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Amanda:
Hey guys. Welcome back to the podcast. I am Amanda.
Laura:
I'm Laura.
Kendra:
And I'm Kendra.
Laura:
And today we are so thrilled to welcome Dr. Atashi Mandel, one of the bravest, kindest, most wonderful souls you could ever meet. She is one of our amazing clients and she has been kind enough to join us on the podcast today to share a little bit about her experience in our coaching program, and she's also going to share some thoughts about the book, the Four Agreements by Don Miguel Ruiz.
Welcome, Atashi.
Atashi:
Hello. Thank you so much for having me. It's a real treat and wonderful culmination to my coaching experience with all of you, and I'm really excited to share my story and my experience with our colleagues listening in.
Kendra:
Awesome. Thank you so much Atashi. We are excited for this show.
So please tell us a little bit about yourself, your background training, what you do now, hobbies, anything you'd like to share.
Atashi:
Sure. So I am a Med Peds hospitalist. I've been in practice for 18 or 19 years. I grew up kind of all over the country. My father liked to switch up jobs quite a bit, so Midwest and South.
And then I went to medical school at Case Western reserve University in Cleveland and came out for residency in Southern California. And so I've stayed there ever since. I worked as a full-time adult hospitalist to start because those jobs are just more plentiful and I very much missed pediatrics.
I'm a community hospitalist. I don't work in any academic settings and it's very difficult to combine the two practices in the community. So I kind of broke out and I suppose developed my own practice. I opened up my own medical corporation and so now I just independently contract with four different hospitals.
Where I do adult at three of them, and I do pediatric at the other one. So it sounds like a bit of a rootless existence. Definitely not your traditional path, although I know a lot of fellow ER physician colleagues who also, you know, work at multiple hospitals and that's the norm. But for me, this has probably been professionally the best thing I ever could have done for myself.
Just taking that chance. Allowing to, you know, not be overcome by the status quo. And I think the first point of recognition is just where I was very unhappy and it was showing up in me physically as well. I love to run, hike. I play the piano, reading. It, it was a real bummer when I got presbyopia cause my near vision was the only thing I ever had.
My whole life. I've been nearsighted since I was like six or seven. So anyway, nothing wrong with piling on the reading glasses for those of you fellow bookworms, I, I also love to travel. So I love animals.
Kendra:
Love it. Awesome. That sounds like so many amazing things. So what was happening when you decided to try coaching? Tell us a little more about that.
Atashi:
Well, if memory serves, I believe I signed up probably in 2021, I think it was. And it was a service that was actually very generously offered by one of my hospitals.
This hospital is actually in a very rural part of California in a town of 4,000 people, but our chief of staff, to her credit, was very invested in doing what she could to help physicians. I know it's a very commonly used word these days, but she really was invested in our wellness and trying to help us through the pandemic.
So I, as a hospitalist, especially an adult hospitalist at that time, I mean, we were just, our life was all covid, COVID, covid. And for me, the, maybe the features of my situation that led me to sign up for this service is that I really don't have anyone, you know, not by the traditional definition of your more intimate circle, your family at home, your partner, you know, someone to kinda just talk to or someone you know, a support system. I, I will say I've been blessed with wonderful, wonderful friends who are also all very busy in their lives trying to cope with the pandemic in their own ways.
Many of them also physicians trying to keep their heads above water. So I really was, I felt like I was just kind of coping on my own. The other part not so much dealing with the present, but caring with me is something that I really wish we would not feel so ashamed to talk about or feel like it's a personal feeling or weakness.
But my background, my family of origin issues a lot of just kind of traumatic childhood experiences that I've felt the weight of for, for decades. I remember talking about this to my psychiatry rotation, attending. At that time I was married and I was very fearful that it was going to take a toll on, you know, my closest relationship, you know, since my first early childhood ones were fractured.
So I was approaching age 50 at that time, and I really was looking for a way to really come into myself. I, I don't use it in the sense of a midlife crisis, but I was getting frustrated and really starting to judge myself and be unkind to myself about why couldn't I get it together already? You know, how many more years was it going to take for me to really understand myself and, and not add these weights to my own shoulders?
So that is what led me to, you. But really I wanna emphasize my chief of staff and, you know, working with the hospital to bring this program to our attention. And they actually helped subsidize part of it as well. That was a big reason. Otherwise, I may not have so luckily stumbled upon your service, so I'd really encourage anybody.
