You're running late to clinic because of road construction that you could have sworn wasn't supposed to begin for an other two weeks. Finding a parking spot is also a challenge this morning, and when you finally walk into the office you're greeted by a pile of phone messages, a schedule filled with some of your most complex patients, and a meeting request to discuss new quality measures and reporting requirements. You're already feeling stressed and worn out, and you haven't even taken your jacket off yet.

Given the rough start to your day, you're curt with your medical assistant and, instead of feeling empathy toward your most difficult patients, you feel frustrated by them. By the time your theoretical lunchtime rolls around, your colleagues and staff are avoiding eye contact and interaction with you. You need to get their buy-in for a new initiative you've been asked to lead, but the tension is too thick today and you're just too busy.

It's tough to show up as your best self when your day is filled with frustrations and increasing demands for your time and attention. Even if you're normally calm, cool, and collected, you may find yourself reaching your boiling point faster and more furiously than ever. Unending regulations, organizational priorities, and technological demands can turn your medical school fantasy on its head, and the impact of incivility in our culture only exacerbates a system already in peril.¹ As a result, you may be feeling at risk of burnout, like so many of your colleagues, and wondering what you can do.²

While you cannot necessarily control the dysfunctional environment in which you practice, you can control how you respond. In the absence of sweeping institutional and industry change, physicians must look inward to ensure their personal goals and values are pursued each day, despite the obstacles that arise at every turn. An important skill that can help you become more resilient and more effective in the face of the unprecedented stress and change is emotional intelligence.

A DIFFERENT KIND OF INTELLECT

The concept of emotional intelligence, or EQ, was introduced in 1990 by psychologists Peter Salovey, PhD, and John D. Mayer, PhD, who defined it as follows:

• The ability to perceive emotions — that is, to accurately recognize emotions in yourself and others as they are occurring.

• The ability to use emotions to facilitate thinking — that is, to guide you to issues that need your attention.

• The ability to understand emotions — their causes, meaning, and relationship to thoughts and behaviors.

• The ability to manage emotions to attain specific goals.³

Author Daniel Goleman expresses the key components of EQ in this way:

• Self-awareness — the ability to recognize and understand personal moods, emotions, and drives,

• Self-management — the ability to control or redirect disruptive impulses and moods,

• Empathy — the ability to understand the emotional experiences and responses of others,

• Relationship skills — the ability to build rapport and manage relationships.⁴

Yet another way to think about EQ is simply taking care of “my stuff,” understanding “your stuff,” and working together on “our stuff.”

The components of EQ are helpful in providing effective patient care and are traits that patients value in their physician. In addition, during the last two decades, many organizations have come to view EQ as a must-have leadership competency. Some have even argued that EQ accounts for about 90 percent of professional success for those in top leadership positions.⁵ Certainly, when physicians and other leaders in an organization demonstrate emotionally intelligent behaviors, they help cultivate teams who work well together and reach higher levels of performance.

BUILDING EMOTIONAL INTELLIGENCE

Is EQ something we are born with or something we can learn? The answer is “both.” While some people have more of an innate ability to flex their EQ muscles, everyone can practice behaviors that cultivate the emotional components of our intellect.

Here are 10 practical strategies for building your EQ:

1. Clarify your intention for the day. A daily practice that can help build EQ is clarifying your intention. As you travel to work, sit in silence and ask yourself, “What intention do I have for today?” Avoid the urge to make a to-do list, and instead consider what you need to be more intentional about given what is on your schedule. Examples include “I need to build understanding today,” “I need to remain calm,” “I need to provide clarity,” or “I need to be light-hearted.” Once you've identified your intention, you can begin to align your actions to it.

2. Practice self-care. Despite your best intentions, you may struggle to control your emotions if you are tired, skipped lunch, haven't exercised all week, or are over-caffeinated. A little daily self-care will help build your capacity for EQ.

