Interview with Dr. Sanj Katyal
In this week's podcast episode, Dr. Sanj Katyal describes how he can help you apply positive psychology and save your career.
Dr. Sanj Katyal completed his Medical Degree at the New York University School of Medicine, and his residency in Radiology at the University of Pittsburgh Medical Center. Sanj also holds certifications in Positive Psychology and Positive Psychology Coaching from the Whole Being Institute.
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Sharing the Science of Happiness
Sanj Katyal has taught principles of well-being and the Science of Happiness to hundreds of physicians. And he is the co-founder of Thrive-Rx: A Practical Guide to Flourishing for Physicians by Practicing Physicians. He is also the author of Positive Philosophy: Ancient and Modern Wisdom to Create a Flourishing Life (affiliate link).
Apply Positive Psychology
He spent years learning about positive psychology and how it can help reframe our perspective. This helps us build our attention on what matters. And that leads to more fulfillment and satisfaction.
During our conversation, Sanj gives examples of practical techniques we can learn to achieve more happiness and satisfaction. For example, he describes how to use negative visualization, and how writing in a gratitude journal can help.
We don't want to wait for tragedy to strike before we realize in our lives how good we had it, or who in our lives was really important to us. – Dr. Sanj Katyal
He began helping others through coaching and teaching, even as he continued his clinical work. Then he partnered with three other physicians to create a program that they now offer to other physicians.
It’s called Thrive-Rx. And it is “the course they wish they had taken in medical school.” It is proven to positively impact personal wellbeing, professional fulfillment, and financial literacy. Today, we learn from Sanj the underlying philosophy and components that are built into his program. And it is available for 50% off the usual price by using the Coupon Code JOHN when purchasing it.
Summary
Dr. Katyal and his colleagues have devoted a great deal of effort to create a low-cost program that will help unfulfilled physicians apply positive psychology. I encourage you to check out his blog and his course using the links below. And don't forget that you can get a 50% discount by using the Coupon code JOHN when purchasing the course.
NOTE: Look below for a transcript of today's episode that you can download or read.
Links for Today's Episode:
- Thrive-Rx: A Practical Guide to Flourishing for Physicians by Practicing Physicians (Don't forget to enter the Coupon Code JOHN to get the discount)
- Positive Philosophy: Ancient and Modern Wisdom to Create a Flourishing Life, by Dr. Sanj Katyal
- Dr. Sanj Katyal's website Positive Medicine
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Transcription - PNC Episode 190
How to Apply Positive Psychology to Save Your Career - Interview with Dr. Sanj Katyal
John: There's a debate on whether we physicians suffer from burnout, moral injury or human rights violations. Approximately one medical school class worth of doctors takes their life each year and 1 million patients lose their physicians as a result. So many of us no longer experience high levels of meaning and fulfillment yet physicians are the most intelligent, diligent, industrious, and resilient people on the planet. What the heck is going on? I'm hoping that today's guest Dr. Sanj Katyal can help us understand this better. Welcome to the podcast Dr.Katyal.
Dr. Sanj Katyal: Thanks, John. It's great to be here.
John: I was looking through, I downloaded your book and, of looking through some of the things that you've been doing, and it just really hits home on all those topics. I've not gone through your program, so I can't speak to it from that aspect, but I really look forward to hearing more about it. But before we do that, I usually have my guests tell us a little bit about themselves, a little bit about their clinical background and education, and then we'll go from there.
Dr. Sanj Katyal: Sure. Thanks. I'm a radiologist. I live in Pittsburgh. I went to undergrad at Carnegie Mellon in chemical engineering and went to NYU for med school. I came back to Pittsburgh for an internship, residency, and body imaging fellowship. I spent the first part of my career in a kind of academia teaching residents. And then I spent the middle part for about 10 years or so, running clinical operations for a private radiology startup group where I managed about a hundred or so rads. And it was really during that time, I was in charge of getting business. And so, I interacted with a lot of C-suite folks, a lot of CMOs. And I began to notice a lot of unhappiness among the physicians that I met. And this was probably back in 2011/12 and it just seemed to be really, really growing. It didn't matter what specialty they were. They weren't happy.
And I remember really clearly driving home from one of these visits and wondering why I wasn't happier. And it's kind of silly to say, but I wasn't unhappy. It's just that I had pretty much gotten everything that I had ever dreamed of. I was married to my best friend. I had a great job designing innovative workflows, a physician executive, and we had four healthy kids. And I began to really worry that if I couldn't figure out how to experience more joy and more meaning when things were this good, how was I ever going to really deal with any real adversity when I knew it would inevitably come.
So, that really propelled me to figure out how to learn different things, to live a different way. And I started flooding philosophy, leadership, business, real estate, and I eventually stumbled upon and became certified in positive psychology. But I was really lost and not unhappy, but I was really searching for something deeper. And I just didn't know what it was at the time.
John: Well, I think there's a lot of physicians out there that feel that way. There's probably a lot of people out there that feel that way, but I feel like physicians spend so much time focusing on their education, their training, they kind of differ a lot of the other things that people get into maybe earlier in their lives. And then, I think it's human nature. And when we get through all of that, it's going to be pretty close to perfect. And it doesn't really happen very often, does it?
Dr. Sanj Katyal: No, not at all. I mean that whole, “I'll be happy when” and delayed gratification it's a vicious cycle. We're all fall trap to it, but it wasn't really until I studied positive psychology that I understood deeply the evolutionary traps of our minds and how to untangle from them.
