73. Finding Mindfulness & Improving Productivity | Serene Shereef, MD

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. Our guest today is Dr. Serine Sharif. Dr. Sharif is a trauma, acute care surgeon, mom to three children and a transformation on life coach who helps a woman physician struggling with burnout and overwhelm to create their life by design. I love chatting with Serine because she has a unique framework which combines the energy of mindfulness and self-compassion. She does this by staying true to the scientific principles of habit building, time design and individualizing systems or productivity, so one can do less, live more and create the dream life. For her medical training, Dr. Sharif graduated from the Penn State College of Medicine in Hershey, PA and went on to complete her residency training there as well. In this episode, we discuss two topics that, to many of us, seem to be at odds with each other. And those two are mindfulness and productivity. I have to admit that, for quite some time, I've been guilty of seeing these as two distinct systems, if you will, but at least my viewpoint on this has developed, though, and, although conceptually, my thinking on this has changed, the application remains quite challenging nonetheless. Luckily, Serine offers us some strategies to help navigate through this skill acquisition period. So, without further delay, let's get right to it. Please enjoy our discussion with Dr. Serine Sharif. All right. Dr. Serine Sharif, thank you so much for coming on to the Medicine Redefined podcast. How are you doing? I'm doing great. Thank you so much for having me. Yeah, absolutely. So, I'm really excited to talk about this, you know, mindfulness, productivity, things that I'm constantly thinking about on a daily basis. And, ultimately, I have touched on this. It's been an underlying theme. I'd like to say throughout all the podcast episodes that we've talked about. So, I really want to start with this question. Usually we start with asking about who you are and things, but I want to delve into it. What is something that 99% of people would not agree with you in regards to mindfulness, productivity that you hold true? Well, what I have experienced is that most people think there are two separate things. And I have found that people really want to focus on having more mindfulness in their lives or, you know, doing activities more towards that versus, okay, now like a separate container of thought, how can I increase my productivity? But I feel like they're both so intricately linked. I have really been a huge productivity nut for a long time and I think it's just, you know, from everything else going on in my life, I felt like it was a foundational aspect of my life. But it wasn't really until I incorporated mindfulness that I saw my, a huge boost in my productivity and really changed how I'm able to do things in a way that I never was able to before. So I think it's very synergistic and together they're definitely way more than, you know, how each of them are independently. Yeah, absolutely, right. I think, especially being in the medical field, I mean, all three of us probably have our workflow somewhat down, right, in terms of efficiency, productivity-wise. I mean, that's the only way you can kind of make it through, right, is to have some sort of system. But to incorporate the mindfulness aspect of it, right, and to delve deep into it, I think takes something, some sort of event, some sort of situation, some sort of event in your mind, like a meditation where it says, hmm, I've now thought about this a little bit deeper and actually mindfulness is a huge, huge part of my workflow. How did you become so interested in mindfulness? Well, it was really because of, you know, a variety of events in my own life. I was going through burnout and I felt like I had hit the sort of the edge of my productivity. I was already working maximum hours that I could. I had borrowed from my sleep and my rest and my personal time as much as I could. And I found that I was doing the best that I was, the best that I could, and yet the needs in my life were just beyond what I could really kind of pull together. So for example, this is probably something that a lot of young physicians, especially as they're starting out, building their practice, and even, you know, mid-career, et cetera, we're all facing this because when we're at work, you know, we're kind of thinking, oh, you know, we've got the sick baby at home or, you know, maybe something's going on with your parents or something is, you know, you're really excited and planning something with your friends. And yet, you know, how many times have we had to put aside our plans or things in our life or even not be able to make it to the things that we want to because of work? And so I find that, you know, what a lot of people really even share with me is when they're at work, they're just trying to not think about home, but they can't get their thoughts, right? So, you know, you're trying to finish charts and your mind is like spinning thinking, oh, I got to go home and I got to do this and I got to do that. But then when you're at home, you think about, okay, I, you know, I need to get through dinner so I can go finish my charts and I can, you know, put those orders in or I don't want to forget about this. So this is really how I came to mindfulness is because I felt like my mind was just racing, thinking about all the things that I had to do. And, you know, you hit a point and you go, this is crazy. Like, this is not productive in any way. And how can I improve my efficiency by actually maybe doing less? How can I dial some things back and be intentional in where I put my focus and my energy? And so I've done meditation and yoga even, you know, in my younger years through my teens and early 20s and it was really just when I started medical school that I stopped having the time to do it. Now thinking back, I wish I had continued because it probably would have, you know, helped me become more mindful and present in my patient interactions and all of the things that I was doing before. So yeah, so I think that's really how I came to it. I was looking for something to help me slow things down so that I could really be intentional. And it was amazing when I started to do it, what I noticed was even, you know, now I find even patient interactions that I used to find annoying or I'm like, I just wish it would just be over. I realized, wow, there's so much in here, you know, there's so much slowing time down, like when I finish a case, for instance, or, you know, when something goes well, we never take time to be mindful and celebrate the good things we only think about, you know, oh, this is all the things that I didn't do right today, right? Or when you're with someone, how can we be present? So yeah, maybe you're not with them, like 24, 7, but the time that you're with them, it could be even more meaningful. So that's really how I started using it. And then I just feel like it's really strengthened every aspect of my life. You mentioned how most people seem to think that those are two opposing things, right? Mindful and productivity. And I have to be honest, I think I've been in that camp for a long time. And only until very recently I've started looking at them as maybe one of the same or at least linked. And I think it just, it's a natural thing, particularly for high functioning professionals, right? We're all in the medical field and it's all about putting your head down, getting through one hurdle to another, right? You're medical school, first year, second year, third year, fourth year, residency, fellowship, et cetera, et cetera. And it's all about checking the boxes and you've alluded to some of those boxes and if you're not checking out the boxes, you're not being productive. You're not looking forward to the future, the next task and the next task. And the misconception often with mindfulness is that you're sitting there, the legs crossed, you know, saying a some type of mantra or just box breathing, some version of, you know, again, people confuse mindfulness and meditation often and we've talked about that at length before. And so, you know, people see that and they're like, well, this, that can't possibly do the same thing. You alluded to the fact that you realize a couple of years ago, hey, these, there is a connection. This is LinkedIn. I need to appreciate that. And so, say