Transcript: EP 348 – GAIN without Pain:The Happiness Handbook for Health Care Professionals with Dr. Greg Hammer

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Dr. Greg: We tend to judge things in a negative manner and then we hold onto those judgments and particularly when it comes to ourselves, we are our own most harsh critic. If we want to get into a happier place and experience more peace, we need to have a practice to focus on the present moment non judgmentally.

Dr. Taz: Hi everyone and welcome to Super Woman Wellness. I’m Dr. Taz, I’ve made it my mission throughout my career in integrative medicine to support women in restoring their health using a blend of eastern medical wisdom with modern science. In this show, I will guide you through different practices to find your power type and fully embody the healthiest and most passionate version of you. I’m here for you and I can’t wait to get started. This is a Soul Fire production.

Welcome back everyone. Welcome back to another episode of Super Woman Wellness, and you know we’re determined to bring you back to your superpowered self. We’ve talked a lot over the episodes about anxiety and stress and super woman syndrome. In fact, the show’s name was born from that to be quite honest, but it’s very real and it’s real for all professionals. It’s real for so many different people out there. But I have a really special guest today to help us talk about this. So we have Dr. Greg Hammer. Dr. Hammer is a professor of Stanford University School of Medicine. He’s a pediatric intensivist and anesthesiologist and a mindfulness expert. And yes, those all go together. He’s the author of GAIN Without Pain: The Happiness Handbook for Healthcare Professionals. I am so excited to have you on. You’ve done so much great work. I’m looking at this bio, but I want to jump more into your story and how as a physician you became interested in mindfulness and the idea of happiness amongst healthcare professionals. What you saw there that encouraged you to kind of move in that direction?

Dr. Greg: Well, first of all, it’s wonderful to be with you, Taz.

Dr. Taz: Thank you.

Dr. Greg: So I’m appreciative of the opportunity. The reason I actually wrote the book is that the prevalence incidences of burnout in medicine has been increasing for some time. In 2011, there was a joint project between the university and the hospital to dedicate a program to wellness. And so the Well MD program was formed in 2011, and I jumped on that and then some point a few years later, I was asked to give a talk at a national hospital administrators meeting because burnout was certainly getting on their radar as well. And then I was asked to give another talk and another talk, and then I had some sabbatical time and I decided, well, how can I get the message out even more? So I decided to write the book, but I’ve always, in my entire adult life, been interested in wellness in its fullest meaning, my undergraduate degree is in nutritional biochemistry.

Dr. Taz: Oh, wow. Yeah.

Dr. Greg: I’ve incorporated nutrition in my ICU practice quite a lot because we do unfortunately tend to starve our sick patients. And I’ve been an exercise enthusiast my whole life, so I’ve always been very interested in wellness and I’ve just been diving more and more deeply for the last 20 or 30 years.

Dr. Taz: I think that’s fascinating. Fun fact, this whole integrative holistic medicine world for me was a complete accident. I actually was supposed to do a fellowship in pediatric intensive care. That’s what I was supposed to go and do, and life took a little bit of a different turn. So it’s so funny to hear your interest in the field too. Was there a personal experience that brought you into it or is it more observing what’s happening around you with healthcare professionals and just professionals in general? I think quite honestly.

Dr. Greg: Do you mean a personal experience with regard to wellness?

Dr. Taz: Yes.

Dr. Greg: Not really. Although I have to say that subsequent to my being involved with the Well MD program, I have experienced signs of burnout too. I would even say the majority of physicians and other healthcare workers, not just doctors, but nurses, respiratory therapists, others have experienced burnout to a varying degree over time. And burnout is a syndrome related to chronic stress whereby we are emotionally and physically exhausted and who among us hasn’t experienced this? Some of the signs are, well, at the end of a very long day in the hospital or in clinic or in your office, you might get a little bit irritable and then you find maybe that that starts happening earlier and earlier in the day. And so something might be triggering even in the morning, and we find that we’re a little bit short with others and just getting irritated and depersonalizing and experiencing many of the signs of burnout. That’s certainly something that I have experienced, so I’m extremely sensitive to it, what the signs are and extremely empathetic and compassionate to those who are really experiencing exhaustion in these ways.

