Michael: Well, hey everyone, and welcome to another episode of Doctors Living Deliberately. We're so happy to have you here with us. Of course. Welcome to my co-host, Arpita. How are you?

Arpita: I am good Michael Hersh, how are you doing? 

Michael: I'm doing really well. And you know, today we are gonna have a little bit of a discussion about these kind of big transition points in our lives that I think come up so often for us. Have you ever experienced one of those kind of tipping points where it just feels like everything shifts or changes for you? 

Arpita: There have been many, right? That's the beauty of it too. There's more than one and, and I think noticing when it happens and being present and aware for it is part of the key. And that's kind of what we're gonna talk about today in a little bit.

Michael: Absolutely. So I wanna go ahead and introduce our guest today. So we've got Dr. Stephen Lewellis here. He is a board certified medical dermatologist who serves patients of all ages and helps people struggling with both acute and chronic skin conditions. Outside of his medical practice, he is passionate about strengthening the collective voice of physicians on social media, fostering community and authentic connection among physicians, as well as educating fellow physicians about how to thrive rather than just survive in clinical medicine, as well as investing in both residential and commercial real estate. He's kind of a renaissance man, a jack of all trades. Welcome, Stephen. How are you? 

Stephen: Thank you very much Michael and Arpita. It's a pleasure and real honor to be here. And I'm doing really well. Thanks for asking and I, I hope the same for you. it's nice to be here. 

Michael: Absolutely. So, you know, we, we were starting a discussion about tipping points and I thought you would be a great person to maybe explain to our audience a little bit better what's a tipping point? 

Stephen: You bet. This only came up recently in my life where I really got to thinking about how powerful and important recognizing tipping points can be. Tipping points are vary. There's the kind of tipping point where you're working towards a goal and you feel like you're just constantly pushing that boulder up the hill, and finally you put enough work in to it that it gets enough momentum and you finally reach that level where it starts rolling downhill and everything seems a lot easier. The opportunities are coming, the. The joy is coming, maybe more income is coming, whatever it is, but it just seems easier because you got over that tipping point. But there's other tipping points in life as well that can be more things that add up in your personal, professional, home life, everything adding together where it's more of like a perfect storm enough things add up that it tips you over into maybe certain maladaptive behaviors that you finally start recognizing or you find yourself becoming more anxious or angry, something like that that really wasn't manifesting as prominently in your life, and it certainly is affecting other people around you, whether you recognize that or not. And I experienced something like that, that finally got me to think about changing things about myself and my mind so that I could be happier and more fulfilled. And have that influence on people around me as well. 

Michael: You've been pretty open about sharing kind of some of these tipping points I've seen you lecture on, would you be interested in sharing that with the audience?

Stephen: You bet, I'd be happy to. I recently had a very special opportunity to give a talk at the doctors on social media conference on physician entrepreneurship. And I gave a talk about how it was, the, the name of it was change Your Mind and Change Your Life. And the reason I named it that is because you really don't have to look outward to make a huge difference on your life when you're experiencing one of these tipping points. It's all about what's going on inside and that I didn't recognize that previously and I didn't really believe it until I experienced it. And it took a tipping point for me to push me to do things that are quite uncomfortable. So that's why people tend to avoid them when they don't really feel like something needs to change. So my tipping point came, we're coming up on a year from when it all started coming together. That perfect storm. It was back in May of last year we were actually talking before the show today is we're having, we're celebrating my daughter's first birthday party later today. And we're really excited for that. Her actual birthday is two days from now, but May 23rd, 2022 she was born and we were very grateful for that event and that was wonderful. And about I'd say, 10 days or so later. We also closed on our first rental property investment, my wife and I. And that was about three years in the making for me. Tons of reading, analysis, paralysis, all these things that you'll hear about, but finally jumped in and, and made this kind of scary decision, but took that action and we were proud to do that. But, we showed up at the closing table with a, you know, less than two week old baby. And it was a lot going on. So we, there were things that could have been starting to tip. And then almost two or three days later my eldest brother his name was Jim tragically died. And it was very fast. Everything happened very quickly and. Those three events were my tipping point. There were things going on in my life for many, many years that I felt to some degree, but my maladaptive behaviors weren't significant enough for me to really recognize that I needed to do something. But after that, a couple months went by and I knew I needed help, and I can elaborate on that. 

