51. Robyn Tiger, MD: Learning How to be Stress Free & Purposeful in Your Life

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Marcus Aurelius 1 said, If you are distressed by anything external, the pain is not due to the thing itself, but to your own estimate of it. And this, you have the power to revoke at any moment. While our guest today is none other than Dr. Robin Tiger. Now Dr. Tiger is on a mission to empower physicians with self-care tools backed by science and research. If physician burnout and mental health issues on the rise, Robin knows firsthand what it's like to love your job while also coping with stress, anxiety, overwhelm, imbalance, and even illness. She uniquely combines her 15 years in diagnostic radiology with a certification in yoga therapy, meditation, and life coaching in her innovative CME accredited courses, private coaching, and podcasts called Distress Free MD Podcast. She is deeply passionate about helping her colleagues relieve stress, elevate calm, and live their best lives. So in today's episode, we asked Dr. Tiger what the impetus was for her to start her own coaching business. Now she has an amazing journey to really talk about how she got overwhelmed with a lot of these burnout symptoms. We then talk about why the great resignation is even happening, which essentially 20% of healthcare workers are leaving the field. We then talk about how we as humans can find more purpose in our jobs and what it means to truly be stress-free. And lastly, we also talk about how we gain comfortability in reaching out for help whenever we truly need it. Enjoy the show. Robin, welcome to the show. Thank you. I really, really love your podcast and it's an honor to be here. Oh, the pleasure is all ours. Today, we're going to dive into stress. I don't think that one podcast is going to be able to cover the ridiculously large topic of stress. I mean, I think that most people, when they think it's stressed, they're thinking negative stress. And of course, I want to talk about all aspects of there's positive stress, negative stress and all those things. And you're the stress-free MD. So you're the expert and you have an extremely unique and special journey that got you to be the stress-free MD. And so before we talk about different ways to cope with stress and all the things that come with that, I'd love for you to share your journey with listeners and how did you get here to be the stress-free MD? Yeah, well, let's see. How far back do you want me to go? All the way back. All the way back. Yeah, third grade. Third grade. Third grade. I knew I wanted to be a doctor, right? That's when it started. My teacher, Mrs. Miller, she rolled out this life-size skeleton and I thought, okay, this is not just a Halloween decoration. This isn't Halloween costume and I learned that that was actually inside our bodies. And I said, wow, I need to learn more about this and that was the one I wanted to become a doctor. So this began when I was, I guess, seven or eight years old and fast forward. That's what I did. I went through all the schooling, got to med school, went through med school, internship and intro medicine, did a residency in radiology and a fellowship and body imaging and then I went into medical practice, went into practice as a diagnostic radiologist. And I still think that being a physician is the greatest privilege ever. To be completely honest, I changed a lot during that journey and at some point during, I guess, I was maybe 10 years into practice, I started to really, really lose myself and I just noticed that I was having many different types of illnesses and symptoms that none of our colleagues could put together. It was like migraine headaches with this intractable vomiting and like prevented us from going on a, on a Disney trip, had us in the wrong line at the airlines for some Jamaica trip because I had no focus on concentration. I had a vertigo that was really, really disorienting, I had bleeding gums, like what did that have to do with anything, right? I was, you know, putting all this together, a pain throughout my body felt like the 10 men, like I would wake up in the morning and, you know, I felt like that two minutes on the Wizard of Oz, like I just, I couldn't move, really, really horrible guest or soft ill reflux, couldn't sleep. And an incredibly scary thing that was happening was that I would get these parasteges in my hands, my feet and like the left side of my bag where I swore I had this debilitating neurologic disease and I couldn't cut up vegetables, making a salad. I had trouble pulling the trigger on the biopsy gun when I'm doing like a breast biopsy. I'd be driving and I couldn't feel the steering wheel. I mean, these strange parasteges were just like, come on the most inopportune times, not that there was ever an opportune time. And it was just me circling the drain. I started to have really bad thoughts, thoughts that I didn't want to be here with that. I didn't actually imagine hurting myself, but I thought to myself, I don't really know if I want to be here anymore. This is just so painful, this is so horrible to live like this every single day. And I just didn't feel worthy at work, I didn't feel respected, hard to get up every day, bring myself into work. And so that is my rock bottom. You know, all of these physical ailments went to see lots of docs, took a lot of pills, had lots of imaging studies, went to mental healthcare professional, wasn't getting better. So me at the bottom, and thinking, hmm, maybe, maybe it's better not to be here. So that's the beginning of the next chapter. Wow, that is extremely powerful and I want to thank you for sharing that, right? And I know that you had several colleagues who maybe weren't allowed, you talked about this previously, to see the next chapter, and I'm glad that you are and so you can share your journey. And if you want, I'd love it for you to shed light on that too, but as a radiologist, I've done a couple of radiology rotations, and it's fascinating how brilliant they are, right? Because you guys have to know the differential for literally every single thing. I'm wondering, you know, you mentioned a variety of symptoms and, you know, they kind of span different systems of the body, right? What was kind of that conversation in your head when you started having these symptoms that seemingly are not related, but now you know that they are, what was kind of like the differential? Like what's going on? You know, how are you? What was the conversation in your head? Right. Well, the period on us thought I had like infections in my gum, so I was getting antibiotics shot into my mouth like every week. The neurologist had me on gabapentin, I was having like MRI examinations of like my spine and then everything can imagine. The orthopedic surgeon thought there were issues going on with my hips and my knees, and I was getting MRIs of those extremes of those areas of my body. The psychologist thought, you know, I was depressed or I just had, you know, work life balance issues, tried all kinds of talk therapy, EMDR, this, you know, the, the, the, the, would it give you the vibrating units in your hands and you talk about your issues? Basically, I was a complex case. And the gastroenterologist had me on, of course, all kinds of meds for reflex and, and I think as physicians, we love complex cases, right? Because we want to figure out really, really hard things because that's what our left brain loves to do, but we don't ever want to be a complex case. No. And so that's what I started to see myself at every physician had me, it compartmentalized in their specific area of specialty and was treating that particular symptom with a specific drug or therapy, and nobody was actually seeing the entire picture. Yeah. That makes sense. Yeah. No, absolutely. I mean, that's the difficult part, right? I mean, I think that for a lack of a better word, holistic is kind of what we're talking about. I don't really love that word because I think that word is often just thrown around and people aren't really using that approach in the sense that it's meant to be in, you know, in medical school, depending on which school you go to, it's a systems-based approach and you do a system-based system-based system. And really, you kind of, you really got to take, I mean, you can have the 10,000-foot-view, you can have 30,000-foot-view, but for you, I don't know, maybe you needed 100,000-foot-view. Who ultimately came to see that? Was it you? Was it a provider? Your husband is also a physician at a radiologist if I'm not mistaken. Yeah. Did he have an input on this? What was the experience like for him and what inside did he provide? So, he didn't really know the extreme situation that I was experiencing because most of it was internalized. He knew that I was going to see this duck and that duck and I really kept a completely different armor and a completely different appearance on the outside. People didn't know that my outsides didn't match my insides. And I think that he always likes to look at the world through those color glasses, which is one of the reasons why I also love him so much, but I don't think that he understood the extreme. As a matter of fact, it wasn't until I developed the practice that I have now and he started hearing me talk just like I'm talking to you that he really said, wow, so did my family. Wow. We didn't know that you were suffering like that. So