In the October 2020 edition of the Annals of Emergency Medicine one can find two references that highlight Physician Wellness. The first is an article, Healing the Healer: Protecting Emergency Health Care Workers’ Mental Health During Covid-19 and, the second an editorial, Moral Injury: The Invisible Epidemic in COVID Health Care Workers. These references talk about the mental health effects of working in the current Covid environment. The editorial states, “To do their job, health care workers not only dress in personal protective equipment but also shield themselves with a protective emotional barrier so they can carry on in times of extreme stress. This is similar to soldiers in battle who arm themselves psychologically and try not to think about the carnage and death that surround them” (Dean, et al). Furthermore, the reference brings to light the fact that being vulnerable and asking for help, for most physicians, causes shame. Most of us would rather die than appear helpless or weak. So, what can be done? Well, as I mentioned previously, there needs to be a huge shift in the culture of medicine. It needs to be okay for physicians to ask for help without feeling shame. However, this shift can only happen if we, as individuals, can learn to give ourselves empathy and understanding. The change in the culture of medicine has to start with a change in us- how we engage with ourselves.
This leads me again into my discussion of MENTAL FITNESS. MENTAL FITNESS is one’s ability to respond to life’s challenges with a positive, rather than a negative mindset. As I mentioned in my prior post, this is something that, like physical fitness, we can build and increase with practice. It is a phenomenal tool that can be utilized by physicians to increase our self awareness and start the change in how we interact with ourselves and our world.
The concept of Mental Fitness was created by Shirzad Chamine, a well recognized Life Coach, who turned researcher and conducted studies on over 500,000 participants around the world. He additionally compiled data from studies in Positive Psychology, Neuroscience, Cognitive Psychology and Performance Science, and then took all of those results along with his original data, and performed factor analysis, resulting in radical simplification. He discovered that there are only three “muscles” at the core of mental fitness. These are 1. The Saboteur Interceptor 2. The Self-command and 3. The Sage. These “muscles” are actually neural pathways in our brain. The saboteur interceptor is the “muscle” that helps us recognize when we are experiencing negative emotions and identify the thoughts behind those emotions. The self-command “muscle” is the one that we can use to choose to shift our thoughts from those negative neural pathways in our brain to positive neural pathways instead. Finally, the Sage “muscle” is all the neural pathways located in the parts of the brain where positive thoughts are born. In essence, we have two brains, the part of the brain where negative thoughts are born and our saboteurs live, and the part of the brain where all positive thoughts arise and our Sage lives.
Mental Fitness entails engaging in the practice of various exercises that strengthen each of these muscles. The exercises are called PQ reps. Controlled studies in which participants were separated into two groups, those that practiced PQ reps, and those that did not, have shown that engaging in active practice of the PQ reps for 15 minutes/day for 6-8 weeks is enough time to cause the parts of the brain where the negative neural pathways are present to begin to atrophy, and the parts of the brain where the sage neural pathways are centered to hypertrophy. As one continues the practice beyond this, the effects only become greater.
It is within our power to change our brains just like we can change our bodies. It is a process, it requires commitment, and does not happen overnight. But, as physicians, we are by nature capable of commitment and we understand the benefit of sticking to treatments. Let us give ourselves what we would all want for our patients-the possibility of living our best lives, of being all that we can be, of engaging with life from a place of positivity so that even through the toughest moments in our lives we can thrive. And, let us begin to change the culture of medicine as we step into this new way of being!
If you are interested in learning more details about mental fitness I would recommend you read, Positive Intelligence by Shirzad Chamine. In my next post, I will write about how you can apply mental fitness to your everyday life and start seeing the change.