a little bit more about how exactly they're linked and how have you continued cultivating that scale where moment to moment, you're able to string together to stay true to being mindful, but also not quote unquote, compromising the productivity of getting things done. Yeah, absolutely. And it's so true, it is the image that people often share with me, well, I don't have time to sit down and meditate for an hour or I don't have time to do, you know, whatever their version of mindfulness might be. And what, what I would challenge is that, you know, or really invite anyone listening to think, what would it be like if you actually were able to be 100% present in every moment of your life? How many times maybe while you're driving, maybe while you're talking to someone or listening to someone, maybe, well, you're even, you know, taking a history and physical, right? Like how many times do we tune out? Do we, you know, our brain just sort of like go somewhere else, you know, our mind wanders? And the reality is that especially with all of the distractions in the clutter in the world right now, in our brain, in our work, in our life, our minds are so like, I mean, I'm sure everybody, you know, feels at some time or another, like they have ADHD, like their mind is just full of so many things and it's hard to focus. It's hard to really put all of our energy in one place because we're doing a little bit of this and a little bit of that. The multitasking has hurt us in many ways because that's not, that's our habit now. That's how we do things. So I would bring it back to what would it be like if just one day you were present for every single moment. Mindfulness is not just about being present. It is about having, you know, there are different elements to mindfulness. So some of the things are, you know, having gratitude and connection, having non-judgment. So doing something, again, having that inner voice going, well, you did that wrong and, you know, oh, you're probably, you know, you're going to screw this up and, well, you know, that person's doing something wrong, et cetera. Like all of that judgment, it takes us away from what is truly happening and somehow trying to figure out how do we create this alternate reality where nothing is wrong, right? That's not how life is. The other aspect is having a beginner's mind, curiosity. When we are, you know, I remember I used to, I was faculty at one of the universities for medical students and first and second years. And there, the way they asked questions and looked at things was so amazing. And it was a time that I was feeling really burnt out and just sort of dissolutioned with medicine. And I'm so grateful for that time because if it weren't seeing that and seeing the magic in medicine again, I don't know that I would have gone back to practice. You know, I'd have been like, I know, it's, you know, it's done because we lose that. We lose that during residency. We lose that maybe in practice and we get so busy with doing the things that we forget what brought us to medicine. And each of us, you know, I know we have a different story, but still there was a curiosity. There was an interest. There was a, you know, that that interest in seeing what is the next step. And I think that's what mindfulness truly brings. So no, you do not need an hour and you don't even need to sit down and meditate. This is just bringing awareness without any judgment to the moment you're in with an open mind, trusting yourself, not saying, oh, well, I probably got it wrong or, you know, somehow there's a problem. There's no problem. But if you open your mind, what would that be like? So I used to tease one of the things that I don't really enjoy doing is laundry. And so I started figuring out, well, how could I do like mindful laundry? What would that look like? And I played with it a little bit, you know, that's part of mindfulness is opening up that creativity and playfulness within us to say, how could this be fun? Even something you don't like to do. Mindful cooking, mindful walking, mindful eating. We know that mindful eating actually can help with emotional eating, overeating, etc. Being aware of what we're eating and building satiety and connection. So it's not just this mindless, like, you know, you just eat and you don't even know how plates empty, right? Being fully aware of your hunger and when you are full. So I think that you can incorporate that into really any part of your life and have fun with it. Yeah, absolutely. So, you know, you mentioned how we've kind of lose that spark of curiosity as we become residents, attendings, onwards. And I mean, I think it's almost safe to say like 80% of maybe, maybe even more, 90% of what I do right now as a resident in the present moment is something that I wish I wasn't doing. You know, I mean, like, I already know kind of what I want to do in the future in somewhat and I know we're going to be talking about not looking at the path. But if we're talking about solutions, right, if we're talking about how to stay in the moment, I mean, I can give you the example today. I had a patient 30 minute visit, the patient afterwards is already there in the clinic. So in my mind, I'm thinking, okay, how do I make this efficient, right? How do I become productive here? But at the same time, I'm asking questions and this patient is tangential, talking about other things. You know, what kind of solutions do you have in mind? How do we increase the mindfulness within medicine itself, especially when so much of what we do is, you know, boredom or not where we want to be in the moment? Yeah. Well, the reality is actually, that's how it is everywhere. You know, again, not to connect it back to laundry, but really everything about life is about laundry, right? How much do you have to get that? So it's really just an analogy, but there are going to be things in medicine in life that we don't want to do. It's the, you know, the tedious part. And connecting the tediousness to something that you want to do is going to be a lot more effective than when you go down the pathway of, oh, I don't want to do this. Oh, my goodness. This patient is talking so much. They're driving me nuts. Like what's going on? You know, that type of sort of thoughts in our mind because then we are totally not paying attention to this patient and we're not serving them and we're not really serving ourselves. So I have found just bringing myself back to when I do things, especially a lot of the documentation part, you know, the clicking the buttons. And I think, oh, you know, why do I have to do this? This is terrible. And then I waste time really sort of persevering over that. I instead think about how what I'm doing is helping somebody. It may not be me, but maybe it's going to help the person who comes after me who's going to read the note and figure out what to do with that patient. Maybe it is the billing and coding person in my office who will find it helpful so they can do their job. Something that we do, whether it is something small and tedious versus what we think is, oh, this is the most important thing that we could do, all of the steps. Each part of it makes a difference. And sometimes I come across things and I'm like, I really do not see how this is helpful to anybody. Then for me, that's a place where I think, well, then why am I doing it again? You know, like, why do I continue to do it? And are there ways that I can either automate it? So for instance, if you look at charting, it's just, you know, if there's like a line that always has to go, then I just make a smart phrase out of it, right? Or if, so you can automate things, you can delegate things, can someone else do that for you? Or if both of those aren't possible and you have determined that it has no value, then it needs to come off of your to-do list or your calendar. So those are ways we can do it. And, you know, I think all of us have challenges with both time in clinic, you know, in seeing patients, as well as the charting aspect. And one of the things that I have found also is just looking at what is enough, right? Because I mean, a lot of us are perfectionists and we want to do the best at everything. And so, and sometimes, you know, that is what keeps me like in there and doing things. And I'm like, well, what if this was enough? Like, do I have enough to take care of the patient and be done so that I can keep going? And how can I really focus on that patient