I kind of hit a lot of it pretty well. He knew some of it, but not all of it. Yeah. You know, I often, my wife is also a resident, right? And we often talk about, you know, you still go through these struggles, whether it's through training and, you know, we still as physicians were people too, right? And our patients, they're coming to us in pain or whatever their chief complaint is, whatever struggle they're going through and of course they have to voice it. And it's very challenging when you're going through that, I'll use the word trauma because I think it's somewhat appropriate to describe kind of what you're mentioning, you know, whether it's internal, external, whatever it might be. And something I always tell to my wife is I just say, hey, the show must go on, right? I mean, you have to be there. Of course, you have to be the best version of yourself for your patients, but it's hard, right? You've got a really cool story where you're doing a biopsy and, you know, you get these parastegias and you just kind of pause and deflect and the text there and try to figure out what the heck is going on with Dr. Tiger right now. Do you want to share that story? I think that's really interesting and give some perspective. Yeah. So as I mentioned, you know, I have parastegias, areas of times I have numbness and tingling in my hands, my feet, my back in case we have any non-medical people listening. Just areas of numb times I have numbness where I just couldn't really feel my hands. And as I mentioned, it would come up at very inopportune times, particularly when I'm in the middle of a breast biopsy, for example, which is something that I did quite often. And the biopsy gun has a trigger that you pull and you put the tip of the needle exactly where you want it to be. And usually I'm pretty quick and pretty good. I actually, in my fellowship at Jefferson, they called me BTI, which was born to intervene because they said I was the best fellow, which I'm serious. I'm not one to compliment myself. But my program director said you're the best fellow we've ever had. And he called me BTI, born to intervene. So for me, to be in the middle of a biopsy and to be taking a really long time, didn't make sense, particularly when the tip of the needle was right where I needed to be. And my tech would say like, hey, Dr. Tiger, you're right there, kind of like looking at me like, did you fall asleep or, you know, what are you doing, pull the trigger? And I would just have to wait until that numbness passed so I could feel my hands again and actually complete the procedure. So that's an example when it came to actually caring for patients where this was a very, very big problem and the hazard, a big obstacle in my ability to practice. Yeah. Dr. Tiger, I think you said some key words there when physicians think about, you know, stress and burnout and what we're going through and that was, didn't make sense. I remember probably exactly a year ago being an intern on the medicine floors with, you know, somewhat difficult team to work with and winter, cold days, dark days and not realizing why I felt almost kind of depressed, anxious, panicky a little bit, really bad mood, you know, and I realized, hey, my wife wasn't here, she's actually back up at home in Boston and kind of going through it on my own. And you don't realize you're in burnout until you're in it, right? And I think a lot of us physicians also don't think we're ever going to reach burnout, especially in today's age where there's so many signs and symptoms and, you know, we've made restrictions on work hours and stuff. It's easier for us to tell. But, you know, back when you were training at what point did you realize that all the symptoms that you were going through were essentially burnout and stress? Yeah, so we didn't really have the word burnout in our vocabulary then. And I didn't have anyone to talk to about it because nobody else was talking about it. I was like carrying this essential, this invisible backpack of pain around with me, right? Like nobody could see. I was putting on a good face for my husband, my amazing little kids, you know, everybody I worked with my patients. So, for me, which is like this sort of bag of symptoms, right, that they didn't seem to connect, right, that complex case. And I decided I don't want to take all the pills anymore and I didn't want to just go to the mental health care professional, although they are excellent when they are doing their job. But for me, it just wasn't working. And I started to look outside the box of traditional medicine saying, okay, I believe in Western medicine, completely 100%, but it's failing me right now, right? So as you mentioned, I had three colleagues that died from suicide. At that point, I think I had lost two of the three. Two physicians that I thought were perfectly fine. I only knew on the outside that they looked completely normal, completely fine, completely happy. You know, one was a resident with me. She was a medical student and a resident with me. She was kind of with my big sister. She was the one we didn't have packs at the time we had actual films. She would come in the middle of the night and go over cases with me. She actually wanted to follow my footsteps and do the fellowship that I was doing at Jefferson. So she called me and she said, hey, you know, I did this interventional fellowship. I'm in practice. I'm not loving it. Can you get permission from me to shadow you for, you know, a day or two or a week or whatever. Like what you're doing and maybe I'll come and do your fellowship. I got permission. I was excited. She was coming. And then two weeks later, she overdosed. So that was just like, you know, and then there was this amazing human who was attending in the practice where I was working my first practice who was the only doctor that always checked in to see how I was doing. He called me when I came back the very first day after having my daughter checking in and how I was doing just this happiest, kindest, nicest man when he overdosed, right? So two examples of people, you know, who look completely different on the outside than the inside. So I was scared. And so that brings me to me looking outside the box of medicine and I started hearing about all kinds of things like things like yoga, things like meditation, you know, things that I never, ever considered in my life because I thought they were kind of like, I were all worthy. Yeah. I mean, I was training for races and at the gym all the time and my gym rat still am and I just, I just didn't see myself in twisty things, turning upside down, saying weird, weird sounds. I mean, I had all these completely wrong preconceived notions. And so to answer your question, how did I know that I was experiencing stress and burnout is that I put myself into a yoga class, a meditation class for the first time, grabbed my neighbor, she's a nurse, she came with me, she gave me the eye roll, we went in. And I have to tell you that after the first class, there was this incredible shift, right? I felt calm, I had clarity, I was not tired, not tired after working a very long day and taking care of my kids and rushing to get to this class, I felt amazing. And so that was my first inclination into, all right, what's the physiology here? Okay, it's my left brain saying, what just happened? And that was my very first inkling into, okay, the pills didn't work, the talk therapy didn't work, but I'm feeling better right now, there's something physiologic going on. But that was my first inkling into, let's go back to what we learned in med school with respect to our nervous system and see if I can figure this out. Yeah, absolutely. I'm sorry. Thank you so much for sharing that by the way. I mean, I'm sorry to hear about those losses, you know, and it's so often that we, it's people that we least expect, right, for these tragic events to happen to. And oftentimes, these stories are short-lived in the medical community. But they leave a lasting impact, right, to those who really feel that deeply and personally, and obviously you're one of those people and you've taken action because of that. And you know, you found a higher truth if I can say, you know, when it comes to burnout and stress. I want to touch on your yoga certification as well, but before we do, do you think it's worth kind of just breaking down terminology within burnout, kind of some of the components that lead to stress and burnout. So if we could kind of just go over compassion fatigue and moral injury and what stress is. Yeah. So, well, first of all, there's, there's good stress, right, there's, there's, there's stress that that is okay, right, because we need a certain amount of stress, okay, because that's what keeps us going, that can make us get a task done, that can, you know, help propel us, you know, there's a stress of coming on this podcast, but it's a good stress, it's a happy stress. I couldn't, you know, I can't wait to talk to you stress. And then there's distress, right, stress that's not, not a good stress. And when we talk about that, we most commonly talk about chronic stress. And that means the chronic stress response is on overdrive. So we've got our autonomic nervous system composed of our parasympathetic and sympathetic nervous system. But our sympathetic nervous system is always on, even when it doesn't need to. So that's the stress that we're talking about that's causing us to