Who is in a position to engage their medical staffs, their administration, to talk about these kinds of services and at least make their medical staffs aware. That would be a big step. Ensuring what you're doing with all of us and helping so many more colleagues that I think would be interested.
Kendra:
Thank you.
We'll be bringing you on all of our conference runs and tours so you can advocate for us. What, so what other modalities did you try to manage, struggles that you were having?
Atashi:
Well, I will say, I'm somebody that copes a lot by talking. I don't particularly journal a lot, but I, I do like to talk, I talk in my own head.
I talk to other people. I enjoy listening to other people, if that helps them. I'm always the person people confide in or they can vent to. So to me that's a very comfortable mode of engagement. I've been in therapy at various times in my life and have had some very good relationships, and I feel like I made some progress with each stint.
But the integration, the, you know, really kind of allowing all of this to come to fruition. It's not necessarily an efficient process, and meanwhile, life keeps happening with new challenges. Pandemic not withstanding, something nobody would've ever predicted. I also think there is a silver lining to everything and it's something that we'll touch on, I'm sure later.
About my own perspective, some of my hardships that I endured when I was younger allowed me to be very self-sufficient, and what I think at times is a very productive kind of resiliency. So I relied a lot on myself and for some time in my life that was very helpful when you're trying to survive. But when you're trying to live, when it's not about just maintaining when you're trying to go past and move beyond to something that is a greater expansion of yourself which automatically benefits everybody around you, then those survival skills are not necessarily helpful.
If anything, they're a little bit... They, I think those kinds of survival skills can make you regress because those skills are to protect you. And those skills create walls. Yeah.
Kendra:
Fantastically put, that was well done. So how was coaching different than the other things that you tried?
Atashi:
I remember talking about this with my therapist and I said, what was really interesting, I think this is my first session with Amanda, the construct.
So I, I think this is something specifically that our fellow physician and provider colleagues would find really interesting because we're very focused on generating that assessment and that plan, right? There's always a plan. For what we're doing what we're doing for our patients, and many times we tend to extrapolate that into our own lives and why it becomes very frustrating and distressing when things are not going according to plan.
I liked how we started out with, you know, what is the result that I want to see. Rather than talking about what I'm thinking and feeling first, you know, where is it that I want to go, you know, what is it that I want to do for myself, what I want to see myself become? And then we work backwards from that.
So we talked about, okay, what are the actions that can produce this result? What are the feelings that drive those actions? And then going back to the very first step, you know, what are, what are the thoughts? How do you begin that process? So I really liked how we actually worked backwards because I'm accustomed to first kind of spewing out what I'm thinking and feeling and then, you know, that can be very helpful.
It's important to identify those things, but you can kind of get lost in a stream of consciousness or on tangents. So I, I liked how we worked backwards from the result that I wanted to see, all the way down to the very thoughts that could start that positive cascade. And the, the thought was for me is that I'll be okay.
Those initial survival skills, those, I don't know if that's the word, regression-ary skills, that helped me endure a lot of hardships at a time, developmental stage in life where you didn't understand a lot. The first question, the first thought that always comes into my mind is that, is this going to be okay for me?
Is this going to compromise me? Is this gonna expose some kind of vulnerability? No. I can just start out by saying I'll be okay.
Amanda:
My goodness, you nailed it.
Laura:
Yeah. That's amazing. So what would you tell another physician who's considering trying coaching but is hesitant to do it?
Atashi:
Well, I think this will tie into when we get into the four agreements, but I think two things.
One of it is of course, the culture of physician training where we are not encouraged to speak up. We are not encouraged to show any kind of vulnerability because it's a sign of weakness. You need to suck up, get through the day, do your job. And, and sometimes there is no emotional space at work to really process anything that's happening because it's so busy or it's so acute.
So I think there is a, a resistance if you didn't start out with it. It's certainly implemented in the course of our training and our practice where this is not something that we need to do. It's not something you have to do, or it's not something you even should do. So I think we need to undo that. I, I think collectively just what's come out in the news, what's come out in our own medical literature, we all get to that, that kind of thinking did not lead us to a good place.
