169. Feeling Stressed is Optional: Redefining Burnout, Identity & Purpose | Robyn Tiger, MD

Welcome to Medicine Redefined, a podcast focusing on helping you reclaim ownership of your health. I'm Dr. Darsha, and I'm Dr. Ultima Shraja, where your hosts, hair to challenge conventional practices and uncover the stories behind pioneers shaping the future of medicine. Our conversations not only focus on the individual level to dissect common practices for health optimization, but also zoom out to enhance systemic change. Join us as we look to break the status quo, move the needle forward, and put the help back in healthcare. We are absolutely thrilled to have Dr. Robin Tiger join us again for a follow-up conversation about practical science-backed ways to manage stress, cultivate self-awareness, and thrive in and out of clinical medicine. In her first appearance on our podcast, we have to go all the way back to episode 51. Dr. Tiger shared her personal story of burnout and the breakthrough realizations that led her to develop a comprehensive stress management approach rooted in lifestyle medicine. This time, she dives even deeper, expanding how to let go of limiting labels, protect her own mental well-being, and rediscover the why behind your work. So in this episode, we're going to discuss labels and identities, why identifying solely as a doctor, or a mom, or a type A individual may keep you stuck, and how to break free. We'll also talk about stress, good, and the bad, and understanding how healthy stress can help prevent chronic disease from impacting your health. Furthermore, we'll talk about practical self-care tools, how busy physicians can eat well, move more mindfully, sleep better, and support their own mental health. And lastly, we'll touch on how you can align with your purpose, and how reconnecting with your deeper why can help you to show up better for your patients, colleagues, and loved ones. Dr. Tigers warm clinical insight and personal experience, make this conversation one that you do not want to miss, especially if you're looking to balance your professional passion with a life well-lived, enjoy this episode. Dr. Robin Tiger, welcome back to the show. Thank you. It is such a privilege. I'm so excited to talk to you again. Absolutely. The privilege all ours. I want to get right into it. I think I'm going to encourage the listeners to go back and listen to our first discussion with you, and we'll plug that into the show notes so people can get a sense of your journey. But something that's been on top of mind for me lately, as we talked offline, a little bit, Darshan, I have both attendings now, and we've got some real world experience if I may say that. I would no longer quote unquote baby doctors for real doctors. And with that, you see the finer sides of it, and you see the quote unquote dark side. And you get to experience some of the pain points that physicians have experienced that we were peripherally familiar with, but now you're in the thick of it, so to speak. And a question that I've been exploring when I think about this, people talk about being a physician as a calling. And sometimes it doesn't quite feel that way. I know you had this really twisting turning journey where you find found you're calling. But the question I want to ask you is, as we see it now in terms of healthcare system in this country, do you think being a physician is still a privilege? Or is it more of a burden? Yeah, I feel it's always a privilege to be able to care for others and to have others trust in you. When we feel like something's a burden, such as practicing medicine as you brought up, we need to go back to what we learn in cognitive behavioral therapy, which is that our feelings and our emotions are driven by our thoughts. So if we are feeling burdened by something in this example you're given practicing medicine, we really need to ask ourselves the question, what is my brain telling me right now? What am I thinking? What are the phrases, the words, the sentences that my brain's offering me that's driving that feeling of burden and really get to the root cause of what that's coming from? You know, a challenge with that is, as I was alluding to a lot of times, the root cause is out of your control. I have a sense of what you're going to talk about here in terms of where we can only control what is within our control and maybe not so much outside. But I think one thing that is worth talking about now lately, what we've been seeing with the insurance companies, right? So Blue Cross Anthem had this insane and shocking policy that they try to roll out. We had the tragic instance with the CEO with United Health Care. And Darshan, I were having this conversation earlier between us. And what was really surprising to me was the response from just the general public. And I'm referring to the latter in particular where you had a person whose life was taken and a person was taken out of the lives of loved ones. And the response that you got, at least that I saw, at least my wife, and we were talking about this overwhelming response, people making insane comments like my condolences out of network. And I get that. I get where that comes from. What was interesting to me was we feel like as physicians, we are struggling so much when we have to get prior authorizations from insurance companies when we have to play this game of trying to document it in a right way. So something gets approved, a necessary treatment has to get approved. And the challenge with that is, okay, that's too big of a problem to try to control. And so in that instance, how do you address that? Yeah, seeing everything that's happened, and yes, someone's life was lost. And even in my groups and social media, my physician groups, there was all types of conversations happening and some people actually had to be shut down because in one group, this individual who murdered was a close family member of a physician in our group. And we need to step back and be human and recognize that killing this person isn't going to solve the problem. And it doesn't help the situation, and only actually made it even worse in many ways. It brought out so much. What you're saying is true. We need to acknowledge the difficulties in your job every day. But coming back to your why is incredibly important. Why did you put that white coat on to begin with? Why did you fill out that medical school application? Who is that person? What was your why? And as difficult as things become every day, it is hard as it is every day to try to take care of your patient as best as possible when you're hitting these brick walls and you're bumping into these mountains. It's important to come back to that why. So really holding space for it all, acknowledging, yes, this is hard. It shouldn't be this hard. My patients need better than this. They deserve better than this. And why am I here? And that for me and that for