John: But I don't think it's the nature. I mean it may be the nature of medicine now, but I think of the physicians who are towards the end of their careers when I started, which was 35 years ago. They really didn't seem to be burned out. They didn't really seem to be unhappy. They seem to have decided this is what they wanted to do. They were happy doing it. Although someone told me most people don't really find happiness so much as find a path to happiness. But they seemed like they weren't burned out. They weren't complaining in the doctor's lounge the way pretty much 80% of the physicians that I run into now do. So, something has changed.
Dr. Sanj Katyal: Yeah, there's no question. The systemic environment of medicine that we work in and people have written extensively about loss of autonomy, inefficient workflows, pressures to produce more, quicker. It's all kind of a perfect storm. The biggest problem that I see when I talk to physicians and really in my own experience is just figuring out how to reconnect with the reason, we went to med school in the first place. And that to me is the key to professional fulfillment.
John: Let me ask you this question because you're still involved with teaching residents. Do you interact with med students too?
Dr. Sanj Katyal: I do. I teach them lectures and stuff like that.
John: Well, the reason I ask is because it seems like when we were in med school and even residency, and I think it's still true. I interact with some residents from time to time. They're obviously focused on learning the science of medicine, physiology, and all of that, but it's like they're in a bubble and they're learning something that ultimately, they're going to be delivering in a completely different way than probably what they have any idea at the moment. They're being trained not as to how that's actually going to work.
Dr. Sanj Katyal: Yeah. I think medical education, the need for change, and the need to revamp certain aspects of it is pretty clear. And if you talk to medical schools, deans, and stuff like that, they recognize it. What we're taught and what we focus on for many, many years, in the end, a lot of it, it doesn't matter. And the stuff that really does matter is stuff that we don't learn. And that's really at the core what I try to teach is the things that I wish I had learned back then.
John: Well, I think I see that there are a lot of us out there trying to bolster that and add to it. I don't fault the med schools necessarily all that much. Obviously, they should be looking at this and trying to make it more applicable and so forth. But they have a ton of stuff. They've got to pour into these young brains and if you add something, you have to take something away. And so, I kind of understand that, but there's probably a much better way to do it. It's just going to take a lot of effort, maybe with people like yourself contributing, something will change over the coming years.
Dr. Sanj Katyal: At least maybe just an adjunct, something that you can kind of wrap around the existing medical education without totally trying to dismantle it from the inside.
John: So, from what I know, you recognized this several years back and you started to do some other new things beyond your clinical. You started some coaching and mentoring and different things going on, but it seems like you've come to a point now where you've kind of coalesced everything together. So, just tell us a little bit about that journey and what you're focusing on now from the standpoint of this aspect of your career.
Dr. Sanj Katyal: Sure. Yeah, I spent a large part of the last five to seven years, just lecturing, working with college students. I taught a class at a local college on positive psychology. I worked with residents, I worked with practicing attendings. There are some common themes among all of these people and really probably outside of medicine too, as you know. Probably the biggest one is everybody's chasing happiness. Everybody's chasing the feeling of feeling good.
The problem with that is that happiness, most people consider it as a transient emotional state. Yesterday I was happy or I'll be happy next weekend when I'm not on call. And that's not what the ancient philosophers, that's not what the ancient texts talk about when they're talking about a life well-lived, or what they're talking about is Eudaimonia or more of a state of human flourishing or optimal living over a period of time.
And that's probably the biggest disconnect. It’s that most people chase these pleasures or happiness, which we know are fleeting and we can get into why they're fleeting, but they are fleeting and it just causes us to chase even more. And I think that's a common struggle that I've encountered with, especially with physicians. Because like you said, we've worked so hard for so long, and we want to sit back and enjoy the fruits of our labor once we finally arrive, but we never arrive. That's the issue.
John: It is kind of ironic, but I must say there are at least the medical students that I run into now, they're actually pretty happy. They're happy doing what they're doing because they're doing what they want to do, and they're striving for that goal. And then later that feeling of just satisfaction and meaning and so forth, it kind of drifts away because they're no longer in that. Although some of them continue to learn, you'll go get another degree and another degree and another degree, but I don't know, it's just human nature, I think.
Dr. Sanj Katyal: Yeah, there's no doubt. You take hyper-functioning individuals that have mental health attributes higher or better than the standard population and you put them into an abnormal work environment and you turn out abnormal physicians with lower mental health attributes on the other side. So, that's really in a nutshell the problem with medicine and trying to figure out ways to prevent that transition is really the key.
John: Now, when you mentioned earlier about happiness and the pursuit of happiness, I can tell you right now, I have at least six books on my shelf downstairs with the word “happiness” in the title. So, there was a period of time that I was looking at that too, to try and understand it. And maybe you can give us a little insight on this without us going into like a whole lecture. But this whole idea of positive psychology was sort of unknown. I don't know if that was three, four or five decades ago, but all about psychology had to do with pathology for a long time. So, is that your understanding? There's a whole body of science behind it, from what I know. How are you using that to address this issue?
Dr. Sanj Katyal: Yeah, that's a great question. Traditional psychology, like Western medicine focuses on pathology, right? We focus on disease, not health. We focus on fixing people that are in acute distress. So, if you think of traditional psychology is taking somebody who's functioning at minus seven or minus eight and moving them to a zero or a plus one, if you're lucky.
Positive psychology takes somebody who's functioning okay. They're getting up, going to work. They make it to some of their kids' activities. They get through their days. They look forward to the weekend. Basically, the default state for most people plus one or plus two, and move them to a plus seven or plus eight. And I think we really need both areas of focus. Positive psychology doesn't deny that there are people that are really in a mental health crisis that need focus, medication, therapy, all of that stuff, but there's a whole host of people that aren't really being attended to.
