Resiliency The Podcast

Ep 21 � Sarah Carlan
Jenn Quader (00:47.272)
Welcome to today's episode of Resiliency the Podcast. Today's guest helps doctors to find resiliency in the face of burnout across the healthcare industry. I cannot think of a more noble or important cause right now. Now, beyond that, she is a well-researched and highly respected therapist and a transformational leadership coach.

She holds degrees from Smith College and a coaching certificate from Brown University School for Continuing Education. And then she went on to deepen her education with additional training in team coaching and completed the great Brene Brown's Dare to Lead curriculum. Now today's guest really spent years deeply understanding how our mindset and our thinking impacts our experiences.

She draws from Buddhist philosophy and then goes all the way to really research-based works like the work of Carol Dweck and the aforementioned Miss Brene Brown. And so from that, she brings a really broad perspective to her work. And as she does that, it distills down into something really important for our resiliency audience, which is how do people in the healthcare industry face burnout and find resilience in that face? Ladies and gentlemen, I'm so excited to dive in. Please welcome the great, the brilliant.

Sarah Carlan (01:58.873)
Thank you.

Jenn Quader (02:04.994)
Miss Sarah Carlin.

Sarah Carlan (02:07.614)
my goodness, that was quite an intro. Thank you.

Jenn Quader (02:12.706)
We're so happy to have you.

Sarah Carlan (02:15.031)
Thank you, I'm so excited to be here. This is wonderful.

Dr Kelly Culver (02:19.758)
Sarah, we're really thrilled that you're here with us today and we're ready to jump and dive into what you do and get some words of wisdom and insight. something that's really key to all of the work we do together is the concept of resilience and resiliency. So we're curious and our listeners certainly are curious, what does resilience mean to you?

Sarah Carlan (02:27.842)
Yeah.

Sarah Carlan (02:36.867)
Mm-hmm.

Yeah. that's a wonderful, I use the metaphor of surfing, that the waves of life are going to come whether we want them to or not. And as a surfer, we need to be agile and, strong and also able to fall down, crash, get back up.

And so just being able to ride those waves versus feeling stiff and wanting to control a situation to be the way that we imagine we can handle it. That's resiliency for me.

Dr Kelly Culver (03:20.484)
It's really a beautiful way to describe it because you can, you know, people can visualize the wave, you riding the wave. We had a guest on in a previous podcast and he talked about the willow tree and how the willow tree has to move and shift and be agile, flexible, nimble in the wind. you know, it's the same kind of thing. It's you have to adapt as you're moving forward. So it's a beautiful picture. Thank you.

Sarah Carlan (03:26.199)
Yeah. Yeah.

Sarah Carlan (03:33.87)
Yeah!

Yes! Yeah!

Sarah Carlan (03:48.141)
You're welcome. And I think the more you do it, like the stronger you get and the better you get at it. I think that our culture in recent years has wanted a flat surface. And that's just not the reality. Like we don't get to choose that.

Jenn Quader (03:48.216)
Well, and I...

Dr Kelly Culver (04:00.2)
you

Jenn Quader (04:06.622)
that our culture wants a flat surface. I agree. think we are all we're all seeking this kind of homeostasis. But and I keep reminding myself that was not promised. Nobody told us like, hey, come to life. It'll be a pudding party. Like that's not that wasn't it. So stop. So which which brings me to and I love your metaphor of surfing. And I agree, Dr. Kelly, it does remind me of that willow tree. And in both cases, what I like that you said, Sarah, you said the be able to crash.

Sarah Carlan (04:09.709)
Yeah. Yeah.

Yes.

Sarah Carlan (04:17.666)
Nope!

Sarah Carlan (04:21.365)
Exactly! definitely not.

Dr Kelly Culver (04:27.076)
Hmm

Jenn Quader (04:36.786)
able to smash out on those waves. And Dr. Kelly, that willow tree, those leaves are gone. They fly away every year. And so where I wanna take us with this conversation, Sarah, because it's so important right now, I can't, the people who are helping our healthcare industry, it's insane. So when they crash, when they burn out, I guess what I wanna find out first, let's go to the origin. Look, we gotta dig deep to understand how did your roots grow?

Sarah Carlan (04:36.931)
Yeah. Yes.

Sarah Carlan (04:50.797)
Yeah, I mean, yeah.

Sarah Carlan (04:55.715)
Yeah. Yeah.

Jenn Quader (05:05.324)
So how did you get into helping these people see the crash, get around the crash, and learn to surf in the healthcare industry?

Sarah Carlan (05:05.848)
Yeah.

Sarah Carlan (05:12.481)
Yeah. Well, I've been adjacent to medicine for most of my adult life. I'm married to a primary care doc. We met in college. So I was, you know, adjacent to all of the training and his career as he has moved forward. there was, despite all the other ways I was serving, I was always pulled toward this sense that this could be so much easier, right? There are things that

Doctors are not given in their training that if they had these skills, if they had these mindsets, their job could be so much easier. They could serve in a way that would feel better to them. And, you know, in my journey, was like raising kids and doing all sorts of other things in my work. And when I pivoted to coaching, I said to myself, I want to serve the leaders who are on the front lines.

doing really high burnout, high stakes work. And because I can speak the language of physicians, right? I understand their mindset. It just became a natural place for me to serve. so although I have educators and nonprofit leaders and folks in other professions in my, as clients, I'm really doubled down on supporting leadership.

at all levels of development. So I work with med students, I teach residents, I work with early career professionals and also mid and late career professionals as well. So that's what drove me. was like, I see this need, it doesn't have to be this hard.

Yeah.