feel all these feelings and an experience, everything we're experiencing negatively. With respect to burnout, you know, burnout has been categorized with, with respect to three main components, okay. So the first component that's talked about is emotional exhaustion. And the second component is cynicism, that's not having a negative attitude, like even if you have been the nicest kindest person that your patients love, you don't even like listen to another word they have to say, you just, you just don't have any more tolerance, you just have this bad attitude. The third is this lack of self-worth. And so burnout has been defined as these three components. For me, you asked who, you know, was able to make that diagnosis, and it was me. So I was the only physician that was actually able to correctly diagnose my illnesses, my symptoms. And the diagnosis was a whopping case of chronic stress, which led to burnout. But it was actually my own physiology, my own stress response on overdrive that was causing all of these symptoms that I was having. Yeah, absolutely. I think all those terms are definitely important to learn about, right? And I think as trainees, we learn about burnout, but we don't understand how much of it is at a personal level, right? I think too often we think it's something external happening to us, and we don't get the chance to kind of debrief what happened. I mean, I remember last year, really not taking the time as I was going through burnout until that period was over, right, I had to go through a hump and get to an easier rotation, and then look back and say, well, what the heck just happened, you know, who was I, what was going on, and what kind of one I have done better, could I have reached out to people? So yeah, I mean, it's a whirlwind of a process, so thank you for going through those. Yeah. And what I'll add to that is, you know, you did a great job kind of highlighting the different steps that they go through, right? And one of the things that we've talked about time and time again on this show is this concept of listening, right, therapeutic listening in particular, my co-fell and I talk about. And, you know, when you go through that cynicism stage that you mentioned, and it's so hard to just hear another word, you know, Darshan, I were a physiatrist by training, I do sports medicine and majority of my practice now is people coming with pain of some sort, right? And pain is a ridiculously complex topic, as we all know, and we're learning more and more about that today. What we do know though, that listening to our patients, their concerns, their pain, their anxiety, what their perception of pain is and understanding that is no question, it's helpful. Right? I don't think it's the treatment or cure. I mean, we'll question say the cure, but it definitely is part of the treatment, right? When you're in that stage though, that's in a cynical stage and you don't see a bi-mechanical cause, something you can't inject, something you can't operate on, something like that, it's very hard to do, right? And I know these things, but depending on what my distress level is, I should say, it can be very challenging to do, right? And so I think that this is probably a great time to dive into some of the strategies that we can use, healthcare practitioners can use, but even those who are not in the healthcare field can use. So you mentioned yoga, right? You mentioned breath work. You mentioned some of these things that really were, for lack of a better word, like revolutionary for you, right? Talk a little bit about that, wherever you want to start with the strategies. Yeah. So, first of all, the preconceived notions, okay, lots of spandex. People twisting their bodies into strange shapes that, as a radiologist, I didn't think that was even possible or they should be doing, okay? What else can I defunct here? Weird music, weird language, you know, all kinds of things. I had all those thoughts. So if you're thinking all those thoughts, I had them, the thoughts that you have to spend an hour, an hour and a half doing this stuff, the fact that you have to be flexible, all these kinds of things. So my story began, like I said, with my very first class. And when I started to see that shift, my doctor brain went into the physiology and over time, as my symptoms started to get better, because that's how I knew what I was, what was I experiencing. I dove deeper and deeper. And I think Darsh asked earlier about the different types of yoga certifications. So just to understand, a base level yoga teacher needs 200 hours. And a yoga therapist is at least a thousand hours over a three year period. And so the doctor in me, once I heard about this field of yoga therapy, which would enable me to take the base level education of yoga and apply it to help individuals with many types of illnesses, symptoms, and diseases, I dove right in. And it was my own personal transformation that I was after and my own personal healing as well as, well, I can help so many people in this much deeper level. So it isn't the yoga class, but it was studying yoga more deeply for many, many years as a yoga therapist and becoming certified in that, and then becoming certified in a few other things such as meditation, but specifically, I rest, which, you know, all too much you're talking about pain. And this is a really interesting, interesting topic because this meditation was originally created for Walter Reed Army Hospital to help our military relieve their suffering from PTSD. And I was looking for a very secular, very evidence-based meditation. And it was found to be so helpful not only for that, but for chronic pain that in 2010, the Department of Defense declared this meditation at tier one treatment for chronic pain. And that's because so much of our pain comes from our stress and our thoughts, because that's causing so much tension and so much inflammation, everything else in our body. So so many of the patients that are coming to you don't have a mechanical issue. You're talking to them, makes them feel better because they're starting to relieve their stress. Right? So sometimes they need you to do something, but other times they don't need you to do as something, other than just listen, just talk to them or give them some tools. So the first component was the yoga therapy, which we can dive into a little bit more. The second component was the specific type of meditation that was very, very clear to me that I needed to learn because I wanted to be very, very neutral and very safe in what I was offering and I wanted to be very evidence-based. And if it's working for a military, wow, I wanted to learn that. And then life coaching, because life coaching helps us work with our thoughts. So up to that point, I'm doing a lot of work with working with the body, the physiology, managing the nervous system, creating homeostasis between stress and relaxation responses, but then working with our thoughts, our thoughts, 60,000 of them a day, which most of them are not so nice. Not learning how to work with them, right? So those are like the three main components that I love to share and that I teach and that I educate on. Let's do that. I love for you to start with the meditation piece of it, right? We've definitely covered this topic, maybe not super deep, but we definitely had, I guess previously I forget what podcast, which episode was a mobile link in the show notes for you, but maybe also if you could just touch on the difference between meditation and mindfulness for people, because sometimes they confuse the two. And then we can go into the yoga and then of course, life coaching. Sure. So mindfulness to make it really simple is paying attention on purpose, paying attention on purpose. So one of the lectures I give, I just gave one this weekend actually, imagine an image, a cartoon of an adult with a thought bubble filled with a gazillion things, okay? And then holding hands with a child with a thought bubble that has a picture of his son and a few flowers. And the picture behind them is actually the walking outside and there's a son and a few flowers. So mindfulness is paying attention on purpose. The child is seeing the son and the flowers and the adult is seeing everything but that. Every single thought you can imagine is in this guy's thought bubble. So mindfulness is when you're actually present and you're aware what's for in front of you, what's around you, what's going on inside of you, and you're intentionally paying attention on purpose, which most of the time we're living from our shoulders up in our brain, 60,000 thoughts per day and we're completely disembodied and we have no idea what's going on around us. Bumping into things, forgetting things, don't know why you came in this room, that room, you know, wise my tovert, I don't know whatever, right? So that's a really simple way to explain mindfulness. Now meditation is really the umbrella under which many different types of flavors, of fat work, of, I should say there's many types of meditation, right? There's many flavors, just like there's many flavors of ice cream. Mindfulness is a form of meditation. It's a form of many meditations and you can bring it into many meditations. So it's really the umbrella under which mindfulness will live, that makes sense. Could you give some, some examples of different types of meditation, right? I mean, but I think most people make of just anchoring