John D. Kelly IV, MD, is a professor of orthopedic surgery at the University of Pennsylvania. He focuses his blog on helping surgeons reduce stress while achieving balance in their practices and families.

BLOG: More peace is a matter of attention span

Times are tough, and there is no sign that orthopedic practice will become easier. Many imposing forces are converging on the practicing orthopedist including declining reimbursement, increasing insurance intrusions and the omnipresent demands of the electronic medical record. It is no surprise that recent data suggest burnout has reached meteoric proportions.

While it is not practical to hope for immediate improvement in the stressors we face, we have the power to choose where we direct our attention. We are endowed with free will and have the power, in any given moment, to choose where we direct our focus. Here in lies our path to peace.

I have quoted in the past the great psychiatrist and Holocaust survivor, Viktor Frankl, who stated that “Everything can be taken from a man but one thing: the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

Frankl knew the secret to inner peace — to choose to direct our attention to the present moment and all that is good. He further expounded on our freedom to choose, “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

When stress mounts, we seem to experience an “uptick” in automatic negative thoughts (“ants”). Many of us face the barrage of “what if” thinking during the course of a trying week.

Common “ants” which likely plague many of us include:

What if …

  • “The wound pusses out.”
  • “The patient sues me.”
  • “The case goes much longer than expected.”
  • “I can’t get the reduction.”
  • “I can’t make practice expenses.”

These thoughts, just like our heartbeat, happen. We have no control over when and how often they manifest. However, we have total control over where we direct our attention.

The great psychologist Carl Jung once stated, “What you resist not only persists, but will grow in size.”

The key to gaining more peace is not to fight the constant barrage of “ants,” but to merely accept them and let them pass. Once we accept that negative thoughts will always arise, we can then choose where to focus our attention.

Our choice is to focus on the present moment and all that is good in our lives or give credence and power to negative thinking. James Redfield coined the phrase “Where attention goes energy flows.” When we direct our attention to negative thoughts, they simply grow in size and effect. When we focus on gratitude, our awareness of what we have increases.

Here are some helpful hints on attending to positive energy:

  • Develop a mindfulness practice. Set little reminders (blue dots, for example) in your office to remind you to stop, breathe and be several times a day.
  • Write a gratitude journal and make entries every morning. You may be surprised at how blessed you are.
  • Whenever an “ant” appears (and they will), stop, breathe, be and then chose something to be thankful for.
  • Make a list of all you love about your spouse/partner and affirm those traits in word and deed daily.
  • Attend to each patient and surgery mindful that the profound privilege of caring and healing another human is unrivalled.

Remember, our brains are plastic and be rewired to become more present and grateful. Just pay more attention.


The secret of change is to focus all of your energy not on fighting the old, but on building the new. –Socrates



Arora M, et al. Prevalence and factors of burnout among Australian orthopaedic trainees: A cross-sectional study. J Orthop Surg (Hong Kong). 2014;22(3):374-377.

Frankl VE. Man’s search for meaning. Simon and Schuster, 1985.

Redfield J. The Celestine vision: Living the new spiritual awareness. Grand Central Publishing, 2001.


Disclosure: Kelly reports no relevant financial disclosures.