Dr Kelly Culver (07:00.238)
And so that's your backstory and that's your passion. You saw this gap, you saw it was present right in your own home. So how do I fix this? Because you've got this innate desire to fix things. So can you tell us, how are you helping those doctors become more effective at their practice? Like, what are you doing?

Sarah Carlan (07:03.385)
Yeah. Yeah.

Yeah.

Sarah Carlan (07:12.31)
Yeah.

Sarah Carlan (07:20.353)
Yeah, so I'm in addition to individual coaching. I am working right now to train residents in this skill set. So wellness has become a hot issue amongst in training of physicians, And both in med school and the residency area. A lot of it has been focused on kind of teaching residents like, make sure you have passions outside of work and

spend time with your family and go to a yoga class. And there's been a lot of pushback against that, a feeling like the system is broken. Why should I have to change? If the system would be better at what it needed to do, then I wouldn't be so stressed out. And so what I really wanted to focus on is teaching medical providers how to notice the stressors, notice the thing, whether that's a story or an underlying belief.

that is really draining them, right? So it's not the EMR, the, you know, electronic medical record or insurance companies, et cetera. Those are stressors they can't control, but what are the stressors they can control? So noticing like, what's the story that emerges when I have a frustrating interaction with a patient.

What is the belief about myself that emerges when I have a patient who isn't taking their medication or doesn't wanna engage in treatment? And those are the stressors they can manage. So I talk about it as how do they meet the moment, right? Those moments as they arise, how are they choosing to meet them? Are they choosing to go down the rabbit hole and

deepen the belief about themselves or deepen the story? Or are they noticing like, wait a minute, I this is emerging for me. And I'm going to choose I have choice here. This is where I have choice and engaging with those in a different way. And so when we when I do that work individually with medical providers, they're really able to identify this thing is stressing me out. I had a provider that could not finish her notes. Like she just had the hardest time at the end of her day, completing her charts, closing the notes. And she had been through all sorts of other coaching, managing her time, et cetera. And really what it became about was that she had a story about how the electronic medical record was getting in the way of patient care. And once she was able to shift that story and have a different relationship with the electronic medical record, she was able to finish her notes. So it was, I mean, it wasn't as simple as that, right? It took many sessions to get there, but it was that shift that was able to relieve a drain on her energy because as the notes weren't finished, they were always in the back of her head. She was always thinking about herself as not efficient, not organized.

And those, all of those pieces were draining her energy. And when she was able to make this shift, all that energy that was being drained was then redirected into patient care, where is where she wanted that energy to be. And then that just builds on itself.

Dr Kelly Culver (10:58.361)
I love what you've just said because doctors are focused to understand and spot triggers in other people, triggers in conditions, triggers in symptoms. And what you are doing is helping them focus on triggers within themselves. So I've got two voices going on in their head, theirs on them and theirs on their patient. And how do you get through the noise?

Sarah Carlan (11:07.769)
Mm-hmm. Mm-hmm. Mm-hmm. Yeah.

Jenn Quader (11:29.92)
It strikes me too that it is like such a, that literature thematic theme, right, is like man versus nature or man versus self. And you've got all these people who are like, man, it's man versus nature. It's the system, man. It's how they're doing it. It's technology. It's what they're doing. But what we're boiling it down to, and I think this is commonplace for resilience, turns out it's man versus self. Turns out we gotta look at how we do that. So with that,

Jenn Quader (11:59.67)
since what you're bringing is such an amazing awareness that can be used every day. And like you said, it's simple in that it's so easily accessible and then it's difficult in that you gotta practice and practice and practice. in that simplicity, can you help us look as an overarching, if I were a young medical student or a veteran doctor,

Sarah Carlan (12:05.397)
yeah.

Sarah Carlan (12:10.615)
Yes. yeah, and practice and practice and practice.

Dr Kelly Culver (12:23.332)
you

Sarah Carlan (12:23.395)
Yeah.

Jenn Quader (12:24.382)
What are those signs I'm looking for? Let's look kind of overarching in this man versus self. What are those signs of burnout that I'm looking for to go, hey, I gotta slow down and look at this?

Sarah Carlan (12:28.121)
Yeah.

Sarah Carlan (12:36.011)
Yeah, that's a great question. So the first thing that arises for many people is this sense of irritability, right? Like they're just living in a constant state of irritability that they can't put their finger on, right? Or they are trying to put their finger on it, right? So they're trying to name the thing that's making them irritated. And as they resolve it, the irritability doesn't resolve, right?

resentment is the other thing that I name, right? If you are noticing yourself feeling resentful, it probably means your boundaries are being crossed on a regular basis, right? And that is like, that's a recipe for burnout. The other indicator for me is when they're looking for an out, right? Could I work fewer days? Could I work fewer hours? Could I have fewer patients? Could I be doing something else entirely?

which is huge when you're talking about the fact that most folks have spent the better part of a half a million dollars and, you know, eight to 15 years of their lives training to do the thing that they're doing. And then for them to say like, I don't know if I can do this anymore. You know, those are, and the folks are saying, I don't know if I can do this anymore. Or like really like, I would say like they're Kentucky fried. Like they're really at the edge.

of burnout, I would love to see it more when they're just kind of noticing a sense of irritability. A lot of the young female physicians I work with, they will name for me that they're feeling a strong sense of imposter syndrome, right? Like, I'm not good enough, I can't do this, everyone else has figured it out and I haven't. Those types of things are what's coming up for them.

