Things I wish we told #residents and #fellows before they start practice:

- Your first year as an attending is the steepest learning curve of your career. Your inner #impostor will be very loud. This is normal. Surround yourself with great mentors, pace yourself, and learn. - There is no “right” way to practice medicine. This is YOUR life. You have mostly seen the narrow career path to academics but 80% of docs work outside of the ivory towers. We are really smart too.

One year sober today.

I always said that work was my drug. As it turns out, alcohol was too. I am from a multigenerational family of alcoholics, and I never wanted to struggle with alcohol use disorder. Instead, I discovered that I could avoid feelings of discomfort by overworking, achieving, and staying perpetually busy. Workaholism became my drug of choice.

Coaching works. Sometimes it can be hard to quantify but here we have empirical data. A thread: 🧵👇🏼 A recent article in JAMA reports that in a randomized trial with 100 female residents. Control group got no coaching. The other group got live coaching via Zoom and written coaching weekly for 6 months.
The findings:

How do you know when you’ve worked “enough?”

I’m not talking about the end of a shift or maxing work hours.

For anyone who is eternally striving for “work-life” balance but never finds it - because work continues to compress your life - this is for you.

A thread 🧵: When I ask the question “How do you know you’ve worked enough?the answers are typically:

- when I’m exhausted
- when I can’t think any more
- when my family complains
- when I literally can’t do another thing
- when I fall asleep

Why is suffering our metric of “enough?”

Brief history of #BMI and why its broad use is inappropriate and discriminatory.

a thread 🧵 Aldolphe Quetelet, a Danish astronomer, developed the BMI in the 1830's using a cohort of French and Scottish men.

Typical of the time, these participants were lean, active, white males with unstable food supply.

academic.oup.com/ndt/article/23…

Leaving my primary care practice:
a thread 🧵 In March 2020, my practice of 13 years closed to protect our patients and staff. Thanks to the #telemedicine platforms I put in place a year prior, we overnight converted our 70+ provider practice to telemedicine for the next 2.5 months.

“I’m so burned out. I can’t do this anymore.”

This is one of the most common issues I address with my #physicancoaching clients.

We avoid #burnout and increase/maintain our #resilience when our basic needs are met.

Let’s start with the basics.

A thread 🧵: Physician burnout is largely due to organizational culture and operations.

Personal resilience plays a smaller role.

wellmd.stanford.edu/about/model-ex…