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So if someone is listening and they’re like, well, I might be experiencing burnout currently, what would you say to them? What are their first few steps? Here’s what I’ve noticed in talking to patients and also colleagues, is there’s a lot of all or nothing. It’s like I’m going to power through, I’m going to power through. I’m going to make it through the day. I’m going to make it through this month. I’m just trying to get over there to whenever retirement is. They all have these benchmarks, but in the process you’re watching them, and they are unraveling and they’re unraveling in different ways. Either they’re unraveling as you’re saying, just in how they speak to other people or they’re hurting their relationships, or they’re engaging in behaviors that are harmful to themselves, whether it’s alcohol or drugs or whatever. How do we prevent this all or nothing sort of mindset around burnout and how do we help people identify it a little bit better and then be able to almost be like, okay, wait, here’s what I need to do next.

Dr. Greg: Great question. I would say, first of all, let’s broaden the discussion to everybody. This is certainly not something that’s limited to healthcare. I think that life itself is stressful. We ask ourselves questions that stress us out. What is my purpose? Am I going to get sick? Am I going to suffer before I die? We all have these questions, not to mention all the day-to-day stuff that’s stressful. So I think we can broaden the conversation to everybody who may be listening. I think that one has to have a plan because our minds, our brains are wired in ways that seem to predispose us to burnout and apparently veil our ability to be happy. Happiness is the one thing that all… I guess now nearly 8 billion of us on the planet want, and what interferes with that, with regard to our brain function is that we all tend to have a negativity bias.

We tend to hold onto and remember the negative and forget about the positive. I read something in a psychology publication wherein it was indicated that 80% of our thoughts are negative, 20% of our thoughts are positive, and I think that resonates. We may wake up in the morning with a little bit of a sore joint, maybe my knee is a little bit sore. I went hiking yesterday and we fixate on that. So we’re thinking of this negative thing could be a lot of other negative thoughts just from the time we get out of bed, instead of being amazed and grateful at all of the wonderful ways our bodies are functioning almost perfectly, and you know as well as I do, what a miracle that is.

Dr. Taz: Yes.

Dr. Greg: It’s a miracle that our kidneys are working, that they’re filtering our blood, that they’re excreting these potentially toxic molecules, and we can get up and go into the bathroom and release all that, and it works perfectly. That in itself is a miracle, and so many other things are miraculous, yet we focus on that stiff back or sore knee. The other way our minds work, our brains work, and the way they’re hardwired is to be very fixated on the past and future and have a hard time staying focused on the present. And the present is really where happiness lives. And I love Dr. Jon Kabat-Zinn’s definition of mindfulness, and I think it’s a definition of happiness, and that is awareness of the present moment on purpose, non-judgmentally. There’s some really important concepts there. Awareness of the present moment brings us happiness and peace on purpose. And again, the on purpose is because if we’re not intentional, we lapse into these old ways of thinking with negativity and distraction and inability to be present.

And finally, the non-judgmentally, because we’re very judgmental, that’s the N in GAIN, which is the practice that I embrace and teach gratitude, acceptance, and tension and non-judgment are the pillars of happiness. And the acronym gain, the N is for non-judgment because we’re always judging everything around us, other people and in particular ourselves. And because we have this negativity bias, we tend to judge things in a negative manner, and then we hold onto those judgements. And particularly when it comes to ourselves, we are our own most harsh critic. Everybody knows that. So if we want to get into a happier place and experience more peace, we need to have a practice to focus on the present moment, be aware of the present moment on purpose. That’s our plan, non-judgmentally. So we have to have a plan and we can dive deeper into that.

