Let me tell you a story from my early doctor days to bring to life the mind body interactions that can occur when our inner mindsets, beliefs and assumptions, face circumstances that activate our ancestral stress-response survival systems. When I was a chief resident, I was given the opportunity for the first time to present and discuss a case at Medical Grand Rounds.

“I stood on the stage behind the podium prepared to start my slide presentation. A part of me felt prepared to present. I knew my stuff. I wanted to do a good job. Another part of me was filled with dread. I felt tightness in my throat. I looked out at all of the doctors and students. As the lights dimmed, I began to see flashes in my eyes. Sweat drenched my body, the room swirled around me, and everything went black. I passed out. I regained consciousness on the floor. The doctors were slowly departing the auditorium. Nobody came up to the stage to help me. Perhaps, like me, they were horrified by what they were seeing. Perhaps they saw in me their younger, less- assured selves. Why did no one come up to help or later explore what occurred? Silence followed as did my shame. At that time of my training, the concept of support or compassion for each other was non-existent. Amazingly, we all had these skills for our patients and family.”

“As I reflected on this situation, I realized that an inner, younger part of me felt highly insecure. This younger part of me was not sure that I had a perfect understanding of what I was presenting and wrestled with believing that I belonged in that space. She felt like an impostor—not an unusual inner experience for young doctors and other professionals. When I went up on the stage, I was unaware that this emotional drama was taking place in my mind; deep inside, a part of me felt like I wasn’t enough to do this presentation. Being unaware, all I sensed was that I was physically unwell and then found myself on the floor”. 

My story is an example of many things having to do with our beliefs and mindsets as physicians. We are high achievers, we want to do a good job and please our patients. We want to meet expectations and never disappoint residency directors, teachers, colleagues and parents. This is particularly important if one is a woman, an immigrant like me, or are seen as the “other.” From medical school to residency training we have been conditioned to care for others’ needs above our own, to be reliable, strong and never be vulnerable or get support or speak about what we really feel or need. We may slowly forget that we are human. Many of us, like me in this story, have a lot of inner emotions, insecurities, past traumas and fears that we are unaware of, thus we cannot even verbalize them. Sometimes awareness of these emotions can be perceived by us as weakness leading to self-criticism and shame. We don’t know how, we forget or are ashamed to seek support. While psychiatric and psychological support has been theoretically available, we may face negative professional consequences if we seek such help.

My story is an example of the power of the mind body connection. My inner emotions (fear of failure and perfectionism, and impostor syndrome) and beliefs (I am not ready, I’m not good enough, my presentation is not perfect, I don’t belong here, I’ll be judged) lead to a strong physical reaction from the autonomic nervous system. These inner unconscious beliefs impacted my actual physiology and reduced my blood pressure enough that I literally checked out by passing out.  Further, my inability to present the case, served to confirm the inner belief that I was not a good enough or capable enough doctor. This affected how I showed up for a long time. Fortunately, I’ve come a long way since then. Now, I love making and offering presentations and see them as opportunities to serve others by sharing valuable information to my younger or older colleagues.

The realization that emotions and stress could have such devastating effects on physiology, psychology, behavior, hormonal balance, and health has captivated my curiosity to this day. I am now an integrative endocrinologist, a board certified specialist that uses skills that enhance mind body spirit interactions to promote homeostasis, hormonal balance and wellbeing. Separately, the lack of support and compassion that I faced in parts of my training, and the complicit inactions of my colleagues led me to recognize with time that we were victims in a system and that I needed to become an agent of change to bring humanity back to medicine and medical training. 

As an antidote, more than 2 decades ago I became involved in supporting medical students and young doctors by participating for years as facilitating faculty at Yale University Medical School’s elective course The Healer’s Art. This program was developed by Dr. Rachel Naomi Remens, to help medical students remember that which they value and wish not to forget in the process of training, to recognize that our humanity and presence matters, and that our work is a service that gives dignity and meaning to our lives. In addition, the course teaches medical students how to talk and be with death with equanimity. Something I wished I had learned before my internship and residency. Many students say this is an antidote for burnout. 

From medical school to the end of residency training we will face our inner judgements and those of others.  How we manage these interactions within and without will shape our experience and perspective as physicians.  The more we understand the impact of our beliefs and of our interactions with others the more able we are to sustain equilibrium within ourselves to support wellbeing when we are triggered or surprised by the unexpected. We can aim to have psychological homeostasis by learning to develop resilience and antifragility. This is accomplished by being attuned to our humanity, normalizing the commonality of our emotional and psychological experience. It is then that, using curiosity and compassion, we connect to our wholeness and empower ourselves to have courage and more agency over our responses to stress, ourselves and our colleagues. This is a path to create positive and healthier outcomes in our personal and professional relationships. 

We can help ourselves. We can develop skills to deal more effectively with our emotions and reactions to how others treat us. Recognizing and normalizing the fact we all experience suffering and joy and that we doctors have a unique and large share of these. We can learn to interpret everyday stress and crises more favorably by lifting the burden of self judgment and perfectionism behind. This is done by learning the skill of self-compassion practices. Our patients will live and die despite our best intentions. We can make an effort to connect to like-minded colleagues and counteract the loneliness and trauma that sometimes embraces us. We can learn to calm our nervous system by knowing how to increase the activity of the vagus nerve—just Breathe. We can create peace in the midst of chaos by focusing on the moment as it is without judging, thereby enhancing our decision making capacities. 

We can help each other.  How can we be sensitive to our colleagues who suffer in shame, isolation, loneliness? While many medical organizations are beginning to create policies to address the anxiety, depression burnout and suicide in physicians, I believe that change truly happens when each one of us intends to be an agent of wellbeing for each other. One option is to just listen to each other without trying to fix. Say I am here if you need me. We can accept that we are all very capable but frankly we are perfectly imperfect. We can create a culture of inclusivity of each other. We can be intent to develop empathy and compassion for each other. We can support and resource each other. We can create weekly resident only discussions about the felt human experience of being a physician in training or beyond. We can individually or as a group have courage to be generative and to not be complicitly silent when we observe failure, fear, suffering and the disregard or abuse of our colleagues. 

We can counteract the ever-present impact and negative effects of stress, trauma and suffering, during medical training and beyond, by nurturing our integrity and shared humanity. With new awareness, we can cultivate a new culture of physicians. We can manifest our desires for our wellbeing by revising old, disempowered interpretations of common emotions into new and empowered meanings.

In this article I have included sections in quotations. They are excerpts from my book Mind Body Secrets: A Medical Doctor’s Spiritual and Scientific Guide to Wellbeing.