so many of my clients, medicine, has been really helpful coming back to that why whenever you feel so overwhelmed that you're treading water and drowning from all of this red teeth and craziness that you're expected to do to take care of your patients. I find that developing your why has to be done with a lot of introspection, a lot of thought, which you said can dictate whether you see medicine as a burden or dictated as you see it as a privilege. Now often when we're even pre medical students all the way up to attendings, the hierarchy, the rigor of academic medicine, so often we're told what to do. We're told how to think. We're told what problems there are. I think there was a recent study or anecdotal evidence that he's showing that most doctors today would even tell their kids or even those who shadow not to go into this field. So when you look at it from that perspective, how does one actually develop their why through medicine? When do they have the opportunity to really view it as a privilege in your opinion? The moment you're making decisions that affect other people's lives, so the privilege is caring for another human and having them trust in you. The burden is the way that you have to do it in the system as it exists right now. But caring for that patient is always a privilege. I think I love that because that's color to the question that I had asked, right? The privilege is to care for that human, but the burden is in the matter that we have to do it in force. When you talked about this last time, you were this phenomenal interventionalist and you were struggling with something personally and you had to just make a play doctor for yourself because you saw all these specialists, nobody could seem to figure it out. At the end of the road, you had to advocate for yourself and almost think outside the norm, outside the box, so to speak. And the interesting thing about that, to me, is a lot of people have circumstances in life where they're just unable to be able to take that leap, much like you did, right? Whether it's being hamstrung by suit alone, that's been chaotic. Whether it's circumstances in life, maybe you're a caretaker, maybe you have young kids, maybe you have other responsibilities, maybe it's just fear that you have this sunk cost fallacy that you've spent so many years building into this thing. You're making a pretty decent salary, sure you're quote unquote miserable day in a day out. But is it really that bad when you come back at night, it pays the bills, does that. But maybe you don't have purpose, maybe you don't have fulfillment. And nowadays, it's so easy to detach, right? We're going to talk about the anxious generation, but I think, I guess maybe this is a selfish question is, you've done this, you've got in a couple of years where you do your coaching, you work with clinicians primarily. If you were to advise somebody who had that type of predicament and said, okay, I buy it, it's still a privilege, but the burden is, how do I go about it? How do I modify my perspective of that? If I'm unable to escape that burden in terms of how I deliver care? Yeah, so it begins with caring for yourself first and recognizing that, again, your feelings and emotions are coming from these thoughts that are being driven by your experiences that are happening in the situation we're talking about, practicing medicine that determines what you do and what you don't do and ultimately the results that you create. And so first, the work starts with self and getting really clear on, am I caring for myself as best I can? Can I do more? Can I do more? Can I work to relieve my stress? Can I eat foods that are going to fuel me, decrease my anxiety, decrease my stress, increase my sense of calm, decrease my depression, increase my focus and concentration? Am I exercising and if so properly? Am I getting the sleep that I need to function? Am I connecting with others in a way that support me? Am I reaching for frisky substances or other escapes to just not feel anything? So the first thing comes to self and seeing if you are the healthiest version of you showing up for this job that you're doing. After you've done all of that and you've really decided that, yeah, I'm doing the work and I'm still not okay. Coming to what would serve me better and if you are in the physician community, you are seeing so many physicians who are decreasing their hours, decreasing their FTEs and taking on other things that really serve them. Some are going into coaching, some are going into real estate, some are doing really interesting other things that create products, podcasting, right? To bring in other streams of income, I have a colleague that I just met at the most recent lifestyle medicine conference that loves practicing medicine, but it's too much in the way that it is now. It's really affecting his joy, his happiness, his sense of self. So he is doing really well in the real estate business to make that income that he wants so he can actually show him practice medicine in the way that he chooses. I have another physician friend who cut his hours back and took a job in wellness leading the entire division of wellness in his medical institution, he's down to two days in clinical practice and spending the other several days creating wellness programming for his institution. It's just enough of a balance for him to keep the salary that he wants and to be able to find that purpose, that meaning, that why and deal with all the other misogynists that he has to deal with in what medicine is offering now. So there are lots of different ways to approach what's happening. I always want to caution anyone in making sure that you're not running away from what you're doing, but you're walking toward that next thing. So if you're bringing all of this stuff with you that you haven't worked out, if you're not caring for yourself physically, emotionally, psychologically, spiritually, you're bringing that same individual that needs to do the work with you to that next thing and you're going to be disappointed, it's not going to be better and you'll be just as unhappy. So we do need to take care of ourselves and walk toward that next thing, not run away from that other thing. That's a really important distinction that I want to share. Yeah, absolutely. It's been pretty fascinating to see the migration of a lot of physicians going towards other passions and finding other passions as well. And I follow you on LinkedIn and I'm constantly seeing these posts of you with other people, Dr. Moses, Thunderman, and other lifestyle medicine physicians as well. And it just seems like you guys have built such a great community and you mentioned social connection and the importance of that. Actually today I was just listening to a podcast on the diary of a CEO with Vanessa Van Edwards who is a charisma coach. She talks about social sciences and there's a famous quote that says