Arpita: Thank you for sharing. That's hard. I'm, I'm sorry about that loss that you experienced. I will say, I, I mean, immediately when you started talking, when we first started talking about tipping points and you alluded to the good tipping points, like when you're pushing the big stone up the hill and it goes downhill and that's when it gets easier and better. I immediately was like, oh, I wasn't even considering that. Right? So it just goes to show that our brain goes immediately to tipping points, this is negative. This means that we get to a point where we can't handle anymore. It's a straw that breaks the camels back. And actually tipping points can go both ways. Right? Yeah. The birth of your daughter. Right? Closing on that real estate property, those are actually each individual tipping points that are unique and we're positive. So I think part of it is also being aware that our tipping points can be good and bad for what we're gonna create in the next phase of life with it. Now that you have kind of experienced the tipping point, we can talk a little bit also about how you move forward then at that point but I also would like to touch upon how you feel like you were able to recognize it. Like what brought you to that point that like yeah, something needs to change. 

Stephen: Yeah. I think what made me recognize it was a combination of the way I felt when I woke up every day and how I was reacting to my family. I had a young family, a wife who is very loving and caring, an amazing, amazing mother, amazing wife, has also an incredible scientist, but she's made a lot of sacrifices for my career. So I, all of those things contributed to sort of an inner feeling of why am I feeling not great in the morning, for instance, before work. Michael has spoken about or written about the concept of work dread. And I, I was experiencing that. I was experiencing it in my first job out of residency almost constantly. I, I moved and got a different job deliberately. And it's much better now, but I was still feeling that to some degree, so, I knew I, I needed some help. And I also knew that a lot of people in my family suffered from chronic mental health diseases, anxiety, depression, bipolar, schizophrenia, that's all in my blood. And I had an element of chronic anxiety all throughout medical school, but I just thought it was normal or maybe the anxious achiever type of thing. But I think it was my maladaptive behaviors. I was getting angry. I was really reactive both to my kids and to my wife. And I felt a lot of shame in that. And that combined with not feeling great about going to work, I just said, maybe it can be easier than this, or maybe I can feel better than this and maybe it's not all my fault. And I can go into what, what I did proactively in terms of seeking help, cuz I knew I wasn't figuring it out. I had done many years trying to figure it out myself and that wasn't working.

Michael: Yeah. So, so what did you do? 

Stephen: Yeah it was one particular evening I remember, it was just a really difficult thing I had just gone through and I went up to one of the bedrooms in my house and got on my phone, opened up the app that I could message my primary care doctor through and just said, Hey, I, I need help, can we have a visit to talk about this? A lot of things have been happening recently and I just need to talk about it. Maybe there's something you can do to help or, or referral you can make. And he was great. He got me in right away. We had a phone visit, we talked about it. We made a shared plan and decision to start a low dose, quite low dose of an S S R I just for chronic anxiety and, and, it ended up six weeks of that as they usually say, I couldn't believe how much different I felt. And if you talk to psychiatrists, they will sometimes say, this dose of this medicine is, they'll joke about it being a placebo dose. Perhaps it is, I believe in the placebo effect, but I also know that this has changed. 

And that was just the start of it. And he also said, did you ever think you had ADHD? And I don't wanna use acronym's, attention deficit hyperactivity disorder, and I immediately said reactively. Oh, no, no, not at all. I've never thought that I'm not fishing for a diagnosis. It made me feel a little uncomfortable actually. And you said, well, I, I wasn't judgemental. I was just asking because as a primary care physician, family medicine doc, I see a lot of people like you who have a lot of chronic anxiety, and sometimes it's undiagnosed, ADHD and untreated. Would you like to explore that at least? And I said, sure. Well, I'm here for help. So I'm open to anything. And he referred me for formal testing with a psychologist and the ball started rolling from there, downhill at this point. It had turned into kind of that good type of tipping point because I connected with a psychologist who I had a great relationship with, and we did some other things as well. And but my primary care doctor was amazing. And it, and it didn't take a lot. So that's where it started. And I'm still working. We said work in progress. I still am more reactive than I'd like to be. I still do struggle with anger and all of this has helped though. But long way to go. 

Arpita: Stephen, you need to take my course on anger management.

Stephen: It's written down in my notes, two weeks ago I wrote down. 