And so that's really its goal. It's to explore the things that make life worth living. It's the scientific study of human flourishing. It's really an evolution of the humanistic movement back from the 50s with Maslow and his hierarchy of needs. And the only thing different is that they have an underpinning of scientific evidence, that kind of underlies their findings in positive psychology.
But it allows us to focus and access that deeper level of flourishing that I was talking to be beneath the superficial ups and downs of chasing happiness, which is largely governed by external circumstance. If something happens good, you feel good. If something bad happens, you feel bad. That’s like living life like a boat rocked by waves that you can't control.
John: Yeah, yeah. There are a lot of people that are really affected quite a bit by whatever's happening around them, which is really unfortunate because I don't know. I think I'm pretty much past that point because that's just life. There's good, there's bad. And you just got to keep going.
Dr. Sanj Katyal: Yeah, that's exactly right.
John: Okay. I want to stop here for one minute because I want to throw in your website. Because if we wait till the very end, sometimes I lose listeners by then. They get busy doing something else. People can find what you're doing at positive-medicine.com, right?
Dr. Sanj Katyal: Yeah. There's a bunch of articles on there. There's a link to our current program. That's a CME accredited. And so yeah, there's my contact information as well.
John: Okay. We're going to get into that in a minute, but I have to digress for one minute because I'm just so compulsive and a lot of the things I was looking at related to you, you were using the term and you actually included it in the book that you wrote two or three years ago called “Positive Philosophy”. Which to me, I was thinking, okay, that was kind of a twist on the word positive psychology or was combining the two. So, do you want to describe that just for my personal interest?
Dr. Sanj Katyal: Yeah. The goals of philosophy are the goals that I think everybody wants to pursue. They use different names, but everybody wants to live a good life with no regrets at the end. You want to look back at your life feeling satisfied and feeling fulfilled. Fulfillment is probably the best word for it. And the ancient philosophers and ancient wisdom texts, the Bhagavad Gita, the Bible, all of these things, they all talk about how that's the goal of a life well-lived. But they don't really offer any practical solutions to get there. It's all these kinds of abstract things, live up from life full of virtue, all of that stuff.
Positive psychology actually attempts to delineate a blueprint to human flourishing and a life well-lived. That's really its goal, evidence-based practices to live better. The problem with positive psychology and the self-help movement, in general, is that it's bastardized by a lot of platitudes, a lot of smiling, and just bumper sticker slogans. And so, what I wanted to do was combine the best of philosophy, which are the goals of living a good life with the roadmap that's being delineated and laid out by positive psychology. And I put together a system called “Positive Philosophy”, which is basically combining these two into a daily roadmap of flourishing.
John: Okay. And so, those are the same principles that are used in your Thrive Rx courses or programs.
Dr. Sanj Katyal: Yeah, basically Thrive Rx is an expansion of the original program. And Thrive Rx is more specifically targeted for physicians and it's more targeted towards what we should've learned in medical school. And at the root of Thrive Rx, at the root of all the work I do is cultivating attention to things that matter. And I think our inability to pay attention to the things to true signal in our life, to things that matter, is really at the root of a lot of suffering.
We talk about personal wellbeing, that's the whole module, grounded in positive psychology techniques, what works, what doesn't work, why we do the things we do, the evolutionary traps of our minds. Professional fulfillment, which is paying attention to high-impact work and meaningful interactions. How can we optimize our attention to those things? How can we create an environment in our work to increase those?
And then we can't talk about flourishing, happiness, success without talking about financial independence. I know you do a lot of work in that area with physicians transitioning out of medicine. But you can't focus on flourishing if you're focused on paying the bills. So, you have to have some level of financial literacy and independence and paying attention to things regarding your finances and being able to convert active income to passive income is something I wish I had learned in med school or shortly after. And so, we have a whole mini finance module on doing just that. So, it's kind of a pry bar X to me as a comprehensive course that basically tackles all three facets of physician life - Personal, professional, and financial.
John: Okay. So that gets us an image, I think in my mind of the gestalt of what it is, what it's trying to accomplish. Can you tell us the structure of it? How is it built? What is it? Is it live? Is it videos? Is it a combination? Is there coaching? What does that whole process look like for someone who might sign up for it?
Dr. Sanj Katyal: Yeah. Basically, I wanted to put together a course that has all of these elements in it. So, I collaborated with three other physician experts in positive psychology, leadership, finance to put together this course. It's in five modules. Each is about 90 minutes, broken up into about 10 to 15 minutes each. So, it's easily consumable on your way to work. We have exercises at the end of each module. We've got live office hours with faculty for answering questions and we've got access to all of us, basically. All of us are practicing physicians with no desire to leave medicine. And the course is basically priced just to cover the CME. We get seven and a half hours of CME with it too. Right now, it's a really good deal. We're just trying to get to that.
John, if you really want to know the real reason I've put together this course is that I want to get to the families of these physicians that are suffering. My wife is a counselor at our local university, and the mental health crisis among youth is massive. And so, teaching physicians will then impart these principles to their patients. We'll also impart them when they come home to work, to talk to their kids. And so, that's why we put it out there at such an affordable rate with CME because it's kind of our way to get back to the profession.
John: Okay. So, your goal is for all those physicians who are unhappy, dissatisfied, whatever, burned out, whatever you want to call it, they're not as fulfilled as they could be. The object would be to teach them and help them through these different exercises and so forth, hopefully to find the meaning of fulfillment in what they're doing currently if they can. And if that's not working find an alternative. Does it involve identifying your goals and that kind of thing?