and communicate that and say, okay, I want to make sure that I address your important point, just to sound like, you know, that's it. And then you're done. Yeah. So I can tell, I mean, you've really delved into this, right? And I think starting with mindfulness will begin that thought process in terms of how do I make a flow chart for myself, right? Is this kind of what you're talking about? One, how do I make this process larger than just myself, right? How do I create value that's larger than myself? Two, is it even worth doing in the first place or do I need to reconsider something else? And then three, how do I just make the process even more efficient? And you may have come across this book by Ronald Epstein called Attending. So I read it during my intern year and, you know, his whole thing is about doing the work in the beginning is going to be hard, but the more time you spend on doing the hard things in the beginning, it makes it so much easier down the road. And that's one of the few concepts that I've taken away at least from mindfulness and productivity that I've still incorporated, but it's tough. It's tough to kind of keep that at the forefront of your mind with every patient encounter, with every click of the button on Epic, right? But I really like how you delved into those three kind of approaches in a way. Yeah, and when you think about automating, so, you know, I was talking about doing a dot phrase on charting, but when you look at the basics of it, it's really habits. So we all have habitual patterns of thoughts, feelings, and actions. And repeated actions are essentially, you know, what we all call habits, but really habits start from our thoughts. And being aware of what is the thought behind, you know, dot, dot, dot, whatever it is that you want to change. So when you want to automate something, anything in your life, from laundry to dishes to electronic medical records, to how you run your clinic, you know, how you may finish rounds, whatever it is, it all comes down to how do you do it habitually, and then you build a system, and then you keep tweaking it until you get it kind of where you want it to be. And, you know, we call that the golden spot, but really, in life, the golden spot keeps changing because life keeps changing, right? You know, things change, the way we practice changes, and we get older, and so we also change. So yeah, something to, I think when people are looking at, you know, how do they make their day a little easier? I find habits are the way to go. I wanted to talk more about this circumstances, thought, feeling, behavior, loop, stuff that you've talked about on your podcast quite a bit. But before I do that, I want to go back to something you said, because I've been thinking about it, you mentioned or you asked, what would it be like if you paid attention to everything basically throughout the day? And to be honest, my initial thought, my reaction was exhausting. I mean, there are some things that have to be automatic, right? I mean, I, I shouldn't have to think about the route that I take to work for the last year straight. Right? If you, if you have to pay attention to every little detail there, or if you have to do a tedious task like you're talking about when you're doing laundry, what is a, or what is a disadvantage of listen to audiobook at that time and not being mindful of the turns that you're making, right? Or not being mindful of the perfect fold on the pants that we're doing and stuff, right? I mean, so to me, those two things kind of, they're kind of at odds with each other. So help me, help me work through that. How should I think about that? Sure. Well, I, I'm not going to tell you how you should think about it. But I'm going to offer a few, few things to consider. And I think that not everything's going to resonate for everyone. So totally, you know, when you do things and if it feels like, you know, that's not really where you are. I think that's awesome to have that self awareness. And actually that's part of mindfulness is doing something and say, I don't really like this. I don't want to do it this way. And, and I think that's great. So the, the invitation I have for you is what if you weren't thinking about the root, right? Like nobody wants to look at the same thing over and over or think about that same pathway over and over. The brain loves efficiency. So when you have done something multiple times, it will automatically, without even you telling it to, it will, it will just, you know, kind of take that part over saying, okay, I got this part down. But what if you paid attention to, you know, when you're driving like maybe for a long time, you weren't really paying attention. Now you're going to look up and you're going to see the sun setting as you drive home. Or you might see, you know, someone next to you in the car and they're doing something funny, you know, engaging with your environment in a way that you have not before. So, and I'm a huge believer in podcasts, audiobooks, all of that. And I totally use the time to listen to other things as well. So I don't think we have to do it the same way every time. But what I invite is for everyone to just think, if I'm being present in this moment, how can I create meaning and value? So meaning and value is so unique, right? I mean, it's, what is meaningful to you is going to be different for me. So when you are driving, I want you to, you know, maybe for the next week, I want you to try something different every day. And you could, you could do an audiobook one day, you could try different audiobooks, you know, see if like there's a difference between listening to something funny versus something serious, like you could listen to music. And maybe one day you're just going to kind of look around, you know, there's a meme about someone's like, there's this person at the coffee shop and he's just looking around and smile like, you know, like, what a weirdo. I mean, people used to do that, right? Not be on their phone or not be on any electronic device, but actually look up and see things around them. And, you know, so I think that there's a lot to be said for just looking around as to see what is going on out there. I recently, when I was driving the person next to me in the car kept pointing to my car and I was like, what is he doing? Like, I'm not sure why he's pointing to my car, maybe the door is open or something. So I pull over, I'm checking and doors are fine and I didn't know what it was. But it turns out that I had my, one of my tires was, it wasn't even that obvious to me, but it had lost a little bit of air. So long story short, I get a check dot and there was a nail there and it was slowly losing air and it would eventually probably have gotten into trouble. But I found it in a place where there was a repair shop right next door and I was so grateful to this stranger who was paying attention and I would never have known otherwise. Not just paying attention, but he, you know, like literally was trying to signal someone he doesn't know me, right? So I think that when you look around with no expectation, but just thinking, you know, I wonder what else is going on out there. Sometimes, you know, what you might engage and interact with might be different. And I, I would say maybe about 50 to 60% of the time when I go for walks, et cetera, I still listen to things, right? I enjoy that and I find meaning and value in what I do. And sometimes I don't and I just listen to, you know, what the birds sound like or maybe I'll take a different route. And I just look at what the environment is like because we want our brain to learn how to recognize these different patterns of creating awareness and creating thought. It is not something that, you know, is going to come naturally. When you first do it, the first thought that most people have I had was kind of boring. I mean, it's not as interesting as that book that I was listening to, right? Because life has slowed down and we're not used to that. Boredom is the first step to creativity. If we aren't bored, then, you know, we are not, our brain isn't pushed to think, to innovate, to create something new that you might never have thought about. And some of my best daydreams and, you know, vision, like envisioning what else could change actually came from these moments of boredom where I was walking and I'm just like, okay, I don't want to listen to these birds anymore. Okay, I need to think about