with the breath, right? That's, that's one, but what other types that people might not be familiar with? Yeah, so I mentioned eye rest, let's start with that. Little eye big R, eye rest, like the iPhone, and initially when it was created for a walk to read, you know, the, the, my mentor actually went in and they said, you can't call it anything like meditation or anything at all because they won't do it. You have to call it something that sounds like they're going to want to do it. And who doesn't want to rest, right? So that is the meditation I'm facilitating, that I facilitate that I'm certified to teach. And it was an over three year certification to really learn how to do that and become certified in that. That is predominantly guided. And what I mean is there's meditation where you're totally quiet and you're just with yourself or there's meditation where someone's talking to you and talking you through it. And most people think you have to be quiet and there's no way I could do that because I've all these thoughts. I can't quiet my mind. There's no way I can do that ever. I'm never even trying. That's what I regularly get from particularly from very, very busy doctors. So I'd like to break meditation down into guided and not guided. Okay, guided is someone's talking to you, not guided is you have other things going on. You're not being spoken to, you're either sitting quietly, you mentioned following your breath, you can listen to music, you can also do things like you're eating. There's an eating meditation, actually, about episode of this on my podcast where, have you ever eaten an energy bar and you go to take another bite and it's gone? Or all the time. All right. All the time, right? You're going to take a chip out of the chip bag and you're like, wait, where do they go? Okay. I call that empty wrapper syndrome and I actually did a whole podcast on that. So we can eat and meditatively eat even if you're, even if you're in between patients, you know, really paying attention on purpose, being mindful while you're eating, tasting your food, feeling the textures in your mouth, smelling it, you know, all of that, feeling it in your hands, you can do a walking meditation where you're outside and you're listening to all the sounds and everything you're seeing and the smells and the taste and hearing the crunchy leaves under your feet. So, you know, meditation is really, anytime you're paying attention to someone speaking to you, your own senses, anything that's outside the 60,000 thoughts that are going on in your brain. And that's how I like to think about it. Dr. Tyra, when you talk about meditation with your clients, you know, obviously it's a process, right? You're not going to find results happen overnight. What do you tell them to expect as they, as they go through the journey? Well, because most of my clients are doctors and most of the doctors are not going to sit quietly. A lot of that is the, that is the, I don't sit quietly, by the way, I don't like to sit quietly. That's really hard for me. I like to have either music or listening to recording and that's okay. There's no ego involved here. Just the fact that you're giving yourself time to be with yourself even if it's five minutes is amazing. So, the meditations that I facilitate are all guided for my docs. I have a morning meditation where I'm talking and I'm giving them something to think about in affirmations, something to think about for the day, talking to them the whole time. I have meditations, like mentioned I rest, where I'm speaking and I'm guiding them through everything. And those are the two main meditations that I work with physicians because they just want to hear me talk and they don't want to think about it, okay? And so, they get results because they don't have to think about it. And once they come out of their thinking mind and they're just listening to me, within a week, no joke, they have a shift. So, it doesn't have to be hard, it shouldn't be hard, it shouldn't be easy, so I make it really easy. Yeah. A week is pretty impressive, is that every single day in seven days took a daily practice? So I recommend that you give yourself some time in the morning to sit and to just be with yourself. Because most of the time you wake up and we're super stressed and jittery and we're out of sorts. I don't know anybody that wakes up super calm and super happy and completely ready for the day. And if you are that person, I want you to know what you're doing because every single one of us, they have thoughts, we have stuff going on, we wake up, there's just how it is, we're not in vacation mode, this is we wake up and life is happening. So I do recommend that now. I don't ever say you have to, right? I don't say you have to do anything. It's really invitation and choice, which is how I share my inner educate. And if Doc's tell me they have five minutes, I say, okay, five minutes, you're going to give yourself five minutes, that's it. You've got 15 minutes, 15 minutes, but I do recommend giving yourself even a couple minutes in the morning to transition between waking up and starting your day. And just that alone is an incredible shift. So yeah, there's no recipe in seven days you will, I mean, it's not like that, but I can promise you that soon, as soon as you start to balance your autonomic nervous system, you will feel better. Awesome. On that note, I would love to kind of go a little bit further into the physiology, all right? You can talk about the nervous system and what's happening. I mean, I know that we're not just for our left brain, right? If we can zoom in a little bit and talk about, you know, essentially what breath work and this kind of stuff is doing both for the central nervous system. Okay. So with respect to breathing, as Doc's, you know, let's go back to our physiology. So there are two key physiologic points with respect to breath. And we learned a lot of physiology in medical school where we're just not really taught that we can actually work with that physiology. So with respect to our breath and breathing, our physiology teaches us that when we inhale our heart rate increases and when we exhale our heart rate decreases, right? So when we want to feel calmer, we want to focus on our exhale breath. Our exhale breath is the key to our relaxation response, that's the key to the calming part of our nervous system. So take a deep breath, doesn't work because you take a deep breath and that's very stimulating. And all your brothers appear in your chest, it's actually your exhale breath. So the first physiologic point is we want to make that exhale breath as long as we can within our comfort level, not forcing it, but just inviting a long exhale that decreases our heart rate, decreases our blood pressure, and that's the parasympathetic component of our breath, sympathetic component, inhale, parasympathetic component, exhale. The second part is where your breath is in your body. So our vagus nerve is the longest cranial nerve, starts in our brain, goes off through our body and entire abdomen, and it's Latin for wanderer, right? So it means wanderers, it's really long wandering nerve. And so the location of our breath is very important. When we breathe into our abdomen, we're increasing vagal tone, the vagus nerve is the key nerve involved in our parasympathetic nervous system and our relaxation response. So when we breathe into our abdomen, we're tapping into that vagus nerve, we're decreasing, our stress response and increasing our relaxation response and we're feeling calmer. Chest breathing is stressful breathing, abdominal breathing is calming breathing, stressful breathing is sympathetic nervous system in the chest, abdominal breathing is parasympathetic nervous system. So those are the two key physiologic points. Now we kind of learn this physiology in a roundabout way, but when you break it down like that, it makes it so easy to understand that if we simply lengthen our exhale and invite our breath deeper into our body, we're going to feel calmer. And there are many different ways to breathe that incorporate one or both of those categories of physiology. So that's the left brain answer to your breathing. Yeah, all that. So go for it, yeah, yeah, oh good. Okay, let's see, with meditation, neuroplasticity gets me super excited because as a radiologist, I love to see those MRI images. And when the people said, oh, that's weird, doesn't do anything, the MRI images are amazing. When I got to see live mass general Harvard researchers lecture on this and show before and after MRI images, I was blown away. And what happens is what they found with meditation is that we have some incredible neuroplasticity happening and way back when I was practicing and learning to be a radiologist, I was told that we can look at the gyro-solc who pattern on CT and MRI to determine how old someone is. So the sulks eye are the crevices, right? And between the gyri which are the tissue and the pattern changes as you get older, we get deeper sulks eye and we get smaller gyri, right? And we could actually look at an image and say, okay, that person should be this age. But when someone meditates, all bets are off. And that's because the brain actually gets younger. The prefrontal cortex thickens. So that's our CEO of our brain, that's our decision making center, that's our critical thinking. So the prefrontal cortex gets thicker, like who doesn't want that, right? And