When many of us face a doctor’s appointment, a little natural anxiety accompanies the uncertainty. And if we’re being treated for something serious, it can often spike.
But what if the doctor is the one with the anxiety?
Questions about heart health start with a visit to your primary care doctor.
Meet Dr. Jonathan Fisher, a cardiologist at Novant Health Heart & Vascular Institute – Huntersville. As he met patients throughout the day, anxiety was often there as a constant companion.
Fisher is a highly educated and trained physician with a deep understanding of how the human body works. In fact, he understands the physiology behind the fact that chronic, unmanaged stress and anxiety are really bad for the heart. But it took his wife, Julie, and three kids to help him understand the toll it was taking on the entire family. It’s a topic he tackled in a much-viewed LinkedIn post:
“Is Daddy on call again?”
That question from one of my three children is one of my warning signs.
You see, my wife has pointed out that when I'm acting distant, unkind or judgmental at home, the kids are reminded of some of my worst nights on … call as a cardiologist ...
I was on edge because I was anxious about the potential outcomes of the life and death for the heart patients I am called to help often in the midst of catastrophe. I held myself to an impossible standard of perfection in every decision and action. I feared judgment and criticism for potential failures or mistakes."
When the call comes in the middle of the night
There are a number of professions in which a phone call or text alerting you to report for duty comes with incredibly high stakes – the military, paramedics, law enforcement and medicine are a few Dr. Fisher mentioned.
“For my colleagues who practice invasive cardiology, that call can be even more stressful than it is for those of us, like me, who practice non-invasive cardiology,” he said. “Invasive cardiologists may have to get to the hospital in the middle of the night and perform a cath procedure to save someone’s life.”
There are times for Fisher when the stakes can feel even higher – if he’s treating an elderly person, a child or a pregnant patient, for instance. “The worst-case scenarios can still play out in my mind,” he said. “But when I remember I set out to be a healer, it helps me focus.”
He’s also recognized that if he’s on too high alert, he can’t think clearly.
“Now, when I get that call in the middle of the night, I take some deep breaths and remind myself of why I wanted to be a cardiologist in the first place – and that’s to help people who are afraid,” he said. “A doctor can have all the skill in the world, but if it doesn’t come with compassion, it’s not optimal for the patient.”
For some doctors, being on call means they must be able to get to the hospital within 30 minutes. Some specialties – obstetrics, for instance – don’t even have a 30-minute window. They take their call duty at the hospital.
“I might still go out to dinner with my family if I’m on call,” Fisher said. “But I often take my own car so that, if I am called in, my wife and kids have transportation home. And I don’t put myself in situations that would be challenging to get out of. I don’t go to the movies or a sporting event, for instance. I’ve got to be able to leave at a moment’s notice.” And then walk through the door with a mind that is clear and prepared.
Most of us are not in professions that force us to face life-and-death situations. But millions of Americans work on-call in some way. And even if we don’t, we all know the feeling of racing thoughts and tightness in our chests and shoulders that comes with uncertainty and apprehension around the “what ifs” of daily living.
“As a doctor with anxiety,” Fisher said, “you run the risk of being disconnected from the very people you’re trying to help.”
The good news is that he learned to control those feelings. And we can all learn from Fisher’s journey so we don’t miss out on life or damage relationships with the people closest to us.
Where does anxiety come from?
Anxiety stems from fear, a natural human emotion. “Fear is what causes us to look both ways before crossing the street,” Fisher said. “And anxiety is rooted in those natural tendencies which have kept us alive. Anxiety involves a hijacking of the brain’s circuitry.”
It can be genetic, he said. But it can also go beyond genetics. In recent years, scientists have begun studying intergenerational trauma. If your Jewish grandparents were on the run from the Nazis during the Holocaust, that innate fear can be passed down via family histories and interactions. It’s the same with the descendants of enslaved people.
In addition, some parents are incapable of helping their children regulate their emotions. If you grow up without that support, you can become an adult with a pervasive sense of uncertainty.
How can we address anxiety?
We can address those held-over childhood fears in two ways. One is in the moment as soon as we recognize we’re feeling anxious. The other is to get to the root of the problem over the long term.