something like, what can I explore? And that's kind of how it happened. So my kids, they know, when they tell me that they're bored, I'm like, that's great. That's the best thing I could have heard all day. Well, I appreciate that and I'll certainly increase the time or the percentage of my time that I spend, you know, driving or just being more mindful. But, you know, one of the words I used previously was being non-judgmental. And I think that that stands out to me because, again, if you don't practice this art of just paying attention to every little detail, the art of not reacting and non-being to the mental, why am I wasting time, that you're never going to develop that. So I think from that standpoint, I do get it and, you know, you work closely with patients now, right? You've got a coaching practice and we'll call this an attention audit. How frequently do you recommend this to your clients that they do this, is it a weekly basis, you know, once a week or, you know, once a month or just really whenever you feel like it or whenever you remember, do you set a reminder? Is there some structure to it, or is it just whenever it comes to your mind? I want to make sure that I understand the question correctly. Are you asking how often I recommend raising awareness on, checking in about the, essentially the judgment part of ourself, because we all get stuck in the rat race, right? So we're, again, we're talking about high-functioning professionals and I know you work with a lot of those, right? So it's very easy to fall in the trap of just thinking about the next thing, right? And one of the things that we've been talking about for the last couple of minutes is taking a step back and not thinking about the three steps ahead, right? Just focusing on this one and maybe just the next one, maybe. And so I imagine that maybe when you're in my seat, you know, there's, it's a skill that you have to develop over time. You know, it's, it's not easy to do, right? Your brain will revert to something you've learned for 10, 15 years. Medical training is depending on what you do anywhere from, you know, eight or seven to 10 years. And so relearning that in the beginning is going to be very, very challenging. So when you advise that and you're unlearning these behaviors or your clients or how do you advise them to do this checking in period? Honestly, every day, and, and it's something that I practice daily because this is something that we have already learned to, to do, I mean, the opposite of what I'm recommending, right? Like we have learned that every day for years and years, even for a lot of us, it is from undergrad onwards, you know, trying to be getting all of the corners, you know, crisp and getting everything right. And so criticism, and I mean that, you know, it sounds negative when I say it that way. But being able to guide ourselves by checking, what are we doing wrong? How can we do better? Is I think a question that we have asked ourselves for a long time. And the goal always was to continue to be better. But what I found is that my brain could only go to what's wrong. And I first started this practice of really the opposite of judgment, self-compassion. So self-compassion work is a huge part of what I coach on and, you know, what I share because I honestly had no self-compassion when I first started because I felt like, okay, you know, like these are all the things I'm doing wrong. And then I just need to suck it up buttercup and get it done, right? I mean, there's no reason to sit here and feel sorry for yourself because that's not going to get anything done. And so these are the kinds of thoughts and habitual patterns that show up in my life. And that I hear from a lot of others as well. It is, you know, if you think about our M&M process, our morbidity and mortality conferences and how we look at each of these cases. Now, I don't know about, you know, everyone, but in my training, without naming any names, you know, it was very, very, it felt like there was a lot of blaming, shaming and guilt involved. And I felt like I lost the part where I'm supposed to be learning. So when we look at something that has gone wrong, right, and of course, there are going to be things that go right and then there are going to be things that go wrong and we need to have awareness as clinicians to be able to do an assessment, an honest assessment about what are the things that didn't go right here? And how can we make this better? That is learning. When we bring in blame, shame, guilt, you know, this person did this wrong, that person did that wrong, and this is why all the things went wrong, you know, as humans, we get defensive. And then our thoughts are either, oh my God, that's terrible. I've done this terrible thing and now like, you know, and then it's like, doomsday, you know, terrible things are going to happen to me and I'm never going to be better. I'm never going to, you know, practice in this area or whatever, whatever it might be. But the reality is that, you know, my mentor once told me everyone who practiced medicine, who's talking about surgery, you know, everyone who operates, they're going to have complications because that is part of medicine. But then we create this terribleness, this, again, you know, like shame blame and guilt is connected to every complication that happens. Where is the learning? Where is the role modeling to our juniors? This is how we take ownership of our mistakes. This is how we talk to families. This is how we own up and we make things right. I feel like that's not really discussed. And so, and that can only happen when we let go of defensiveness, when we're open to talking about what we feel, what we struggle with because the reality is honestly everybody's struggling with this. But no one wants to talk about it because they don't want to seem like, you know, they're not quite all that great. Well, you know what, you know, we all make mistakes and we all learn from it. So I think that that's for me, that's why it's so important, especially when we are, you know, doing something that is, you know, that has that life and death implications and the decisions that we make in the recommendations that we tell our patients in the procedures and, you know, processes that we follow through. So if we don't practice actively every day self-compassion, then we're going to go down this rabbit hole and then we're stuck back in that burnout path where we feel like, you know, things are terrible and it's never going to get better. So let's go back to this thought feeling behavior loop, right? And well, I guess it's all preceded by circumstances, as you've said before, maybe if you could explain to the learners this framework that you have and then we can talk about some interventions of, you know, how we can break that loop and maybe reframe it positively. Sure. Yeah. You know, this is really just sort of basic psychology, but a lot of people have taken this idea and they have, they've really explained it in a beautiful way. So I'm going to use the model, it is the self-coaching model from the life coach school, which is where I did my coach training. And you're going to see this. I mean, there's so many authors who've written exactly this model and I did undergrad psychology and I remembered this from, you know, undergrad psychology. So what I'm going to share is really not anything like new that no one's ever heard before, but even though I had heard it in undergrad, you know, even though I had read books on it, I never really, you know, the simplicity of what I'm going to say, I never realized how transformational it is. So circumstances are facts. There are these things that are in our environment. So people, things that happen, you know, words people say, whatever it is, these are just things that if I looked at it and you looked at it, we would both agree, okay, that is a fact. In a court of law, we could prove that, you know, so and so really did say this, right? And then we have no control over circumstances. But everything else I'm going to share now, we have absolute control over. And when I say that, I want to put a caveat to it. Half of what, well, actually, probably more. And this is where mindfulness, by the way, comes into play and self-awareness. We have our conscious and our subconscious, unconscious space, okay? We are only aware of and therefore can only change things that are within our consciousness. If we don't know it