Arpita: I'm teasing.

Stephen: I know, but it's important.

Arpita: It does impact us, definitely.

Stephen: And it impacts everyone around us. I understand now how much my behavior is contagious to other people. Not just my family, but at work. I'm a leader now. I have a team and I know that when I let myself do the outward sort of, that kind of thing at work, that I can see when my staff starts to do that too. And I know it's because of me. So I'm trying to be more intentional about that too. 

Arpita: No, the first step is always awareness. I wanna go back to a little point that you mentioned about recognizing, you had mentioned that you were wake up and you were, you were just not feeling like you wanted to go in, even in residency or right after residency. And what I've noticed when I've spoken to other guests, and specifically male guests. Is they all kind of refer to this, this vagueness around not feeling good. But they don't really know what, so I, I would love to hear your dive deep into that. Like, what did that feel like and look like to you? And then from there, what was that awareness of, this is not what I wanna do, this is, I need to make a change.

Stephen: Mm-hmm. It felt like a weight, first of all, a lot of hitting the snooze button and just really, very maladaptive behavior in my opinion. But tons of that because I just never wanted to start the day and primarily on a workday. Much easier on the weekends when I just got to hang out with my family. I loved that part. So I knew a lot of it had to do with work. But I was trying to figure out like I don't think I made a mistake becoming a physician. I do think this is the right thing for me. But I did have a lot of fears about what if I did all this and now I have a job and I feel this dread about it constantly, so I needed to explore is there something that can unlock something that will make me feel the, the joy that I at least perceive in other people. I know a lot of people do feel the way I do, but I, I think some people actually get up and are excited to, to go to work. And you know, I would sit in the car before work, and this was at my first job, it was a real struggle. I just didn't have the clinical support that I needed to practice the way I wanted. That's why I took the different job. Now I'm very happy in my job. I'm excited to go to work. Legitimately excited to go to work. Some days I'd rather stay home, of course, like anything. But I am happy to see my staff in the morning. I don't have to put on a facade. I don't have to hit the snooze button. That's, I think the, the biggest thing I noticed after the antidepressant I would wake up before my alarm and I'd get outta bed and I wouldn't be upset about it. I would just get up and say, okay, we're gonna go to work today. And that was an amazing feeling and I just couldn't, I never believed in my heart before that, that a subtle change in brain chemistry could have that big of a change in how you actually feel. It, it felt like a fairytale to me. 

Michael: So, I wanna point out how deeply uncomfortable a lot of this probably was for you in terms of number one, first, recognizing that you were showing up in ways that you didn't wanna show up, both at home and at work. For two, leaning into the discomfort of asking for help, which as a man and as a physician is really, it's incredibly difficult to take a moment to ask for help and to recognize, like, I want things to be different. And in order to be different, I have to do something differently. And that means leaning into discomfort. Can you talk a little bit about what kind of the discomfort has meant to you and, you know, is it always a bad thing? 

Stephen: Mm-hmm. Absolutely not. I think that it's almost always a good thing. There is a spectrum for this. I, I spend a lot of time at work when I'm counseling patients, a lot of diseases exist on a spectrum. And some kids are gonna have them for less than a month and they get lucky and they're all gone. Some kids have 'em for three years and it's extremely frustrating and there's everything in the middle. So the discomfort, the importance of discomfort is on a spectrum as well. We shouldn't always be in what I may call sort of a green zone, where it's just fine. You're happy, you're watching Netflix, or you're reading a book that you're enjoying, you're not being challenged and you know, you're not serving anyone else either. It's all about you. And then on the other end, there's sort of a red zone where it's way too much discomfort. And your cortisol is gonna be through the roof and you're not even able to function because it's so uncomfortable. And that's more of a danger zone. Occasionally be in that area, but more be in a productive, healthy discomfort zone frequently and embrace going into that because, you know, that's where you're going to get to the next step. If there is a next step you want to get to. 