you are the average of the five closest people that you are, yeah, the five closest people that are to you. And with that comes this decision of who to achieve that, right? And the hospital, I feel like it can be very tough because you're bound by the facility and whoever kind of gets employed. But then as you make that migration, you tend to find these groups that are maybe more like minded that maybe have more of the struggle that you did and are now turning it into something else. But touch on the importance of the community that you found and how that's really helped you not only with your career, but also with your health overall. Yeah, it's such a great question because social connection really feels intangible. It's easy to tell you, tell another individual focusing on yourself in terms of the food that you're eating or the hours of sleep that you're getting or the type of exercise, the number of minutes and the different genres of fitness and so on. But social connection is seems intangible. It's also something that we never really think about or talk about until more recently. And we can actually thank Dr. Vivek Murthy, our surgeon general who really brought this to lead in 2023 when he put out his advisory on loneliness and isolation. And then we have this epidemic of that in this country and actually throughout the world. And I never thought of social connection as being something we actually should be prescribing for ourselves or for other people until I started to study more about lifestyle medicine and learned that Harvard actually says that is the number one key to our happiness. And even to our longevity is those connections that we have, the positive connection that we have with the other people in our lives. And I've found that when people understand you, that see you for who you are, that are on the same path as you, that are cheering for you, those are the people that you want in your circle, the people that lift you up that make you feel good, you can just sense their energy and you share that same energy. I found that with my friends at the American College of Lifestyle Medicine, we all have similar passion and we're cheering each other on all the time and anytime anyone asks me to do anything, my hands both hands go up right away because it's just something that I'm so excited about. And those are the kinds of people you want in your circle. We see from the research the medical literature that lack of social connection has a direct correlation to illness, disease and even mortality or death. It's incredible that humans, knee humans, were actually built that way. And so we need to start thinking about prescribing that for ourselves as well as for the others that we care for in our lives. Yeah. And so social connection does not necessarily just need to go out and meet people right and also go to the bar or to meeting places that might be the first step, but the key where is that connection, right? And so I'm curious, what do you pay attention to to know that somebody should be in your inner circle or that somebody that you want to collaborate with? It's how I feel on the inside. You can sense people's energy. Einstein talked about subtle energy. So you know when you walk into a room, you can sense whether somebody is feeling a certain way or you get a vibe about that person. So for me, I'm very interceptive, I notice how people make me feel and there's that quote about. People aren't going to remember what you did, people remember, we're going to remember how you made them feel. And that's really where I focus. How does someone make me feel? How do I make them feel? It's all about non-judgment, it's about allowing, it's about acceptance, it's about elevating others, being in a place where people make you feel that way and to create that space for you. But also be your mirror and be honest with you and let you know when you need to have someone tell you that maybe you need to think about this or do a little bit more of that or do a little bit less of that. So you want people are going to be totally honest and truthful with you. And it's okay to complete relationships, it's okay to complete relationships and this is a newer concept that I learned in the past couple years is that sometimes relationships that you had before don't really serve you now. You've changed, people change and it's okay to complete those relationships, to recognize that isn't something that you should be experiencing anymore, that there are other people that feed you, that feed your soul that serve you so much better. So completing relationships is something that you are allowed to do and that you deserve to do when it's important for your health and well-being. I find it so interesting that you choose the word complete rather than end or terminate. I imagine that's intentional and to the podcast that Garsh referenced earlier, I found it to be fascinating and I encourage the listeners to listen to it. People put in the show notes for people, but in it she talks about people have competence or warmth and you can dial up your warmth cues if you're somebody who is highly competent and is always exuding that energy. You obviously, to us, one of the people who are watching and just from your voice, you are very high on the warmth and competence, but just using words like that, I find it to be interesting. The other piece, I think what you're talking about in terms of relating with people understanding them, making them feel a certain way, the word that comes to mind for me is compassion. I think it's a last time we might have talked about empathy and how critical that is to be an exceptional physician when we're talking about connecting with people, connecting with our patients. I think compassion is maybe when you level up from beyond that. I saw this really interesting thing on LinkedIn a little while back. I might have reshared it where you have, it's a line graph and on the x-axis, you have how much you might want to help somebody and on the y-axis is how much you understand their struggles. On the bottom left, closer to zero, you have sympathy on the very top right, you have compassion. It's like, maximal wanting to help somebody, maximal understanding their situations, even more so than empathy. I think people are familiar with that, right? In fatigue, we talk about all those things. What I'm getting at is you have developed that over time and I think that's probably what makes you very good at what you do now. Just like you also mentioned, at some point in your fellowship training, you're called GPTI born to intervene, right? Some people are just meant for a certain profession, some people are just meant to do something. I'm wondering though, when it comes to compassion, are people born with something like that? Are they wired a certain way or when it comes to human beings and healthcare where it's sometimes these abstract concepts that you