← Extend Podcast with Darshan Shah, MD
Extend Podcast with Darshan Shah, MD
185. Dr. Neha Sangwan: The 5 Questions That Predict a Health Crisis Before It Happens
00:52:30
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- [00:00]
A
Before we get started with this episode, I'd like to invite all of you to the first ever next Health Longevity Summit happening in Nashville, Tennessee at the Conrad Hotel on Saturday, September 12, 2026. This is an all day summit where you're going to be hearing from some of the best speakers in longevity medicine, including Dr. Vonda Wright, Dr. Luisa Nicola, many of the podcast guests that you've heard here on the Extend podcast, and of course I'm going to be there curating the entire day. We also have incredible vendors coming so that you can try the latest technologies in health, wellness and longevity. Go to next health.com summit and buy your ticket today. We only have 400 spots and they're going quickly. That's next health.com summit. I look forward to seeing you all there. Welcome to Xtend with me, Dr. Darshan Shah, a podcast dedicated to cutting edge science, research, tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. Welcome to xtend, the podcast dedicated to helping you live a longer, healthier, more fulfilling life. Today I have the immense privilege of speaking with Dr. Neha Sangwon, a true pioneer in the understanding of the mind body connection. Dr. Sangwon is an MD, a board certified internal medicine physician and a former hospitalist who also holds a degree in Mechanical engineering. After experiencing burnout herself and witnessing patients arrive in crisis and she transitions from treating illness to preventing it. Focusing on the upstream causes of disease, her groundbreaking work emphasizes how communication both with ourselves and others, profoundly impacts our health. She's the author of insightful books that guide individuals to unlock their inner wisdom in transforming their well being. Get ready to discover her unique awareness prescription and learn how listening to your body's subtle signals can be your most powerful tool for health and longevity. This is an episode you don't wanna miss. Hey everyone. Before we dive into today's episode, I wanna talk about something that you hear me talk a lot about. Your Biomarkers. And I wanna tell you how I'm approaching this situation right now with all of the patients that are calling me from listening to this podcast. So what happens is every day patients are writing to me saying they feel exhausted, they can't lose weight, they're having brain fog, and they see their doctor and the doctor tells them all their blood work is normal. But the problem is this usually is only checking about 10 to 15 biomarkers that only tell you if you have a disease developing. Meanwhile, your body has 160 different systems that are running. And all of these have blood tests that we can test on how effective they're working for you every single day. So if someone is not close to one of my clinics, one of my next health clinics, then I tell them go to their local laboratory and get on Function Health. Function Health gives you access to 160 different biomarkers, the same kind of comprehensive testing that we do at all of our next health clinics. And if you tried to get this on your own through your regular doctor, it can cost you thousands of dollars. Hormones, inflammation, toxins, nutrient levels, they're all tracked over time in this one platform called Function Health. They could even help you get an MRI scan or a CT scan if you want one. So what I love most about this company is that they don't have a crazy incentive to do this. Function doesn't push supplements, they don't have pharmaceuticals they're trying to get you to take. You're just getting the data and you're getting insights from the data. And you can bring this data to a clin like ours, and we then have the information that we need to tell you how to improve your health. Membership is now only $365 a year. Literally, it's just a dollar a day. And right now, if you're one of my listeners, you can get a $25 credit towards the membership. You just go to the link in the bio or go to functionhealth.com Dr. Shah and use the code DrShaw25 for a $25 credit towards your membership. Dr. Sanguine, thank you for joining me today.
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B
What an honor. Thanks for inviting me.
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A
It's really great to have you. I've heard so much about you and can't wait to talk to you about what your newest book is about, what your last book is about. We're going to have a great conversation. So you're an md, right?
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B
You bet.
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A
And what type of medicine did you practice in the past?
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B
Internal medicine. Internal medicine. And I was a Hospitalist?
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A
Yes.
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B
So I was the one in the hospital where someone comes in from the emergency department. I took care of them through their hospital stay because some people don't even don't recognize that. Yeah, but it's the acute care medicine.
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A
Yeah. There's doctors that basically just live in the hospital taking care of people in the hospital. And that was you.
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B
And we never left residency. Yes.
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A
Yeah. It's like an eternal residency.
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B
It is.
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A
Oh, no.
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B
Yeah. That's painful.
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A
You switched your careers a little while ago.
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B
I did.
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A
And you saw a much bigger need for your skills outside of the hospital. Right. Can you talk us about that transition a little bit?
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B
You bet. Well, first of all, I'll tell you that as a good Indian child, I am both a mechanical engineer and an internal medicine physician.
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A
Oh, okay.
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B
And that led me straight to burnout at 34 years old.
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A
Yeah. Thanks.
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B
And that's when that was one of my first wake up calls. And the other one would be when my patients would say to me, Dr. Sangwon, this was so helpful, this conversation you had with me the night before I was discharged. Why was the price of meeting you a heart attack or a stroke or a pneumonia? Why isn't someone like you out in the world 20 years earlier helping me before my stress got me to this level? And for about seven years, I said to them, because this is what they pay me for. They pay me to clean up the mess, not prevent it. And that was 20 years ago when no one was talking about this. Right. And so I just feel so honored to meet a fellow soul on this journey that understands what I mean when I say good Indian child. And you understand what I mean when I say we just weren't looking farther upstream.
