Managing Stress, Anxiety and Fear
Date Published: November 28, 2018
How do you cope with stress? Why do some give up, while others persevere? Listen as Medical Student Jordryn Feingold and Otolaryngology resident, Benny Laitman, MD, talk about the stressors faced by young medical professionals—from performing a first surgery to managing course loads—and explain how reframing stressful thoughts and facing fears has helped them thrive.
What causes you the most stress and how do you deal with it? Some may feel like giving up while others persevere. In this episode of Road to Resilience, we're breaking down how you can make it through these challenging times in a positive way. I want to introduce you to our exceptional guests, medical student Jordyn Feingold and resident Dr. Benny Laitman. Both are true leaders at the Icahn School of Medicine at Mount Sinai. They're explaining how they use resilience to deal with incredible stress in their daily lives. This includes reframing stressful thoughts, facing their fears and prioritizing their well-being.
Hello, Jordyn and hello, Benny. Thank you so much for being part of this podcast.
Jordyn Feingold: 00:36
Oh, it's a pleasure to be here.
Benny Laitman: 00:37
Thanks for having me.
I want to first congratulate you Benny, you just graduated from med school and started your residency. How's it going?
Benny Laitman: 00:44
It's pretty great. Simultaneously amazing and terrifying. But yeah, I'm loving it. So I'm doing ENT residency, so Otolaryngology here at Mount Sinai.
And Jordyn, you're just starting your third year of med school?
Jordyn Feingold: 00:58
That's right. So far it's been wonderful. I started on outpatient medicine, I was on geriatrics for two weeks, and I spent the last week on palliative care or end of life care. And it's been really, really wonderful.
As you both know, this podcast is focused on resilience. What does resilience mean to you?
Jordyn Feingold: 01:16 So I define resilience as the ability to bounce back and grow after adversity or challenge.
Benny Laitman: 01:25
So for me it's more being able to sort of live with simultaneously all the scary, terrifying things you see and the really good, enjoyable things. So with patients, all the morbidity we see on a daily basis or just the stresses, the exhaustion, the anxiety and sort of balancing that with the good things in your own life outside of medicine and being able to kind of live with those simultaneously.
Jordyn Feingold: 01:49
I totally agree. Even when things are so hard and it's really challenging to see a path forward, being able to still have hope and gratitude and awe in everything that's going on and really taking things in their totality rather than just focusing on the negative.
Why is resilience such an interesting topic for you?
Jordyn Feingold: 02:10
I became really fascinated studying resilience when I discovered positive psychology and I realized that there's a whole science of living well and not just settling for getting rid of depression or anxiety or disease, but really that we could focus on something more than that. So flourishing, having well-being and actually having health as opposed to just not having those bad things. And I see resilience as the path forward as we're moving ourselves along.
Tell us what positive psychology is?
Jordyn Feingold: 02:43
So positive psychology is about focusing and fostering what's best in human life. Adding positive things into our lives can actually also help combat the negative. It's just a different approach to doing so.
Benny, why are you so interested in resilience?
Benny Laitman: 02:57
I definitely am at an interesting of life right now. Starting residency is a really scary time. It's exciting, but it's terrifying because you're much more independent than you are in medical school. And it's one of the first times in life where you have a lot more responsibility for other people's well-being. So I'm interested in this because I'm scared on a daily basis and I need to grow and learn how to deal with that and not let it overshadow some of the good things that are happening in my life. For example, I'm having a kid in a month and I want to enjoy that. So it's more how can I sort of savor all the good and not let the scary things that are happening to me on a daily basis overshadow that.
Well, congratulations! A lot of good things happening all at once. Talk to us about the scary aspects of your career right now?
Benny Laitman: 03:47
I think one of the biggest fears is that I'm gonna hurt somebody, you know, not intentionally, but I'm still learning. Even small things, as an ENT, just learning how to hold otoscopes the right way and cleaning out ears, even something as simple as that. You're going to cause mild discomfort on your first few people you do that on and I feel bad that I'm doing that. We do surgeries even as simple as like a tonsillectomy, there's about a three to five percent bleed rate on that. That's just the numbers doesn't matter, it's not about skill. So the ones I'm working on, there are going to be some people that come back with postoperative bleeds and it'll be because of me, and I'm going to have to learn how to deal with that and not let that destroy me.