Each of these methods of addressing anxiety has two aspects. “You’ve got to address anxiety in the mind (where it lives) and in the body (where it’s stored),” Fisher said. Here’s some of what he’s learned through practice, reading and just paying attention to his own emotions.
- In the moment, you can use deep breathing, gentle stretching, getting out in nature, listening to relaxing music, talking to a friend. All help create some distance between you and your emotions. “It also helps to call it by its name,” Fisher said. “Label it as anxiety."
- He’s also found that it helps to give the anxiety you’re feeling a number on a 10-point scale. “If I start out at a 10 but notice I’ve moved to an 8 a few minutes later, it reminds me that my anxiety isn’t constant. Paying attention to how anxiety changes over time gives us hope it will ultimately fade."
- When feeling anxious, it helps to engage your senses. “Look around the room, and name the things you see,” he said. “Notice the sounds you hear. Pick up on what you can smell. When you tune into other senses, you can turn the dial down on your anxiety.”
- When anxiety becomes debilitating, it helps to talk to your doctor. “If you view anxiety as a loop or a trap – and it is – you’ve got to learn ways to escape the trap,” said Fisher.
Become mindful wherever you happen to be
Part of his work – his mission – now is educating his health care team members on how we can all calm ourselves by practicing mindfulness. It’s become quite the buzz word in recent years, but at its core, it’s learning to calm the mind by being aware of your feelings at the moment and using breathing, imagery and other steps to relax.
And you don’t need a nest of $45 candles and a carefully appointed room to get there. Many doctors and nurses Fisher has helped say this is the most important advice he shared: Mindfulness can be practiced anywhere.
“I do it when walking from one exam room to another,” he said. “I notice my body – am I upright, or am I slouching? I don’t look at my phone. I reset myself. It brings me a sense of calm and kindness – which is a much better way to walk into an exam room and greet a patient than walking in anxious and hurried.”
When his phone is going off, the requests are piling up and his schedule is heading south, a strategic deep breath, purposeful relaxing of the shoulders and momentary pause can help him reboot in a flash so everyone gets his best.
Adopting new habits
In learning to manage his emotions, Fisher said he “had to let go of the idea there was something broken about my brain.”
“I used to be afraid I’d be judged as harshly by others as I judged myself,” he said. “But the more I delved into this way of thinking, the more I discovered I wasn’t alone.”
He began by reading books on stress. But soon, that negative topic became overwhelming. “So, then I looked for books that were on the opposite of stress – books that dealt with how I could live my best life. Reading positive psychology books made a big difference. It wasn’t about avoiding stress; it was about becoming a well-adjusted person who knows how to manage stress.”
Fortunately, he noticed changes pretty quickly.
“I started meditating and noticed a greater sense of calm within about a month,” he said. “When I took up yoga, my body became more relaxed within a month. Then, I started writing in a journal – I actually use an app on my phone – and I noticed positive changes within another month.”
“This is a journey I’ll be on for the rest of my life,” he added. “You have to practice awareness every day.”
An introvert, Fisher said he once avoided people. Now he sends good wishes to complete strangers across the hospital or on the highway. “I now view the world in a radically different way,” he said. “That doesn’t mean I don’t acknowledge that bad things happen and that people can do bad things. But I’ve learned to judge people’s actions – not their humanity.
“The world became a less threatening place as I got more into mindfulness. Anxiety is not a life sentence. The main point to all this is: The least stressed people are those with loving, caring, lasting relationships.”
Read and listen: Recommended resources
Here are a few books and podcasts that helped Dr. Fisher become more mindful and less anxious.
- “Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness,” by John Kabat-Zinn and Thich Nhat Hanh
- “Flourish: A Visionary New Understanding of Happiness and Well-being,” by Martin Seligman
- “Hardwiring Happiness: The New Brian Science of Contentment, Calm and Confidence,” by Rick Hanson, Ph.D.
- “Ten Percent Happier” podcast with Dan Harris
- “The Happiness Lab” podcast with Laurie Santos, Ph.D.