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A
Right. Right. And that's the problem with medicine is we don't look farther upstream. And so, you know, I really appreciate that you've kind of bring this dimension to our field because people are getting sick and our traditional diagnostics aren't telling us why. Right. Yeah. And your first book identified communication as an issue that makes you sick. So unpack that for me. How does that happen?
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B
Well, if I build on what we just talked about, which is my patients, I did something really interesting the night before I discharged them. I had realized that we had taken care of their physical health. But I knew that stress causes or exacerbates more than 80% of illness. I learned that when I went on burnout leave myself, I started doing all this research. So I said, well, what if we get to the root of their stress? Should that be part of their prescription when they leave?
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A
Yeah.
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B
So I came up with five questions that I call the awareness prescription. And for those of you listening, you can use this for far more than your physical health. You can even use it in business. You can use it. It's much more applicable. But let me tell you, would I ask them the night before I discharged them so now they're stable? I'd say, question number one. Why this? Why a heart attack? Why did this part of your body break down? Why not your liver, your left leg? Is there any significance to you? And whatever their answer was, was the right answer. They would just speak from the heart. It was amazing. So I'll give you an example. Like a Vietnam vet said to me, oh, I know why I had a heart attack. I haven't cried since Vietnam when I lost all my buddies. I have been crying for the last two days. This heart attack gave me, like, legitimacy that I could actually open my heart again.
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Right. Wow.
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And I was like, whoa.
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Yeah.
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The second question. So that one is, why this? It was, why now? So why not three years ago? Why not two weeks from now? Tell me why your body? What's the message your body wanted you to get, that it stopped you in this moment, put you in a hospital bed and had you here with me? And they'd say, you know, I've been pushing through this tightness in my chest. I've been ignoring my sleep. I've been making everybody else more important than me. They knew exactly what it was. Question number three is, if hindsight's 20 20, since hindsight is usually 20 20, tell me what clue, pattern, symptom, you know, have you missed that now? Makes perfect sense. And they would say things like, you know, oh, I had this headache, but then I would just take a pill to get me through a meeting or whatever it is now, I understand that that was the signal. So I just wanted them to start picking these signals up earlier. And then the fourth one was, what else in your life needs to be healed? And the last one, this one, always got them. I said, if you spoke from the heart, what would you say to me? And so by the time they had gone through those other ones and now them and I have gone through this crisis together, they just opened up, and they all knew what was at the root of their stress, what they needed to do. And I made that part of my prescription.
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A
That's such a great technique.
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Yeah. And 80% of it, 75, 80% of it was their inability to communicate with themselves and pick up Signals or their inability to communicate with someone else. Like, they'd say, you know, I. One of them even said, you know, I abandoned my son because he married outside of our faith. And me cutting myself off from him, his family, and my grandchildren is exactly what's making me sick.
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Yeah, yeah.
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And so they knew. So I think the beautiful thing is, I think as physicians, we've been schooled to write a prescription, but as a coach, I could see at the intersection of asking questions and then turning their answers into their own prescription.
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A
Yeah, yeah. It's a really cool thing that we're able to do is give a prescription. But this is a different way of framing it where you're actually having them write their own prescription through this series of five questions.
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You bet. And I call it the awareness prescription.
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Yeah.
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So I'll make sure we give it to you so that if anybody wants, like, what are those questions?
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A
Oh, we'll definitely put them in our show notes, for sure. So, you know, why do you think it is that people have an inability to communicate with themselves?
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B
Such a great question, really. I think it starts from the beginning of our lives. We come from the inside out when we arrive here. Literally from inside our mother. Okay. But we're living from the inside out when we arrive. What do I mean? I mean, if I'm hungry or my diaper's wet or I'm tired, I cry. I don't care what's going on. I don't care if we're in public. I don't care if we're in private. I live from the inside out, but very quickly, because I depend on the world around me. The world around me starts teaching me to work from the outside in. This is not the appropriate time. You are not allowed to. If you go in your room and you don't come out until you have a smile on your face, all of a sudden, we start adjusting to our caretakers, to our society. We want to belong. And so in our need for belonging, we start arranging our behavior, our lives, our purpose for our work and our world starts coming from the outside in.
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A
Yeah.
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B
What is success? Well, who defines success? To my immigrant parents, it was a million dollars in the bank or your own home. Yeah, but that was external measures of success. I don't know if that was really the internal happiness factor that came. So why do I think this happens? I think by the time I meet people in the er, they've been in a career, they've been in a marriage that isn't working, but they don't know how to voice it. But they've been taught that they need to care more about what things look like, seem like, behave like. Right. Like what other people will think of them more than they care about themselves.
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Yeah. People stop listening to themselves and therefore they stop communicating with themselves.
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They do, because it's survival.
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Right.
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Like when you think about it, when we're little, it's our family, but then we move into our teen years, who do we care about?
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Yeah.
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Our friends, our peers. Yeah. Who do. And then we go into college, it's, you know, or work, and it becomes our peers and then we get in a relationship and now it's our in laws, our partner, whatever.
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A
Yeah, it's so true. It's really, it's really a. It's really something to be aware of, of yourself. But then having a tool to then flip that narrative, like your five questions, for example, makes it real. Right. But you know, I think about people that are asking themselves, or maybe they're going to the show notes, they're gonna ask themselves these five questions. Yeah. But you know, like you mentioned, people normally come to these five questions when they're going through a crisis, like a heart attack. Right. You don't wanna wait that long. Right?