So you're learning firsthand about how important resilience is in the medical profession?
Benny Laitman: 04:40
Oh yeah. For sure.
What are the mental challenges that you face?
Benny Laitman: 04:43
I mean, just even last week I'm having to dress a large gaping wound on a man's back and it's not something you see on a daily basis. And it's really, I don't know, it's been difficult in the first few weeks of residency to sort of deal with that, that I'm going to see such out of the norm things and have to deal with them.
And that obviously has a psychological effect to some extent?
Benny Laitman: 05:09
For sure. As I was saying, I think every once in a while these images will definitely pop back into my head. But I think for me they're all learning experiences and I think that's kind of how I handle it. Is that every sort of frightening thing, every big anxiety I'm approaching every sort of discomfort I'm causing a patient, any sort of negative thing or any failure, for me, I utilize as a learning moment.
This series is focused on the prescription to resilience, ten simple steps you can take to become more resilient, all created by our own world renowned, Dr. Dennis Charney. What are the factors you apply? You had talked about a lot of fearful situations you've been in. So one of those prescriptions is facing your fears.
Benny Laitman: 05:50
Yeah, you have to kind of dive within residency, I think it's sometimes easy not encounter some of these things. We see lots of clinic patients and I can look down the list at which clinic patient, I can choose the easy ones to see as an intern. And oh, maybe let's take the one that needs earwax cleaning or I can take the one that maybe needs a cancer workup. That's much scarier, and of course there's oversight, there are people that I could speak with, but that's really going to affect someone's life and I have to just say, all right, you know what? I'm going to see that person. I'm going to deal with the discomfort. I'm going to jump into that discomfort, and I'm going to feel it, and I'm going to own it, and I'm going to learn from it.
How does that help you become resilient?
Benny Laitman: 06:34
Every time you do that, you learn a little bit more. You feel a little bit less uncomfortable. You feel a little bit more confident with yourself. You also know how to approach it in the future. You are supposed to feel a little bit of fear and anxiety. You're supposed to be uncomfortable because that's how we grow. If you're not feeling uncomfortable, then you're probably not learning anything. You're probably avoiding things that'll make you better.
Is there one specific instance that you can recall in recent weeks where you remember being fearful and you tackle that head on?
Benny Laitman: 07:06
Yeah, my first surgery I guess. My first week of residency, it was just a tonsillectomy. But for a first year resident, that's the first surgery. And it was a child of course, because that's usually who's getting tonsillectomies. And so I was shown how to do it and then I do the other tonsil and I am absolutely terrified. But this is going to be one of the easier things I do in my career compared to the other surgeries that ENT's do. So I have to do it, I have to jump in and I have to be okay with if I made a mistake that I did it and I have to own that and learn from it.
And another prescription that we've discussed in this podcast series does apply--reframing stressful thoughts. So how do you do that?
Benny Laitman: 07:53
For me, I try to use every stressful thing to teach me. Every time I'm stressed about something, I want to think about why am I stressed about that? How can I make myself less stressed about that in the future?
And Jordyn, I want to turn things over to you now. Talk to us about med school and the stresses you go through.
Jordyn Feingold: 08:12
Medical school has kind of been a wild ride and a lot of different ways. So my medical school career was predicated on this idea that I would be anticipating a lot of anxiety and a lot of stress just based on all of the expectations and being in such a high stress environment and being evaluated in the context of our academics. And I think that notion of anticipating stress is sometimes even worse than the stress itself.
Let's talk about one of the most stressful times in your life while going through med school, take us there.
