and take a little time out), T (take 3 slow, deep breaths), O (observe yourself from the lens of compassion), P (plan and praise yourself).

Anticipatory dread and catastrophic thinking in medicine [49:40];

  • Anticipatory dread is common in all fields of medicine. It’s costly, given the number of hours one can be absorbed in the painful, gut-wrenching sensation of dread, anticipating the worst.

  • It is a mind state that is workable with proper tools.

  • Gazelle coaches her clients to avoid succumbing to it by acknowledging the dread and reassuring themselves. “There goes my mind again, going into worry, fear and dread. That’s what my mind does. But I’m going to be OK. I’m going to get through this, just as I have a lot of other difficulties.”

“The mind creates all these narratives, and they have so much power over us. Dread is about a narrative. ‘This is going to be bad. I know it.’ Maybe it is going to be bad, but maybe it isn't. Or maybe it's going to be somewhere in between.”

The crossroads of imposter syndrome and perfectionism which makes for a cycle of perceived inadequacy [55:30];

  • Most of us are walking around feeling like imposters, hyper-focused on what we perceive we ARE NOT doing well. We are equally hyper-focused on what we perceive others ARE doing well,

  • We spend a lot of time comparing ourselves, and that fuels imposter syndrome.

  • The good news is that the imposter syndrome is simply a thought process, and it's actually not based on reality. Once you get that, you can laugh and question why you’re devoting so much energy to it.

“Perfection is an unattainable standard. It leaves us so dissatisfied with ourselves.”

An affirmation Gazelle created for her clients who struggle with perfectionism: “I am good. I do my best. I cannot control all the rest.” [59:40];

And more.

Shownotes by Melissa Orman, MD

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