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B
Yeah.
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People should be asking these questions now. But what gives people the motivation to ask these questions now? How do you, you coach a lot of people. Right. And so is this what you first talked to them about when you. What is the motivation there?
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So, Zarsen, think about our medical training.
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Right.
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We very early on studied physiology. Nobody ever told us that. It's what I now call our body map. You and I have physiology. If we get stressed, our blood pressure goes up, our heart starts racing, something will happen internally. But you and I will experience stress differently. So you have a unique body map and I have a unique body map. So when I move out of my comfort zone, the first thing that happens is my throat starts constricting and I can feel a little bit of a swirling in my stomach. Do you know what it is for you? How does your body map talk to you? When you get outside your comfort zone,
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my heart starts beating really fast and I feel like I'm having palpitations.
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So do you see how two doctors, two Indian, like, we probably have a lot of things in common. Sure. But boy, our body map speaks uniquely to us. So I also know that when I don't speak my full truth, when I'm not saying what I need to say, that signal alone comes without the stomach turning.
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Okay.
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So when I start picking up signals long before something is a crisis. It's because I am picking up data from inside me that we've been taught to override.
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Yeah.
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So remember how we just talked about we come into the world inside out.
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Yes.
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And then the world teaches us to go outside in. Well, how do you go outside in? You override these uncomfortable signals so that you can perform for whatever's happening in the world.
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Right, right.
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So what's gotten a lot of people to being successful successful is their ability to override that body map.
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That's so true. Right.
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And now what I'd say to people is, you've gotten where you needed to go this far with those tools, overriding, you needed to do it. So don't be upset with yourself that you overwrote it. Thank your survival mechanisms. But here's what I'd say. In a world moving this fast, today we're fine, and tomorrow there's a pandemic. We have to pull on our own internal data when the external world doesn't have all the data yet. So the people who are going to be able to navigate change quicker and quicker. Now we have AI and how quickly that's moving. So the data you will always be able to draw on uniquely yours is your own physiology. And so I'd start people with the body map.
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Listen to your body.
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Listen to your body. Instead of thinking these signals are annoying or uncomfortable, breathe. Slow down. This is where feeling your feet on the ground, feeling gravity pulling you down, feeling your heart beating, and not taking that as an annoyance that's slowing you down, but rather as a signal that you're moving outside your comfort zone. What else do I need to notice and tune into? So it's a little bit of a flip.
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Yeah, it's a big flip for a lot of people. So once you have these questions answered, you know the why. How do you turn that into action? What is the next step then? Yeah.
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Okay. So when you feel this discomfort, it's the most normal thing and protective for our bodies to contract.
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Yes.
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And protect us. Okay. So the first thing you have to do is actually become aware that the signal is happening and then get curious. Not furious, curious, not furious. Okay. Some people think like, oh, that's annoying. Not now. I gotta do. Okay, you get curious, not furious. And you take a slow, deep breath, which is going to expand your chest cavity and take your diaphragm and it'll contract. That triggers your vagus nerve, which slows your heart rate down, opens your creativity and your thinking. And now you aren't Just thinking, do I stay? Do I go? You have creative options. Like, hey, I wonder what we can do now. You don't get up and storm out of a meeting. There's no options here. What you say is, hey, I'd really like to work with you, Darshan. I'm wondering if maybe we could get creative and think of other ways of value creation so you access this part of yourself that you otherwise wouldn't. But you have to work with your physiology, not against it.
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A
Yeah, very true. It's really hard to sometimes do that in the moment, but I see the value of it, for sure.
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Well, we need to practice a little bit when it's not that moment. Right. You don't wanna take something like this and go straight to your hardest challenge. What you wanna do is start noticing. How about if we take it to an easier place? Your body speaks to you when you're in resonance and relaxation as well. Your body is in constant communication with you. Okay. So I just met you outside. We talked on the phone, we talked on Zoom. We connected. But I noticed when I saw you, first of all, you are very tall. And I, of course, on zoom, never noticed that. So I noticed myself a little surprised, and I could feel a little tightening of my muscle, like, oh, I didn't know that. And then I could feel everything relax. And you reached over, you gave me a hug, and I could feel myself move into resonance, like, oh, I feel a resonance with this man. Yeah, right. It's the first time I'm meeting you, but I feel like there's so much in our worlds that we're parallel.
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Yes.
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But the way it showed up in my body is I felt that initial tense, like, oh, surprise. And then everything just relaxed. So that's how my body map told me I was in resonance with you. So people can even start by noticing when they see their favorite person, when a name comes up on your cell phone that you're excited to text or talk to.
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Yeah.
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How you. Your physiology will also tell you that.
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Yes. Yes.
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That might be an easier way to start.
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Yes. Like noticing the good feelings, too, that happen. You know, it's so funny that I feel like we're so disconnected from our body's sensations. Right?
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B
Yeah.
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And what you're talking about is become more aware of those sensations that you feel and connect them almost to emotions that are coming up at the same time.
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We only learned in medicine to pay attention to that data when the heart attack was happening at the very end. And all I'm doing is saying, long before you show up in our offices or in the er, you can start picking up your own signals.
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Sure.
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But we've actually in a world that thinks faster is better and do more with less. Right. And sometimes profit over people.