our make-delicate smaller, that's our trauma center, that's where our anxiety is, that's where our stress is, and that's where all of our previous memories of bad things are living. And our hippocampus gets thicker. And that's where new memories are stored. So this incredible neuroplasticity is happening when people meditate. And so that to me, again, left brain wants to see it, wants to know it, and that is pretty amazing. So if you have any question, go to that neuroplasticity. And then, you know, with respect to movement, right, so stretching, right? People think stretching, what happens? So if I look, I'm looking at both of you, no one else can see you but me, but I see some shoulders forward, right? So if I tell you to sit up and bring your shoulders back, do that for me, okay? And then just soften again and just come back to, right? So you come back to where you were. So for everyone else listening, they brought their shoulders back, and then when they relax, they came forward again. And that's because stretching doesn't work. Stretching doesn't change us permanently because it's a spinal cord reflex. So the physiology of muscular movement is, when we stretch a muscle, it's a spinal cord reflex. The mechanoreceptors send a signal to our spinal cord saying, muscle stretched, spinal cord send a signal back to the muscle saying, re-contract. I mean, you know this from your background and, you know, you're both in his busy sports medicine, his dietary and whatnot, right? So I'm not telling you anything you don't know, but think about it this way. Why do we keep stretching? It was not working, right? It makes us feel good temporarily, but does it permanently improve your posture? Does it change the shape of your body? No, we just go back to where we were. So moving in a different way that I learned, the somatic-based way, is using eccentric contraction called pentagulation and inter-reception. So when we contract into chronically tight muscles and slowly release them, over time, they will lengthen. And they lengthen when we bring our brain involved and we allow for inter-reception or that sensation so we contract into a tense muscle, we sense it, and we slowly release it, which is the opposite of stretching. And we bring in the brain because we're sensing what we're doing. Over time, chronically tight muscles will lengthen and you will increase the resting length of those muscles. And that's how you get rid of the tin man feeling. That's how you no longer feel like the tin man from the wisdom of lies. So we talked about the physiology of breath. We talked about neuroplasticity with meditation and how you can move in a different way to actually decrease the pain in your body by increasing the resting length of those chronically tense muscles. Wow. Well, thank you so much for going into a lot of detail with all of those, I think, it's a great reminder for us, even in healthcare, even for Ultima Shania. Those are really great reminders to realize, hey, we might even be telling our patients to stretch or when they're in physical therapy stretch, but to realize, again, we go back to this component of being integrative and realizing how the body truly works, right? From a neuromuscular way, personally, in the morning when I'm waking up, and if I am doing a meditation practice, I choose to do pranayama, right? And that's essentially a box breathing for a lot of people. And what I've come to realize is it's tough to expand the diaphragms, right? So you know, I want to quote the cervical diaphragm, your actual diaphragm, these are tough to kind of expand, right? We have a lot of fashion in those areas, but over time, you can really release those tensions. And after you are able to mindfully push this air in and out and you have this control, I've come to realize my gratitude and perspective on life have come to enlarge in, right? You're not solely focused on what you're doing in the next 10, 20 minutes, but you can kind of step back. And as Ultraman has always said, you know, you look at from a 30,000 foot view of life and what you're going through. I know, so there is a book on my list called Breathe by James Nester. I haven't read it yet, but I've heard it's, you know, it recently came out. It's pretty good resource. Are there any other resources that you recommend that our listeners can check out if they want to get more into breath work? Well, I can't say any specific book. I think I teach 18 different breathing tools in my Physicians program. I teach a lot of that square breath is box breath is one of them. That's also militaries, one of the my militaries client favorite breathing tool because they really like things that are very structured and organized and doctors like to have structured and visualization as well. So that's a great breathing tool. I do have three free videos on my website and one of them is a breathing tool. So if anybody wants to check that out, they can go and learn and practice that. Perfect. So you are the resource and we'll definitely link everything that you have up in there. Yeah. Cool. Yeah, I don't have any book to read, but I believe not that you should have read that book, but we learn best by doing it. And so I love to teach by doing and letting people sense an experience. So when I teach, it's usually visual in terms of something like a breath. I love the fact that you go into the physiology as well, right? Because for a lot of doctors, I mean, we're evidence based. We need the data. We need to understand how it's working before we do anything, right? So I think that's a huge component and I think everything that you said is vital. I want to transition to life coaching because I mean, this is something I'm definitely interested in in the near future of getting what is it one and then two, how has it added benefit to your practice in comparison to kind of yoga, meditation, breath, work movement? Yeah, so for me, I've been on this, it's probably in this space of stress management, expertise and personal transformation and education for about 10 years now. And it started with learning how to regulate my own physiology like we talked about with the autonomic nervous system. But I did feel that there was some more that I needed, that even though I could feel calmer, more grounded and shift, how I was feeling, there was still still work to be done with respect to thoughts that come up. And I heard about life coaching and I decided to join a group that was specifically for physicians. And it was incredibly transformative when I learned about how to work with my own thoughts and how powerful they were. And that's why I went on to study, you know, to become a certified life coach. So to answer your question, what is life coaching, what is it, and people get confused with therapy. So I like to think about as therapy is really learning about processing your experiences and bringing you to that back to who you are. And life coaching is you're already there, but you need to take a step forward and achieve your goals, right? So they are both very, very important and they have very different reasons why somebody would seek out both of their errors of expertise. And I like to also think of it like a mental health care professional is like a physical therapist where they're getting you back to baseline, right? And the life coach is like the personal trainer that's taking you forward. So since you're both an athletics, you gotta think of it that way. And that has been a really good analogy for some people. What life coaching teaches us is that we think most of our problems, most of our feelings and our emotions come from our circumstances. This job is horrible, that's why I'm so sad, right? But someone else might look at that job and think it's amazing, right? So what we come to understand is the job is neutral, even though it's hard to say that, the job could be neutral, but it's our thought about the job that's making us feel sad and angry and disgruntled and hurt and upset and so on. And so we spend time really understanding how to separate fact from thought, because our brain is offering us lots of thoughts all day long and thoughts determine how we feel and what our emotions are. It's not the thing, it's not the circumstance, it's our thought about the circumstance that determines how we feel and determines our emotions. And they determine how we show up, our actions, our inactions, which ultimately determine the results we create in our life. So when you start to recognize, when you're having a thought, is that really true? It's just words my brain's telling me, I can choose to believe that or not. And what is the circumstance? You know, what isn't really changing? What is what in a court of law would be a fact? Job is a fact, what I'm thinking about that job, not a fact, because you love that job on day one and you hate that job on day day, 200 or one, same job, right? So we start to really, really work with, when is our brain talking to us? What is it saying? What's not true? What is true? And then when we start to recognize that, we can actually decide what we want to think about something. And then we can create what feeling and emotion we want to have, and then we can determine how we show up and the results we want in our life. So it's really an aha moment when you start to be able to differentiate between fact and thought. And that was just this huge shift for me. Absolutely, that's amazing. And