We all get that now. So now what? Now what do we do? The other thing this is a common assumption Well, what we ask ourselves, what, what, what more do I need to know? Or I already know everything that I need to know. There is no more development to be had, or I'm too busy for this because I'm tending to everything and everyone else around me without realizing that as we deplete our own cup, not gonna be able to attend to anyone else very well.
And I think a far more common assumption is that it's not anyone else's responsibility to fill that cup for you. That's just an automatic setup to fail and something I learned the hard way. So I think to embark on something like coaching, we first need to examine. What is it we are telling ourselves that this wouldn't be a good idea?
No different than going and getting your physical. I turned 50. I had a whole bunch of preventative medical interventions I needed to undertake this year. Why wouldn't I if this is going to promote my future health? So I think we need to look at this being the preventative medicine for our emotional health, and nobody is above this.
There is no mark against anyone for considering this. So it, it's really time to not just shed this kind of thinking, and we need to just completely jettison this because it's just served us in, in so many wrong ways for so long. So I, I think it's, for me, I really push this message very aggressively. But the first thing is that it's, it's okay.
It's okay to make that safe space for ourselves everywhere we go and in everything we do.
Amanda:
Yeah. Well, if we are judged on our results, how is the system of medical training and lack of vulnerability, like our results so far have not been stellar, so maybe it's time to try another avenue.
Atashi:
Well, it is the definition of insanity to keep repeating what know has not worked.
Yes, I, I do see positive changes. I do see the ship slowly turning its hull. And hopefully with future generations of learners, we can impart this kind of behavior and, and that it is very acceptable for us to, to debrief after an acute situation for someone to admit where they're struggling and not only admit it, but so they can be put in touch with the proper resources right then.
Part of it is we need to share our own stories Now for everyone, that could mean something different and everyone will have different comfort levels of doing so. But the more we see of our own colleagues that, yes, you know, I was in therapy and yes, I had these struggles too. The more this can be normalized, you're not a pariah for admitting these things and getting the help you need to take care of yourself.
Amanda:
God forbid we be human, you know?
Atashi:
Mm. Not allowed.
Laura:
No. I think it's interesting that we've touched on what the medical training system has done and kind of, and you kind of glancingly mentioned your family of origin and we, you know, we go to therapy and work out our things with our family of origin and coaching helps us kind of look towards the future, but both of those things remind me that I assert that the medical training system is a system of narcissistic abuse.
And people hear me say this over and over again. It, and it often pulls people in who have been in family situations like that. And some of us don't even recognize that anything wrong is going on about the way we're being treated. And so it's so important to look at what's real. How should we be treated and how should we treat others and what should our expectations be for our profession?
And. Where do we want to be? What result do we want in the end? And I think we want a system where the patients are healthy and well. And that is gonna come from the physicians being healthy and well also. So thank you for sharing all that.
Atashi:
I think that's a really interesting insight Laura, the kind of attraction to these abusive environments.
I mean, we've heard so many times abuse begets more abuse and some of those survival skills. I had mentioned previously that, for lack of a better word, resiliency, and I don't wanna call it resiliency. When you have thick skin and you have skills of endurance and you can tolerate these kinds of abusive situations cuz you've been there before.
That is not how we want to be resilient. The point is that we should not be in those kinds of abusive environments. It doesn't, it matters not that, you know, you can give yourself props because you can get through this better than anyone else because you've been there before. I think that is such a dysfunctional way of looking at it, and yet one that understandably evolves because otherwise there's, you get the sense you went through all this without any kind of reward.
But can we shift the paradigm so that you can pack those survival skills away for that rarely needed occasion? Find yourself in a natural disaster. Find yourself in some other calamity, or somebody who falls ill, you know, you, you have that skillset that, okay, we're gonna get through this part, but it should not be the first batch of skills that we reach for.
Laura:
Well said. Well said. So, Tasha, what's different for you after going through coaching?
Atashi:
I've been able to really incorporate within myself what's been a personal mission of mine I think I was trying to accomplish, but at, you know, great depletion to myself: I want to leave a footprint of kindness wherever I go and with whomever I may interact.