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Yeah.
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We have thought, ignore that because I want to succeed. And now I think the definition of success is changing. This is all about data that I'm speaking about. I'm literally saying physical signals in your body are data that we've been taught to override that. I now know that my top performing leaders, my. The people who are gonna do the best in the next phase of our world are gonna be the ones who tune in to their internal data. And it's not just physical signals in your body. It's your emotions, it's the thoughts going on repeat in your mind. It's when you stay in a company culture that drains you of energy. It's when you stay in a relationship that you know has long since expired.
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Right.
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It is when you don't know the higher purpose of why you get up every day and go to. Of course you know what it is for next health. I read it on the wall. I've read it and I've seen it in your podcast. Like, you radiate because you are connected to that higher purpose. So there's all these different energies that you can use this one tool in to see where you resonate and it gives you energy and where it depletes you of energy.
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Right.
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So we're going to start making that much more practical once people understand your GPS system is your body's physiology and your heart's emotions. Yeah, that makes, that's what tells you.
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A
That makes a lot of sense, actually. So using your. You know, I think a lot of people now are using wearables and they're using biomarkers and these are all data points, but they are actually listening to your body and what it's telling you is another major data point for us
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B
to be looking at. And I think that you bring up such a good point because if somebody wakes up in the morning, I know before me you had some sleep experts that you were talking to. Okay. One of my pet peeves is when I asked someone if they slept well today and they look at their data on their phone to tell me, I know they want to know their sleep. They're like, my sleep score was, here's what I'm going to advocate. That's awesome. But when you wake up in the morning, close your eyes and check in to see if you feel well rested. How Good. Are you at knowing your body? Then check that with your sleep score. Because when we start tuning out of our own bodies and we're relying on machines outside of us to tell us we're moving farther and farther away from picking things up early.
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That's so true. Yeah.
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So I'm not saying anti tech. I love tech. And I'm saying you have the most sophisticated technology right here. Please use it.
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Yeah. Don't forget those internal signals your body's
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trying to give you, because then you'll pick it up in real time in a meeting, before you can even check your phone, you'll know if someone just took credit for what you've been working on.
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A
Really?
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B
Oh, yeah. How is that for me? It's that throat constriction and that stomach turning. I know the moment this is happening. I know what's going on. Neha, you're not speaking up. Somebody just took credit, and you're not going to say anything. And my body holds me a little bit back. Like, you know what? In the past, when I spoke up, I lost a friendship. I lost an opportunity because someone didn't like me or whatever it is. Each of us have these different maps inside of us. You got to know yours because it's different than mine.
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A
Wow. Yeah. And so I think, like, to your point, just do it more often. Just sit there and try to understand what your body is telling you. I think the questions you pose in the book are also a really good way to get really deep into what could potentially be causing those signals. Right?
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B
Yeah. And if somebody's listening and they're like, I don't know what she's talking about. Like, listen to my body. Really, What I'd say to that person is, congratulations, you're a master of the external world. And that probably means you're pretty darn successful. Okay. Now, so why don't we do this for someone who's like, okay, what's the first step I could do? I don't feel any of this. Everyone's got an AirPod case or, you know, for your headset, or you can grab a smooth stone from outside on your next walk. Okay. In your next meeting, hold on to it. Okay.
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Okay.
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And when you notice something change in the meeting, something surprised you, someone that you didn't expect was in the meeting, pay attention. And if you can't notice what is happening here, just say to yourself, I can feel this in my hand. Okay. After about four or five times of that, you're going to say, oh, my gosh, My right Shoulder is a little tight. Oh, wow. I didn't notice I was having tension across my head. So what happens is we've been so trained to the outer world that what I'm gonna do is I'm gonna take something from that outside world and I'm gonna bring it in. Cause you'll be able to feel this the other way. Is anyone sitting and listening right now? Whether you're driving, walking, whatever it is, just notice where your clothes touch your body. Is the belt feeling comfortable or a little tighter than usual? Does it feel relaxed? You know, just noticing. You can do these really simple, simple things to start noticing, but this is usually what we're pushing through.
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A
Yeah.
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B
So it's a little bit of a.
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A
Take some practice for sure. But these are all great tools. Wake up in the morning and ask yourself, do I feel well rested? Hold something in your hand like a
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B
stone before you check your biohacking.
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A
Yes, yes. Make it a game before you check your wearable. What are the other kind of tools you have in TalkRx?
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B
Sure.
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A
Tell us a little bit more about what tools you can give to people.
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B
So TalkRx was my first book that I wrote, and it's really about. I noticed that a lot of those patient answers were around avoiding conflict.
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A
Right.
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B
That woman did not cut off her own son. Communication with her own son.
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Right.
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It's unless she was in conflict that she didn't know how to express. So somewhere along the line, people were in conflict with themselves or with each other.
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Right.
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So the first book was about what are the five steps to lean into any conflict confidently, clearly, compassionately, and concisely.
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Okay.