likewise for me, when I started meditating, I think again, I gained a deeper perspective in terms of this greater outlook, you know, in terms of that mentality shift and what matters and what's important and the attitude and the gratitude and taking those two things and really running away with it. And putting, planting those seeds almost into every single thing in your life, right? And then you see those trees blossom, those flowers blossom, and you start to realize what a wonderful life you actually have. And you start to look at things like envy from a different light. But to talk about sad jobs is actually a perfect transition. Currently, you know, due to COVID, we have this new era right now called the Great Resignation and so many people are leaving their jobs and 20% of the healthcare workforce is now gone. What are your thoughts on kind of what's going on and what people need to think about, especially those leaving and trying to find different opportunities? Yeah, so a lot of these people are my clients. A lot of them are my physician clients and whether they're taking my courses or whether they're private coaching with me. And what I like to always start with is let's make sure that you're not running away from something, but that you're moving towards something else. Let me say that again. Let's make sure you're not running away from something, but you're moving towards something else. And so several of my physician clients, after they learn how to feel better all by themselves, independent of this broken healthcare system that we're all living in, they don't leave their jobs because they find joy again in medicine and it wasn't leaving the job wasn't the problem. Even though the job didn't change, they were able to find joy in practicing medicine again, which is why they filled out that medical school application to begin with, right? So we have to be really careful and try and poke holes in what's going on. It is somebody really want to leave medicine because it's just not right for them anymore and they really want to pursue a different career or are they running away because that same person that needs to heal, that needs the education to feel better all by themselves is not going to change when they go to that next job or the next thing. So that's really what I like to work with first and really try and figure out what's going on. Yeah. And I think a lot of people out there may not have found their calling for passion, right? And I think this is an opportunity for them, as you said, to move on to something else. I know you've had a similar story when you were actually thinking about getting your yoga certification and clicking that pay button. Take us through that story. I think it's pretty cool if you can. Sure. Well, you know, I had to decide, you know, first of all, my medical practice, I had been unhappy for several years and I was actually working with a coach who was a physician herself who went through residency, started practice with the very unhappy, got a corporate job. Didn't really love it. And lots of other doctors were talking to her and saying, Hey, could you help me find some nonclinical work and she got so busy that she started her own business helping physicians find nonclinical work? So I started working with her, trying to figure out if I should add something to my existing job or if I should leave my existing job or what should I do with my life? And I was working with her for a while and she kept saying to me, you know, you could review medical records and you could work for an insurance company and you can do expert testimony and she gave me all these things and none of them were really hitting me. I wasn't making my heart sing to get off and do any of those things. If you're doing those things and you love it great, but for me, it wasn't anything I wanted to do. And I had a decide, you know, do I want to stay in medicine? You know, do I want to do something else? And while I was trying to decide because the practice I was working in lost a hospital contract, it put five extra doctors in the system that they didn't need. I was working part-time at the time I was job sharing so I could take care of my kids and so the non-partner contracts were not renewed. So I had to make a decision. Do I do a lateral move and give another job in radiology or do I do something else? And that was the fork in the road for me. They actually did me a favor because I was really very unhappy for many reasons we don't need to get into right now. But I said, you know what, there are lots of radiologists out there. And even though I was very, very good at my job and the cardiac surgeons were frying in my office no joke, like don't leave, you know, the breast surgeons were like, we don't need anyone else to do our needle loaks. But I said, you know what, I need to fill a gap that no one else is feeling right now because if I'm feeling this way, other people are feeling this way. And so I learned about the field of yoga therapy like I had said and I found a program that I really wanted to study and it was like all this money and I had this money drama. Do I, do I put all this money up to do this thing? Like where am I going? In medicine, we know we do four years of college, four years of med school, one year of internship or you know, it's very structured. I knew exactly point A, point B, point C, this had, there was nothing and there was nobody but me. I was just totally traveling. So this, this application sat on my computer for days and days and I just, I just couldn't click send and my husband was sitting next to me on his computer and he's just like, just click send. And I just, I couldn't do it, but finally I did it and then I was feeling guilty about it and then I got this check in the mail and it was a check for more than just a little bit more than the amount that was going to cost me to get the certification and it turns out that way back when I was a resident, the hospital, one hospital took over our hospital and in the transition, somebody messed up the amount taxes that were coming out of my paycheck and decades later, I had all this money coming to me in the form of a check. So I looked at it and I said, oh my gosh, someone's handing me, the universe is handing me this and saying, you have to do this, like why would I get this check all these years later that's just about the same amount that's going to cost me to do this training. So if that's the story you're talking about, it's, it's just, you know, pretty amazing. It truly is amazing. And you know, I think that, you know, so far we're coming up in an hour here and we've really gotten the sense that you mentioned when it came to your diagnosis, you were the one to make that diagnosis right? Despite having seen lots of professionals and I think that all of us are somewhat privileged, not somewhat, we are privileged that we have access to amazing colleagues who will get you the treatment. And so you probably had that, but you ultimately came to this diagnosis. You are clearly a person with a tremendous amount of intrinsic motivation, right? Who was able to pull the trigger, if you will, to be able to take that step out of medicine, like, like Darce was talking about. He also mentioned that a lot of those, a lot of your clients are the colleagues who are going, are part of the 20% who are leaving. And, you know, I'm wondering what some of those conversations are like because at the outside, you talked about, look, being a physician is still incredibly meaningful. And for a lot of people, it is, right? And maybe people are kind of on the fence and they're like, hey, this, you know, I want to do this, but hey, EMR, right? Previous episode with Dr. Peter Valenzuela. It's the being of my existence, right? Insurance companies. God are they miserable. Those kinds of issues are really contributing to it, but like the patient care, I love that, but I got to go over these hurdles. And I could do this. I could do what you're doing, Dr. Tiger. But I don't know. I'm not really sure I'm on the fence. Could you walk us through what a discussion, you know, might look like when you're having with your colleague to help them identify what it is that you literally want? Well, if they come to me, they're coming to me for education to learn how to take and shoulder physiology and they're coming to me for my management through life coaching. So, I really let it unfold, right? I'm not there to tell anyone what to do. But if they're coming to me, they're in that in between of, let me see if I can help myself first, you know? So, I always say the job isn't going anywhere. Help yourself. Get grounded. Get clear. Make decisions for a point of abundance, not scarcity. And if you still want to leave, well, then you have your answer. So, I think that even if it's not even just really about the job completely, but what we know is that the chronic stress response is responsible for so many of the chronic diseases in our country, in the world, right? Diabetes, heart disease, stroke, cancer progression, and growth. It's even shortening our telomeres prematurely, right? It's decreasing our longevity. So, I always like to let physicians know that no matter what happens, you're taking care of yourself and this education isn't going to be for nothing. And it really gets them interested in taking care of themselves when they look at it from that perspective. I haven't had a single physician