exists, even if it's deep in our mind, we can't change it, right? So the more mindful you are, the more connected you are to your own thoughts, you know, self-awareness on what is happening, why are these things coming up? You know, why is this a trigger for me, et cetera? We're not going to be able to change that. So we, each of us, we experience this world through our thoughts. Now what I mean by that is, say there's a chair. I sit on this chair, chair being the circumstance and my thought is, this is amazing, this is the coolest chair ever I like it. That thought triggers a feeling of maybe wonder or excitement that I found this cool chair. And my action that is directly connected to my thought and my feeling is, I sit on the chair, you know, maybe I don't want to give up the chair to someone else, right? Like, I'm like, hogging that chair. And the result is, which is always a reflection of our thought is that this chair is amazing. Like I am enjoying and finding wonder in that chair. Now you come sit on the chair and you're like, this chair is so uncomfortable, I do not like this chair, right? I mean, we've all had that. We look at the same thing. We experience the same thing and we think one person experiences it differently than another and it's just through our thoughts, our thoughts are really, again, how we experience the world. And it generates the feelings, then actions and ultimately our results, repeated actions become our habits. So repeated thoughts become our beliefs, our stories that we tell ourselves, the, you know, what sometimes people call mindset, et cetera, it's just, this is stuff we repeat to ourselves. So when we are aware of a thought that causes pain, that maybe is causing problems in our life, you know, we call that a thought that doesn't really serve us. It's not really making our life any better. Then we have the choice to say, well, I don't have to think that. I could think something else. Now, it's not going to be easy to go from this thought that you've thought for a long time, you know, you're kind of attached to it to creating something new. And that's, again, where repetition, awareness, self-compassion, all of that comes into play. And we can really slowly shift and it's really as simple as that, but so much more complicated because it takes a lot to build that awareness and then be able to create that shift. So, you know, with your clients, when you're talking about getting to this level of awareness, right, we're living in a dopamine crazed world right now where our mindsets or thoughts are really lasting five seconds, right? And I think, you know, I've gotten to the point of what you're talking about, but a lot of it took meditation. It took sitting with my thoughts and being uncomfortable with them as if it's in, you know, I think of meditation as my email inbox and things are flooding. You're sifting through it. You delete, but as you're deleting, more things are coming in and the goals eventually, you know, kind of look at it, get to an inbox of zero, but that's going to take a long time because you're starting with an inbox of a thousand with human nature. Is that kind of what you're recommending to your clients is to be able to sit down with their thoughts? How, what's your approach with that? Yeah. And first of all, you know, something to, to even ease that feeling of, oh my god, you know, I've got like 10,000 emails or 10,000 thoughts, which by the way, we have about 60,000 thoughts a day. So and and the majority of them are subconscious. In fact, a lot of thoughts that cause pain, fear, anger, frustration, all of these negative feelings, a lot of those thoughts tend to be subconscious. We don't want to be aware of them, right, because they cause pain. So, you know, I offer to my clients that you don't, you know, the goal isn't to get to an inbox of zero, because life is going to continue to happen. The goal is really to learn how to create a pause when you experience something that creates, you know, generates emotions that you're not quite sure how to deal with. So a lot of us, we, we experience something, we have a thought about it and we react. We're in a reactive mode. And you know, when you think back to all of the times in the past where you've maybe reacted and you haven't taken the time to think about it, some of those aren't really great experiences, right? But when you, when you create a pause and you think, okay, this has happened and it is now generating an emotion within me that I'm not, you know, I don't feel comfortable with. Maybe it is fear, maybe it is pain, maybe it is discomfort. How can I allow that feeling? How can I understand the thought that is coming from it, right, the thought that is triggering it? And how do I want to intentionally, consciously respond to it? And that is, that is a learned skill. So so that is the ultimate like, okay, yes, we want to get to a place where no matter, you know, like, no matter how crazy it gets, right, like the kids are going nuts and dinners not ready and, you know, everybody's crying and, you know, our patients are upset and, you know, our boss is like saying things to us that we don't, we're like, why are you saying this, right? When all of those things happen, how can we find peace and calmness and contentment? Just where we are. And that is, I mean, I'm still working on that. But back enough for a second, what I really have my clients do is, I ask them, you know, what are the things that are coming up for you? What do you want to work on? And that's really kind of how we start. So I have a framework that I take them through. And my goal is to help them go from where they are, where things feel difficult and uncertain to getting to a place where they feel like they're really living their dream life. So they get to design and create what they want it to look like. We do do some visualizations and guided meditations and things like that, as well as, as well as a lot of journaling, you know, I give them, I give them journal, like idea prompts. And I, you know, these are the things that based on what they're struggling with, et cetera. These are the things that I want them to think about. And then just free journal, whatever is coming up. And I have found that when you, when you combine meditation, and it could be really short, like five to ten minutes, you do not need to meditate for an hour to truly get those benefits. But you need to learn to let your mind be where it is and just open up, you know, go through any type of meditation process, you know, that they want to. And then that is when you're the most connected to your, you know, the thoughts that are not accessible. So this would be your subconscious. It takes a little bit more work to get your unconscious. That's like, technically, they call it like the space that we can access, right? But it is accessible. All of this is accessible to us. So you meditate and then you journal right after. And I have found that with that, it really opens up a deeper level of connection and awareness. And so when you journal, when you journal from that space, you're accessing information that you may never have been aware of before. Yeah, I like that, right? And I think throughout you talking about that, you said the word learned, right? And this is a learned skill. And I think it's so easy for people who have, I don't even want to say master mindfulness, but who are pretty comfortable with it to say, oh, this is what you do. And, you know, this is all I do. And I've said that many times to many people is like, oh, I just meditate for 15 minutes. I journal, I do this, and people try it. But they say, whoa, whoa, whoa, like no way I'm doing that. And thing again, it's a learned skill. This thing takes time. It takes practice every single day. It's an up and down journey. But over time, you're going to look back, you know, two, three months and say, whoa, like, look how far I came and I'm seeing things that otherwise I wouldn't have before. I want to transition now to something you've mentioned in another podcast where you say, we need to stop looking at the path forward. And we know it's human nature to look at the future, have some sort of anxiety, and try to understand where their life is going to unravel and kind of have a path. And I love this concept because a year and a half ago, I did a TEDx talk, and it was about how our truth is ever evolving. And I think it kind of hits the same notion, at least from my