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B
And that's what TalkRx really is. And I start to show that it's. The first one is picking up the signals so that there's data. You received an email, you heard someone say something, someone ghosted you. Like, what's the data that's happening that's externally? You and I have just spoken about the internal physiology data. Then we move to. Okay, if you think of me as a tall skyscraper, the top floor and the surrounding of the building is us picking up data. Okay. Inside and outside. Get in the elevator, go down, open up on the mental floor, take all that data, and the next thing we do. Step two is we make sense of that data. Right. We make meaning of it. Most people have a penthouse here. They spend so much time here. Okay, get in the elevator. Now you've made meaning of it and you're believing a story about it. Let's say someone ghosted me And I believe the story. I knew they were never gonna be interested in what I have to offer. Okay, so I make that story up. I believe it. Get in the elevator. Now I open on the heart floor. Most people have a fire burning here. And there's no floorboards. It says, danger, do not enter. The heat is too much. So what they do is they build a fire escape back up to think their way out of what they feel. Or they build a fire escape down to the floor, which is gonna be doing. And they do, do, do, do, do, keep themselves really busy doing so they don't have to feel. Okay, so fire escapes go two ways, but this closes. And they're so grateful. You go down. The fourth step is you figure out your desire. What do you want in this conversation? This conflict? Whatever's happening, but not just, what do you want? Why do you want it? So if my parents, as immigrants, wanted to have their own home in America, what I would then ask is, why do you want that home? Like, what is getting that home gonna give you? And if they said a stable place for our family to grow and flourish, someone else might say, a place where other people who are suffering and don't have a chance could come here and be with us. The first one would have been valuing the stability of our family. The second one would be in service to others, having a new opportunity. So do you see what I mean? You can have a desire, but why you have that have it is how you know what someone values. And then all the way down to the foot is the fifth and final step, which is taking action. And having that conversation. Makes sense.
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A
Makes total sense. Yep.
- [29:15]
B
Let's say I had to have a conversation with you ghosting me, which of course has never happened because this is our first meeting.
- [29:21]
A
I would never ghost you.
- [29:22]
B
You would never ghost me. Thank you. So let's say I had to have that conversation with you. Once I go through these five steps, it would sound like this. Hey, Darshan. I know we had talked about meeting last Tuesday. I'd love to have a conversation about that. Is now a good time?
- [29:38]
A
Sure.
- [29:38]
B
Well, thank you for being open to that. I noticed on my calendar it said 6 o' clock Tuesday at Sweet Greens. We were going to meet by 6:30. I had texted you. I hadn't received anything back, and so I left. If I hadn't gotten a call from your team, I wouldn't have been here. But I don't know, I have this, like, pit in my stomach a little bit and I'm feeling a little Bit like disappointed, really. And what I want to know is what happened. Do you see how you understand what's happening for me? And now you might say something like, oh, my gosh, it wasn't on my calendar or whatever it is for you. But if I can go to curiosity and I can tell you the data I had, I can tell you the story I made up about it. I thought maybe you weren't interested or whatever it is. I felt disappointed. What I want to know is what happened.
- [30:29]
A
Right. Right.
- [30:30]
B
Do you see what I mean?
- [30:31]
A
Yeah.
- [30:31]
B
So now you take this thing that separates families, that, in our politics, has divided a nation and a world. The fear around AI, all these things keep us up at night. And this, in the end, I think, is contributing to a lot of pain in our world. And ultimately heart attacks, strokes, pneumonias. All of these.
- [30:51]
A
Yeah. Leads to disease, but also, like you said, leads to a lot of conflict in the world. It's a really great structure of getting your head in the right place and your heart in the right place before having the conversation. I think people rush into conversations that become very unproductive without actually thinking it through in a structured manner like you've just presented.
- [31:10]
B
Yeah. And I have to tell you, as a surgeon, I have always admired how meticulous, organized, and structured surgery is. Like, you would never walk into that conversation with someone else's body without that preparation.
- [31:26]
A
Without preparation, Exactly.
- [31:27]
B
And so that's the inner data that people need to get clear on to navigate our outer world.
- [31:34]
A
Wow. It's so powerful to think of it this way. Just take a beat. And having this type of structure before a conversation can make a world of difference. So you understand where you're coming from.
- [31:43]
B
You bet.
- [31:43]
A
Right. So I want to talk more about this for sure. So I'm going to have to have you back for sure. But I think I would love to have my audience introduced to your next book, Powered by Me, which is about burnout, because this is a topic I'm really passionate about. I almost quit my job completely 12 years ago as a surgeon because I was very, very burnt out. And so I happened to find a new passion in life that turned me back into a passionate individual and kind of saved me, you know? But burnout was a real thing, and I think a lot of physicians feel this. Almost every physician I talk to is in some stage of burnout. It's just pretty much like a 99% of physicians, after about 10 years of practice, are there. And I look at it as not just it'll change their career and their path to financial freedom. But also people get really, really sick, physically sick. Right. When they're burnt out. So I would love to hear your thoughts around burnout and why you wrote this book. Cause I'm sure it has a lot to do with your own personal story as well.
- [32:46]
B
It does. I mean, Thurston, I remember the day I walked in. I was hospitalist with 18 patients and it was the day to hand things over. But somebody called out sick. You know how in the hospital we're often understaffed?
- [32:59]
A
Yeah, often. Like almost all the time.
- [33:02]
B
I kind of wonder if it's actually a strategy to making budgets sometimes. But anyway. Well, I got handed the alpha pager, so now I'm taking all incoming requests for transfers. I walked up at 11am I walked to the nurse. It had been about five hours I'd been in. I was only on my second patient out of 18. And I walked up to her and I said, hey, Nina, can you get me 40ml equivalents of IV potassium for the gentleman in 636? And she looked at me and she was like, Dr. Sangwon, are you okay? And that was my first indication that I might not be. And I said, yeah, why? And she said, because that is the fourth time in under five minutes you've asked me that same question. And I've answered you every time.