3. Perform an emotional check-up. Physicians are rewarded for their cognitive intellect, so it's no surprise that you value the brain that got you here. However, be careful that you don't ignore or suppress your emotional side or downplay the mind-body connection. For instance, when traffic is slow, the cell phone company messes up your bill for the fourth time, or the neighbor's cat ruins your flower bed, what happens to your face, your chest, and your stomach? Noticing your emotions and how your body reacts to them can help you better manage your stressors at work. Before walking into clinic and throughout the day, ask yourself “How do I feel?” and clarify both the physiological answer (e.g., “My shoulders feel tight”) and the emotional answer (e.g., “I feel anxious”). Then, consider why you are feeling that way. Often our emotions point us to an issue that needs to be addressed. For example, you may be feeling frustrated because a broken process is leading to rework, or you may be feeling stressed because you need to set limits with someone. Paying attention to your emotions can help you identify and address these issues.

4. Slow down. Pausing for just a few seconds before you respond to a stressful situation can often help you gain control over your emotions before you say or do something you might later regret. As you pause, simply take a deep breath. While there is science behind building a ritual of deep breathing to lower overall stress, you can't usually lie down in an exam room to escape the stress of the day.⁶ Instead, learn to center yourself by simply taking three “nose to toes” breaths between patients, during a meeting, or before logging onto the electronic health record.

   Emotionally intelligent people are open about their weaknesses, willing to change course, and quick to admit “I don't know.”

5. Get curious. Curiosity is a difficult mindset to have, particularly as we get older, wiser, and more confident in our beliefs, judgments, and opinions. However, cultivating your curiosity is one of the best strategies for building empathy for yourself and others. Curious people pause before reacting or making assumptions and instead ask questions to better understand the other person's experience and perspective.

6. Create space for all emotions, not just the pretty ones. Researcher and scholar Brené Brown, PhD, contends that vulnerability about our struggles is not only the great equalizer but the seed where strength is born.⁷ Emotionally intelligent people are open about their weaknesses, willing to change course, and quick to admit “I don't know.” (They also know the difference between healthy vulnerability and over-sharing.) Further, they are willing to put themselves in the ring, show enthusiasm, and motivate others with an inspiring vision.

7. Read the room. It's easy to get stuck in your own head and not pay much attention to the world around you. Have you ever been sitting with your team, deep in discussion, when one of your colleagues walks in the room with great fanfare and total disregard for what's going on? The energy shifts in a palpable and awkward way. Noticing our environment is a crucial skill for building EQ, and you can practice it through intentional mindfulness, taking your attention off your phone and tuning into both the context and the content of the group interaction.

8. Make an effort to connect. Making time for those around you can seem like an impossible task, even for the most outgoing physicians, if you're struggling to be productive within the confines of a tight schedule. It feels counterintuitive, but connecting with others can actually save you time and angst in the long run. With every genuine greeting or conversation with someone on your team, you are building a coalition of people poised to help you, give you the benefit of the doubt, and work hard on your behalf. And practice makes perfect, so the more you thoughtfully interact with others, the more you will grow your EQ.

   With every genuine greeting or conversation, you are building a coalition of people poised to help you and give you the benefit of the doubt.

9. Clean up your messes. There are few certainties in life, but one absolute is that you will mess up — a lot. Getting comfortable with extending genuine apologies is a way to maintain strong, healthy relationships and regulate our emotional responses when things don't go as planned. While it is common to want to hide our mistakes or even feel ashamed or embarrassed as a result, there is nothing more powerful and contagious than authentic humility and accountability. For example, if you snapped at your nurse earlier in the day, it's important to apologize promptly for the specific behavior.

10. Begin and end well. Stressful, busy days can often blur together, with no discernible beginning or end. While you cannot suddenly become less busy, you can pay more attention to the moments in between your commitments, particularly the beginning and ending of your day. A morning ritual that excludes your phone and includes your favorite music, for example, will help you start your day on a positive path. Likewise, saying goodbye to your staff when you leave the office and expressing gratitude at the end of the day will leave you and your team feeling more positive, even if the hamster wheel is still spinning.

EQ, RESILIENCY, AND BURNOUT

With no end in sight to the changes and complexities permeating the health care industry, physicians and teams should make EQ a priority in an effort to increase resiliency, stave off burnout, improve professional engagement, and achieve higher levels of patient satisfaction.⁸ Team members with high EQ are more capable of taking care of themselves, one another, and ultimately their patients. While you cannot avoid most of the external factors that seem to conspire against you, EQ can help you create the internal conditions for enjoying practice even in the face of tremendous stress and change.