Dr. Taz: Yeah, I am super curious. Can we rewire this negativity bias? Can we quiet it down? Has science shown that that’s possible? It feels like for a lot of people, I think they’re like, okay, let me try to meditate but that almost reinforces the negativity bias because they find their minds racing back into that negative space. So how do any of us pull out of that and then continue to stay in this rhythm of GAIN? As you say it, staying positive and staying kind of in alignment.

Dr. Greg: Well, a lot of people think that meditation, which I think is a very important practice, means we have to sit still for 30 minutes, possibly in an uncomfortable position, not scratching an itch, and that we have to ban all thoughts from our brains and nobody can do that. So they’ve tried it and failed, they’ve put it aside or maybe they’re just too intimidated to get started. So that’s not the case. And so the GAIN method is a three-minute meditation that we do in the morning.

To your question about can we rewire our brains? The answer is absolutely yes and that’s what the GAIN meditation is. It’s a baby step by baby step way of rewiring our brains, because our brains have this amazing quality, as you know, called neuroplasticity. That means it can be rewired. I’ll refer to a very simple and wonderful study that has been… I’m not sure it’s still going on, but I think it might be at Duke University, it’s called Three Good Things. And the essence of it is that you can sign up to participate online and you pledge to think of three good things that happened during the day before you go to sleep. Ideally, you would write them down, you would’ve three good things journal. And then there’s an interactive component to it where you’re submitting information online and you’re taking a quality of life survey sequentially.

And what the investigators have found, and these are PhDs, very smart people who are very good at analyzing data, is that in general, people who simply think of three good things that happen during the day before they go to sleep become happier. So this is a great example of rewiring the brain simply by doing something that actually takes no time. You can do it while you’re turning down the bed covers at night before you get into bed, just thinking of three good things. So for me, I know I’ve already had a lovely walk with my dog this morning. My conversation and connection with you will be on my list.

Dr. Taz: Yay. Awesome.

Dr. Greg: And all I need is one more good thing to happen today and there are my three good things. So that’s a great.

Dr. Taz: Sun behind you, that’s your third good thing. There you go.

Dr. Greg: Yeah, exactly. Well, I’m so grateful every day for my circumstances. But yes, so this is a great example of a very simple, really non-time consuming practice that will help us rewire our brains. And so again, we have to have a plan. We have to be intentional. The eye and gain is intention. And the good news is we have brains that have neuroplasticity and we can rewire our brains. We have to recognize that they’ve been wired the way they are over tens of thousands of years of evolution. Why are we so wary? For example, maybe 75,000 years ago, our forebears were in a cave caring for their children, keeping a fire going, and they had to be wary. They had to be worried about that there might be a saber tooth tiger lurking outside the cave. So it paid to be wary, to be negative, to be suspicious to catastrophize because it led to a longer life.

And therefore, the genes that code for these patterns of thinking were propagated in the population and here we are today. But for most of us, there’s no longer that kind of threat. We don’t have a saber tooth tiger lurking at the mouth of the cave, and yet this is how our brains think. We are overly distracted with the future and with our negativity bias, we think of the worst thing that can happen. We catastrophize, we generate a lot of fear and anxiety. So this is the way we think, but we can change it. It’s not going to happen overnight, but like everything else, it’s a journey. It’s a process. Life itself is a process. There’s really no destination.

Dr. Taz: It’s such a good point. It’s interesting, I was having a conversation with somebody and they brought up a really good point. If you think about our profession as physicians, or if you think about many of the successful professionals, business people, even celebrities that I’ve made, you are still rewarded today for living in the future, to be honest. You’ve got to make that A, or you have to pass your boards or you have to get whatever spot. You have to publish that research, or you have to make X amount by quarter two. They’re all these benchmarks, they’re all in the future. None of them are really in the present. So we’re still kind of playing that game.

And my brother-in-law, who was a refugee from Bosnia, brought this point up and he’s like… he goes, “It’s a luxury to be able to step outside of this sort of negative thinking and be able to now have the time to change and rewire our brain.” He goes, “Because I have been negative because I did have to look over my shoulder to see what’s going on and to how I’m going to succeed.” So I would say it’s not even ancestral, it’s happening today. It’s in our present that we still… success is determined almost by how much fear we have and it’s only when we crash and burn or have a health crisis or something implodes that we are forced to pull back and be like, okay, wait a minute. How do I change what’s happened?