Jordyn Feingold: 08:45
Sure. So I think the end of second year was one of the most stressful times and I don't think I realized how stressful it was until after the fact. Just being pulled in a lot of directions. I love going to class and it started getting harder to have the time to sit through a one hour lecture. So, instead I would stop going to class, watch my lectures on 2x speed so that I would have time to get everything done in a day and still do my studying and still have time to exercise. And I felt like I was just sort of fighting against the clock at all times. Like there just simply were not enough hours in the day to do everything that I wanted to do and feel fulfilled. While it was challenging to feel like I had a pile of things that I had to do each day, I really tried my best to bring a mindful orientation and self compassion and say, you know what, I'm reaching for the stars here in trying to get this all done, and if I don't, it's still gonna be okay. I think part of why I love positive psychology is because there are so many interventions we can use that are just little changes toward daily routines that actually improve our well-being. So you know, just taking those moments to savor positivity. So prolonging when something positive happens, whether it's something like having a really meaningful interaction with friends or even just sitting and having a meal. If I could deepen the engagement I have in that moment with something that's positive, that could really transform my whole day and make me more productive in the times that I have to sit down and actually do the work. I had to practice self-care. One of the best things I invested in this year was a Class Pass membership and I'm not even kidding, this was totally a positive intervention for me.
For those who don't know what that is?
Jordyn Feingold: 10:32
It's a subscription service to fitness classes all around New York City. I pay a fee per month and I get a certain number of workout classes. It ends up being like five a month and it gets me out of my own routine. It gets me sweating and going with friends and just doing things out of my comfort zone that I would never do if I didn't have that incentive. So going to kettle bell classes and spin classes and yoga with friends. For 45 minutes or an hour, when you're in that space, you can't think about the stress, you're so in the activity and you leave feeling totally renewed and ready to just keep going with your day.
And how does that help you build resilience?
Jordyn Feingold: 11:13
I think building that physical reserve and really seeing what I'm capable of physically totally translates into my mental world and what I'm capable of mentally. So it helps me with my stamina. It helps me feel like I have self efficacy and I can take control over this area of my life and see myself improving. I think it really translates to my performance.
So one of the most beneficial resilience factors that you've applied is prioritizing your well-being?
Jordyn Feingold: 11:45
Absolutely. And it's something I tell all of my friends in medical school, all of my friends, not in medical school and now these past couple of weeks, my patients and their families who are going through really hard times, we can't put ourselves in the back seat. We really have to take care of ourselves so that we're as equipped as possible and as robust as possible to take care of other people.
Benny Laitman: 12:09
A lot of the physical activity Jordyn was mentioning is probably how I got through a lot of the different stressful events. It kind of allows you to have a time where that's your only focus. You get to be more mindful. You get to be really invested in that and sort of disengage from all the other stresses that are going on in life. When I started my third year med school, I actually started running a lot for the first time and training. I ended up running the New York City Marathon. Now, as I go into residency, running has become a very big part of my life where I kind of force myself to keep running by signing up for races and spending money. So then I feel guilty about not running the race. It's been interesting trying to integrate it into residency, which are longer hours, but it is a little bit of forcing yourself. So I'll get home and maybe just put on my running clothes, pass out on the couch for a few minutes and then wake up and force myself. Okay. I'm already in my clothes, I'll run out. Running around Central Park at sunset and really taking that in I think calms me down, allows me to sort of flush out all of the negative moments of the day, and reset.
So I do think physical activity, although sometimes difficult for a lot of people, can be a really great way to handle some of the stresses, anxieties, and fears of the day. Jordyn was mentioning some things that that really resonated with me and that, a lot of what we have learned in this profession is to put the patient first and patient care first. And while I really respect that, I do think the pendulum has swung so far away from students and physicians taking care of themselves, that we do need to sort of swing the pendulum back a little bit so we can take care of ourselves. So we actually can do good by patients.
I want to talk about burnout among students, residents and doctors. It's a big topic right now in the medical world.
Benny Laitman: 13:56
So this is something that is increasing, is prevalent, and why it's so important for medical students to learn to be resilient even at an early stage. I've been doing a research study with our Dean of Medical Education here, Dr. David Muller. And the number I want you to think about and walk away from is 34, and that's the number of medical students who have committed suicide in the past ten years across the country. While burnout, depression, all these things are important, the most important thing we want to avoid is individuals committing suicide and taking their own life.
Jordyn Feingold: 14:30
Absolutely, Benny. It's just horrible to hear those numbers and realize that this is our profession and we're going into healing others and we are in such pain ourselves as a profession. At the same time there's so much beauty and so much meaning in the work that we're doing, and I think teaching medical students from the get-go to stay in touch with those things and to always remember why we're here in the first place and be part of cultures and schools that support us in retaining who we are as individuals and not letting our whole identity get swept up in that of medical student or resident or physician.