Jenn Quader (14:33.996)
fascinated by Kentucky Fried. I'm just, I'm stuck on that. Cause that's, you know what I mean? Because like, it's what a great way to say like, please find yourself or find help before you are full out fried. And, and, and I, and really you're speaking. So I want to, I want to go off script for just a minute and just, just dig into this for a minute, because a lot of our listeners are business leaders. A lot of our listeners own companies or they run teams or they do those things. And I got to tell you, when you're talking about these

Sarah Carlan (14:36.569)
Yes!

Sarah Carlan (14:43.125)
Yeah, before you are. Yeah.

Sarah Carlan (14:52.066)
Yeah, yeah.

Sarah Carlan (14:57.837)
Yeah.

Jenn Quader (15:03.534)
that you said irritability, resentment, looking for an out, okay? And I wanna ask you, Sarah, you're the expert here from the employer standpoint, how do I, what do I do when my gals get Kentucky fried? Like, how do you pull that back? Because I understand from the individual coaching standpoint, what needs to be done, there's a therapeutic process. But when we look at this organizationally, do you have any advice?

Sarah Carlan (15:08.513)
Yes.

Sarah Carlan (15:20.256)
Yow!

Sarah Carlan (15:25.176)
Yeah, yeah, yeah.

Remember, right?

Yeah, I think curiosity is the most important element that we can embody as leaders, right? To continue to get curious with the folks that we're leading to help both ourselves and them understand more deeply what's showing up for them, right? So often employers will say like, what can we do to make this work for you? Which is a lovely question, right? It's a very kind question.

But it doesn't name what the, it doesn't help folks get to the underlying, excuse me, the underlying thing that is stressing them out, that is impacting their sense of wellbeing. So I would really begin as an employer, if you're noticing like folks that are, you know, have high absentee rates are like less efficient than they used to be. Yeah, more irritable.

looking to ease like they're trying to find more ease but they're having a hard time with that to just begin to ask what's happening for you like what's coming up is a great question that I asked like what's coming up for you when you're at work what feels like a heavy lift and then asking stories like you know

Sarah Carlan (16:57.433)
What is the story that you're telling yourself about why you're stressed out? Right? Those are some questions that are not, maybe they're coaching questions, but they're questions any, like a coach-like leader could be asking to just be help, help them, both the employee or the staff person or your, your, your team or yourself understand that better.

Jenn Quader (17:23.086)
It's so brilliant because on a different episode we had another great and brilliant therapist, similar in your realm, but in a different world. They worked in the world of children who have autistic and speech difficulties and difficulty eating. And what I'm seeing is a really interesting through line here, that in all of these cases, whether it's a little child who's battling something that they are facing in a diagnosis or whether it's an employee.

Sarah Carlan (17:34.329)
Yeah.

Sarah Carlan (17:42.413)
Yeah.

Jenn Quader (17:49.81)
a medical professional, someone who is battling this burnout, it's all about taking the time to ask those questions. And we don't give ourselves that time.

Sarah Carlan (17:56.857)
Yeah.

Yes. Yes, because we are already onto the solution. Or we're already onto... Yes, yes, yes, exactly.

Dr Kelly Culver (18:06.692)
Yeah, and we don't even understand the problem. That's the thing. We're already onto the solution. We haven't clearly articulated the problem.

Sarah Carlan (18:15.447)
Yep, bingo. That's a great way of naming it.

Jenn Quader (18:16.59)
Please, Dr. Kelly, please, Dr. Kelly, can we just, Sarah, let's both learn from Dr. Kelly for a minute because this is a woman who goes around and like counsels countries on how to organize things. Can you talk to us a little bit, Dr. Kelly, about identifying that problem and tell us more about that for just a minute before we dive back into the medical field.

Sarah Carlan (18:23.81)
Yes, please.

Sarah Carlan (18:36.471)
Yeah. Yeah.

Dr Kelly Culver (18:38.705)
It's funny, I was talking with somebody yesterday and we were working and we were looking at working on a project in the UK and we just both rolled our eyes and said the government clearly doesn't understand how to articulate the problem is, what the problem is. They think they have the solution but they don't even know what the problem is. Right? we, and that happens. It happens all the time because I think Sarah you said something really important about being curious and it's sort of stop, ground yourself and listen.

and try to put the pieces of the puzzle together, try to connect those dots so that you can see the bigger picture of the problem. Too often in this quick world, we want to say, right, here's the issue I've solved it, check. Next thing, here's the issue I've solved it, set. It's like you've got popcorn brain. There was a really cool study that came out in Canada about ADHD, and it's like popcorn brain. You're out and in, out and in, out and in. Dives me nuts. How do we, seriously, we...

Sarah Carlan (19:06.233)
Bingo.

Sarah Carlan (19:17.645)
Yeah.

Sarah Carlan (19:23.064)
Yeah!

Sarah Carlan (19:30.775)
Yeah. Yeah. Right.

Dr Kelly Culver (19:33.305)
We have to kind of stay together and in one place at one time and breathe and look. But if we don't clearly articulate the problem, we've invested and wasted an awful lot of time on a solution. So Jen, to come back to your really great question on how do we apply it in organizations, I don't think leaders spend the time articulating the problem because they don't care, because they're too busy on something else, because they don't know how, or because they don't know how to invest the empathy.

Sarah Carlan (19:39.127)
Right.

Sarah Carlan (19:47.8)
Yeah.

Sarah Carlan (20:00.311)
Yes.

Dr Kelly Culver (20:02.636)
to do that. My observation.

Sarah Carlan (20:04.246)
Yeah. Yeah.