But that footprint also needs to be left on me. And these myriad ways, even subconsciously, where we're criticizing ourselves, we're judging ourselves. It's not okay to feel that way. Why am I still doing this? Why after so many decades can I still not figure this out? I'm already steering myself wrong by letting that be the voice in my head,
That voice of, you know, I'll be okay. No, I'm not gonna get everything right. In a community of physicians, other medical providers, there is definitely that slant toward perfectionism. Another trait that is embedded within us that is just so far from realistic. Would we ask anyone else for this? No, but we do it to ourselves all the time.
No, we're not gonna get anything right. And something that Laura was teaching me and coaching that I just really hold onto all the time is, for everything in this life that we cannot control, which is a lot of it, most of it will not follow an assessment and plan as Mother Nature just showed us for the last three years is the only thing we really can control.
Well, I'll add on. If you have a good hairdresser, you can control your hair. The only other thing you can control is how you show up. That's it. Your own attitude and what you bring, how you bring yourself, the words that come out of your mouth this is the only part that we can affect. You can't affect how someone else shows up.
You can't affect how that other person interprets how you show up. So you just do the best you can, showing up the best way that you can.
Amanda:
It's funny you me mentioned hairdresser cuz if you guys could see Tasha, she's gorgeous and she says she turns 50, but you would never, never, never in a million years guess it. And her hair is. See, here we go.
Atashi:
I should, we need to just graciously accept the compliments and kindness, what this is giving us.
Amanda:
Right. You get to be flaming hot.
Atashi:
I do have a good, I I do have a good hairstylist.
Laura:
So in one of our sessions, you mentioned the book, the Four Agreements, and after reading this book or listening to it, I listen more than read these days. It seems like I realize that so much of what we do in coaching relates to these four agreements and helping us live our best lives. Would you mind sharing a little bit about the first agreement?
Atashi:
So the first agreement, I believe, was where we should be impeccable with our word. Yes. Is that correct? Yeah. That's it. Yes. I was pointed out to the four agree, the four agreements to, pointed out to me, excuse me by two of my friends who had been referred to this book for their own reasons. And oh, this resonates with me.
On a daily basis, almost all four of the agreements all the time. I think we already touched on earlier in our talk today about the very few things that we can control. Although if we recognize what those are and we utilize that, it goes a long way into creating that satisfaction, professional, personal, living, the life that we want to, and one of them is harnessing the power of what comes out of our mouth.
Our words are extremely powerful. I can't tell you just being a hospitalist and meeting people in very acute situations similar to what you do in the ER, and I'm kind of taking them through the rest of their journey, sometimes involving very bad life-changing news and just how you choose to speak to someone.
If we want to remind ourselves why we signed up for this job, you know, that we wanted to heal, I, I, as an internist, we encounter, you know, oftentimes we're encountering symptoms for which we can't find a diagnosis or we get a diagnosis for which we cannot offer any cure. That's part of what internal medicine is.
But my words can always offer something. Whether you're doing that with the attention to bring healing, to bring solace whether you're doing it to deescalate a situation our words can also inflict severe harm. I have a few instances in my life where I, I wish, you know, I could take something back that I said to someone or an action.
So I look at all the four agreements as really a moment. A moment to pause. There was something, I can't remember what book it was, where the first thing you actually do in a code is you actually check your own calls. And no, I'm not talking about standing there for 20 seconds and counting, but just the point is you always have that very short moment, as brief as it is to think, what do I wanna say?
What do I not wanna say? How do I wanna be present in this moment? What is it? What is about me and what is this other person bringing into the situation that's not about me? There's always a moment to stop and consider,
Laura:
So many doctors have trouble with their relationship with themselves. If we are impeccable with our word, how does that manifest in the way we treat ourselves and talk to ourselves?
Atashi:
Well, I think just as I was mentioning, how our words have the power to create tremendous good or hurt that applies to the words we say in our own heads too, that self criticizing voice.
You shouldn't have done this. Why did I screw up? I'm always screwing up. Nobody else does this except me. That shame and guilt that we bring on ourselves, we can also choose those words that we tell ourselves. Going back to what you had just asked me a short while ago about that kindness. It's unfortunate that you have to make a conscientious effort sometimes to remember to bring that kindness to yourselves.
But I think if there is one thing you can do an every day that will guaranteed make every day better for you, it is to do exactly that. It is to take that moment of pause. Remember what you are doing for yourself that is automatically going to have. Deep positive ramification and ripple effects coming out from you. Anything else you do for the rest of that day.