perspective, it's about how we have all these truths and it's written in stone. And we think all those stones are going to line up perfectly for us. But the next thing you know, a stone is turned over. And you now have to take a different path. And so it's okay to be comfortable with understanding that this truth, everyone's truth that we're always seeking, but we'll never find, is going to change. So I just want to hear from your perspective what exactly you mean by, we need to stop looking at the path. Sure. So it's interesting. If anyone had told me like 10 years ago that this is what I would be doing, and this is where I would be, I would be like, I don't know what you're talking about, like that's totally crazy, right? This is not what I ever expected to do. Now I used to be one of those people. I wanted to know what was going to happen for the next 20 years, like planned out, you know, this is like, this year I'm going to do this. And you know, next year I'm going to do whatever. And I still like to plan. I'm a planner. And that's just who I am. But I guess now I'm a planner that literally, like I have an overall vision of what I want my life to be, but I don't worry about what is going to happen. So 100% right? So because you know what, the reality is that we just don't know. And it opens up a space. It opens up a space that, you know, you get to explore, you get to play with it a little bit, because the old version would be like, well, I mean, if I need to get there, then I need to stay focused. And I can't get distracted. And I got to do this, this, and this, and you know, you're going down this pathway and you're right. And then you know, like where are you really going to find that energy or, you know, that focus to pivot because you've got all of your eggs invested in this path. But if you don't, if you allow yourself to just be and do one step, then what I found is that every action builds more clarity. When I do different things is when I realize, wow, like this is amazing. And I never would have known that if I hadn't kept an open mind. So I think it's, when we try to think 10 steps ahead and we're living in that space instead of now, then well, first of all, we're not being mindful to the present moment. But also we are, I think, missing a little bit of the magic of discovery. Yeah. Yeah. I've also seen, I think, more opportunities open up to you when you, when you, when you yourself are open, right? Like after residency, I don't know where I'm moving to. I'm open. Yes, I have a vision. Yes, I know exactly kind of the things I want to do. But I don't know the people I'm going to meet. I don't know what tomorrow brings or in two months. And I think there's so much excitement and wonder to that that I've really truly learned to appreciate. I mean, before I could tell you as a pre-med, it was like, nope, I'm in a 7 year med program and I'm going to this and I'm going to that and none of that happened. And looking back, it was like, wow, that was actually the best thing that's ever happened to me. So through those process and quote unquote failures, I've learned to really just appreciate the journey, right? And I think it's just, it's just such an exciting time when you can, can, when, when you can truly enjoy it and not really worry. Right. And I just want to highlight something that, that you said that I think is beautiful and something that I think we, you know, it is a skill to be learned, which is just having belief in yourself, right? No matter where you go, you know you got your back, you know you can figure it out. It's going to be just fine. We think that life will only be okay if we follow the path. And when we get off the path, then like somehow life is like, it's over. You know, I've heard this from so many, like, oh, I didn't get that promotion. I didn't, you know, like, I didn't get accepted for that job. Like it was my dream job. And now it's over. Well, what if there's another dream job? What if there's something even better out there for you? And when you close your mind, when, you know, you're off the path, then, you know, then it's harder for you to see what is out there. And actually when you open your mind and look at, okay, what else could be available? You know, this didn't work out. I mean, it's totally great to have visions and, you know, I do that too. I love to plan. But when things don't work out, it's okay to say, I wonder why this didn't work out. What could be, what else could be out there for me? What am I missing? And asking yourself questions is actually a great way to explore curiosity because when you ask anything in terms of a question, it actually makes your brain go, oh, yeah, I wonder, you know, what could be as opposed to saying, well, this is just the way it is. And then, you know, then you're kind of like putting a period, putting a, you know, closing the door on anything else that may come up. So believe in yourself, you've, you know, I mean, all the things that we have done to get here, we'll figure out the next step, whatever, whatever it is. And we don't have to know all of it. Speaking of skills, I want to ask you about conquering time. And I think I'm going to take the long way there. You know, we've talked a lot about, or you mentioned that our brain has the need for creating more efficient systems. And I think again, I keep going back to high function professionals, at least I speak for myself that that's essentially two X if not 10 X, right? Maybe trying to consume knowledge, trying to apply that as well. And so I often, with whom I listen to podcasts, following people on social media, whatever it might be, I'm looking for systems to make workflow productivity more efficient. I think about a recent podcast, I'll listen to all the hacks by Chris Hutchinson, an awesome podcast. And he had a recent guest talking about the apps that basically, again, make systems more efficient, right? Or it's InstaPaper, ReadWise, Superhuman as an email workflow to make more efficient so you can, you know, save time everywhere possible. And so that was amazing. And all of a sudden, I'm downloading all these things onto my phone and my Chrome extensions. And then on the flip side of it, you know, I'll listen to your podcast. I'm reading a current book by Oliver Berkman, it's called 4,000 Weeks. And I picked it up because the subtitle said, time management for mortals. And I said, yes, this is what I need. I need to, it's going to give me the answers. I'm not through it all, but I've been pleasantly surprised about three-fourths of the way in because essentially what the author's talking about, well, the fact of the matter is you can't conquer time, right? And he highlights several different ways to approach it, but one of the things he talks about, listen, you know, you'll create a list of 20 of the most important things to do. And you'll get through the first five and then you'll put a category B for the next five. And the fact of the matter is when you finish the first five, you'll have another five of the bottom part at the top. And you're never going to continue finishing the list. So make a list of 20, focus on the first five and get into the next 15, even though they might be just as important, right? He also talks about how this concept of, you know, leisurely activity to be more productive, right? Is only a recent development, maybe in the 19th century, where, you know, before people could just take vacation for the sake of taking vacation, but now you have to take vacation so you can be more refreshed to come back and work and be more productive of an employee, right? Oh, you must take the vacation so you come back. And so there are a lot of nuggets in there. But I look at these two things, this and then the episode that I mentioned and all these, you know, task lists on iOS and all that kind of stuff. And there's a hard delineation for me, at least. And maybe it's because my brain is in sophisticated enough to process them together. But I'm curious, how do you balance or how do you reconcile those two opposing truths? Well, when there are two truths, usually it just means that each of them may be a half truth, right? That's how I approach when someone says, well, this seems pretty valid and this seems pretty valid. Like, how do we, like, you know, but they're opposite of each other. How do we equal? Equalized, you're not going to. What you're going to do is take whatever has meaning and value for you. And for all of