Jenn Quader (20:06.222)
I'm gonna observe just in my own little baby as a leader that I think one of the biggest problems with articulating the problem might be just what Sarah talked about with that medical professional who had problems with her notes. You don't wanna face the problem. You really, you wanna prove that you can solve it, but you don't really wanna look. I'm gonna tell a really quick silly thing, but this is a very, very feminine thing, but like.

Dr Kelly Culver (20:20.973)
Yes.

Sarah Carlan (20:21.495)
Yeah.

Sarah Carlan (20:28.429)
Yeah!

Jenn Quader (20:29.998)
I grew up always trying to manage my weight, trying to be smaller, trying to lose weight. So I would do like a Jenny Craig or a Weight Watchers. And I would go and I'd show up and I'd get all the food and I'd do... But I'm gonna tell you, when I knew I hadn't eaten right, I didn't show up for that weigh-in. Because I didn't want to see the reality of...

Sarah Carlan (20:47.257)
Dr Kelly Culver (20:48.814)
Mm-hmm.

Jenn Quader (20:50.508)
And so I wanna bring this back over, because I really like what we're talking about. There's this kind of popcorn brain, there's this ability to articulate the problem, and we're seeing that at the organizational level across the countries, the healthcare industries, and then we're seeing that at the individual level, Sarah, as you're working therapeutically with your clients, you're helping them individually to identify this problem. And I had in our show notes this one particular problem that you mentioned that I just thought was so interesting, I've gotta bring it up, and it was this idea of a...

Sarah Carlan (20:50.679)
Mm-hmm. Mm-hmm.

Sarah Carlan (21:18.221)
Yeah.

Jenn Quader (21:19.828)
Morale injury and I want to know a moral injury a moral injury. Okay I thought it was like a morale injury but a moral injury Tell me about a moral injury. What what is that? How does that play in and you know, we're talking about articulating the problem Let's look at those injuries and what kind of problems those those show

Sarah Carlan (21:22.595)
a moral injury. Yeah, moral injury. Yeah, yeah, yeah.

Sarah Carlan (21:31.97)
Yeah.

Sarah Carlan (21:36.225)
Yeah. So the conversation around moral injury in medical providers has been growing over the last, I would say, five to eight years. And it has come out of a noticing that burnout was kind of...

Many people felt that burnout was a blaming the victim issue, right? was saying like, you're burned out because you're just not tough enough, right? And you're not resilient enough or you're not. And what doctors would say were like, I made it through med school and residency. I passed the MCATs. I'm tough. I'm smart. I'm hardworking. I am resilient. And so they needed to name a

the deeper root of the stressor. And part of what happens in medicine is that we have so many levers that we can pull at this point. And the levers have become increasingly expensive to pull. And the impacts on health, on our patients' health, reach beyond what we can address. And so doctors are in constant relationship with the fact

that they will be making decisions about their patient's health and wellbeing that may be antithetical to their values, right? And when we have to make decisions that are antithetical to our values, it's like a death by a thousand cuts, right? It's like you're getting these little paper cuts on your soul, so to speak, that begin to...

Dr Kelly Culver (23:22.284)
Thank

Sarah Carlan (23:26.997)
multiply in a way that shows up as this sense of irritability and resentment and et cetera, looks a lot like burnout, right? Feels a lot like burnout. You know, it's semantics, but we can also name it as moral injury, right? And I think it's been an important thing to name for physicians because it is happening in the background.

It is like, is not been named for them as part of what they're experiencing and therefore they begin to blame themselves, right? So if there is something that is systematic that is happening to you and you don't notice it, it's like the water you're swimming in, then you begin to self blame and to take on the responsibility of solving that.

thing when it's not actually in your power and control to solve. So moral injury is something to really, it's important to name for physicians and it's important to notice when it's happening and to notice how you're in relationship with it.

Dr Kelly Culver (24:39.927)
I like your definition. I'm glad that you went into a deeper dive to explain that. just I know Jen has a question. if we take it out, not but, and we can take it outside the health care community. I'll give an example. In a certain point in time in my career, I won't tell you when, because then you'll know how old I am.

Sarah Carlan (24:47.128)
Mmm.

Sarah Carlan (24:54.849)
absolutely.

Sarah Carlan (25:03.385)
Ha

Jenn Quader (25:04.366)
Ha ha ha.

Dr Kelly Culver (25:05.22)
I was working with the Ministry of Transportation for the government of Ontario and we were going through a significant change in who does what and how we do things. And I was heading up a policy and human resource unit at the time in a particular area. And we decided to get out of the business of sort of, I call blue collar work. And we laid off about 5,000 people in an 18 month period of time.

Sarah Carlan (25:06.169)
you

Sarah Carlan (25:27.693)
Mm-hmm.

Sarah Carlan (25:32.857)
Mmm.

Dr Kelly Culver (25:35.589)
and I had 500 of those notices to deliver and families to talk to. And we did that in remote areas in Ontario. They were all men. They were mostly 55 and older. They would never have another job. They were not employable at the time. Some of them committed suicide. And after the 500th one, I had become detached.

Sarah Carlan (25:35.907)
Mm-hmm.

Sarah Carlan (25:48.953)
Yeah.

Sarah Carlan (26:02.307)
Yeah.

Dr Kelly Culver (26:02.84)
from creating that letter and looking at that profile of that person and getting ready to sit down with that person, that it just became a transaction.

Sarah Carlan (26:08.601)
Mm-hmm.

Mm-hmm. Yep. That compassion fatigue.

Dr Kelly Culver (26:16.802)
and I left. quit.

Sarah Carlan (26:18.541)
Yeah, yeah, yeah, because it was so antithetical.

Dr Kelly Culver (26:22.052)
Yeah. Yeah, it just this, was just fundamentally wrong. It was morally wrong. Policy wise, it was right, but there was a different way to do it.