Amanda:
I love that. On the same subject, Don Miguel Ruiz says that humans are the only beings that suffer for something that they did wrong thousands of times over and over in their mind. Like that doesn't exist anywhere else in nature. You mess up, you learn from it, you move on.
But humans revisit it over and over and over, and that voice in your head, which I didn't even realize I had any authority over. You know, without that awareness that you aren't your thoughts, you're the observer of your thoughts. I just thought that that's what you do is you beat yourself up. So moving on to the second agreement. Don't take anything personally. What are your thoughts on that?
Atashi:
Well, I think all of these so dovetail so nicely into each other so that, again, that moment of pause. Especially, you know, for what we do and what many other people do in other lines of work is it has deep personal meaning to us. And so when there's a bad patient outcome, there's an angry patient or family, a colleague who's, you know, being condescending or points out some mistake that we made it, it's very hard not to really embrace this extremely personally.
But just as a, a poignant example, you know, encountering angry colleagues or angry families or patients, there is that one moment. Even though you're involved in the situation, it may have very much involved something that I said or I did. I can take that brief moment and say, okay, what do I want to bring into this situation?
If I make it that it's all about me, that this other person's anger or negativity is all about me, I, I can equally counter with just as much anger and negativity, or I could take that moment and say, Give that kindness to myself. What do I need? What do I need to go into this conversation? Can I see where this person, other person may be coming from a position of being hurt themselves, or, you know, thinking that no one's been paying attention to them for hours.
They're scared for their family. A colleague who was treated equally badly and now just doesn't know any better. Now, I'm not saying we should give a free pass to everybody, but I'm saying that we can definitely control how we enter that situation. Even if it's to say, look, I know we have a situation here.
We need to talk about it, but this is actually not a good time for me. Can we regroup? You know, do you need to go get support from your leadership from another colleague? Do you need to go talk to someone about it first? There's always that moment where yo don't have to insert yourself into that situation and where you can see maybe how the older person is showing up, and that doesn't mean you have to show up the same way.
This is a hard one because the tendency is to really take everything very deeply, personally. And then stew about it, and then let it affect the rest of what you're doing that day and let it spill out. You know, when, when you come home, or if some, if something bad is happening at home, letting it spill out at work.
But it never has to be that way if you just give yourself that moment. I'm not even gonna call it a moment of pause, I'm gonna call it a moment of kindness.
Amanda:
Love it. The third agreement is don't make assumptions. How can making assumptions make us miserable?
Atashi:
This is the one agreement, if there's nothing else I can remember for that day or no other agreement that I ever remember, again, it's this one.
The power of assumption is, I'd say just as potent, if not more sometimes in the power of our words. There are two parts to that: we don't realize when we're making assumptions a lot of the time. This can very much apply to our professional work with our implicit and cognitive biases. Patient's short of breath and they have CHF written all over their chart must be CHF and or you don't realize how much you just advance that to the front of your differential.
So from something as basic as what we do in our professional capacity to, well, every time that person says these words or walks that way, it means this. And I just know that. Or every time. That person is looking at me, or when I walked into work and that person said this to me, oh, I, I, I already know they don't like me.
Or they're, they're, they're just thinking, I'm gonna screw up today because I screwed up last week. Not only are we not realizing that these are actually all assumptions, we actually have no idea what the other person is thinking unless you ask them. You have no idea what they're thinking. But we not only make these assumptions, we very swiftly incorporate that into reality.
Don't even give ourselves time to consider that actually what we're thinking may not be true at all. And that one also takes, I think, a lot of active effort because you have to first, again, that moment of pause, that moment of kindness, say, wait a minute. These people may not be thinking about me at all when they're scowling and wandering around.
It actually has nothing to do with me or that conversation we had last week. Oh, okay. Maybe they have something else going on in our life. I know that sounds very simple, very intuitive. So why don't we do this process more often? Because it's just so much easier to make those assumptions, to keep those negative voices in our head and to perpetuate these realities that actually may not be true at all.
It's also difficult. Sometimes it's not easy to go and ask somebody really what they're thinking. And I'm not saying that we have to do it at that moment. I'm just saying that we need to untie what the truth is and is not from what we are assuming it to be.