Dr. Sanj Katyal: Yeah. At the root of all of the dissatisfaction is really people looking for things in places that they won't find it. And that's where we're trying to increase insight and understanding. Why do I keep chasing this new title, this new job, more money? I know that's not going to bring me more satisfaction, so what will bring me real satisfaction? And then you can talk about signature strengths. There's a whole exercise on that.
Everybody has unique strengths, and it's been shown that if you employ these signature strengths on a daily basis, personally, professionally, you're going to be much more successful. You're going to be much happier. You're going to be healthier. There's a whole body of research on all of that stuff. So, it's really about giving insight to what really matters and then reframing and designing our day-to-day lives to cultivate more attention to those things.
John: All right. Well, I want to make it easy for my listeners to find the Thrive Rx program. At least to look at it and learn about it and see if it's something that will help them. So, to make it easy, they can just go to nonclinicalphysicians.com/thrive. I'll put it in the show notes and it'll just take them right to that homepage for the program. I think that'll work.
Dr. Sanj Katyal: Yeah. And I think for your listeners, what I'd like to do is just offer them 50% off on the program for the next month or so. And so, we have a coupon called JOHN on there and if they use that, they can get 50% off.
John: Now, that sounds great. And my listeners know that I sometimes get involved in affiliate programs. This is not an affiliate program, so I'm not marking this or promoting this for me, by any means. I'm wanting to bring things to you guys that are going to help you. And if this sounds like something that would be a benefit, then yeah, take advantage of it.
I've looked through the modules, that are on the website and it looks pretty comprehensive and could be very, very useful. So again, if they get there, they can put JOHN in wherever the coupon code needs to go and they'll get a 50% discount on whatever that cost is. I don't even know what it costs, to be honest.
Dr. Sanj Katyal: Yeah. It's $497 for seven and a half CME hours. So, we cut that in half and you get seven and a half CME hours. So, it's basically a nice dinner out.
John: Yeah. And that's a really good price for CME these days unless you're trying to scrounge it somewhere for free in your local hospital or something.
Dr. Sanj Katyal: No, the average CME cost is like $125 per CMI hour. And that's what I was saying. We're not doing this as a profitable side gig. We're doing this because this is what we want to do. It's our passion and it's interesting to all of us.
John: Okay. Tell me a little bit more, we have a few minutes left, I think. What would some of the exercises look like?
Dr. Sanj Katyal: Well probably the single biggest problem of physicians is you alluded to it earlier, it’s just delayed gratification, or “I'll be happy when”. One of the big things of positive psychology is elucidated, this is a process of hedonic adaptation. So, we get used to stimuli in our lives that are constant. So, we'll get a big boost when we make attending or we make partner or a group, and then we'll come back to our baseline level of happiness. We get a big boost in marriage when we come back down. It's the honeymoon effect.
And physicians, unfortunately, lived their lives waiting to get to the next stage in their careers, but they feel unfulfilled once they get there. And that's because they adapt to that stage. And so, there's a whole body of research on how to combat heat on adaptation. There's a whole bunch of exercises that we talk about.
One of the biggest antidotes to hedonic adaptation is gratitude. Simply learning how to pay attention to the things that we have before they're gone. And the scientific study of gratitude is probably positive psychology, his biggest contribution. And gratitude journaling, there's a gratitude letter or there's gratitude visits, all very, very powerful. And it doesn't take that long. Three times a week, write down three good things that you're grateful for and why and it helps to go through beyond the big three – Health, family and job, and to go really deep. I probably have been doing gratitude journaling since 2012 or so, and I can tell you now, I see things or I'm doing things during the day that I know I'm going to write about in my gratitude journal.
So, it's kind of like a positive feedback loop because it makes me more mindful of the things as they're happening. And now gratitude journaling is not going to make you into a Saint. You're still going to get upset at difficult work situations or something, and all that stuff. But it does bring a sense of gratefulness and calm into your life. That's pretty, pretty impressive.
The other big thing that people have told me that worked with me over the past years is the exercise that I gave in just negative visualization. And I think if your listeners don't do anything else from this podcast, do negative visualization. On the drive home from work at a stoplight, take 30 seconds and mentally subtract something good from your life. Imagine your job, your group imploding and losing the contract for your hospital. And imagine having to look for another job. You are too tired to take your daughter to her softball game. Fast forward to a time where she's at college or no longer living at home, and imagine how much you miss those times, or you crave a time to spend in the car ride with her.
Mentally subtracting things is actually even more powerful than paying attention to the positive. So negative visualization has been, I hear virtually from every single physician that I've taught this to. It's phenomenal.
John: No, I can relate to that. And I hate to admit it in a way. I don't tell too many people this, but my parents died a couple of years ago. And now I visualize the
people around me that I love as being deceased. I do it with my pets. I get tired of my dog. And then I think about him being gone. And I say, okay, then you get five minutes of being petted because you're going to be gone. And so, I need to be grateful that you're here now.
Dr. Sanj Katyal: That's very insightful John, because a lot of people don't do that. We don't want to wait for tragedies to strike before we realize how good we had it, or who in our life was really important to us. And that's the problem with hedonic adaptation. It's an evolutionary advantage because you want to recognize new stimuli or potential threats from old ones that should just fade into the background. That's how you're going to survive better. But the problem is the things that fade into the background are the things that really matter. Our families, our meaningful relationships, our high-impact work, our health, all of that stuff.
John: That's good advice to devote your attention to it.