- [33:43]
A
Wow.
- [33:44]
B
My introduction to burnout was a nurse who was willing to go against power and hierarchy and ask me if I was okay. And I am so grateful because I could have done something so much worse. I could have prescribed the wrong medication or the wrong dose or whatever it was that day. I went and called a psychiatric colleague and I said, I don't know what's going on here, but I think I need to see you. He said, great, I'll see you at five o'clock today. Why don't you swing by? I'll. I'll squeeze you in. And I'm looking at my pale face in the mirror in the bathroom and I said, how about now? We don't do that to each other, right? We don't ever. But I knew something was wrong and I didn't understand it. What happened next was probably what scared me about our medical system the most. Him and I did weekly sessions. He wrote me for a prescription of Prozac. I'm driving home that day and I remember looking at the Prozac sitting on. So I went from running the hospital to being a patient in line to being on medical leave. And I'm looking at that Prozac. And all I could think to myself is, I don't know what's wrong with me, but I'm pretty sure it's not a Prozac deficiency.
- [34:56]
A
Yes, exactly.
- [34:57]
B
That was an eye opening moment. So I get home and this is the hard part about treating doctors. I put the meds up in the drawer and I said to myself, all the side effects started going by me from pharmacology. And I thought, how about if I have these meetings with him and I see how I feel and if I don't get better, then I'll try this. Okay. Five weeks go by. I'm weekly, I'm going in, I'm seeing him every week, and it's the first time I sleep through the night. And that throat constriction relaxes. Five weeks.
- [35:29]
A
Five weeks of therapy.
- [35:31]
B
I come in and he says to me, oh, my God, Neha, you look so much better. And I said, I just cannot wait to tell you I think I'm starting to improve.
- [35:41]
A
Yeah.
- [35:41]
B
He said, right on time, that Prozac is kicking in.
- [35:44]
A
Of course he said that.
- [35:45]
B
And that was the moment I realized, oh, my God, I was self managing. I didn't tell him.
- [35:50]
A
Right.
- [35:51]
B
So I said, oh, no, no, no. I put the meds in the drawer and I was going to try them if this didn't work. And he said, oh, my gosh, Neha, I can't bill for you if you're not on medication. I'm a psychiatrist. We don't get paid for. So would you like to start medication or would you like to see another
- [36:13]
A
provider that's so broken?
- [36:15]
B
That was the moment, you want to know when I went down this path. It was when I realized that I could get better through mental and emotional healing and reconnecting to my purpose and communication and all of these things. And I was sitting there and I thought, wait, but I'm a partner in this organization. You're not gonna let me see a colleague? What is happening for everybody else?
- [36:36]
A
Yeah.
- [36:37]
B
So that was when I committed to saying I believe that people do need to get time off and sometimes need medications for anxiety or depression to bridge them. But I also believe in parallel that we have to figure out where you're having a net gain or a net drain of energy in a physical, mental, emotional, social or spiritual area so that when you go back in two months later, you're not going back in the ring for round two, not knowing how you got there.
- [37:04]
A
Yeah.
- [37:05]
B
And that's what I committed myself to, which is the 20 year journey of Working with people. So they had the medical help. And in parallel, I helped them figure out where are you having a net gain or net drain? So for you, with surgery.
- [37:20]
A
Yeah.
- [37:20]
B
If you think back to that time. Okay. On a physical energy level, I would be asking you questions like, how well are you with your circadian rhythm? Do you go to sleep at the same time? Do you wake up rested, feeling fully rested? Would the answer to that be yes or no? No, not at all. Right. You're on call schedule. I'd be asking you things like how regularly during the day do you nourish yourself with whole foods, or are you grabbing something from the vending machine or the cafeteria or is it soda or whatever? Yeah, right. Then I'd be asking things like movement. How many times a week do you move your body joyfully?
- [37:58]
A
Right, right.
- [37:59]
B
It's like running from one crisis to the next.
- [38:02]
A
Exactly right.
- [38:02]
B
And the last one, on a physical energy level would be like, is your energy even throughout the day or are you having those 3 o' clock energy dips?
- [38:10]
A
Yes.
- [38:11]
B
That's just physical energy. But you go through an assessment, mental, emotional, social, spiritual. And we'd see, like, how strong are your social networks? Name the top three to five people or groups of people that you're interacting with. Does their name cause your body map to constrict, feel tight and heavy, or feel open, light and relaxed like when I met you?
- [38:32]
A
Yeah. Yeah.
- [38:33]
B
There's gonna be clues that tell you where you're leaking energy and where you're gaining energy. So each person, just like you, have a different body map, each person has a burnout map where they're leaking energy or gaining energy. And they use that until they are mostly net drains and then they burn out.
- [38:52]
A
Right.
- [38:53]
B
Does that make.
- [38:54]
A
Yes. I think what you're saying is there's never just one thing that's draining their energy. There's a combination of physical, emotional, mental, social, mental factors and spiritual factors that come together to have this net drain. Right.