You don't always have to be striving to get somewhere else. It's a, it's also important to recognize that like right here, right now is pretty awesome and that is okay, but I know that there are many things in my life that I want to be just the way they are. I don't want my daughter to turn one cause she's perfect right now, and I want her to be this forever. But there are parts of me that I want to expand and grow and living in that discomfort zone. I think Dr. Una of EntreMD speaks very eloquently about that frequently. And it's the only way we grow. And Michael, you said to your point about male physicians, they, they all feel this as well, but there's different analogies. A lot of, there's a lot of sort of macho culture in male physicians who are talking about this stuff. And we can think about going to the gym. If you're just going, getting on the bench press and throwing up, you know, 135 15 times, every time you go in, you're gonna be wondering, why am I not changing? But if you are going to sort of failure and that last rep is miserable and it's really uncomfortable, but you have someone spotting you so you don't crush your sternum and, and have a really bad injury. Then you're gonna grow and you're gonna see those results. 

So, that's why we have need so many different coaches and different people out there because no, the space is not overcrowded just because it's become a lot more visible recently because every single person will resonate with a different person, a different delivery of the same essential message. So that, yeah, that zone of discomfort is, is super important. And I've just embraced being in it and I enjoy, you can enjoy being in it once you recognize how important it is and how productive it is.

Arpita: I think it speaks back to the stress continuum, right? You have stress, it becomes toxic stress. If it's not resourced well, if it becomes too much, too heavy, too strong, and then you go on to trauma from there. So, where we are in that stress continuum really kind of determines the level of discomfort. And yes, stress is good, it can be good. And I think we had Dr. Shideh Shafie talk about that with stress and how we can create stress to be good stress versus when it becomes bad. And so this discomfort zone that we're talking about is when we're able to recognize that, of course, when we do things that are new for us or when we do things that are to help us grow, it's going to be uncomfortable because it's not what we're typically used to. It's not what our brain has become comfortable with, and that's where we get to push ourselves to be able to reach our full potential, our maximum abilities. 

So tell me what you've done, I guess now that you've kind of had some experience with being in the discomfort zone. What actions are you taking and what actions would you suggest to our audience with regards to maintaining that? So that it's something that, it's not gonna be perfect, of course we talk about that, but that it gets to a point where it becomes the new norm for you so you can continue to move forward.

Stephen: Mm-hmm. I'd be happy to. And you're so right about that, stress is critical. It's a, it's a natural thing. That our, our bodies will do in response to certain stimuli and it can be adaptive or maladaptive. And it's all about how our reactions to it and whether you can know in certain situations to recognize, I just need to turn down the temperature and relax, take some breaths, and you can use that stress response productively. So I would suggest to fellow physicians to just take a step back if your life doesn't feel quite like what you expected or it's much worse than that. If you haven't asked for help yet, that's the first step. Well, the first step is awareness and then the second step is asking for help. And as physicians, we should be the first and the best people to do that because we rely on other people doing that to us, for our livelihoods. If no one came to us asking for help, we wouldn't have jobs. But for some reason, there's this block that we don't as easily ask for help. So you don't know what you don't know. And I didn't know I needed a small touch of a, of an antidepressant. I haven't increased that dose at all. I also didn't know that I might have had undiagnosed A D H D. I never even thought, that thought never crossed my mind. I didn't know anything about the disease other than the typical stuff that a lay person might know about it, to be honest and asking one person for help, I then met another person who's been helping me and have been treated for two different diseases I didn't know that I had, and I had two very different but additive and synergistic responses to the solutions that we found or the treatments that we found for those things I was suffering from. And I feel like a completely transformed person, even though I didn't move, I didn't buy a new house. I didn't get a new car. I didn't change jobs. I did change jobs prior to all of this, but since starting this, no new job. No new anything really outside of me. Everything that's new is in here and you can't, it's kind of like a wealthy person who says money can't buy happiness, like, you just don't, and you know, I wanna find out for myself at least. Like, I don't, I don't really want to hear that from you. You will not believe me until you experience it yourself, but it's pretty darn hard to get there by yourself. So, whoever it is that you need to ask just ask. And that can be the importance of having a community of people that you trust and who are talking about things like the three of us are talking about, might give you that tiny dose of courage to, to talk about it yourself and say, oh, that's all he did to have this massive transformation. He asked his doctor for a little help with anxiety and that I think that's the most important thing. We can't do it alone and there's no reason to. And it's not fun either. 