Dr. Sanj Katyal: Exactly.
John: All right. Well, you've given us a lot of things to think about. I'll give you another minute or two for any last bit of advice you might want to give to our listeners before we go?
Dr. Sanj Katyal: I think just doing negative visualization and maybe getting a journal and make writing habit, it can often bring some clarity and to access deeper parts of yourself than the superficial level that most of us live at with our minds searching for opportunities and threats because that's just the way we're wired. I think maybe creating a little bit of a writing habit and doing gratitude and negative visualization. If you do nothing else, I think you're going to be way ahead of where you are otherwise. I know it's been really transformative, both of those things for me.
John: Awesome. All right, Sanj, thanks so much for being here today. I'll mention again, the website positive-medicine.com. You can actually get to the Thrive Rx or anything else you're up to, through that website. Don't forget to put JOHN in there if you purchase and get that discount or not. It sounds like you should just pay the whole amount, keep it going. We don't want this to disappear. So, thanks a lot. And I really appreciate you for being here and hope to talk to you again soon.
Dr. Sanj Katyal: Yeah. Thanks, John. And keep up the great work. Appreciate all you do for physicians as well.
John: All right. Take care. Bye-bye.
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Transcription - PNC Episode 190
How to Apply Positive Psychology to Save Your Career - Interview with Dr. Sanj Katyal
John: There's a debate on whether we physicians suffer from burnout, moral injury or human rights violations. Approximately one medical school class worth of doctors takes their life each year and 1 million patients lose their physicians as a result. So many of us no longer experience high levels of meaning and fulfillment yet physicians are the most intelligent, diligent, industrious, and resilient people on the planet. What the heck is going on? I'm hoping that today's guest Dr. Sanj Katyal can help us understand this better. Welcome to the podcast Dr.Katyal.
Dr. Sanj Katyal: Thanks, John. It's great to be here.
John: I was looking through, I downloaded your book and, of looking through some of the things that you've been doing, and it just really hits home on all those topics. I've not gone through your program, so I can't speak to it from that aspect, but I really look forward to hearing more about it. But before we do that, I usually have my guests tell us a little bit about themselves, a little bit about their clinical background and education, and then we'll go from there.
Dr. Sanj Katyal: Sure. Thanks. I'm a radiologist. I live in Pittsburgh. I went to undergrad at Carnegie Mellon in chemical engineering and went to NYU for med school. I came back to Pittsburgh for an internship, residency, and body imaging fellowship. I spent the first part of my career in a kind of academia teaching residents. And then I spent the middle part for about 10 years or so, running clinical operations for a private radiology startup group where I managed about a hundred or so rads. And it was really during that time, I was in charge of getting business. And so, I interacted with a lot of C-suite folks, a lot of CMOs. And I began to notice a lot of unhappiness among the physicians that I met. And this was probably back in 2011/12 and it just seemed to be really, really growing. It didn't matter what specialty they were. They weren't happy.
And I remember really clearly driving home from one of these visits and wondering why I wasn't happier. And it's kind of silly to say, but I wasn't unhappy. It's just that I had pretty much gotten everything that I had ever dreamed of. I was married to my best friend. I had a great job designing innovative workflows, a physician executive, and we had four healthy kids. And I began to really worry that if I couldn't figure out how to experience more joy and more meaning when things were this good, how was I ever going to really deal with any real adversity when I knew it would inevitably come.
So, that really propelled me to figure out how to learn different things, to live a different way. And I started flooding philosophy, leadership, business, real estate, and I eventually stumbled upon and became certified in positive psychology. But I was really lost and not unhappy, but I was really searching for something deeper. And I just didn't know what it was at the time.
John: Well, I think there's a lot of physicians out there that feel that way. There's probably a lot of people out there that feel that way, but I feel like physicians spend so much time focusing on their education, their training, they kind of differ a lot of the other things that people get into maybe earlier in their lives. And then, I think it's human nature. And when we get through all of that, it's going to be pretty close to perfect. And it doesn't really happen very often, does it?
Dr. Sanj Katyal: No, not at all. I mean that whole, “I'll be happy when” and delayed gratification it's a vicious cycle. We're all fall trap to it, but it wasn't really until I studied positive psychology that I understood deeply the evolutionary traps of our minds and how to untangle from them.
John: But I don't think it's the nature. I mean it may be the nature of medicine now, but I think of the physicians who are towards the end of their careers when I started, which was 35 years ago. They really didn't seem to be burned out. They didn't really seem to be unhappy. They seem to have decided this is what they wanted to do. They were happy doing it. Although someone told me most people don't really find happiness so much as find a path to happiness. But they seemed like they weren't burned out. They weren't complaining in the doctor's lounge the way pretty much 80% of the physicians that I run into now do. So, something has changed.
Dr. Sanj Katyal: Yeah, there's no question. The systemic environment of medicine that we work in and people have written extensively about loss of autonomy, inefficient workflows, pressures to produce more, quicker. It's all kind of a perfect storm. The biggest problem that I see when I talk to physicians and really in my own experience is just figuring out how to reconnect with the reason, we went to med school in the first place. And that to me is the key to professional fulfillment.
John: Let me ask you this question because you're still involved with teaching residents. Do you interact with med students too?
Dr. Sanj Katyal: I do. I teach them lectures and stuff like that.
John: Well, the reason I ask is because it seems like when we were in med school and even residency, and I think it's still true. I interact with some residents from time to time. They're obviously focused on learning the science of medicine, physiology, and all of that, but it's like they're in a bubble and they're learning something that ultimately, they're going to be delivering in a completely different way than probably what they have any idea at the moment. They're being trained not as to how that's actually going to work.