Sarah Carlan (26:27.565)
Yeah. Yeah.

Sarah Carlan (26:32.193)
Yeah. Yep. Yeah. And that's, and that's the difficult place, right? That's where many physicians are having to ask themselves the question, is this a system I can function in? Right? Is, is the moral injury something I can be in relationship with in a way that I can continue to, to be in this place and be working in this space? Or is there something that needs to change?

I mean, there's tons that needs to change outside of them, but is there something that they need to change about where they're working or who they're working for or how they're in relationship with their patients?

Jenn Quader (27:14.318)
I'm flabbergasted by that because I feel like...

No one is immune. know, like that's really, no one is immune. There is no one who is immune from this opportunity to live and work and try to pursue one's passion, which, know, in your case, Kelly was helping this government do these things. And Sarah, in the case of your clients, is pursuing the very best healthcare for these patients and then having to fight with what is available and make these kinds of decisions that are, like you said,

Sarah Carlan (27:23.843)
Uh-uh.

Dr Kelly Culver (27:25.314)
No?

Jenn Quader (27:49.538)
What's that word again? Say that beautiful word.

Sarah Carlan (27:52.268)
Antithetical.

Dr Kelly Culver (27:53.547)
Yeah.

Jenn Quader (27:54.226)
Antithetical, what a word guys, word of the day, Resilience Podcast listeners. Antithetical, because it's such an important piece of the puzzle. I think, boy, it's deep though, Sarah. And that's where I'm wanting to bring us to a place where, because all of our listeners, can imagine, I probably feel antithetical about a lot of that. I feel antithetical about like getting on social media. You know what I mean? Like honestly, there's so many things in life that we face.

Sarah Carlan (27:59.764)
It's a tentacle.

Mm-hmm.

Sarah Carlan (28:16.579)
Yeah.

Yeah, right, absolutely, yeah.

Jenn Quader (28:22.658)
that we have to have this fight with our own morals. And so I guess I wanna bring it back to something actionable for our team. And we've talked about, I say our team, but our listeners and those who are part of this resiliency community. And so we've talked about like really a lot of things. We've talked about how people face burnout, how they, when you first see it, it's irritability and it's coming in in that way. But then really once you look down to it, it can be little tiny things that are holding us back.

Sarah Carlan (28:23.277)
Yes.

Sarah Carlan (28:26.776)
Yes.

Sarah Carlan (28:33.624)
Yeah.

Sarah Carlan (28:51.424)
Yes.

Jenn Quader (28:52.43)
I want to look to the future of like, how do we get better? How do we, how, if Dr. Kelly had been in her job in Ontario and she had to lay off those 500 people and maybe at person 100, if she had recognized that she was feeling irritability and resentment and other things, what might she have done to stay sane and continue?

Sarah Carlan (28:57.303)
Yeah.

Dr Kelly Culver (29:14.316)
My husband did.

Let me tell you, he said, are we at war? He asked me that question. He said, has Ontario declared war? I said, no, he said, then get a perspective.

Sarah Carlan (29:18.881)
I'm identifying some irritability.

Jenn Quader (29:19.485)
I bet.

Jenn Quader (29:35.534)
That's so important. Thank you to the sweet memory of your husband, a brilliant man. Because truly, and that Sarah is what you're giving your clients. Because I can imagine your clients coming in and literally, I mean, listen, you have your husband saying, are we at war because you're having to fire some people. This poor doctor who is saving people's lives is freaking out because she can't do her notes. Like, are we at war? How do we put things in perspective? Sarah, from your brilliant therapeutic brain,

Sarah Carlan (29:35.673)
That's, yes.

Dr Kelly Culver (29:39.893)
I know.

Sarah Carlan (29:44.131)
Yeah. Yes, perspective.

Sarah Carlan (29:54.349)
Yeah. Yeah.

Yes. Yeah. Yes.

Jenn Quader (30:05.08)
How do we get it in perspective?

Sarah Carlan (30:08.385)
Well, think they're okay. So the first thing I always I begin with many of my clients and all of my residents is we do a values assessment, right? We come up, we do the work to identify three values that are things that are deeply intrinsically important to you. So these aren't the values of your organization. They aren't your partner's values. They're not your

you know, the values that your parents gave you, like they are the things that are really, really deeply important to you. And then we begin to use those to define success, which is a huge one, right? Like it's how I define success to, I teach people how to set boundaries with them, right? To notice like, you know what, this is my line in the sand, right? This isn't my wall, cause I talk about how boundaries are not about creating walls.

They're actually about bridges, right? They're about creating connection. And then I use the values as understanding like when these things are coming up, which value has been violated, right? So when we're noticing resentment, when we're noticing irritability, what value do I hold really dear that is being violated? And how do I wanna work with that, right?

For some people, they don't have choice. Some people quit their jobs, some people can make something change, and other people are stuck. That's where they're at. How are they going to then work with that? I think when you name, oh, this is the value that is being violated for me, then it's not your fault. It's not something you did that's making you feel this way. It's like, oh yeah.

You know, I'm not sure what your values are, Dr. Kelly, but I imagine in the firing of those people, there were some values that were being violated for you. And so when your husband noticed, like, we at war? Like, this is how, it's because like that was what was happening for you. was intrinsically what is important to you was every day being stepped on multiple times a day, probably. And so how to name that and then make a decision. Like, okay, what am I gonna do about this?