Michael: Right. And you know, just you don't know what you don't know. And one of my favorite kind of lines or mottoes about coaching is you can't read the label from inside the jar. You know, we use that frequently in coaching, but the truth is, you know, we do this in medical practice all the time, you know, coaches are not the only ones who can help us see things that we cannot see or know for ourselves. And so who in our lives can we allow to hold up a mirror to us and show us the things that we can't see for ourselves? And for me, that was coaching. And it has made all the difference and if you had asked me before all of this, are there things that you don't know about you? I would've thought that, that question was, was just ridiculous. Like of, of course I know all the things about me. I've been living my life in my body for, you know, 40 plus years. And of course I know all the things. And just astonished by all of the things I learned just by somebody questioning the things that I was saying and how I was showing up and recognizing, gee, like I do want things to be different. And the pivotal question of, if you don't do this, if you don't ask for help, if you don't attempt to do things differently than you're currently doing, what will change? How will your life be different? How will you be different and allowing yourself to exist in that space. It's been all of the hardest work I've ever done and some of the most important. 

Stephen: For sure.

Arpita: And I think part of it is also, like you touched on, is having that community, right? We have to build the communities where we feel more comfortable and we tend to become isolated with thinking and believing that we're the only ones feeling this way, thinking this way, having these struggles and ultimately when we keep siloing ourselves with those beliefs, we are isolating ourselves from our pack. And that makes it even harder in our minds to ask for help. So when we can start to maybe reach out, you know, for me the coaching journey was amazing because of the community I have within the coaching realm, the world itself, those people are my people. And I know no matter what, I'm putting myself out there, I can create what I want because I believe in it. And when I have the setbacks and the falls, I have my tribe that are gonna help raise me. And it's not just within the coaching community now, it's kind of grown into the other areas of life. You get to find your people, you get to figure out who is going to be there regardless for you and vice versa, who you're gonna be there for and build that group so that you've had that internal support at all times. That's what living a true, authentic life is gonna be when we can feel and experience the negative crappy times and have the people there to support us to, to lift us back up and straighten our crowns and straighten our ties for the guys. So, so, yeah. Well, Stephen tell us a little bit about what you're, what you're doing, what's coming up for you. 

Stephen: Sure. Well, I am still practicing full-time as a medical dermatologist. I'm seeing people of all ages. I'm very happy doing that. I see patients at Aspirus Dermatology in Wasa Wisconsin, and that is primarily what I'm doing right now. I do a lot of stuff on the side in terms of personal development, business development, I mentioned Dr. Una before, I love her idea of the intrepreneur, so that's me right now. I am an entrepreneur, but in an employed job, and I see a wave of transition back to private practice ownership for physicians who want to keep practicing medicine, but in a more deliberate way. I think we've abdicated a lot of things that we didn't want to do cuz we only wanted to take care of the patient and now we have other people doing everything else and, and that's gotten us into a very difficult spot. So I think things are, are gonna transition back that way. I'm sure I will own my own practice someday. And I wanna start behaving and I already am with my team as if they are my team, as if I own the practice. And then I'll be all the bar ready for that when I do. And it affects every other part of my life. Real estate, ownership business development, at home with my kids, parenting, being a better husband which is probably the thing I need to work on the most. And so we've talked about balance and things. So as I continue to get more opportunities like this, remember the people who are home as well, and always prioritizing that as the number one most important thing, even if the snowball really starts rolling in other entrepreneurial pursuits things like that because we can't forget about the people who are actually allowing the snowball to, to form. 

So that's my life in a nutshell. Right now I'm active on LinkedIn. I post fairly regularly on there. My webpage lewellismd.com. You'll be able to visit that and just see some of my musings there. And I am also making some content on my YouTube channel, Lewellis md. For my patients that they can use for patient education. And I hope to collaborate with some other physicians and other specialties at some point too, to discuss how our specialties intersect and some key things that patients can learn from. So be happy to talk to any of your listeners about any of those things, whether it's real estate, personal development, just getting over that tipping point, dermatology, practice ownership, being an entrepreneur.

Michael: This has been fantastic. We appreciate you so much coming here, sharing your story, your journey and all of these important tips for our listeners and just being an example of what is possible. Dr. Stephen Lewellis thank you so much for being on Doctor's Living Deliberately. 

Stephen: Thank you very much to the both of you. Thank you for what you're doing for the community out there. We really need you and you're doing an incredible job, and thanks for giving me the platform. 

Michael: Thank you. Take care. 

Arpita: Take care.

Stephen: Take care. Bye bye.