- [39:09]
B
And we're usually compensating. A few of them can hold us for a while. Like, we like the people we work with, so they help us get through the day, even though we're having net drains in other places. But at one point or another, after your physiology's adjusted and you've done all these things to try to make it work. Let me just make sure people know burnout is a slope. It's not a trap door. You're not fine on Monday and burned out on Friday. You have too sophisticated of a system that adjusts and moves. And by the way you walk in, you know how you know you're moving down the burnout slope, how you walk in. One day you normally go to your barista in the morning and one day you say, make it a double. You're using more and more coping mechanisms to override your physiology to get the same effect. Caffeine, or if you're a runner, you used to be able to run two miles on the beach to get stress of the day off, and now you find yourself running 3 and 4 to get the same effect. So that's a big clue that I look for. But people are on a spectrum from burned out to fully charged. Everybody is okay. And that can change. And so if you're someone who's not burned out now, it's so important for you to understand burnout so that you can see it and help people. Those you love and lead pick it up earlier. So it can be for the people who are burned out, or it can be someone who has people they love and lead.
- [40:31]
A
Yeah, that's so true. And I think I really like this spectrum of that you talk about from net gain to net drain. Because if you work on all the draining influences in your life and get rid of them, but also double down on where it gains you energy.
- [40:45]
B
Yeah.
- [40:46]
A
As well.
- [40:46]
B
You bet.
- [40:47]
A
You can gain energy throughout day to day, right?
- [40:49]
B
Absolutely.
- [40:50]
A
And actually feel more passion and more life in your life.
- [40:53]
B
You can do it immediately. And I say to people, they say, where do I start? You know, which one do I start? This book doesn't have to go in order literally start where you feel inspired. Something sounds like, oh, yeah, you know, I really am ready to deal with that emotional stuff. Yeah. You know, sleep is where I'd like to go. Right. Wherever it is, pay attention to what lights you up. That's that resonance piece that we were speaking about. If you're not tuned in, you don't know what lights you up. Right.
- [41:23]
A
Right. You need that data feedback to know it's really working. That's giving you the gain in energy.
- [41:28]
B
And a big secret that I tell the corporations that I work with, like, we do this for one company at a time. But essentially I say your clue to finding your highest purpose in this world is by being able to know and look across your life at your bliss and your heartbreak. People are like, no, no, no, I don't wanna do my heartbreak. Yeah. But you know what? The things that light you up and the things that break your heart are what matter to you.
- [41:57]
A
Yeah.
- [41:57]
B
That's how they will take you to your higher purpose. And I'd say to you that becoming a surgeon and burning out as a surgeon, all of it is what led you here, right?
- [42:09]
A
Absolutely. I believe that. You know, you mentioned social influences in burnout, right. And so I think this is becoming a major factor now in people's burnout because just the way we interact with others and because of social media and loneliness and all these things becoming a factor, it just seems like that's a major contributor. Would you agree with that?
- [42:30]
B
Huge. And people blame it on hybrid work. They blame it on technology, like they blame it on the pandemic. That's not true. Because I would tell you, even in our conversation on Zoom, I felt like the two of us were willing to show up authentically. We were willing to engage. It is the quality of our exchange that determines our connection, not the medium in which we show up. So one of the big things in companies now, if people don't start showing up in a hybrid space where they feel connected, we're going to have to make sure we're in person more. Right. So the way I think of this, this is going to be my next book, so I'll give people a preview here. But the five levels of exchange, okay? Level one, the lowest one is broken. Broken means maybe you were friends with someone in high school and you don't. Your lives have gone in different directions. Maybe you've lost someone, they're no longer on this earth. Broken. Exchange. Maybe you had a disagreement and you don't want to talk to each other. Broken. Second level, dysfunctional. So the first one was broken. It's not with you. No one, no longer with you.
- [43:39]
A
Got it?
- [43:40]
B
The second level is dysfunctional. Someone's with you, but, boy, they are not for you. Passive aggressiveness, manipulation, gaslighting, ghosting, whatever it is, there's something that's going on here where it's dysfunctional. Third level, transactional. Someone's with you, but they're for themselves. That's a different quality of exchange. Right. That means if I'm not getting something that I want out of this, I'm out of here. Fourth level, relational. Someone's with you and they're for you. So let's say you and I are in a relational exchange. Something good can happen to you. You receive an award, you get noticed about something, and it may have nothing to do with me, but I'm cheering you on. Relational. Okay, so I'm with you and I'm for you. Right? And then there's sacred exchange, and this is my personal belief of what the world needs now to heal sacred exchanges. I'm with me, I'm present. For me, I'm present with you. And our exchange shapes us, changes us, and heals us. And it's almost alchemy. It's like we are not the same because we have connected and shared at a level that matters to both of us. And I call that sacred exchange. So the healing effect that comes from the different levels at which we connect determines the quality of our connection. And I would ask the people listening, both at work and at home, what types of exchanges. Right. Broken, dysfunctional, transactional, relational, or sacred? What types of exchanges, predominantly, are you experiencing in your world?
- [45:19]
A
Wow. Yeah, that's a great question to ask. And if you think about your day and everyone you've spoken to that day, if you could almost put in a score next to each one of those exchanges and just tally them up and see kind of how much quality exchange you have throughout the day.
- [45:35]
B
Yeah.
- [45:36]
A
And sacred exchanges are hard to come by, so, you know, actually, they're not really.