Sarah Carlan (32:32.183)
And so that's always where I begin because I think if we can name those and utilize them, we have at least one lever that we can pull. And then we can kind of build from there. Mindfulness practice is, often will encourage my clients deeply. And when I'm teaching my medical residents, we always begin with mindfulness, right? teach.

some really simple mindfulness practices. This is not like becoming the Buddha and finding enlightenment. This is like, how do I use walking meditation to reset myself between patient rooms, right? Or from the car into the building or from the building into the car, right? How do I use a gratitude practice? Talk about getting perspective. Start your day with a gratitude practice. That gives you some serious perspective.

the people who have the greatest resilience are the people who have a gratitude perspective. Even if they don't have a practice, the data has demonstrated, those are the people that just have natural resilience, are the people who can see the bright side. And this isn't like toxic positivity, only good vibes, that's not what I'm naming, but having a gratitude practice is the other. So those are the three kind of hallmarks.

that I would name. Values, mindfulness, and a gratitude practice are a great place to begin the work.

Dr Kelly Culver (34:06.67)
And I'm wondering if you can take us to maybe what might be the next place. So you've talked about mindfulness, and I love the example you use, mindfulness as you're walking between patient rooms, and gratitude. But how do we learn how to conserve energy as well? And to not spend energy on those things that aren't worth spending energy on. How do we do that?

Sarah Carlan (34:12.127)
Sarah Carlan (34:16.963)
Yeah!

Sarah Carlan (34:22.743)
Yeah. Yeah.

Sarah Carlan (34:29.559)
Yep. Well, I think that's where like those three hallmarks or pillars are where you begin. And as you're practicing those, it then highlights what's coming up. Right. So when we're in that mindfulness practice, the next, once we kind of learn how to concentrate on our breathing, let's say, we notice that what is interrupting that. Right.

it's this story of I'm not good enough. That's what keeps coming up when I'm trying to pay attention to my breath. how can I then work with that story? Right? So that's like the next step. It's like, how do I work with these stories that are coming up that are getting in the way of me doing the things I want to do or having the energy I want to have? Because those stories are where the wasted energy is happening. Right?

I have a client recently who like justice is one of his values. And one of the ways that it was feeling violated is when people around him weren't behaving in the way that he felt like was part of the social contract. Right. So whether that was, going into a, you know, coffee shop and someone hadn't cleared the table or, you know, misbehaving in the parking lot of the Costco or whatever it was. And.

When he was able to name the value, he was able to notice his reaction to when that value felt violated. And then he was able to notice like, wait, do I need to waste that energy on? I mean, he would get to a 10 when he would walk into a coffee shop and someone hadn't cleared the table. And he's like, is that a good use of my energy? Yes, I can notice that that's ticked me off, right?

I can notice it feels like my value of justice has been trompled on and is it worth that energy? Is it worth it to put that kind of energy in? And that three step process allowed him to like harness so much of the energy he had wasted because he wasn't then building an emotional experience on his initial reaction.

Dr Kelly Culver (36:49.007)
So you're helping us know when to go to 10 and when not to go to 10. Go, no, go. We need that.

Sarah Carlan (36:53.748)
Yeah. Yeah. Well, before we, yeah, like before we started, we were chatting about the person next to me in the coffee shop yesterday who was like arguing with the manager, right? And I was like, I'm not going to get to a 10, but like this situation has gone to a place where like my sense of like, you know, you're being a bully. Like that was like being violated. And I was like, we're going to, this is a place where I'm going to spend some energy to be like, you're all done. She's asked you to leave, you know.

Dr Kelly Culver (37:02.51)
Yeah.

Sarah Carlan (37:23.405)
I'm gonna step in here and support this person who's being bullied. But we get to choose that, right? There may be other situations where I'm like, that's not where I'm gonna spend my energy. But most of the wasted energy becomes the stories and emotional experiences that we overlay on top of the experience that we're having in real life.

My brain at two o'clock in the morning is not very nice. So like that is a place where I can say like, this is like, this is me choosing, my brain is activated and is draining my energy in a way that's, it's not actually gonna be helpful to the situation.

So that's a great question you can all ask yourself. Is this helpful? Is this useful?

Jenn Quader (38:15.392)
What is

Dr Kelly Culver (38:19.502)
Mm-hmm. Mm-hmm.

Jenn Quader (38:21.566)
Is this useful? Is this helping me? And I think that's what I keep hearing in all of this. in what I, I just want to say back what I heard, which is in these values, you really help create a framework. Cause you're like, Hey, you don't just ask me like, what are your values? You're like, name me three values. Let's get clear on what are those three. And then that gives me a framework against which I can, I can look at that. Then I have my mindfulness and my gratitude. So, so what it strikes me as is that you are building like a dashboard.

Sarah Carlan (38:43.127)
Yes.

Jenn Quader (38:49.88)
for all of those, all of us digital folks who've looked at that. And it makes me think, and this is gonna, it's physical metaphor, but like, for example, this year, you know, as you get older, your body likes to break down. And so I've met my gallbladder this year. Since we're talking about medical. I've met her, she's come up and decided to tell me she exists. But in meeting her and learning how she functions and what she is, I've learned that she's a very good indicator for me, where I go, wait, I'm not gonna...

Sarah Carlan (38:50.253)
Yeah.

I love that.

Sarah Carlan (39:04.713)
Yeah.

Sarah Carlan (39:10.585)
Yes!

Jenn Quader (39:19.042)
You know, I used to love all those French fries and all that heavy food, but I call her Golly. That's her name for me. So Golly doesn't like it. because my mental state, don't have, you know, my physical body, all of our digestive systems have a lot more control, but our minds can run and run and run and run. So what you're doing is you're helping each person to create their own dashboard, their own indicator that says, hey, wait.

