Is it true that taking 10 minutes every day to practice self-care can reduce the risk of burnout? Urologist and life coach Diana Londoño, MD, believes so. In a recent interview, she discusses how urologists can practice wellness on a daily basis and why more clinicians should be paying attention to the numbers when it comes to mental health in the field of urology. Londoño is a urologic oncology surgeon and assistant clinical professor in the department of surgery at the City of Hope National Medical Center in Duarte, California.
I really appreciate, first of all, being here and speaking about this because I think these are really important things that we don't speak about enough in our daily life, whether we're at work or with friends or with people [in general]. Compassionate health care really means trying to cultivate kindness and love for ourselves. It really gets to the core of what it means to be human—that we're just not perfect and that we have to have compassion for ourselves, meaning, again, understanding the imperfection of humanity. When we come to the world, or to work, or to health care with that lens, we start seeing that we are not different than each other. We can see what is the same about each other. It's a more expansive world and lens that we see each other from, as opposed to one where we show up with an ego [that is] closed [off], [where] we're perfect and we know all the answers. This is a very different lens. So, obviously in urology, [or] any surgical field, it tends to be more associated not with a compassionate lens, but more with an ego. "I know everything, and I'm perfect." Something that is taught to us in health care is that we have to be perfect, and then when we fall short of that because we are human and we will, because we're not perfect, we start spiraling down into shame, guilt, anxiety, and imposter syndrome.Then it becomes a place where it's just not healthy anymore, but we just have to repress our feelings that and keep going.
In my years as a urologist, I've been burned out twice. I was like, "Wow, I didn't really know [it] could happen twice." Even though you know about it academically [and] you know what burnout is, you [really] don't know what it is until it hits you in the face. You don't wake up one day and say, "Oh, I'm burned out." You are [just] angry all the time and frustrated. You're short tempered, and you're just tired and you don't know why. Then you realize, "Oh, yeah. I'm totally burned out." And sometimes other people have to point it out to you, like, "Maybe you need anger management classes,” or “Maybe you need a vacation,” or “You really have become very negative." And then you're like, "Whoa, what is going on?" But again, we don't live in a working environment of introspection, pausing, resetting, and really thinking, "Why am I feeling angry all the time?" We just plow through, and we don't stop and reset.
So, I was burned out first just a couple years after I finished my residency. And at that time, I went to therapy, got Zoloft, and I quit my job. I reset my neurotransmitters that were out of whack. That was helpful and I got through it, but then this time, I actually wasn't depressed or anxious. I was just in a negative cycle, like spinning thoughts and loops. [Then] I found life coaching. I found it so powerful that I said, "Well, not only do I need coaching, but I want to learn about it because then maybe I can help other people. Why spend a certain amount to be coached when I can like learn [an]other skill, which would be a skill for life?" So, the second time I said, "I [have to] do something different because this is not working." I also don't want to be a statistic. I don't want to be statistic where I will be suicidal. I have little kids. They don't deserve a mom that's not present. That's really why I decided to do life coaching.
Life coaching is really not something new. It sounds kind of trendy, but it really isn't. The concepts have been around forever and it's about the Buddhist principle—introspection, quieting the mind, meditation. Coaching is not truly about meditation, but it's about awareness. “Why are we thinking that? Why are those beliefs?” Understanding that the circumstance that happens is a neutral circumstance. For example, somebody's late in your clinic. They just show up late. You'll have a thought about that, but you don't realize you had a thought. You just start feeling angry, or maybe you feel happy about it, and then how you feel for that moment will probably shape your whole day—how you act, what you do, and the results for the day. I can either be really upset and be like, "How can they do this?" and just be angry. I'm going to show up to that patient and every patient after [that both] snappy and impatient, and not really wanting to listen because I'm annoyed. The whole day is going to be painted in that spectrum. [Or], I can be like, "Wow, fantastic. They're late. I have 5 more minutes to do something else. This is great. I have time to catch up on this." [It's] just the same situation [and] how you interpret that with your thoughts. The whole day is different. You have to have awareness that we have a choice. I can be really upset and grumpy, or I can just see the positiveness and be like, "How could this be helpful today?" And then, you arrive in a different place. That's how I came to it, why I find it so important, and how it really empowers us to change how you want to live your life—either reactive and angry, or more calm, introspective and growing. "How can we grow? How can we evolve? What can I learn from this?" as opposed to, "I know all the answers, I'm perfect." It's very different.
I think if we were not number 1 and number 4, I would say, "Yeah, we're doing an amazing job," but we really aren't. Where are we putting our focus? Where are we talking about this in a more open manner? Are these sessions that we're talking about in AUA? Is this talked about? Are these discussed in research papers? Are we talking about this a lot more or not? Because where you put your money is where your beliefs are. Money is not an evil tool. It's a tool, and you can do great things with money or [you can] do evil things with money. So, if you believe that this is important, you're [going to] back it up in some ways. I don't think we're doing enough. Absolutely not. Otherwise, we'd be in a different situation. And it really is trying to change the culture, and changing the culture sometimes seems like an enormous task. But if we don't try, we'll never get there.