- [45:40]
B
Can I tell you. I will tell you that you can do it with a stranger, and you can do it in your next encounter, Whether it's with your barista, whether it's with someone at work. All it requires is you being fully present and when I'm paying attention to you. So, Darshan, I will tell you in this exchange right now with us, if I'm listening not just for what you're saying, but I'm present with you, I can pick up not just the words that you're saying, but with your body language, your choice of what you're saying, et cetera. What I would say to you is to have a sacred exchange with you is. I'd say something like this, Darshan, thank you so much for having me on your podcast. I hear how much you value authenticity, vulnerability, and excellence. All a sacred exchange is, is me paying attention to you. Do you value those things?
- [46:35]
A
Of course. Yeah, absolutely.
- [46:37]
B
And so then you would pay attention to how your body map knows.
- [46:39]
A
Right? Right.
- [46:41]
B
Because if you didn't value those things, you'd be paying attention to how your body map resisted that. You see what I mean? But when I'm present with you, we can have a sacred exchange. It doesn't matter who you are. You could be a stranger next to me on the plane. It could be the stewardess who served me my water, and I just say, thank you so much for your service. I see how much your job matters to you. That's it.
- [47:06]
A
I Love this podcast because I feel like every time I'm doing this, it's like a sacred exchange. Oh, I love that it's one time that I really get to speak to someone with no distractions, and we're getting to really learn from each other and understand from each other. And so I crave doing these podcast days sometimes because I really get my fill of those sacred exchanges and I think about, you know, everyday people in their lives. If you could have more of those moments where you're not distracted and you put your phone away and you really focus on what someone's telling you, try to learn from them, it's a game changer. It really builds up the amount of energy that you have. Wow. Yeah.
- [47:44]
B
Okay, then I'm gonna say a few more things that I just heard.
- [47:46]
A
Please.
- [47:47]
B
I am so impressed with how you are a lifelong learner, how much you value authentic connection, and how you're using your podcast not only for your personal purpose, but to amplify the opportunity for true and meaningful, like, exchanges. So thank you.
- [48:08]
A
Oh, thank you. No, I love it. And I really appreciate you coming on here and having this discussion with me. It's a little bit different than our typical health discussions, but I feel it's so important to focus on these aspects of our mental, emotional, social health because it is a major factor in our health that is very much ignored by traditional medicine. You know, there's a lot of talk around health, and this needs to be injected into the conversation because it is so basic and fundamental to how our physiology is. There's this massive connection between our mental health and our physical health. Right.
- [48:45]
B
You know, something amazing that I read in the research was that your leader has more of an influence on your health than your doctor.
- [48:53]
A
Right.
- [48:53]
B
So we can keep it as the old way that this is happening, but I would say your primary relationship and how supported or not supported you feel in that and your social health and well being you are in interactions with those, your peers and your leader so much more often than the twice a year that you would see someone like me or you.
- [49:15]
A
Yeah, absolutely.
- [49:16]
B
And so I think we're going to start realizing that the unraveling of our social health is having a much bigger effect on our emotional and physical health than we ever realized.
- [49:28]
A
Yeah, I truly believe that for sure. And I think the media social, sooner we realize that, the better it is for everybody.
- [49:34]
B
Yeah. And the sooner we get the tools to be able to communicate in a level, in a way that feels safe so our body doesn't feel threatened and really What I'd say is the sooner we lead from the inside out, we get more authentic exchanges.
- [49:47]
A
Yes.
- [49:47]
B
But we gotta know ourselves in order to do that. We can't be reading society and doing what society wants.
- [49:54]
A
Absolutely. Wow. You've given us so many tools today, so many things to think about. And I'm sure the books are packed with even more tools and more incredible information and I just can't wait to read them both. Talk RX Empowered by Me.
- [50:09]
B
Yeah. Thank you.
- [50:10]
A
And the next one when it comes out, I can't wait.
- [50:12]
B
Yeah. Something around Sacred Exchange. I don't know what it'll be, but it's coming. I love that.
- [50:16]
A
By the Sacred Exchange. Piece of. This is such a beautiful concept that I hope everyone comes away from this podcast and really internalizes that and tries to make more of that happen on a day to day basis.
- [50:29]
B
Yeah. And you can do it in your next exchange.
- [50:31]
A
Yeah. Well, this is fantastic. How can people learn more from you? Where can they find you? Tell us. Give us a little bit of your contact details.
- [50:41]
B
So intuitiveintelligenceinc.com so inc.com or an easy way to kind of there is nehasangwan.com that'll also go there. And I'm a CEO, Health and Performance coach. And we then go into companies and we do this work one company at a time. Time. So we're taking, you know, in the old days they thought wellness and you know, well being was like fluff. Like you bring in, you know, massage chairs on Friday and say like, oh yeah, I did that. No, this is about how you literally help everybody create their own maps of their body map, how they understand how to communicate in conflict, all of that. So we, and I do, I actually also do relationship workshops as well. So I really believe in any way that we can start aligning our energy, the stronger our physical health and well being will be.
- [51:28]
A
Yeah. And I believe that right along with you. So thank you so much for speaking to my audience. I can't wait to have you back for your next book and dive in further. Thank you.
- [51:37]
B
You bet.
- [51:40]
A
Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps us support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and is always important important to seek their guidance.