Sarah Carlan (39:22.121)
huh.

Sarah Carlan (39:39.705)
Yes, yes, yes.

Jenn Quader (39:46.452)
this and so that we can find it earlier and we can get in there and not get too Kentucky Fried. Is that, what do you take from that?

Sarah Carlan (39:54.303)
Exactly, that is it. You named it. Good. Yes, yes, I love it. I love it. It's a dashboard. My clients, and this is such a fun conversation because it helps add to my vocabulary around this and how I think about the work I do. I had a client the other day, that's it to me, Sarah, you're like the iPhone. She said, before you have an iPhone, you don't realize you need an iPhone. Then you get the iPhone. didn't know how do you live with

Jenn Quader (39:58.604)
Beautiful!

Sarah Carlan (40:23.967)
I was like,

Jenn Quader (40:26.136)
Exactly, exactly. You have to put it... Well, look, and congrats, because that is a dang good testimonial. Equally, I think what you bring up is so important, a shared language around this. We all understand the pressures across the workforce. Again, we have listeners in across tech, across entertainment, across...

Sarah Carlan (40:29.431)
Yeah!

Yeah!

Sarah Carlan (40:41.345)
Yeah. Yes.

Sarah Carlan (40:46.211)
Mm-hmm.

Yeah.

Jenn Quader (40:50.316)
public relations and marketing across government and across healthcare. And we all are facing this kind of crisis of wellness and crisis of understanding. And when we pull it down through this through line of resilience, what it's coming down to is we have to practice. We have to do the work and we have to find the opportunities to kind of work together. We talked about this in an earlier episode, but mentorship and inspiration.

Sarah Carlan (40:52.385)
Yeah!

Sarah Carlan (41:05.815)
Yes. Yes.

Jenn Quader (41:15.842)
to bring people together and really, and this is what you're doing, you're teaching people the skills and then they can go on and teach them the skills. I wanted to ask kind of a final question before we move into our fun, rapid fire discussion, but I wanna wrap this up in a way because you said in your origin story, which was really touching, you grew up medically adjacent, you've lived in this world a long time and you saw a void.

Sarah Carlan (41:16.281)
Yeah.

Sarah Carlan (41:23.319)
Yeah.

Mm-hmm.

Sarah Carlan (41:36.555)
Yeah.

Jenn Quader (41:40.864)
in the industry of what these people need. And we've talked about how this can apply in daily life and in organizations. But I kind of want to ask across the American healthcare system, a big trigger word right now, and that's an honest choice of words, but it's from a micro level, what could really help our doctors become more effective across the American healthcare system?

Sarah Carlan (41:41.411)
Yeah.

Sarah Carlan (41:51.821)
Yes. Yeah.

Yeah!

Sarah Carlan (42:05.593)
That's a great question.

I think that, so I think at a system, I think at a small system level, not a big system level, we need to give our doctors an opportunity to notice that there is possibility, right? There is hope that they can navigate this, that there are places where they can grow.

their resiliency, right? That they are resilient beings and that is a great place to start, but there's more places that they can grow into that will help them to navigate this space that's hard. Yeah, just think it's, much of the conversation around burnout has been one of no hope. And what I really hope

is that we can give medical providers hope because they love what they do. It's a calling. It is not a choice. And for most of them, and it is heartbreaking to see a physician who's gotten to the point where they say, I just can't do this anymore. And to give them the power back is I think the place where

we can help them to be more effective.

Sarah Carlan (43:41.721)
I hope that answered your question.

Jenn Quader (43:41.88)
Sarah, did it ever. Give them the power back. And look, a physician without hope is like a cake without sugar. Okay, it doesn't have what it needs to give us what we need. And so I think that what we are talking about here, you know, there's nothing more life and death than the medical field. That is life and death, all right? And so I would just want to applaud and say that

Sarah Carlan (43:54.647)
No. Yeah.

Sarah Carlan (44:03.617)
Yeah. Yeah.

Jenn Quader (44:10.648)
the work that you're doing to build this resilience and to build that kind of hope, it really is a ripple effect because that one physician that helps not only their patients, but all of the people that are with them, that faith is what is necessary to keep life going. And I think that really speaks to the power of resilience and to how that picks up. So I think with that, we should kick right into our rapid fire questions. I don't know, what do you think, Dr. Kelly?

Sarah Carlan (44:17.945)
Mmm.

Sarah Carlan (44:26.775)
Yeah.

Sarah Carlan (44:32.174)
Yeah.

Sarah Carlan (44:35.629)
Alright!

Dr Kelly Culver (44:37.188)
I think it's a great idea because we've learned a lot today. You've shared so much with us. There's a lot of insights that we can take. I think our listeners, you've given them some really powerful tools. So Jen and I want to thank you for that very much.

Sarah Carlan (44:53.827)
You're welcome. Thank you for having me. I appreciate it.

Dr Kelly Culver (44:55.775)
we're delighted, absolutely delighted, but we want to know you more. So in order to get to know you more, tell us what's your favorite movie or TV show that makes you feel resilient?

Sarah Carlan (45:06.905)
I've been watching Shrinking lately, which is as a therapist, like there's some really cringy, like pseudo therapeutic, you know, interactions. You're like, that is not what therapy looks like. However, I love that what it demonstrates is kind of how people can have conflict and find resolution and with

because they have a deep seated sense of love for one another. And that just, I love that. So instead of it all being like a perfectly flat, you know, lake, it's a show that has a lot of ripples and waves and people crash and they pick themselves back up again and they lean on each other and there's humor and so I love all that.