Amanda:
Yeah. Silliest but classic example on this is when somebody's texting and you know, Kendra and Laura and I have a group text, and every time Kendra would give a thumbs up, I'm like, is she pissed or is it a thumbs up? Like she really do? Is it is like exciting? Like we, we had to clarify like what, what does the thumbs up actually mean?
Laura:
Heavens forbid anyone text Amanda without an emoji.
Amanda:
I know, I'm just, I'm saying I read into the text, so I need, I need an emoji. Like, is this a happy comment or is this an angry comment? I don't know. When it's just text.
Atashi:
Good to know that we need that follow up emoji, even though I don't know what emojis mean.
Like the, the fist one. Is that, I assume that that's a, like, yeah. Is that kind of an aggressive you go, or like a happy or...
Amanda:
Is it a throat punch?
Laura:
My daughter Alex uses emojis a lot and she actually made a code, like she did a page long sheet for me.
This is what. This is what the rocket means. So maybe that's excellent when you're I like that.
Amanda:
Well, I took us, took us way off course. I shot us on a rocket of off course from the conversation.
Atashi:
I think that, that, this is, I think one of the unfortunate consequences of convenience. There are some things you just need to pick up the phone or go face to face the old fashioned way and talk about, because there is no context within a text. So here's a perfect setup to make all kinds of assumptions.
Amanda:
Yes. So moving on to the fourth agreement is always do your best. Tell us about that one.
Atashi:
This is my favorite one. And kinda brought me back to what I was talking about that I learned from Laura in one of our coaching sessions is, you know, the best you can do is the, the only part you can affect is how you show up.
Part of my mission to leave a foot for, to kindness is also to live a life where I try, I really try to minimize guilt and regret. And what we talked about, that cycle of suffering that we perpetuate. No, you, you absolutely can commit mistakes. You learn from it. Maybe you'll commit it once more again, but you learn from it and you try not to repeat it.
You try to remember how powerful your words are and how you can hurt people with them. If you're not careful, if you don't give yourself that moment of kindness to be kind to others before the words come outta your mouth. And sometimes things don't work out. Sometimes there's a bad patient outcome in spite of your best efforts.
Sometimes relationships get fractured. Sometimes we don't get whatever the goal is that we were trying to achieve. And so what we're left with is. Did you try? Did you, did you do your best? We're we can't be perfect physicians, we can't be perfect partners. We certainly can't be perfect parents. What I tell a lot of my parents of my peds patients is the one question a child can always ask themselves is, did my parents try?
All kids figure out very early, the parents are not perfect, but they do know if they tried. And so I think no matter how the day goes, how it turns out, when you bring your best self forward, which I think you can only do by taking those pauses of kindness for yourself, you'll know that you did your best and that's all you can do.
Amanda:
I love it. That's so powerful. Atashi, thank you so much for being with us today. We appreciate you so very much. Do you have any final thoughts for our listeners?
Atashi:
Well, thank you for having me. This has just been a wonderful healing journey for me and I want you to know how much you've been a part of that, and I really do hope anybody listening in will leverage this tremendous opportunity. Cause our process, our self discovery and journeys are never ending. And that's not a bad thing, doesn't mean that it's, you know, walking around in circles. It means that we're only seeing the tips of our own icebergs when it comes to the tremendous potential that we have to always continue growing into that person that we want to be.
So, there is a quote from TS Elliot that I love. We shall not cease from exploration. And at the end of all, I'm sorry, lemme start over. We shall not cease from exploration and the end of all our exploring will be to arrive where we started and know the place for the first time.
Laura:
We got chills.
Amanda:
Love that.
Atashi:
Yeah, I really love that quote and you've definitely helped me to kind of arrive in that place. Where I'm just very happy. I'm happy I'm me.
Amanda:
Well, we're happy you're you too. I know. Heart exploding.
Kendra:
Well, thank you so much for coming on today. Your bravery, your courage, the amount of healing that is just evident in the way that you speak, not only on this podcast to us, but to our listeners. I know that it will just exude through the radio waves and people will just We get to, we get to stare at your beautiful face, but it just resounds through this podcast.
So if you're interested in working with us, go to our website, www.thewholephysician.com to find out more information and follow us on the socials for more great content. So until next time, you are whole. You are a gift to medicine and the work you do matters.