completely leave their practice yet. And I feel like part of my job is to help physicians find joy in medicine again. I'm not saying that I, that nobody will ever leave. But I like to believe first, let's heal the healer, right? Let's bring that, as you say, health back to health care. And, you know, we have to heal health care so health care can heal. And I think that is the very, very first step because you have to go back to your why. Why did you even start this journey? Do you want to give all that up? And most of the time it's no. So, I think that you can be calm in the chaos and you can find joy in medicine again, independent of the EMR, an independent of the bureaucracy and all the other stuff that's going on. But if you really get to that amazing place and you feel like you are your best self and you want to step out, that's okay too. I love that you talked about healing the healers, right? I think, I think back to Dr. Ndi Cheng who came in and also brought up this concept that we have to do. You know, I'm wondering though, if we don't have to, if there's a future where we don't have to. And I think that one way that that can be addressed is if at the start, at the level of the younger generation, I put myself in that category, darshan, I still train ease, where they don't have to go through some of the things that you might have went through, right? Whether it's residency, the training hours, that kind of situation, the mistreatment, what not. And I think that we've just made strides, right? We've got work hours, restrictions, 80 hours. Everybody knows not, everybody follows that. But still, that's a different discussion. ACGME has really made a tremendous push for wellness, right? And whatever that means. And that's an important concept. You also, but at the same time, I think that culture of medicine, it takes a long time for that to change, right? I mean, you're one of the ways that you're doing it, you had to kind of step out of it, right? You're still there, but you had to step out of it. And you also, a few moments ago, talked about how we do so much, right? We do so much of undergrad and medical school and then resins training, which can be anywhere from three years to eight years, depending on the fellowship. And I think about this concept of that I'm going to talk about, it's an escalation of commitment, right? Or commitment bias. And I think he references his own brother, who always knew he wanted to be neurosurgeon. So they kept going. Then it was the next step, the next step. And now you're 15 years in. And well, God, you can't leave now, right? Now it's the next step, the next step. And then before you know it, you're, you really tremendously need healing before you can actually heal your patients. What are your thoughts or what advice would you give to train these or maybe even medical students or maybe even undergrads thinking about going into medicine. So the harm isn't even done. And the healing isn't required later on. Yes, great question. So my dream while I'm still on this earth is that the education that I'm providing now, which is essentially relieving suffering and picking up the pieces becomes intra-curricular at the very beginning so that we can prevent what's happening. Everything right now is on the back end, right? So I have medical students reaching out to me and I am working with them. I have pre-med students reaching out to me. I have pre-med students that have taken a gap year between college and medical school because they actually know the stats of what's going on and they want to educate themselves before going to medical school. But they are a few and far between. So putting this education, making it intra-curricular, you can decrease the call hours and you can you know improve a lot of things going on at the level of the healthcare system and the EMR and whatever. But you still have the human, the human that is sitting there on day one of orientation and medical school freaking out that they're not smart enough that everybody else is better than them that they're not going to make it as somebody made a mistake in choosing them and in you know accepting them. That starts day one of medical school. I work with those medical students you know and they're already a mess a few months in. And what we know from research is that when they studied matriculating medical students and their age matched peers, okay, they studied them. Medical students aren't coming in broken. Medical students actually have a higher quality of life less burnout and less depression than their age matched peers. So they're coming in at higher protoplasm right? Our mid students are coming in amazing but 50% of them are getting burned out and 10% of have suicidal radiation and 30% of them are depressed. So we know that starting at medical school in medical school we are taking these amazing humans and the process is already breaking them down. So I believe that we need to have this education intracurricular at the very beginning starting with day one of orientation. Now how can I do that? I've tried to talk to deans. I've had conversation with deans and I am working on it but I believe that that's the answer. No I love that and it sounds like a three-hour mandatory module on burnout isn't going to take care of that right? I say that tongue in cheek but I really love that. I mean again, you know we talk about the concept preventative medicine that you know sometimes doesn't really exist right? I mean it's just something this made up thing but what you're talking about now I mean it all has to start about earlier intervention right and risk ratification and unfortunately going into the healthcare industry it's it's kind of a risk right for this. Much earlier than other professions I think. You know we wanted to ask you what you would tell the younger Robin right knowing this story knowing all the information right from the physiological level the mechanistic explanations but also that 50,000 view that we talked about. I'm actually curious what you would tell the Robin in third grade when you saw that skeleton come out. Yeah well I still will tell her to go for it but I would want her to make sure that she got the proper education so she had the toolbox that she was equipped so that when she stepped into this journey she was armored with which she needed and I was not and every other medical student that starts with they're not either so I wouldn't say don't do it but I feel that there needs to be this education that is this missing gaping hole in this whole process. Yeah I couldn't agree more I mean you know we're talking about education in medical school I think there's a need even for education for these things in grade school you know starting us even younger I know a lot of other countries look at that I think man I can't remember if it's China or Japan but they actually just teach social and emotional intelligence up until they're about in like fourth or fifth grade and that's when they really start you know they're basic science as math and all that so it's interesting you know and there's a lot of wisdom that you're saying and you know there's a lot of wisdom through your experiences and journey and you know ultimation to eye or you know lucky they even have you on here to kind of listen to this and soak it in I do want to ask you you know you're known as the stress-free MD what does it mean to be stress-free now that we've kind of talked about this yeah well the thing is nobody walks around 24-7 without stress I mean that would mean we'd have no sympathetic component to our physiology we're just kind of ragdolls all the time but what I think is it means is you do have the tools and you've built your toolbox for whatever's coming your way so you know how to take care of yourself you know how to feel better you know how to be the healthiest and happiest version of yourself that's what it means I like that you know something that we're striving for every day you know um and you can just tell by your composer and demeanor here you know making this podcast episode stress-free so absolutely loving it you know one thing I did want to ask too was you know again I'm going to reference my burnout from last year is I didn't really reach out for help you know to family to my wife to friends when I probably should have you know just to kind of release some of that pressure to vent a little bit how can we gain comfortably when we are feeling stressed and burnout to reach out to our loved ones to reach out to those who probably have a way of securing or messaging with them well I think it's important to normalize what's happening I don't know if you've seen the med escapes 2022 physician burnout and depression report that just came out but we pretty much have four out of five physicians burned out at this point so if we've got a million docks in the country we've eight hundred thousand burnout positions okay so a lot of people think they're alone because also egos do not allow us guilt does not allow us we feel we've been through all this who am I to say I have a problem look at me I'm so lucky like I can't complain about anything right so we need to normalize it normalizing it doesn't mean it's okay normalizing it doesn't mean it's fine but when physicians recognize that four out of five of us are feeling the same way it can make you feel not alone and you feel that this community is with you so for me I didn't know