Dr Kelly Culver (46:00.133)
What about a song that makes you feel resilient?

Sarah Carlan (46:04.78)
So my favorite is a song by the High Women who are a super group that include Brandi Carlile and Dolly Parton and a few other amazing women. If you haven't ever picked, yeah, they're amazing. And they have a song called Crowded Table, which is all about bringing together the people in your life that you love around a table and just all that you glean from that. So that's my.

That is where I find my resilience in my people.

Jenn Quader (46:36.654)
I'm headed to Spotify right after this, because that sounds amazing.

Dr Kelly Culver (46:38.702)
Mm-hmm. Mm-hmm. Mm-hmm.

Sarah Carlan (46:38.777)
It is amazing. It's my theme song.

Jenn Quader (46:41.486)
Wow. I love it.

Dr Kelly Culver (46:45.956)
What's the last thing that made you laugh out loud?

Sarah Carlan (46:49.817)
a lot, I laugh a lot. So that's a little bit tough, I think.

Sarah Carlan (47:00.599)
I think my kids often make me laugh out loud. I have two young adult children who are just at these really fun places in their lives. And so, and they're very funny. My daughter in particular is very funny. So she, she often makes observations that are so spot on that they bring me, bring me joy and laughter.

Dr Kelly Culver (47:24.204)
And no filter, that's why they're so beautiful. Yeah.

Sarah Carlan (47:27.085)
yeah, yeah, there's... She was recently like, so have we talked...

Jenn Quader (47:47.896)
Fabulous. Fabulous.

Sarah Carlan (47:49.657)
I was like...

Dr Kelly Culver (47:49.74)
today dear but I'll put that on the list of things to do. Right?

Jenn Quader (47:56.014)
Thanks for cutting right through it and getting right to the point, honey. We love ya.

Dr Kelly Culver (48:04.098)
And what's one question that you'd like to leave for future guests?

Sarah Carlan (48:08.569)
That's a great question.

Sarah Carlan (48:18.873)
What is a way that you have really leaned into your values?

What's a way that you can, yeah, would say what's a way you deeply lean into your values?

Jenn Quader (48:35.766)
Love that question. Beautiful, great question. Really cool. And good way to get that framework going. All right, now I love it. I have a question for you that was left by a past guest. Are you ready? All right, here we go. The question is, do you worry about money? And if so, why?

Dr Kelly Culver (48:37.038)
so appropriate.

Sarah Carlan (48:37.249)
Yeah, yeah, thanks. Exactly.

Dr Kelly Culver (48:43.172)
you

Sarah Carlan (48:49.444)
cool, yep.

Sarah Carlan (48:56.249)
ooo

I worry about money from the perspective of privilege, I would say. I feel very privileged and I worry about how that, living in that impacts the way that I think about and work with money. So, yeah.

Jenn Quader (49:22.882)
What a sustainable, pure view. You know what I mean? It matches your, I think, what we've seen in you today, which is that you really seem to be able to look at a global perspective of a challenge and feel an empathetic and a compassionate way toward that. But then also really set up a

Sarah Carlan (49:30.765)
Thank you.

Jenn Quader (49:49.708)
values that serve that. And that's where I see in that answer is that you're thinking about the whole and taking care of the individual within it. And I think that that really breeds resilience. Wow. Well, Sarah, what a gem. I feel like I've learned a ton of things I know that our listeners have also. Where can our listeners find you if they want to learn more about you, your business, burnout, those types of things? Where can they find you online and connect with you?

Sarah Carlan (49:53.315)
Thank you.

Yeah.

Sarah Carlan (50:01.593)
Yeah, thank you. Thank you.

This has been really fun.

Sarah Carlan (50:13.461)
Wow. Yeah.

Sarah Carlan (50:19.533)
Absolutely. I am, my website is a great place to start. It's sarahcarlin.com. And my name is spelled S-A-R-A-H-C-A-R-L-A-N because my grandmother-in-law made it up when she converted. So it's not spelled like normal people spell, Carlin.

Occasionally on Instagram, my newsletter and blogs come out and I'm just in the very baby, baby stages of potentially a podcast. that'll be out on my Instagram if, yes, if and when it materializes. So yeah.

Jenn Quader (50:57.486)
Jenn Quader (51:02.882)
Well, we send our good vibes and energy because what you are doing is so important. We thank you for being a resilience warrior for all of these people across the healthcare industry. And we just thank you for sharing those insights. And so from all of us and to all of you, our dear listeners, thank you for tuning in today to Resiliency, the podcast. If resilience is something that you are seeking in your life, please.

Sarah Carlan (51:11.533)
Thank you.

Jenn Quader (51:26.142)
Like us, subscribe to our channel on YouTube, give us a thumbs up, join our community. It's really important to us. Resiliency, the podcast is the place for stories and strategies and inspiration on how to embrace change and overcome challenges and really redefine resilience in today's ever evolving world. I'm Jen Quader. You can find me online, J-E-N-N-Q-U-A-D-E-R.com or at Jen Quader on all of the socials.

My dear, wonderful, brilliant, illustrious co-host, Dr. Kelly Culver. You can find her at theculvergroup.ca. That's .ca because she is a brilliant Canadian. She's also, also find her at Dr. Kelly Culver on Instagram and LinkedIn. And guys, again, find us everywhere you listen to podcasts, join us, tune in again next week. And until then, stay strong, stay resilient, surf those waves of life.

Sarah Carlan (52:03.639)
Yes, Canadian. Yay!

Jenn Quader (52:22.752)
We've you've got friends in us. We thank you again. Tune in next week or two weeks from now for the next resiliency, the podcast. Thanks, guys.