us, it's going to be different. So what I mean by that is what I think of as productivity is going to be different for you and for, you know, my partner or, you know, like for all of us where we have different ideas and visions of what we want productivity to be. Now, having said that, I am probably more on the side of the do less to achieve more camp, but I do think that any ways that we can create efficiencies, I think it's amazing and we totally should use it. So I do use, you know, a variety of apps and programs and ways of managing my life, both personal and professional so that I can maximize my time. Now time is, you know, I'm sure you've heard this referred to before, time is neutral. Time actually, none of us are going to conquer time because time is like, you know, it's just something fixed, it is a circumstance and we all have thoughts about it. So the thoughts about time are multitude, I don't have enough time, I wish I had more time. You do so much more if only I had more time, right? Well, no, your to-do list would probably just get longer, you know, I don't know that you're going to finish any bigger percentage, but I wonder if we instead of trying to like somehow figure time out and making time like the thing that we're going to like, you know, break down and make it work, I think the thing that we really need to focus on is our focus and our energy and how we manage that because I don't know about you, but so many times I have sat down to do something and it will like, I'll spend three hours and I'm just not making much progress and then I take a break, maybe I'll go for a walk, I'll do something else, I come back 30 minutes, it's done. So it had nothing to do with time. Yes, I spent three and a half hours doing it, but really I spent three hours squandering my energy, you know, my focus, I know focus, and then I spent 30 minutes of intense focus and energy to get something done. And people refer to this as your deep work or creating that flow state, you know, there's very many different ideas on creating that, you know, time, energy, focus, like continuum, time, space, like, you know, similar in concept, but different. So that's really where I try to maximize my efforts is how can I manage my energy, how can I manage my focus? If I don't have both of those managed, then there's no reason for me to sit down to work. I'm not going to get anything done and it's a waste of my time. So I'd rather do something else, you know, with that time. So I do look at, you know, and some days we have a natural flux of energy that are going to be some days that you feel like super productive and focused, use those days and get a lot done. But there are going to be some days you are just naturally going to be low energy. And I think pushing ourselves to do things that requires deep flow or focus when we are in that space is not very productive. So I have low energy and high energy tasks and I do my low energy tasks on the days that I have low energy. Because I know that these are just routine like things that I don't really need to think too much about. I can get some of those things done. The other thing that I have intentionally scheduled actually into my calendar is rest every day. And rest is that vacation time that we're talking about. And I'm a huge believer that when we create moments of rest, intentionally every single day, it changes the way our creativity and our productivity is boosted. And so when I say this, most people tell me, I don't know, time to rest every day. You know, like, what are you talking about? So a lot of different ways to do it. But the main thing to consider is, you know, we all have five minutes. If five minutes is what you have, then create a restful routine for five minutes. You know, maybe you have 10 minutes, maybe you have 20 minutes, whatever it is. Don't think of it as a waste. Think of it as the magic to get your productivity back to that 10X or, you know, whatever you're looking for. So lots of ways for us to manage our focus and energy. But ultimately, I think time is just, you know, a circumstance. And when we let go of the concept that we're somehow managing time, then I think we really focus on what's important. Yeah, like that. So a comment about time brings me back to one of my favorite passages from Meditations by Marcus Aurelius, you know, book two, passage 14, where he talks about how, you know, a three-year-old and a nine-year-old don't have a difference in terms of time and how long they live. The thing that they have in the same is that the present moment can be taken from them at any point, right? And so I think it really, talking about what we're talking about, it really brings you back to the point and time that you're in right now, right, which is the present and enjoying that and kind of conquering the present, if I can say. So I just kind of looped me into that mindset when we were just talking about time and all that. You know, you talk about how people say that they don't have time to rest. And if anything that we've learned during COVID is that maybe there isn't such thing as a work like balance, right? Maybe they're not two separate things. Maybe they are just one and it's life. I wanted to get your thoughts on what work life means. You know, is it two separate things? Is it one? How should people view that? Yeah. I think that the illusion that we are going to have this balanced life where we get to focus on, you know, the, we talk about the wheel of wellness, right? All the different aspects of our life, et cetera. Those are all, those are all, I think, ideally great. And of course, the theory or what we work towards is finding that balance. But in the meantime, I think integrating them and working on how do we do during different parts of our life, different seasons of life even, how can we focus on what we're doing? So for instance, you know, how I explain to people is in a seven day period, you're going to have some days that work is going to take priority and there are going to be some days that life is going to take priority. Every day, every moment, you're not going to have work life balance, you're not going to have like an equality between the different things, especially in our profession. And that's okay. But overall in your week, maybe even a month, you know, when you look at it, if you are only able to do one part or only pay attention to one part of your life, whether it is career, you know, whether it is, and even if, you know, say you're kind of taking a break from work and you're doing just, you know, you want to like have a vacation, et cetera. When we try to split those things, there are going to be some parts of our life that gets priority over time. But at the end of it, if we don't have all of these parts represented, what ends up happening is our self goes out of balance. So I think that the integration is really just recognizing that different seasons and different, you know, different days, different weeks, if you will, because some of us, I mean, I take, you know, call like one week at a time or a bunch of days together. So it might be that week, yeah, I don't really do a lot of life, I just work. But that's okay, because I know next week, I'm going to do maybe more life, or, you know, the week after, there may be, and we kind of like, you know, I mean, it's just two categories, but really, like the wheel of wellness, the wheel of life, like it looks at it from like six to eight categories. And we want all of those parts represented, because they're all part of us. Yeah, I like that, right? The wheel, the pendulum, we talk about, we were listening to a podcast, The Ultimation Eye about with Kelly Starrett talking about, you know, when he become a father, sometimes, you know, it's the fatherhood that takes over the president of working out and being busy at work. And then, you know, at some point, it'll swing the other way, and you can take care of those things. And being aware, self aware, and being okay with that, you know, is part of a huge process of learning to be human. So interestingly, throughout this, throughout this episode, a lot of books came to my mind that I've read. And when you talk about your journey, the whole reason I got into mindfulness and productivity was actually just by reading and learning these concepts and then really digging into it. So, you know, some of the books that I like to share with the audience, at least from my end, is The One Thing from