The culture of medicine is one where, again, we have to be perfect. There's no space to talk about feelings, and if we don't talk about feelings, then eventually it's just going to boil and burst. It's a culture where sleep is not something necessary. We just plow through with 4 hours of sleep. When are you going to exercise if you have meetings at 6 o'clock every single day of the week? There's no time to exercise with those lenses [emphasizing that as] how medicine should be. We eat poorly because there's no time to cook, so we're just going to eat whatever. We don't have social connection because everybody's in different places. We build a culture [where] all the things that are going to help us are not there anymore. We call it "health care" and "well-being," but there's no well-being in that. We [have] to go back and think, "Okay, is this really working? Are we doing this the right way? Because it seems like we're not looking at the numbers and the data." So, let's look [at] research-based evidence that has been proven that can reverse all this. Get us out of the sympathetic stress response all the time. Stress, stress, stress. Get us into more [of a] parasympathetic [response], releasing the hormones that can be helpful, like dopamine, serotonin, [and] oxytocin. And those are secreted and developed by practice things like self-compassion, right? Gratitude, expressing emotions, sleeping, exercise. Again, good food. All these things that we do secrete those hormones in our brain and there's a neuroplasticity. Our brain changes, and we feel different, and we act different. We cannot give if our cup is empty. We've got to give with a full cup, and that's not taught in medicine. [We're] just taught, "Let's just plow through it and we'll get through it." But we've got to balance the energies of really nurturing and still [being] goal focused, still [having] focus on what we do and be the best at stuff but with a nurturing side of medicine, which we really have completely ignored. [We’ve come to] think we're just going to be in a good place. I don't think that's really the case by looking at the numbers.]
I really do a lot of things all day; it's not just 1. I think that's the myth—we [have] to do 1 thing and that's it. I mean, these are all tools. Coaching is a tool. I actually started something called Physician Coach Support, which is free support for life coaching for any physician where you can come and get free coaching. I think that's really important. And so, I practice what I preach. I do what I think is important. I self-coach myself, which means [that] when I get triggered by something, I think, "Why am I getting triggered? Why am I annoyed? What's happening that is triggering me?" Because maybe it's something that's triggering, something that I'm not fulfilling myself or have neglected in myself. I have to think about “why?” It's [having] a curious mind all day. Think of 3-year-olds. They ask "why?" all the time. We [have] to be curious. [Ask], "Why am I feeling that? Why am I acting like that? Something's happening." I think about that, and I coach myself throughout the day.
I practice breathing. It's sort of obvious, but it isn't. [It's] conscious breathing, where you breathe 3 deep breaths. [It] starts your parasympathetic, and I do that in between patients when I need to release the energy from 1 to the other so I can start [over] with a fresh slate, really focus on that patient, and not let the energy from the last person affect this interaction so I can be present. I breathe in between patients and sometimes I shake it off, [my literal] body, to get rid of the energy and really be focused. I [also] dance with my staff, and I started this during COVID because we are all struggling. We are all not doing well. We need some healing and movement is healing. I mean, that's why there's dance therapy. It's been studied and proven. So, we [have] to dance because movement heals you. It releases serotonin, the happy hormone when you are either dancing or exercising. At the end of the day on Thursdays in my office, I dance with my staff. At the end of the OR day on Fridays, I dance. It's just fun. It's 7 minutes because it's 2 songs, and that just makes everybody laugh and be silly, and just be joyful because it's stressful to be in surgery. So, I try to incorporate that in my day because, again, it's been proven [that] 10 minutes a day—which is a very short time; it could be how long you wait in Starbucks today—[of] some type of self-care, whether you go drink your coffee by yourself and that brings you happiness, you dance, you read something you like, you listen to music that energizes you, are [going to] decrease anxiety [and] depression, [and] increase your resilience and your happiness. It's easy stuff all day. You don't have to do some major yoga retreat in Fiji. You can if you want, but it's not about that. It's about little things you can do every day to add those things to fill your cup.
I always do meditation at night, listen to little YouTube videos, try to just quiet my mind. I do that. I practice gratitude a lot. [For] every patient, I'm like, "Well, the good news is..." because there is good news about everything. So, when I see a patient, I'm always like, "Well, we didn't find stones and that's the good news," or "The good news is this..." We really try to shape and focus a lens of how we see the whole interaction, and it brings people some happiness as [it is] good news. It's not all bad news. Even in the worst situation, we can find a silver lining [in] everything. So, let's focus on that. We're going to feel much different than when we just focus on everything that's terrible all day. That's how I practice every day, and again, it's not 1 size fits all. Some people don't like 1 thing. If prayer works for you, do prayer. If meditation works, do meditation. If walking 10 minutes helps you, do that. But we [have] to find a time in our day to do that every single day.
It's important just as it's important to know all about the latest bladder cancer treatments. If we don't treat ourselves, we're going to be in a place that is not going to be as happy. There's actually a quote from an Athenian doctor in AD 2: "These are the duties of a physician: first to heal his mind and to give help to himself, before giving it to somebody else." It's so important, right? This was thousands of years ago, but we need to practice that. We [have] to practice what we preach. Take care of yourself, so we can take care of other people.