Responding vs Reacting: Overcoming Stress in Medicine

Nadine Kelly, MD


March 14, 2022

This is the second installment in a series of instructional videos and guidance from Nadine Kelly, MD (YOGI MD), helping healthcare professionals to use yoga techniques to reduce daily stress and focus on their personal well-being. To view the accompanying video, click here.

When I was practicing pathology, there were days when all I could do was keep up.

My time was spent reacting to emergencies and the workload of the day. Frenetic days involved handling frozen sections speedily, giving the waiting surgeon the correct information to guide the following steps, ensuring that the radiologist performing a fine-needle aspiration had enough material for diagnosis, keeping up with the next batch of slides to review, and getting it done fast. It was nearly impossible to squeeze in a break on days like that — eating in front of the microscope to save precious time became one of my go-to tactics to stay afloat.

Racing against time was not the only challenge. I knew that a person on the other end of that slide depended on me. When I felt my concentration wavering, I would remind myself that this was someone's mother, sister, or beloved friend, not a number. It could feel like a tightrope act, navigating the delicate balance between efficiency and excellence.

Being a healthcare worker is an honor and a great responsibility. It requires dedication, sacrifice, and empathy. Empathy is not a one-way street. We all know that we cannot serve others from an empty vessel. Compassionate caregivers deserve care too. That's why learning tools that fit your lifestyle, especially amid chaotic days, are so critical to your wellbeing. Those tools can help you do fulfilling work that you are proud of, serving the humans that depend on it.

Last month, we talked briefly about some of the benefits of deep breathing, emphasizing good posture to support calm, focused, and pain-free days. Yogic breathing techniques induce calm by activating the parasympathetic nervous system, taking us out of the fight-or-flight response.

In addition, yoga breathing is an effective adjunct modality in managing hypertension. Relaxation breathing techniques have been shown to mitigate the effects of posttraumatic stress disorder and hyperarousal symptoms in military personnel without mental health issues.

As mentioned previously, there are many yogic breathing techniques. In the video in this article, we practice yogic square breathing, also known as "box breathing." As its name suggests, this breath has four parts, making it easy to remember. If you have uncontrolled hypertension or are pregnant, this technique is unsuitable for you. You may practice box breathing in a seated or standing mountain pose or lying down in a comfortable position, as follows:

  1. Inhale to a count of four.

  2. Hold your breath for a count of four.

  3. Exhale to a count of four

  4. Hold your breath out for a count of four

Repeat these steps as many times as you need, noticing how you feel both before and after practice.

The next time you're feeling spread too thin or overwhelmed at work, take a moment to practice the box breathing technique to help you reprioritize. Spending a minute or two refocusing on yourself may be just the thing you need to get through a hectic day. 

Nadine Kelly, MD is a retired pathologist, experienced yoga instructor, health integration coach, American Council on Exercise–certified Health Coach, and host of the YOGI MD podcast.

Kelly practiced in a thriving community setting for several years. Despite numerous warning signs, she had a health crisis. It was more than burnout, and it was more than a weekend getaway could solve. Seeking help from her internist, she was diagnosed with major clinical depression. She took a leap and became a yoga instructor, empowering people to maintain the healthy bodies and minds they need to live life on their own terms, at every stage.


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