Gary Keller, The Power of Now by Eckhart Toley, which he talked about the present moment, Deep Work by Cal Newport, Atomic Habits as well, is a great one by James Clear. Are there one to two books or resources that you recommend that people should be checking out in order to gain some more knowledge in this area? Sure. Well, now that you've said one to two, you know, that kind of limits. So, I'm a huge fan of Atomic Habits as well, so it really is in categories. I'm going to go with Habits, which is a lot of what I help people do with as well, is Atomic Habits and Tiny Habits by BGFog and The Power of Habit, which is really more of the neuroscience, but truly understanding, you know, how we develop our habits and all of that. So, and that's by DuHig, Charles DuHig. So, I think those three are my favorite habit books. Then, really, any of the work by Brenne Brown, I think, you know, Darren Greatley, Atlas the Heart, Power of Vulnerability, Gifts of Imperfection, so many of her books are amazing. And Kristen Neff did a lot of work in self-compassion, and she also has, if you go on Audible, you know, she has like some of her, I think it's like a seminar that she did or something, but it's amazing. It's just like a variety of different meditations, so that, you know, is one of my favorites. And then, let's see. So, you know, I would say those are my favorite authors, but there are, you know, there's really, honestly, so many. Man, I don't have room anymore, but I've got to pick those up, I guess, and get started. So, awesome. Well, thank you. Yeah. Oh, one more. Positive intelligence. Yeah. By Shurzad Shamin. It looks at, like, the way we self-sabotage and how do we build our inner wisdom? So it's amazing. Well, Serene, I want to thank you. I think that this has been, this discussion has given me a lot to think about, and I really appreciate that I always, you know, when I'm, for a black and black word, humbled, and have to reframe or rethink about the way that I'm approaching, whatever that I do that I'm always excited about that. And when you were talking about how focus is more important than time, because time can be wasted, I thought about, you know, same Harris talks about how time isn't the most valuable resource. That kind of reminded me that our attention is, right? Because we often do things, and we never think about if that's the last time where we're going to do it for whatever reason, whether it's life or other circumstances, or that's it, that's all the time that we have on Earth. And so I want to thank you for giving us your attention and your time. This has been, this has been a lot of fun. And before we ask you the last question, please tell the listeners where they can find you. How can they connect with you and, you know, how can they reach out if they want to work with you? Sure, absolutely. So they can find me on any of the social medias. I'm on Facebook, and my, and I'll share the information with you as well so you can add it. But I'm on Facebook and Instagram, you can find me on Instagram at Serenity Wellness MD and doctor dot Serene. And I'm on YouTube podcast. My podcast is Mindfulness and Productivity Systems. And my website is serenity wellness MD dot com as well. So lots of ways to reach out. And there's a way to, you know, talk to me or send me email, et cetera, connect with me through my website as well. So I think those are probably the best ways to reach me. Awesome. So with that, the overarching theme, as you know, is adding the health back to health care. And so that's the question for you is, how do we do that? How do we add the health back to health care? Well, I think it's really making sure that we're healthy. You know, what we do is such a critical part of health care and providing care to our patients. And when we are not healthy, and I'm like, you know, I'm talking about my body and soul, when we are not healthy, then we're not able to give our best. And so many, I think, you know, people are going through burnout in either leaving medicine or, you know, struggling with mental health, physician suicide, as you know, is, you know, it's unbelievable. Like, we shouldn't have to know our, we shouldn't have to struggle with losing colleagues who are struggling with this because they're not aware, right? They don't realize that it is not them. When I was going through burnout, I felt so isolated. And the again, coming back to that shame blame and guilt cycle is so real. Like, I felt like I was the only person struggling. Everyone else had it figured out. And there was something that I was doing wrong. And it was really just my problem. And so I think part of it is, you know, things like this, when we talk openly about our journey, and when we open the door to discussion and curiosity and engagement and sharing, you know, being vulnerable with our journeys, even though it feels like, oh, I don't know, if I, you know, if I want to talk about it, but really, if we don't, then, then I think we're going to continue to lose our colleagues, either not wanting to practice, which is a loss to health care, or, you know, even worse. So I think it is really important for each and every one of us to know that we matter, and that, you know, our health, our well-being is really important, and that is how we can give our best to health care. And, you know, just to bring, highlight something here, you know, a lot of the reason why I decided to quit full-time medicine and kind of explore what's going on and what to do is because of that, really, people in my life, and just different interactions that actually highlighted to me that life is so short. We don't know, as you mentioned, right? We don't know if we're going to experience something for the last time. And as I engaged with others who were either struggling with this, you know, because of illness, disease, or not even, like, sharing that this is what they're struggling with, what I realized is that, is this really how I want to live my life? What if today is my last day, like, how would I want to live it? What would I fill it with? And how would I create meaning and purpose and value, both for myself and for others, right? And I think that's the question we ask ourselves. It's just what do we need to do for ourselves so we can do, we can help others. But when we are trained to think, how do we help others? And then, you know, maybe, like, as an afterthought, we think about ourselves. And I think that's just backwards. So not to make it morbid. I don't, I mean, I feel like because of what we do, like, death is part of what we do. So we are always aware of it. And it doesn't have to be morbid. It can help us be mindful and live each moment like it is truly precious. Healing the healers, put on your own oxygen mask first. Definitely. And momentum worry. Love it. Serene, thank you so much. Yeah, thank you for having me. It was great. Thank you. Thank you for listening to another episode of medicine redefine. Our hope is that there was something actionable in there for you that you can implement into your day lives today. At the very least, maybe it dischanges your perspective on what productivity means. And today's day and age, where we have more applications, more systems, and this idea that we have to do more and more and more, it's very challenging to reconcile that with the fact that we also have to be present. I think most people tend to appreciate that, but feel helpless when they are trying to do both things at once. I know I've been guilty of that as I mentioned before. So at the very least, this episode can be a gentle reminder that you're not alone. Now, if you need help with that, please be sure to follow Serene at serenitywellnessmd.com. Her link tree is linked in the show notes so you can follow her on all the social media platforms. And also check out her podcast, mindfulness and productivity systems, which I found to be quite enjoyable myself. Now, before we sign off, please remember the important disclaimer that everything in this podcast is for educational purposes only. It does not constitute the practice of medicine, nor should it be considered as medical advice. No physician-patient relationship is formed, and anything discussed in this podcast does not represent the views of our employers. However, if you enjoy the show, please be sure to subscribe, review, and share with anyone who you think will gain value from this, and we'll catch you next time. Thank you for listening.