There's some new Mount Sinai research out there that shows physician burnout and depression can lead to major medical errors, and that's something that can obviously affect patients.
Jordyn Feingold: 15:24
Patients should be concerned about this because what patient wants to be going to a doctor who they perceive as burnt out or unable to give them the highest quality care. Additionally, physicians can be role models for their patients, so we really need to think about this as a way to help doctors be the best versions of themselves, to be role models for patients so that they can really be delivering high quality patient care.
You've actually created a wellness program to help this community build resilience. Talk to us about it. What is this?
Jordyn Feingold: 15:58
We realized that there was a huge gap in the education of doctors and the education of medical students in talking about resilience and well-being and what these things are, and why they're not just important for us to maximize our love for medicine and to sustain our careers. But these things are really clinical skills that we need to be able to address and really confront for our patients, not just for ourselves. So we created this resilience curriculum that has become a mandatory part of medical education. It teaches topics of resilience, everything is skill based, we incorporate mindfulness. This program, the PEERS program, is a nine-session curriculum that takes place nine times throughout the four years of medical school. So they're small groups of eight students facilitated by a psychiatry resident to debrief, talk about what's going on in their lives and medical school right now and really learn tangible resilience skills that they can use in their everyday lives as medical students.
What are the resilient skills that they're learning about?
Jordyn Feingold: 17:06
So, for instance, the first one is all about values and how to incorporate our values into our daily lives as medical students. So we give them a sheet with all of these amazing values listed. So things like family, physical activities, zest, love, interest, humor, all of these values that all of us have. And we challenge students to choose five of them, that they really are so core to their identity. And then we challenge them to say, hey, how are you using these values? How are these values coming into play in your life as a medical student? And what is one goal you can make to further these values into your life as a medical student? So that's one example.
And how does that help them?
Jordyn Feingold: 17:53
So I think these are questions, you know, what are your greatest values that these students haven't necessarily been asked before, especially not in the context of their medical education. So I think the idea of sitting and thinking, who am I and what matters most to me, and how can I actually infused that into my life that's really a lot of studying and sitting in classes, that could really transform one's experience as a student and just incorporating what matters most to them into their daily lives.
And ultimately that can build resilience?
Jordyn Feingold: 18:24
Absolutely. I think such an important part of resilience is having values and living by them, having a moral compass. By having students directly confront what their values are and what matters most to them, we're helping them bolster those parts of themselves so that they can be as robust as possible.
And Benny, how do values help you become more resilient now that you're a resident?
Benny Laitman: 18:48
It allows me to really put things into perspective that being a resident, being a doctor is what I do. It is not my life. What drives me is, what Jordyn said, my five values would probably be family, love, humor, I can't even think of the other two, but things like that. That's what motivates me to get up in the morning. And I think actually this is an interesting concept because I think it's something that patients need as well. I think that if there was a way to transmit to patients that really, what are your values in life and what are we working towards? And when you see a patient around in the hospital, helping them realize that their identity is not patient, that that is what they are going through right now. They're in a hospital, but that is not who they are. We have a lot of patients that have cancer, that have gone through some serious surgeries. We want them to feel like people, we want them to feel like human beings. So, every morning we make sure they're clean, dressed, we unhook as many of the wires and cables that are with patients because they don't need to feel like a patient everyday. They should feel like a person, like a human, and be reminded of the values in their lives.
And that's so important because everything that these students are learning in this resilience course, they can then apply it to their patients and their patients can learn something from it and become resilient themselves.
Jordyn Feingold: 20:06
That's exactly the goal of the program. It's to get medical students and these future doctors to really hone these skills for themselves such that when they're sitting with a patient who might be struggling or really is so sick and really becomes to identify in that sick role to help them flesh out who are you, what matters most to you? What do you want in your life and how can we align our goals of care to be what you want in your life, not just what you want as a sick person. Teaching medical students to do this and then letting them be the disseminators of this type of thing for their patients is the way to shift medicine away from something that's just concerned with curing disease but is also really concerned about nourishing a whole person.
That's not the only program you were involved with though, right? There's something called REVAMP.
Jordyn Feingold: 20:54
Tell us what that is.