Do you see a way of intervening earlier, like someone going in this journey… if I was your med student or if you were talking to my brother-in-law in the midst of his stuff, what could he have done in those inflection points of his life, which are incredibly stressful and you’re not established and you do have to kind of future think to just kind of get through whatever you’re doing. What would he look out for and what could he do to make sure he doesn’t just crash and burn and engage in destructive behaviors?

Dr. Greg: Great question. Well, I agree with everything you said. The key is to be at peace and mindful and consider to what extent these thoughts are adaptive versus maladaptive. With regard to the future, yes, I have to pass my boards. Yes, I have to get an A. I want to get into a good school, I want to get into medical school, what have you. So there are lots of things on our minds that we have to plan for and we need to determine what is adaptive and what is maladaptive.

So make a list of things you have to do, make a list of things you have to worry about. And then as soon as you recognize that your thoughts are becoming maladaptive, redirect them back to the present. And this again is this one baby step toward rewiring the brain. So yes, I have to get an A, so I’m going to spend a certain amount of time doing my homework, and then I’m going to forget about the grade. I’m going to forget about what’s happening down the line, what college I’m going to get into. Am I going to get into medical school? That’s maladaptive thinking when we wring our hands, when we worry about that. So decide what we need to think about, what we need to do right now, and then tuck that thought in and put it aside.

And the same with the past. We not only think about the future incessantly and we’re not thinking about the future, we’re thinking about the past. We’re equally obsessed with the past and it’s adaptive to think of our good memories, loving times with people that we’re close to in our life. It’s adaptive to reflect on good times that we’ve had, but it’s maladaptive to stress about the past. And what happens is with our negativity bias and our obsession with the past, our overthinking of the past, we generate a lot of negative ideations and a lot of shame and regret. We regret things we said or did or didn’t do. And again, we are our own most harsh critic. So we obsess over things we did wrong or didn’t do right and we blame ourselves. We generate a lot of low self-esteem, and this leads to depression. So overthinking the past with our negativity leads to depression and overthinking the future with our catastrophizing leads to anxiety.

And anxiety and depression are two of the biggest problems we face. I think almost all of us, if not all of us, are saddled with these things to some degree. So it takes a plan. We have to sort of sit and think. I love the serenity prayer. We have to discern between what we can change and what we can’t change. So with regard to our thoughts, we can generalize that. We have to discern what is adaptive and what is maladaptive. And we all know people who have maybe not mastered that, but they’re pretty good at it and we call them pragmatists. They’re very practical. They’re pragmatic. They tend to be more optimistic, and they decide, okay, what do I have to do to get this done? I have to do X, Y, and Z. I’m going to do that or I’m going to discern that those are out of my control. So I’m going to put those thoughts aside. So again, we have to be proactive. We have to have intention. Again, I love Dr. Kabat-Zinn’s expression, awareness of the present moment on purpose. We have to be purposeful.

Dr. Taz: I love that because I think there’s so much talk right now in the wellness community about the many different tools, and some of them are just simply intention and awareness, and I love that you call attention to that.

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I think you mentioned too, I think I might’ve seen in your book or your notes, the importance of sleep and nutrition and getting outside. Where do those play into burnout and burnout syndrome in general, and what’s your advice to our listeners and our viewers?

Dr. Greg: Right. So sleep, exercise, and nutrition are the three legs of the tripod that support our physical wellbeing. And if we don’t attend to those, it’s going to be hard to be happy no matter how grateful, accepting, intentional and nonjudgmental we are. So again, we have to be purposeful. Our true nature is not necessarily to focus on our sleep, our exercise, and our nutrition, so we need to have good sleep hygiene. There’s a long list of things, most of which are intuitive, caffeine for example, caffeine has a very long half-life of five or six hours. So that blood level you get from that morning jolt of coffee, half of that is with you in the early afternoon, and a quarter of it is with you in the evening.