Dr. Sanj Katyal: Yeah. I think medical education, the need for change, and the need to revamp certain aspects of it is pretty clear. And if you talk to medical schools, deans, and stuff like that, they recognize it. What we're taught and what we focus on for many, many years, in the end, a lot of it, it doesn't matter. And the stuff that really does matter is stuff that we don't learn. And that's really at the core what I try to teach is the things that I wish I had learned back then.
John: Well, I think I see that there are a lot of us out there trying to bolster that and add to it. I don't fault the med schools necessarily all that much. Obviously, they should be looking at this and trying to make it more applicable and so forth. But they have a ton of stuff. They've got to pour into these young brains and if you add something, you have to take something away. And so, I kind of understand that, but there's probably a much better way to do it. It's just going to take a lot of effort, maybe with people like yourself contributing, something will change over the coming years.
Dr. Sanj Katyal: At least maybe just an adjunct, something that you can kind of wrap around the existing medical education without totally trying to dismantle it from the inside.
John: So, from what I know, you recognized this several years back and you started to do some other new things beyond your clinical. You started some coaching and mentoring and different things going on, but it seems like you've come to a point now where you've kind of coalesced everything together. So, just tell us a little bit about that journey and what you're focusing on now from the standpoint of this aspect of your career.
Dr. Sanj Katyal: Sure. Yeah, I spent a large part of the last five to seven years, just lecturing, working with college students. I taught a class at a local college on positive psychology. I worked with residents, I worked with practicing attendings. There are some common themes among all of these people and really probably outside of medicine too, as you know. Probably the biggest one is everybody's chasing happiness. Everybody's chasing the feeling of feeling good.
The problem with that is that happiness, most people consider it as a transient emotional state. Yesterday I was happy or I'll be happy next weekend when I'm not on call. And that's not what the ancient philosophers, that's not what the ancient texts talk about when they're talking about a life well-lived, or what they're talking about is Eudaimonia or more of a state of human flourishing or optimal living over a period of time.
And that's probably the biggest disconnect. It’s that most people chase these pleasures or happiness, which we know are fleeting and we can get into why they're fleeting, but they are fleeting and it just causes us to chase even more. And I think that's a common struggle that I've encountered with, especially with physicians. Because like you said, we've worked so hard for so long, and we want to sit back and enjoy the fruits of our labor once we finally arrive, but we never arrive. That's the issue.
John: It is kind of ironic, but I must say there are at least the medical students that I run into now, they're actually pretty happy. They're happy doing what they're doing because they're doing what they want to do, and they're striving for that goal. And then later that feeling of just satisfaction and meaning and so forth, it kind of drifts away because they're no longer in that. Although some of them continue to learn, you'll go get another degree and another degree and another degree, but I don't know, it's just human nature, I think.
Dr. Sanj Katyal: Yeah, there's no doubt. You take hyper-functioning individuals that have mental health attributes higher or better than the standard population and you put them into an abnormal work environment and you turn out abnormal physicians with lower mental health attributes on the other side. So, that's really in a nutshell the problem with medicine and trying to figure out ways to prevent that transition is really the key.
John: Now, when you mentioned earlier about happiness and the pursuit of happiness, I can tell you right now, I have at least six books on my shelf downstairs with the word “happiness” in the title. So, there was a period of time that I was looking at that too, to try and understand it. And maybe you can give us a little insight on this without us going into like a whole lecture. But this whole idea of positive psychology was sort of unknown. I don't know if that was three, four or five decades ago, but all about psychology had to do with pathology for a long time. So, is that your understanding? There's a whole body of science behind it, from what I know. How are you using that to address this issue?
Dr. Sanj Katyal: Yeah, that's a great question. Traditional psychology, like Western medicine focuses on pathology, right? We focus on disease, not health. We focus on fixing people that are in acute distress. So, if you think of traditional psychology is taking somebody who's functioning at minus seven or minus eight and moving them to a zero or a plus one, if you're lucky.
Positive psychology takes somebody who's functioning okay. They're getting up, going to work. They make it to some of their kids' activities. They get through their days. They look forward to the weekend. Basically, the default state for most people plus one or plus two, and move them to a plus seven or plus eight. And I think we really need both areas of focus. Positive psychology doesn't deny that there are people that are really in a mental health crisis that need focus, medication, therapy, all of that stuff, but there's a whole host of people that aren't really being attended to.
And so that's really its goal. It's to explore the things that make life worth living. It's the scientific study of human flourishing. It's really an evolution of the humanistic movement back from the 50s with Maslow and his hierarchy of needs. And the only thing different is that they have an underpinning of scientific evidence, that kind of underlies their findings in positive psychology.
But it allows us to focus and access that deeper level of flourishing that I was talking to be beneath the superficial ups and downs of chasing happiness, which is largely governed by external circumstance. If something happens good, you feel good. If something bad happens, you feel bad. That’s like living life like a boat rocked by waves that you can't control.
John: Yeah, yeah. There are a lot of people that are really affected quite a bit by whatever's happening around them, which is really unfortunate because I don't know. I think I'm pretty much past that point because that's just life. There's good, there's bad. And you just got to keep going.
Dr. Sanj Katyal: Yeah, that's exactly right.
John: Okay. I want to stop here for one minute because I want to throw in your website. Because if we wait till the very end, sometimes I lose listeners by then. They get busy doing something else. People can find what you're doing at positive-medicine.com, right?