understand, it's obscure, it doesn't really make sense. In your particular case, I think about, you had all these unrelated symptoms almost, nobody could figure it out. I think you said your husband is a physician as well, is that right? He couldn't figure it out and you attributed all to stress and I'm wondering if you have that high level of compassion now and you are good at your job is because you've been through something like that from personal struggle. I guess that's what I'm trying to ask is, in order to develop the highest level of empathy and compassion, do you personally have to go gone through that struggle so you can deeply connect with the human being? No, I don't think that you personally have to experience something to be a compassionate individual. I do think that compassion is a combination of nature and nurture in the sense that some people are naturally born more compassionate. I remember before my daughter even spoke when she was in the two-year-old classroom, she had all these dolls lined up and the dolls were on the floor and each one had a crib and a blanket and the teacher said, wow, she's so compassionate already at age two. She's not even really speaking and yet she's making sure that every one of these babies is cared for. They have a place to lie down, they have a warm blanket, they've got food and so on. So sometimes we're born with that. Last night I was at a restaurant and the waitress was a bit dismissive. I was out with my husband and another couple and every time she came she really didn't make eye contact, she seemed very aloof, she was making mistakes and some of the other people at the table were complaining about her the entire time. I'm not going to say which of the other three people but there were other people complaining about her saying she's terrible waitress, she just doesn't care, I don't even know why she's working here, she's got other things on her mind, blah, blah, blah, blah, and I didn't think that at all. What I thought was she must be having something going on, something must be going on in her life that is causing her to be this way. I'm really concerned that something's going on with her and before we left the restaurant I went into the bathroom, she was in there and she was filling the soap containers and she turned around and I could see that she had been crying. And so here's an example where I had compassion for her the entire time. What I came out of the bathroom, I told the other people from the dinner what had happened and they all felt terrible and one said wow I really need to think about how I think about people in the next time something like this happens, here's an example of educating and teaching people how they can have compassion for others. So I feel that compassion is both something that you are innately born with, there are more people that are more compassionate from the time they're very young, but it's also something that you can learn from and the individuals that were at that table didn't go through what I went through in medicine. So I don't think you have to come from a dark place to evolve a compassionate person, but it can take someone like me to help point that out. I've heard this before, for instance, the example that came to mind as similar is when somebody cuts you off in traffic, just very aggressively. Most people's initial response, oh man, what an e-hole, you want to flip them off or you want to see some bad things to them, rain some choice words. And then you don't know if that's person is trying to run to the emergency department because they're child in the hospital or they're wife's in labor or something crazy is happening. And I forget where I heard it and somebody just said, just for a moment, if that ever happens, you would just think for, I hope that person gets to where they need to get to emergency. In my 35 years of age, I've never met a person who that's how they approach, we've been cut off very many times. So majority of the people will not have the response that you just described. Why do you think that is? Yeah, it's our default brain network that tells us negative things first all the time. It's how lots of us are wired to think the negative first, but it can be learned. I've taught my children this from very young age and when someone cuts me off, actually the first thing I think about is, okay, I'm okay, I'm okay, everyone's okay. All right, we're good, we're safe, no one got hurt. And then my thought goes to, wow, hope that person's all right, I don't know where they need to be, I hope whatever's going on with them is they're going to be okay or her they're trying to get to is going to be okay. So I actually do have that thought, I don't actually have the year in A-hole thought, I don't think like that. I think more along the lines of, they're doing that for a reason. There's a reason why that person did that. I don't know what's going on with them, but there's a reason. I think that we can train our minds to think a little bit differently. If I could add, sorry, I got lost there, can you hear me? Yeah. Yeah, okay, okay. Yeah, if I can add two thing, what are the other frames, a reference that I look at two now is childhood trauma, okay? Today I was walking back to my car and somebody just came out of a carton garage just whipping their car tire screeching and I look back and said, what is going on? This is a small road and this guy proceeds to drive by me and stare out the window looking at me as the, as if he's tough and trying to pull me down in my head. I'm just like, man, I wonder where that behavior comes from, right? It's trying to flip that from, oh, this guy's an A-hole and just trying to be hard to who heard him, right? Or like, why did he have to do that? And I think a lot of my frame of reference now has really moved towards what type of trauma have they endured as a child to make them form that behavior to think at the advantageous in that moment. I think a lot of that gets sparked from Gabor Mote, who's done a lot of just research on powdered trauma, but I should want to add another point there. Yeah, there are many layers as to why somebody may behave in a certain way. The thing is we can't make anybody think or feel or act in any way. The only thing we can control is how we think and feel an act. So you're choosing to think, wow, what's going on with that guy? What made that person do that instead of guilty until proven innocent, which is how a lot of people are thinking about others, right? And then when you find out that they're innocent, you feel terrible. So why can't we just start with innocent and be compassionate and just be humans? Yeah, yeah, totally, totally, also like that. Now, I was going to say, I think it actually reminds me of Darce where you're talking about, I think there's this clip from maybe it might be Ted Lasso and they're actually watched a show, but where he's throwing darts and