So if you have a cup in the afternoon, half of it is with you in the evening, and a quarter of it is with you when you’re trying to sleep. And if you’re sensitive to caffeine like I am, that’s not going to help your sleep. So I stop drinking coffee after my morning cup. There’s a whole lot of elements of sleep hygiene that most of us are somewhat aware of. The same thing about exercise. Exercise is vital to us, especially as we get older. And so we need to have a plan. We need to be purposeful, we need to have an exercise regimen. And so again, some is better than none. Get out and walk around the block every hour or so.

If you’re working at home, take five minutes to stretch, to go for a quick walk, what have you, and then maybe every three or four hours, take a half hour and go for a walk or get some exercise. And then of course, nutrition. Simple principles move toward a more plant-based diet, avoid refined foods that come in a can, avoid a lot of sugar and sugar-like products like corn syrup and so on. So there’s plenty of resources where people can learn about good sleep, exercise, and nutrition habits, but we have to take care of our bodies, otherwise we’re going to feel sluggish. We’re going to be distracted by the fact that we’re 10 or 15 pounds overweight and we feel really out of shape and deconditioned. So we do have to have that as part of our plan is taking care of those three things. And then we can focus again on rewiring our brains so that we think in a more present oriented fashion when adaptive and more positive, and that’s what the gain practice is.

Dr. Taz: I love that. I’m curious, men versus women burnout higher in one group than another, or not necessarily?

Dr. Greg: Well, I think it might be in… we look in medicine for example. I think actually things are a little bit more challenging for women because they are generally the primary cares for their children. Not in every case, but just in general. So I think as far as… especially in academic medicine advancing, getting promoted, doing research, writing papers, all that, when you have kids for whom you’re primarily responsible. So I think women who have young children, I think maybe they’re slightly more predisposed to burnout than men, but it’s quite prevalent across the board, unfortunately.

Dr. Taz: Yeah, I think I see it everywhere and I see the extremes, but I’m hoping everybody watching and listening can catch it early and hopefully use some of these simple… these are simple tools. This is not making an appointment or having to run around town to go somewhere. These are super simple things that hopefully are checks and balances to prevent the crash that so many people, I think experience in medicine, out of medicine, in Fortune 500 companies, you name the profession. I think it exists. Now if anyone watching and listening today wants to learn more about GAIN and your work and all of this around burnout, what’s a good way for them to get ahold of you?

Dr. Greg: Well, Taz, the best way is probably to go to my website, greghammermd.com, G-R-E-G-H-A-M-M-E-R MD, all lowercase .com. And I had like to say that I’m writing a book now about teenagers, it’s called The Mindful Teen. So when you say start early-

Dr. Taz: When it’s that coming out? Exactly.

Dr. Greg: When you say start early, parents can model mindfulness processes for their kids so that’s how I would advocate starting early. You got to have it from your parents and teachers and others.

Dr. Taz: No, and I do think it’s slowly becoming a part of some of the schools and some of what they’re teaching, which is great but I have two teenagers. I have a 14 and 15 year old, so they learn some from me, and journaling and meditation is a part of their routine, but kids are stressed nowadays. And mental health among children is definitely an issue. I think the earlier we can teach our children this and model it, like you’re saying, ourselves, the better. I think it’s important for the entire family unit too, which is also highly stressed. But thank you so much for taking time out to join us today. I really appreciate it.

Dr. Greg: Thank you, Taz. Anytime. It’s been a pleasure.

Dr. Taz: Thank you. And for everybody else watching and listening to this episode, don’t forget to rate and review it. You can share it with your friends. I really feel like this is an important message, guys. We are seeing everyone, all ages, really suffering from anxiety and mental health issues. And the more we can do to really… again, it doesn’t have to be a fancy wellness plan, little things matter, and Dr. Hammer’s approach is an example of that. I’ll see you guys next time.