that there was anybody else and I didn't have a label I didn't have anything right so I think that the more we talk about it the more that people like me are vulnerable and share stories the more that it's out there in the literature doctors will feel more comfortable discussing it because we normalize it and I think that's really important what about the flip side right I I don't know this for sure but I suspect that you know you mentioned your colleagues who lost their life way too soon and you mentioned one of your big sisters if I think sometimes there are signs right often there aren't but sometimes there are signs and what would you tell you know somebody who listens to this episode I don't know if it'd be a good strategy to send it to somebody who might be down right might be experiencing that just forward this I don't I don't think people are as receptive to that um how could someone who can register those signs with their colleagues their you know residency mates and you know trainees and that kind of stuff or just even in the attending good are picking up on those things and and know that some things off but need help but aren't reaching out to them like Darsha asked for how can they communicate and open up that conversation to say hey this is the safe space I'm here yeah I mean I think just being there you know I had to take a suicide awareness course for life coaching and there are a lot of really important points in there but recognizing when somebody isn't themselves and being there and saying hey I'm here for you do you want to talk can I help you you know do you want to talk to me and you know there is this there's an incredible collective of mental health care professionals that offer free calls physician to physician for physicians who are suffering so in addition to a suicide hotline they're actually mental health care professionals that are doctors that have voluntarily given their time to provide therapy sessions to doctors and they can call this number whenever they want to call it so I think giving resources is very helpful too because someone might not want to open up to you but they might be more willing to talk to a a neutral individual who is specializing in this area who's also a doctor doctor to doctor so that's what I would recommend but I didn't see any signs because again lots of people wear a completely different armor like I did on the outside absolutely I mean it's definitely challenging to say the least in you as you mentioned or as I mentioned a long time ago you know it's sometimes having not all this knowledge of course like I've learned so much or talking to you but I think just being in this space and having an interest and and appreciating how often it is important to step back and look at the bigger picture for the patient but also look at the mirror and see what's going on I still find myself sometimes just because of the culture that we talked about the way that we're trained telling my wife hey the show must go on right and and I think that this is given me some some time to just reflect in some introspection as well and that when it is appropriate and the important of a social network like you're talking about you mentioned a little while ago about all the courses that you teach right and the 18 different courses that you mentioned that we're going to link what's your what's your current business or practice look like you know you're teaching about courses but what else are you offering yeah so I focus on getting CME and everything I do because I feel like physicians should get paid for learning how to care for themselves so I do have this one program rx inner piece a physician's guide for self-care which is a really innovative one-of-a-kind program which incorporates everything that we talked about it teaches the busy lot physiology aspect of things how to really bring home new stasis tear nervous system and also that live coaching piece and it's self-paced docks are super busy so lessons are really short like 15 minutes or less because everybody's really busy right and so that program is like the mothership program and I also coach privately right so physicians lots of them will come from that program and want to continue with me or they just want private coaching I have a podcast which is the stress-free MD podcast where I teach short snacks of stress-free tips that can be implemented right away I am starting to coach my medical society I was just asked to join the faculty of the American College of Lifestyle Medicine as the subject matter expert for stress management so I'll be creating the content for their next board review coming up um how else do people work with me I've been doing retreats I present I give talks virtually being me in um didactics for residents you know like social med students you name it so it's really whatever whatever people need I love that you are so incredibly busy you're getting the message out it's amazing that you're managing people's stress levels low oh with that um so you know just just hearing all that stuff like oh my god there's so much getting anxious but so something that I need to work on you know Darce tells me when I tell them I don't have 10 minutes to meditate he tells me I need 20 minutes that's what I need to do so um it wants to have at a time we'll work on it um yeah so all those things you you mentioned work in our listeners find you how do they access all this stuff that you mentioned yeah they can find me through my website stress-free md.net and wherever you are in social media I'm pretty much there linked in instagram facebook twitter okay you can find me in all those places wherever you're favorite social media platform I think I found you guys on instagram um and uh yeah I'm really accessible if you want to hop on a free call I'm happy to you know help you get started on your stress-free journey perfect well this has been an awesome doctor tiger I really want to say thank you from the bottom of my heart for you know showing up here um keeping it again stress-free your demeanor your composure I mean I can really feel it through the screen even um it's been inspiring and really motivating for me to even you know just hone in on my practice a little bit more and become more grateful and to have those conversations with with myself right I think we can be our biggest enemies but also our biggest friends um and there's no one else you kind of go in this through this life with other than yourself you know day in and day out um and I truly believe in synchronicity right like your yoga story um in the check and today is the chinese new year and it is the year of the tiger so what is so what is next for you oh what's next for me um well I'd like to be able to work at a national level and so I heard dr. Vivek Murthy our surgeon general talk about how he's focusing on a national agenda for physician well-being I have the privilege of meeting with the chief of staff last month and I'm hoping to continue the conversations to help at a more national level so dr. Murthy if you're listening or max your chief of staff I am here to assist another than that um just saying yes to as many projects and collaborations as I can to coach and help as many on the medical journey journey that I can love it yeah I know ultimation I can't wait to get this episode out there for everyone to listen to uh last question for you uh we ask all our guests is how do we put the health back in health care so I think it starts with the human right and recognizing that we are humans right and so we as physicians are really the gatekeepers of health we need to set the example the most recent stats that came out through medscape set less than one third of all physicians care for themselves on a regular basis so we have some work to do so I think the answer to that is first from the top down not that we're better than patients but they expect us to set the example we need to care for ourselves first and that is how to put the health back in health care when we set the example we can teach our patients what we've learned um my CME provider UNC loves that what I teach physicians they are now teaching their patients so when you learn how to do box breath you teach your patients how to do box breath for example so we put the health back in health care by taking care of ourselves first and then sharing it with everyone else love it thanks so much Dr. Robin oh thanks Robin thank you thank you so much and there you have it an amazing episode with Dr. Robin Tiger the self-care doctor and the stress MD now as you guys know mental health issues are at an all-time high right now so if you feel like this episode will benefit someone you know please please share it with them I think the information that Dr. Tiger presents in this episode is super valuable and I think we can all learn how to become a little bit more stress-free and if you are enjoying this podcast please go ahead and leave a five star review on apple or Spotify or wherever else you listen to this podcast everything in this podcast is for educational purposes only it does not constitute the practice of medicine and we are not providing medical advice no physician patient relationship is formed but anything discussed in this podcast is not representing the views of our employers we recommend that you see the guidance of your personal physician regarding any specific health related issues to see you in the next episode