he's talking about maybe people bullied him. And nobody ever asked him like, if he's ever played darts and he says, you know, I got curious and he went in doubt, get curious. And then just remind me of that, Darce, you have maybe an adverse event happened to you with something negative. You used to get curious, you're like, huh, I wonder what that person's days like. Yeah, I wonder what happened. I wonder where they have to be and it completely neutralizes your, your fear response, your anger response, whatever the immigrant is, if you just get curious, I think. Well, I wonder why you haven't seen Ted Lasso yet. Oh my gosh. Ted Lasso's amazing. He needs to see it. Get curious about Ted Lasso. Yeah, get curious about that Lasso. Fair enough, fair enough to share. So speaking of, I guess it's a Netflix, but speaking of this stuff, I think one of the reasons maybe what we're all getting at, I think this response that you talked about, the default responses anxiety, some people have maybe even labeled our generation, I'm a millennial now, and maybe we're all in the similar ballpark and just anybody who's coming up in the world today with access to social media, with just instant gratification, that kind of stuff, been labeled as the anxious generation. And again, some of it has to do with social comparison, all these types of things, and you just constantly getting input. And I find this to be very interesting where, particularly recently election time, people will talk about the world is worse now than ever was. Again, a fascinating thing, or we talk about how it would just like 80 years ago, where people were burning log to heat up their home when it was like three degrees outside. I'm not really sure the work is worse today than it ever was, right? And so if you look at it from that work, it's objectively the world's been never a better place. I forget, Darcy, I sent this to you, I forget where this quote from, but subjectly, people seem to feel like it's a horrible time that we're living in, and the world's gonna end. You hear these kinds of things all the time. And I want to get your take on in terms of this anxious generation that's been labeled. Yeah, I do believe that research is showing that anxiety has been on the rise, even as as young as children. We've got data from college students, and then of course, we've got the medical community. So there is this rise in anxiety and stress, and that of course causes lots of symptoms illnesses and diseases, and we don't want any of that. I think that it is multifactorial. I think it's some of the things you talked about already that social media can be a good thing and a bad thing. Social media tends to portray people at their best in general, unless there's people that are going on rants, but when it comes to comparison and comparison, I eat this where people are comparing themselves to other people. I see this all the time, even in my own coaching and my clients, physicians comparing themselves to other physicians. There's this never enough, not good enough, eat this sense of enuffness is never fulfilled. And I think that social media causes a lot of this anxiety, that you're not where you're supposed to be, that other people are doing more than you, they're better than you, they have more than you, what's the matter with you? And so there's a lot of that when it comes to social media. I think that the other problem with social media is that we know that by looking at these screens, we've got boosts of stress hormones that are released every single time you look at your phone. So research out of, I believe Stanford years ago, and I saw this healthcare professional give a talk on this, I was really blown away, that we're getting a little boost of stress hormone is released every single time you look at your device. And that's because your brain doesn't know if you're going to see something positive or something negative. So it's gearing itself up for getting some bad news, that could be a text, that could be an email, that could be a post, whatever it is. And so think about how many times a day, on average, people are looking at their phones, hundreds and hundreds, think about all the boosts of stress hormones that are coming out. So that's the second reason why social media, looking at our devices, can be causing all this anxiety and all this stress. And so that is just one factor that has been really the ideology behind what's going on with our own feelings and emotions that are taxing on our longevity, our health span and our lifespan. Well, this messaging around stress is harmful, stress kills, I understand you're the stress 3M Dean, this is your MO here. But I even find that sometimes that can go overboard, and that can be quite detrimental. For instance, we talked about people being wired a certain way. Are you have these type A people, type E people, and some people are just wired, they're more sympathetically dominant. And they have a very difficult time toning out that stress response. And if you approach the whole, the stress is killing you, particularly for this insecure overachiever, the term that I borrowed from Chris Williamson, I'm not sure where he got it from, but who is trying to pursue longevity and their interest in your health span. And you tell them that, hey, this stress is killing you, man, like it really is. I think that's maybe going to be even more harmful for that. You pointed to the research, I think Beth Frey is Dr. Bradford, he's came on a long time ago, she pointed to some of that multiple guests have come on in the past. But we also talked about last time how stress is actually good, we need stress, right? Stress is very important that response has been created for a reason. But the challenge always becomes the practical application for it, particularly when it's unchecked chronic, that's when it becomes problematic. And so for that person who's high type A, who this is how they are wired, they know no other way, what is the lowest hang of fruit that you can think of? And I imagine majority of the physicians that you come into contact with are like this. Yeah, so you're right, not all stress is bad. We need some stress, and we have the U stress, U stress, which is the good stress, that's the stress about coming on this podcast. That's the stress falling in love, right? So that's good stress. That's also the stress that helps us get things done, get our jobs done, it helps us put our focus in our concentration, keeps us in the flow. That's good stress. We need that. We in the new stress, neutral stress is the stress that something's happening far away. We hear about it, we know it's not a good thing, but it doesn't really affect our daily lives. And the stress that you're alluding to is the chronic stress is the distress. And that's the stress that's really damaging to our health and well-being. Someone can be a type A personality, and that's okay, right? The