Dr. Sanj Katyal: Yeah. There's a bunch of articles on there. There's a link to our current program. That's a CME accredited. And so yeah, there's my contact information as well.
John: Okay. We're going to get into that in a minute, but I have to digress for one minute because I'm just so compulsive and a lot of the things I was looking at related to you, you were using the term and you actually included it in the book that you wrote two or three years ago called “Positive Philosophy”. Which to me, I was thinking, okay, that was kind of a twist on the word positive psychology or was combining the two. So, do you want to describe that just for my personal interest?
Dr. Sanj Katyal: Yeah. The goals of philosophy are the goals that I think everybody wants to pursue. They use different names, but everybody wants to live a good life with no regrets at the end. You want to look back at your life feeling satisfied and feeling fulfilled. Fulfillment is probably the best word for it. And the ancient philosophers and ancient wisdom texts, the Bhagavad Gita, the Bible, all of these things, they all talk about how that's the goal of a life well-lived. But they don't really offer any practical solutions to get there. It's all these kinds of abstract things, live up from life full of virtue, all of that stuff.
Positive psychology actually attempts to delineate a blueprint to human flourishing and a life well-lived. That's really its goal, evidence-based practices to live better. The problem with positive psychology and the self-help movement, in general, is that it's bastardized by a lot of platitudes, a lot of smiling, and just bumper sticker slogans. And so, what I wanted to do was combine the best of philosophy, which are the goals of living a good life with the roadmap that's being delineated and laid out by positive psychology. And I put together a system called “Positive Philosophy”, which is basically combining these two into a daily roadmap of flourishing.
John: Okay. And so, those are the same principles that are used in your Thrive Rx courses or programs.
Dr. Sanj Katyal: Yeah, basically Thrive Rx is an expansion of the original program. And Thrive Rx is more specifically targeted for physicians and it's more targeted towards what we should've learned in medical school. And at the root of Thrive Rx, at the root of all the work I do is cultivating attention to things that matter. And I think our inability to pay attention to the things to true signal in our life, to things that matter, is really at the root of a lot of suffering.
We talk about personal wellbeing, that's the whole module, grounded in positive psychology techniques, what works, what doesn't work, why we do the things we do, the evolutionary traps of our minds. Professional fulfillment, which is paying attention to high-impact work and meaningful interactions. How can we optimize our attention to those things? How can we create an environment in our work to increase those?
And then we can't talk about flourishing, happiness, success without talking about financial independence. I know you do a lot of work in that area with physicians transitioning out of medicine. But you can't focus on flourishing if you're focused on paying the bills. So, you have to have some level of financial literacy and independence and paying attention to things regarding your finances and being able to convert active income to passive income is something I wish I had learned in med school or shortly after. And so, we have a whole mini finance module on doing just that. So, it's kind of a pry bar X to me as a comprehensive course that basically tackles all three facets of physician life - Personal, professional, and financial.
John: Okay. So that gets us an image, I think in my mind of the gestalt of what it is, what it's trying to accomplish. Can you tell us the structure of it? How is it built? What is it? Is it live? Is it videos? Is it a combination? Is there coaching? What does that whole process look like for someone who might sign up for it?
Dr. Sanj Katyal: Yeah. Basically, I wanted to put together a course that has all of these elements in it. So, I collaborated with three other physician experts in positive psychology, leadership, finance to put together this course. It's in five modules. Each is about 90 minutes, broken up into about 10 to 15 minutes each. So, it's easily consumable on your way to work. We have exercises at the end of each module. We've got live office hours with faculty for answering questions and we've got access to all of us, basically. All of us are practicing physicians with no desire to leave medicine. And the course is basically priced just to cover the CME. We get seven and a half hours of CME with it too. Right now, it's a really good deal. We're just trying to get to that.
John, if you really want to know the real reason I've put together this course is that I want to get to the families of these physicians that are suffering. My wife is a counselor at our local university, and the mental health crisis among youth is massive. And so, teaching physicians will then impart these principles to their patients. We'll also impart them when they come home to work, to talk to their kids. And so, that's why we put it out there at such an affordable rate with CME because it's kind of our way to get back to the profession.
John: Okay. So, your goal is for all those physicians who are unhappy, dissatisfied, whatever, burned out, whatever you want to call it, they're not as fulfilled as they could be. The object would be to teach them and help them through these different exercises and so forth, hopefully to find the meaning of fulfillment in what they're doing currently if they can. And if that's not working find an alternative. Does it involve identifying your goals and that kind of thing?
Dr. Sanj Katyal: Yeah. At the root of all of the dissatisfaction is really people looking for things in places that they won't find it. And that's where we're trying to increase insight and understanding. Why do I keep chasing this new title, this new job, more money? I know that's not going to bring me more satisfaction, so what will bring me real satisfaction? And then you can talk about signature strengths. There's a whole exercise on that.
Everybody has unique strengths, and it's been shown that if you employ these signature strengths on a daily basis, personally, professionally, you're going to be much more successful. You're going to be much happier. You're going to be healthier. There's a whole body of research on all of that stuff. So, it's really about giving insight to what really matters and then reframing and designing our day-to-day lives to cultivate more attention to those things.
John: All right. Well, I want to make it easy for my listeners to find the Thrive Rx program. At least to look at it and learn about it and see if it's something that will help them. So, to make it easy, they can just go to nonclinicalphysicians.com/thrive. I'll put it in the show notes and it'll just take them right to that homepage for the program. I think that'll work.