Jordyn Feingold: 20:55
Sure. It's a six session course for medical students and really anyone in the health system. It's an elective course, it's called positive medicine and it focuses around what is sort of my well-being prescription called REVAMP.
What does it stand for?
Jordyn Feingold: 21:10
So it's six letters and it stands for relationships, so pretty self evident, the relationships we have with our close family and friends, patients, colleagues and ourselves. Engagement, so being in the moment and being present in the work that we're doing, being able to embrace the best of who we are, use our character strengths and practice mindfulness. Then there is vitality, which we talked a lot about, about just nourishing our physical activity, our bodies with nutrition and sleep. And then there's accomplishment, so feeling like we're setting goals for ourselves and meeting them. And then there's meanings, so just our sense of purpose and values and what do we care about most in life? What do we feel connected to that's beyond ourselves? And then finally, positive emotions, how we experience daily goodness every day.
What changes have you seen as a result of this program?
Jordyn Feingold: 22:06
For instance, the three good things exercise was the first homework assignment that I gave, and that was every day for five days, I invited my students to, before they went to sleep, write down three good things that happen to them each day and I asked them not to stop there. Don't just write down what happened, but write down why it happened. I have friends who since last November are still doing this on a regular basis, to write down those good things that happened because then what that does is you get in a habit of not just retrospectively thinking, oh, what are three good things that happened to me today? But you start to notice them and really, they take on so much more value in the moment as they're happening. It just helps you shift your focus towards those amazing things that happened to us that we're so used to just brushing off. You know, we don't want just want to treat burnout, we don't just want to treat depression, which is so important, but we want to prevent it from happening in the first place.
This is a program that could be implemented in so many different places, not just medicine.
Jordyn Feingold: 23:02
None of this is exclusively for medical practitioners. This is about being a human being. It's so important to embrace psychology and organizational scholarship to inform our own profession and also things that are working really well in medicine to export to other industries such as the business world, lawyers are also experiencing huge levels of burnout. My mom runs a preschool, and I've given her a lot of these interventions to use with her staff, her teachers who are working with early childhood and that presents its own level of stress. I went up to my summer camp this year during their staff week to help inoculate some of the counselors against the stressors and teach them about being a resilient camp counselor. So all of these things are totally transmittable to other domains and the essence, the core of what we teach is the same. It's just the examples, the anecdotes, the points of application that differ.
Benny Laitman: 23:55
I think that we're doing a great job here at Mount Sinai and definitely teaching a lot of the medical students this and some of the early residents, but if we change the next generation's perspective on this, then over time it will take over in a lot of these different workplaces and hopefully will become more commonplace.
What do you foresee for the future?
Benny Laitman: 24:12
I do think that, at least in the healthcare sphere, physicians are going to be more engaged with wellness curriculum, wellness programs, be more cognizant of their own well-being. Especially in some of the things Jordyn mentioned about how this actually impacts patient care. If you're in this field and what you really care about is taking care of a patient and having a good outcome, the realization that the science says that if you take care of yourself, you'll do better. I think people are going to link up to that and it's going to be a much bigger part of training and practice.
Jordyn Feingold: 24:45
I think we're going to see a rise of chief wellness officers across the country and hospitals and health systems who it's their job to help create the culture is that put this at the center of what we do in patient care. I would like to see programs like PEERS and my REVAMP course to be embedded in curricula that are mandatory across the country for medical students and even pre-medical students because these are skills that we need everywhere throughout the whole course of our lives and they really should be seen as clinical skills. So really imbuing this into the way that all medical students and future doctors are trained across the board is something that I'm really hopeful about.
Such an important message and something everyone can definitely learn from. Thank you so much for sharing your insight.
Jordyn Feingold: 25:33
Thank you so much for having us.
Benny Laitman: 25:34
Yeah, it's been a pleasure. Thank you so much.
So the takeaway is you can persevere through the most stressful of times by changing your approach. Coming up next month, we're going to address gun violence, how this can impact your mental and physical health and how victims can use resilience to move forward. We have an amazing guest who has dealt with this firsthand. Hear how she used active coping skills to overcome this incredible tragedy. To listen, just head over to iTunes and remember to subscribe, review, and rate us. That's out December 26th.