personality in itself isn't bad, and it's when we have chronic stress, all these hormones that are being pumped out all the time that are causing hypertension, eventually diabetes, causing heart attacks and strokes, leading to dementia, cancer, shortening our lives, no matter who you are, no matter what your personality is, it's not safe to be living at that level. And so that low-hanging fruit, they need to take a bite at it and start to decrease that. Because when people say to me, I don't have time, and I say, you're right, you don't. Because the time is being shaved off, the time is being shaved off of every minute, every day, every hour, every week, every month, that you don't start to get control of how you're feeling. I love that. I absolutely love that. I'm going to steal that and use it for sure. He don't, you actually don't have time. Yeah, it's true. That is the number one objection that I get, Josh, the number one at all time. And I say, yeah, you don't. And then people just look at me like, what? Right. And I explain. And then you get to actually, when you change the way you look at things, the things you look at change, and offering way to look at time changes everything. How do you reconcile decreasing chronic stress with coping mechanisms that may go against some of the lifestyle principles? For example, the best two thoughts that come to mind are somebody might reach for alcohol, which might lead to social connection, and they're using that as a stress reliever. The other example I always talk about is warm buffet, right? He apparently drinks a Coca-Cola a day just to get a reduced stress. It's in his routine and he's in his 90s doing pretty well for what I hear. How do you talk about those with the opposite ideas, but in the end, the goal is to reduce that stress? So stress is a physiologic response. And so we can work with our own physiology to decrease the stress response. I spent some time in Sardinia, one of the blue zones a few months ago. The blue zones are the areas in the world where we have the highest number of centenarians. And actually, the American College of Lifestyle Medicine is partnered with the blue zones, and there'll be a blue zones physician certification coming up in the beginning of 2025, which I'm very interested in. In the blue zones, they drink one to two glasses of wine a day. They're drinking it with their food. They're pairing it with their food. But they're not drinking it as a drug to relieve their stress. It's very different when you are drinking alcohol. Are you drinking it as a drug? If so, we need to come back to the physiologic response of your stress and teach you ways to decrease that, to bring homeostasis or balance back to your autonomic nervous system so you can feel better. So it's not all or none with the alcohol, but you need again to go back to that why. We talked about why earlier. In the show, we're coming back to that why? Why are you drinking that? Are you drinking that because it tastes good and it's really great with your meal? You don't need alcohol to be social. You don't need that to be social. If you need to feel more relaxed before you connect with others, then practice tools to get you to that place before you show up to connect with others. But it doesn't have to be a drug to do it. Yeah. I want to stay on this thread of coping, particularly for that high performer over a cheaper person. Maybe selfishly, that's who I am, right? Am I a close attending friend? Actually, whether there's type A people, there's type A ultimush. And at some sense, I would take that as a compliment, but from what you're talking about is we don't have a lot of time and this is something that I need to work on, something that I'm not so good at. Something that comes to mind is actually heard about on Chris Williams podcast matter was he talked about people with type A problems and type B problems. And so I'll read this piece to you and I'm curious to get your take on this. And so he says, I think type A people have type B problem and type B people have a type A problem. insecure overachievers need to learn how to chill out and relax and lazy people need to learn how to work harder and be disciplined. Given that subscribe to me, I'm going to guess you're a type A person, a kind of walking anxiety disorder, harness for productivity as Andrew will consensus type A people get no sympathy because I'm miserable, but outwardly successful person always appears to be in much more preferential position than a type B person late being lazy but on the verge of bankruptcy. Goggins and her mosey style advice reliably makes everyone more successful in the only way that you can get judged outwardly. But there aren't many issues in life which can't be solved by just working harder a little bit. So everyone just smashes it with a hammer. But for certain, perhaps minority cohort of people, they actually need to hear the opposite. We need like a parasympathetic Goggins, like hashtag rest harder than me. And that's the creativity. What do you think about that? Well, it feels ouchy. It's the whole thing. And what I'm seeing, what I'm hearing is a lot of labeling. I'm this. You're that. You're this. I'm that. And it puts you in a box. And when you say, I need to do this. And it's hard. And I have to do more of that. And I'm this. It's just, it's so much labeling. And it feels heavy like I felt myself just sinking down in my chair as you were reading. So I just invite you and everyone else listening just to take those labels off. Don't label yourself as anything. I'm ultimately, this is the person that I am. And it just so happens that anxieties here or stresses here or I tend to work in this way. But you're this individual. Just take all those labels off. They don't feel good. And they allow you to sometimes hide behind them. And it can prevent you from evolving and growing and transforming. So whether you're someone that's lazy, take that label off, right? Just take it off and just come down to the human that you are. What do you need? What do you need? What do you want? How do you want to feel? And how do you want to get there? It just makes it so much easier. And as I say, there are no problems, only solutions. We don't want to worry about these things as problems. We can think about this personality. Part of it can be a really good thing. Can really be a great way for you to get things done and to get to the place you want to be. So we don't want to label. That's the first thing I say is get rid of those labels. Just like I don't want to say, I'm anxious. I'm stressed. I'm angry. I'm frustrated. No, it's like I'm this person Robin. And just sometimes anger is here, frustrations here, anxiety is here. It doesn't change who I am. And it just feels so much better to get rid of those labels. So as I heard you're reading that, I was like, late label and I think I'm like box, you're in this box. And just