Dr. Sanj Katyal: Yeah. And I think for your listeners, what I'd like to do is just offer them 50% off on the program for the next month or so. And so, we have a coupon called JOHN on there and if they use that, they can get 50% off.
John: Now, that sounds great. And my listeners know that I sometimes get involved in affiliate programs. This is not an affiliate program, so I'm not marking this or promoting this for me, by any means. I'm wanting to bring things to you guys that are going to help you. And if this sounds like something that would be a benefit, then yeah, take advantage of it.
I've looked through the modules, that are on the website and it looks pretty comprehensive and could be very, very useful. So again, if they get there, they can put JOHN in wherever the coupon code needs to go and they'll get a 50% discount on whatever that cost is. I don't even know what it costs, to be honest.
Dr. Sanj Katyal: Yeah. It's $497 for seven and a half CME hours. So, we cut that in half and you get seven and a half CME hours. So, it's basically a nice dinner out.
John: Yeah. And that's a really good price for CME these days unless you're trying to scrounge it somewhere for free in your local hospital or something.
Dr. Sanj Katyal: No, the average CME cost is like $125 per CMI hour. And that's what I was saying. We're not doing this as a profitable side gig. We're doing this because this is what we want to do. It's our passion and it's interesting to all of us.
John: Okay. Tell me a little bit more, we have a few minutes left, I think. What would some of the exercises look like?
Dr. Sanj Katyal: Well probably the single biggest problem of physicians is you alluded to it earlier, it’s just delayed gratification, or “I'll be happy when”. One of the big things of positive psychology is elucidated, this is a process of hedonic adaptation. So, we get used to stimuli in our lives that are constant. So, we'll get a big boost when we make attending or we make partner or a group, and then we'll come back to our baseline level of happiness. We get a big boost in marriage when we come back down. It's the honeymoon effect.
And physicians, unfortunately, lived their lives waiting to get to the next stage in their careers, but they feel unfulfilled once they get there. And that's because they adapt to that stage. And so, there's a whole body of research on how to combat heat on adaptation. There's a whole bunch of exercises that we talk about.
One of the biggest antidotes to hedonic adaptation is gratitude. Simply learning how to pay attention to the things that we have before they're gone. And the scientific study of gratitude is probably positive psychology, his biggest contribution. And gratitude journaling, there's a gratitude letter or there's gratitude visits, all very, very powerful. And it doesn't take that long. Three times a week, write down three good things that you're grateful for and why and it helps to go through beyond the big three – Health, family and job, and to go really deep. I probably have been doing gratitude journaling since 2012 or so, and I can tell you now, I see things or I'm doing things during the day that I know I'm going to write about in my gratitude journal.
So, it's kind of like a positive feedback loop because it makes me more mindful of the things as they're happening. And now gratitude journaling is not going to make you into a Saint. You're still going to get upset at difficult work situations or something, and all that stuff. But it does bring a sense of gratefulness and calm into your life. That's pretty, pretty impressive.
The other big thing that people have told me that worked with me over the past years is the exercise that I gave in just negative visualization. And I think if your listeners don't do anything else from this podcast, do negative visualization. On the drive home from work at a stoplight, take 30 seconds and mentally subtract something good from your life. Imagine your job, your group imploding and losing the contract for your hospital. And imagine having to look for another job. You are too tired to take your daughter to her softball game. Fast forward to a time where she's at college or no longer living at home, and imagine how much you miss those times, or you crave a time to spend in the car ride with her.
Mentally subtracting things is actually even more powerful than paying attention to the positive. So negative visualization has been, I hear virtually from every single physician that I've taught this to. It's phenomenal.
John: No, I can relate to that. And I hate to admit it in a way. I don't tell too many people this, but my parents died a couple of years ago. And now I visualize the
people around me that I love as being deceased. I do it with my pets. I get tired of my dog. And then I think about him being gone. And I say, okay, then you get five minutes of being petted because you're going to be gone. And so, I need to be grateful that you're here now.
Dr. Sanj Katyal: That's very insightful John, because a lot of people don't do that. We don't want to wait for tragedies to strike before we realize how good we had it, or who in our life was really important to us. And that's the problem with hedonic adaptation. It's an evolutionary advantage because you want to recognize new stimuli or potential threats from old ones that should just fade into the background. That's how you're going to survive better. But the problem is the things that fade into the background are the things that really matter. Our families, our meaningful relationships, our high-impact work, our health, all of that stuff.
John: That's good advice to devote your attention to it.
Dr. Sanj Katyal: Exactly.
John: All right. Well, you've given us a lot of things to think about. I'll give you another minute or two for any last bit of advice you might want to give to our listeners before we go?
Dr. Sanj Katyal: I think just doing negative visualization and maybe getting a journal and make writing habit, it can often bring some clarity and to access deeper parts of yourself than the superficial level that most of us live at with our minds searching for opportunities and threats because that's just the way we're wired. I think maybe creating a little bit of a writing habit and doing gratitude and negative visualization. If you do nothing else, I think you're going to be way ahead of where you are otherwise. I know it's been really transformative, both of those things for me.
John: Awesome. All right, Sanj, thanks so much for being here today. I'll mention again, the website positive-medicine.com. You can actually get to the Thrive Rx or anything else you're up to, through that website. Don't forget to put JOHN in there if you purchase and get that discount or not. It sounds like you should just pay the whole amount, keep it going. We don't want this to disappear. So, thanks a lot. And I really appreciate you for being here and hope to talk to you again soon.
Dr. Sanj Katyal: Yeah. Thanks, John. And keep up the great work. Appreciate all you do for physicians as well.
John: All right. Take care. Bye-bye.
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