get out of the box. Don't knock those walls down and get yourself out of the box. And then just take a step back and look at yourself with this bird's eye view. And look at what's going on with you. What's working for you? What do you want to keep? And what's not working for you? What do you want to change? And then just find what you need to do it. What's interesting about that though, our entire training and medicine were designed to make an assessment on an individual. If somebody comes with a problem or if you're dealing with something, you need to label that with a diagnosis. Only then can you arrive at the correct treatment plan, right? Time had a tending who would talk about DX. If you don't have the proper DX, you can't make the proper RX or you can't suggest the proper RX. And what you're suggesting is contradicting that in a sense or at least, that's how I'm hearing it. So help me think through this for a second. Yeah, go ahead. Yeah, no, just giving a diagnosis on a patient because their glucose is high and you're saying they have diabetes is very different than boxing yourself in as a type A personality who isn't able to learn anything else. It's too hard, right? It just makes you already hide behind that. And so I'm just suggesting to like just take that label off instead of I am, just get rid of it and just focus on the human that you are and what's going on in your world. I think that's very different than looking at a lab value and giving someone a diagnosis that you need to treat. You're not talking, your patient's not coming in and you're not saying you're a type A personality so you can't learn how to get better, right? No, that's not, this too. We're talking about apples and oranges here. I don't see it as being the same thing. Yeah, I think actually on the same podcast, probably with a different guest, I'll plug a camera member, but it was I think about happiness. And I think the guest was talking about you're talking about Dr. Tiger is getting rid of the labels breaking about walls and being more fluid, being like water and not allowing yourself to be identified by the current situation that you're in, but by who you are and the journey that you've been through and that this is just you in the present moment in this state. Actually, it was Michael Posler who was talking about on Instagram that I saw and he just really talks about this is you in your own little vessel and your experience in the world essentially for the first time as you in this moment. And so when you are able to do that, you now take an information very differently about the world but also about yourself. And so how you interact with the world is that they're going to change that neuroplasticity, the growth mindset, all those things will allow you to have the courage to go beyond what you possibly thought you could. I guess the one question I have though is that a lot of people look at labels and self identifiers as a way to mark their status in community and to mark who they are from a self-esteem standpoint. When we aren't able to do that and we take away these labels, how do we still build ourselves from a self-esteem standpoint. Then you have the freedom to do even when you say I am a doctor versus I practice medicine. I'm a mom or I have children. Do you see the difference? You're this person and there are these other things but that's not who you are. And when you start to recognize that you are not these things that you are this whole, unique, incredible human and that there are these other things that you happen to do or that you happen to feel your whole world opens up and allows for that space to build that self-esteem because then you can be really clear in who you are and you're not hiding behind any of these other things which can prevent you from becoming the best version of yourself. There's got to be some, so let's go back to the example of identifying as a parent. This person who says I'm a mom, I think much like anything probably it's your perception, but I think Dr. Dr. Mike Ezra will talk about this. People, let's go back to the high stress individual. They're people who have tremendous much stress but they perceive that to be a negative thing and they do just fine. There's no adverse outcomes that we talked about in terms of chronic comorbid conditions and that kind of stuff. So that person who identifies themselves as a mom, that's their identity, maybe they're incredibly proud of being that person and maybe that allows them to thrive. So my question for you is how do you tease out whether that self-laboring is a positive or is it something that's going to be more detrimental where we need to rewire that? Really being clear and understanding who you are is so so important because of those things went away. If your partner went away, if your children went away, if your dogs went away, if your job went away, if all these things that you are identifying yourself with went away, who are you? A very confident person full of self-esteem or a person that is nothing because they were only the things that they identified themselves with and that's why it's so important to be you and be really clear on who you are and drop all those labels. You can be proud to be a parent, you can be proud to have children, you can be proud to care for others, but if that's the only thing you're labeling yourself with and then those children go away, that when people children go away to college and then the parents are just lying on the couch and they can't move for weeks because they only identified themselves as a parent but they lost who they really are. So I think it's really important to be clear on who you really are and then this person, this incredible human, this unicorn of an individual happens to do all these other things but that's not who you are because of all that went away, who are you? And that's really important to be clear on. Yeah, I think what I'm hearing a lot of is to bring it back to the beginning when you talked about privilege versus a burden is the words that you choose, the reframing of identity is actually more of an abundance of mindset. When you can say I have children versus I'm a mother, you're actually looking at everything you have in life versus that versus everything that you need to take care of now, which that burden and that just flit by I think really energizes you, it changes your physiology, you view stress differently, you view your role differently and then the grand scheme of things and I think that's where physicians can really take the next step. I think so often we're bogged down like all doctors saying about talking about diagnosis, the patient in front of you, we even label patients, right? We group them together, we bucket them even when we try to be one on one with that. And I think being able to isolate things, being more fluid, looking at abundance not only helps the patient and the direct care, but also ourselves and the mites that we go in. So I definitely appreciate that mindset. Yeah, that's so true. The GI bleeder in a 205, the diabetic in room 206, the whoa, right? No good. When I was in medicine, that's how patients were identified and we've evolved into having this like person first language, Mr. Biller with the GI bleed. He has a GI bleed, but he isn't the GI bleed, right? And so we need to drop the labels even as we describe patients and see the patient as the human who happens to have this thing. I love this conversation, but in other news, exciting for you, you have a new book out called Feeling Stress is optional. Tell us about the book, why you wrote it and what you hope the listeners gain from it. Yeah, so thanks for sharing that. The book is called Feeling Stress is optional and that's because stress is an optional. There are going to be things that happen in our lives. There are going to be forms you have to fill out as a physician. There are going to be thoughts that your brain offers you. There are going to be hurricanes as we just had recently in Nashville. There are going to be things. So stressors come up, but how you feel about them, that's where the magic begins and that's where you get to decide and that's where you really get to tap into that physiology and that anatomy and that thought work and all the other pillars of lifestyle medicine so that you can feel calm in the chaos of what's going on. And so previous to the book, I had created online digital programs or people who like to learn at self-paced formats. I created the podcast, the stress-free MD podcast. I coach 101 and do group coaching and give lots of talks and lead retreats. And the one method of learning that I hadn't done was write a book. And I had been asked by many over the last decade or so about a book. And so when the pandemic hit in 2020, and I started to think about all the ways that people like to learn best, a book was something that I hadn't done yet. And I like to create as many opportunities for people look to learn in the way that they like to learn a way that they learn best. So I began writing in 2020 when the pandemic hit originally, really focusing on our colleagues and recognizing that the anxiety, the depression, the stress, the burnout that they were already experiencing was only going to rapidly rise with the COVID epidemic. And so now is the time, was really what came up. I have this card. It's now is the right time. It sits on my desk. Whenever I'm not sure if I should do something, I look at it. I'm like, oh yeah, now is the right time. And so in 2020, I started writing the book and it just released a few months ago. And I also wanted to be interactive and multimodal. So one of the questions or objections I frequently get is don't just tell me I need to do these things. I don't know how to do these things. And so the book has over 20 short videos. There are QR codes throughout the book so you can practice tools along with me about five minutes each because I know how busy you are. And they're also downloadable worksheets. So whether you're someone that's auditory or tactile, someone that just likes to read somebody that likes to learn by doing or what have you, there's all different ways to learn in the book. And then that connection piece that you mentioned, many physicians are getting more and more involved in book groups. And so I wrote a chapter specifically for book groups with already curated questions so that you can have a really meaningful conversation and grow together. I love that it's a practical workbook. And much of what we're talking about, much of what you talk about it's for that. I keep coming back to this individual that this avatar that have created high stress individual who this hopefully will benefit. And they need to skill up. And the only way to learn that is to actually go through that practically. So they encourage any of my colleagues to be able to go through something like that because I think that's the only way. And I think maybe the most powerful statement that you made, something that I'm also going to steal is when people talk about, hey, I don't have time, write it, we're all time poor. And to your point, yeah, we really don't. And so we better get to it today rather than holding off because that time is being shaved off. So Robin, I want to thank you, as always, as I mentioned earlier, I think it's just your demeanor in essence, the way that you come across. I think it really just defuses any type of stress. And it's always a privilege to talk to you. You've been doing some amazing things, both with ACLM, with Stress3MD and all the partnerships in the community that you build up. And keep kicking ass. Thank you so much for being here. You might remember this from last time. And I'm curious if your response has changed. I think the last time you had talked about, started with healing the healers, which I really love. You've already talked about today. But we are passionate. The mission is to put the health back in health care in the sick air system that we practice. As you see it now, what is there are many ways to do this, but what is one of the ways that you would attack first if you wanted to put the health back in health care? Physician heal myself and that begins with education. And that begins at the medical student level that begins on day one. And we don't know what we don't know. And so really educating the medical provider, don't like that word provider, the medical health care professional. The individual that's going to be caring for other people can't possibly care for other people if they haven't learned to care for themselves. Physically, emotionally, psychologically, spiritually, down to their soul. And I'm really excited that certain medical schools are already beginning to incorporate this education into their programs. It's becoming intra curricular. And so I would love to see this intra curricular in every educational program possible. Robin, thank you so much. Thank you. Thanks for listening to the other episode of Medicine Redefined. If you enjoyed this episode, please be sure to check out some of the additional resources in the show notes. Please also check out our social media platforms where you can find more content like this. You can follow us on Instagram, Twitter, and TikTok at Med Redefined. We also want to thank our team for the production of this podcast, specifically Ethan Jewel in video, Harita Yekorean social media, Zanablegmani on research and Sarah Hahn for newsletter. Oh, and if you want to get similar bite-sized information delivered to your inbox every Sunday, please be sure to sign up for our newsletter. Also, if you enjoy the show, please be sure to subscribe, review and share with anyone who you think will gain value from this as well. Now, time for the ever so important disclaimer. 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