Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Navigating Burnout: Balancing Technology, Wellness, and Mindfulness
Ever wondered if the pressures of modern medicine are taking a toll on our doctors? Dr. Tom Pohlman, a committed nephrologist and key figure in the physician burnout committee, joins us to shed light on this critical issue. Together, we navigate the historical landscape of physician burnout, revealing its rise in prominence and the pivotal role played by Dr. Maslach in bringing this to the forefront. From loss of control and overwork to the weight of patient expectations, learn about the multifaceted challenges faced by healthcare professionals today. The intricate dance between technological advancements and increased workload is no secret, making the quest for a balanced work-life equation more crucial than ever.
Beyond the confines of the hospital walls, we explore lifestyle factors impacting health and wellness. As we tackle issues like poor sleep, diet, and the omnipresent specter of obesity, Tom shares practical wisdom on small, incremental steps that can transform your energy levels and resilience. Simple actions, such as staying hydrated and integrating art and music into your daily routine, are highlighted as powerful tools to enhance mental health and productivity. By focusing on self-care, we aim to inspire listeners to cultivate a lifestyle that cherishes both professional responsibilities and personal well-being.
Finally, we invite you to a journey through the world of mindfulness and meditation. Discover the various practices that can help you manage stress and boost concentration, whether it's through Buddhist practices, mindfulness, or Transcendental Meditation. Tom also reveals his personal strategies for improving sleep quality and incorporating more movement into everyday life. As we discuss the subtle signs of burnout and its far-reaching impact, we underscore the importance of early recognition and proactive measures. Tune in to gain valuable insights that will not only serve healthcare professionals but anyone striving to lead a balanced and fulfilling life.
Hi, my name is Jason Edwards and I'm here with my friend, tom Pullman. Tom's another fellow physician and he's involved with our residency program in multiple areas of the hospital, and Tom's a nephrologist by trade. Is that right, tom? That's correct. Tom also deals with our physician burnout committee, and so I thought that it would be interesting to talk about burnout in general, and so one of the things I read was that the term was initially coined by a physician who worked with drug addicts, and he noticed that they would sit there and watch their cigarettes just slowly burn out. I don't even know if that's true, but that's what I read. But I did some PubMed searches on burnout and one of the nice things they have on PubMed, which is a repository of scientific articles that you can search on the Internet there were 27 papers in 1980 published regarding the subject of burnout, and in 2022, there were 3,700. So certainly this has become a more popular topic. What are your thoughts on burnout in?
Speaker 2:general. So I think Dr Maslach came up with a survey on burnout. She's a psychologist I believe she's at Stanford and developed the burnout concept and looked through a number of different quality of life issues that she identified, and she identified it in not just physicians, but it's been applicable to physicians, so that's a little bit of background. When we started the Physicians Resilience and Wellness Task Force, we wanted to be there for burnout, but we wanted to emphasize more wellness than burnout.
Speaker 1:What do you mean by wellness?
Speaker 2:So the fact that the person, whether it's a physician or non-physician is enjoying their job, enjoying their family, enjoying their life and really trying to get the most out of it that they can. Burnout is pretty much the opposite of that where you're dissatisfied, and there's some controversy about whether we separate this from depression versus burnout.
Speaker 2:They dovetail and sometimes it's a matter of semantics, but there's a number of things that go into burnout Life stresses overwork, but when they've looked at it, often it's loss of control, excuse me, which is kind of a new concept, where physicians are asked to do things that they don't really believe are the best interest of the patient, but the institutions or the insurance companies or somebody else are asking them to do a procedure or a test that they know has been guidelines, not appropriate. But turning down the provider or turning down the institution to do the x-ray, they get disqualified, punished for. So there, and there's a lot of examples of that.
Speaker 1:Yeah, it actually happens a lot with patients being educated these days. You know you can, you can Google what tests do what and what scans do what, and so you can actually have, you know, the patient really pressuring you to get a PET scan. You know a ten thousand dollar scan when it's not indicated and they feel very passionately about it and you can explain logically why that's not a good idea and like, while the insurance company will almost certainly deny it. But it puts you in a kind of a weird position and I mean that's life right. I mean especially as a physician. But in anything you do you will be put in weird positions and you have to figure out how to deal with it.
Speaker 2:Right, but when you're reduced to an RVU generator, when you're hit with mindless task of clicks and you're not seeing your family, that leads to burnout. And in fact we did a survey of St Luke's staff last February and one of the recurring comments back was the loss of control, the loss of work-life balance, the EMR, and those are recurrent complaints that lead to burnout.
Speaker 1:Yeah, for sure, and it's a tough time too. With the computers getting better and the Internet access and patients being able to message you, that's a good thing for the patient. But if you're answering messages till 8 o'clock at night and you're not seeing your children, that's tough. So you know a lot of occupations, work, long hours and difficult jobs. Sometimes I think that the public perception is that physicians have like a cush life. If I show up 15 minutes late for a consult, I mean I realize the patient's been waiting in there 15 minutes and they don't like it, but it's not like I was hitting balls at the driving range. I'm probably doing some sort of implant in the operating room or something like that.
Speaker 2:My comment, I would bet, is that the second time you see them they don't do that, Because one of the things that's been found is making patient wait is not right. But if the physician spends time with the patient and acknowledges that they were late, the patients are fine.
Speaker 1:Yeah, yeah, yeah, and so, yeah, you do your best. In a lot of jobs, including being a physician, there's there's a lot of stress, and you can be put in compromising situations and you're around people who are in high stress situations, and and your job is to try to keep things calm, and usually we kind of figure that out during our career and do an okay job at that. But I, I, I, um, I worked with a uh, uh a physician who was a young mother, and I I saw her at in the hospital at eight o'clock at night you know too many nights and you realize, you know, if you've got a three-year-old at home, this isn't going to work, it's not tenable, and soon enough changes were made, as they should be. You can't keep going like that, and so increased workload is one of the main drivers probably in every job, main drivers probably in every job.
Speaker 1:I feel like, though you know you can divide it into there are external factors for burnout and there are internal factors for burnout, and sometimes it is not an option to say you know what I've kind of taken on these responsibilities, whether it's my family or my job or whatever it may be, or taking care of a loved one or a parent or something like that. But this isn't working for me and I'm not doing that anymore. Sometimes that's not an option, and so then I think you've got to turn and say what they call self-care. Initially, I thought self-care was sitting on a beach drinking margaritas, and it turns out that's not it. But you've got to find some internal factors to improve your capacity to deal with stress.
Speaker 2:That's resilience.
Speaker 1:Yeah and grit, and you know me and you have seen a lot of people, a lot of patients, and so you see a wide range of how much resilience some human beings have and some people don't have a lot, and some people have an incredible amount of resilience, a shocking amount of resilience, to deal with psychological, physical, stress and keep going. And, and you know, I have some idea of what makes up that, but what's your take on that? The difference between people's internal resilience?
Speaker 2:Well, that's an ongoing issue, Dr Bayless, and the teaching program is actually trying to find out if you can teach resilience or not. I think some people are intrinsically resilient. You look at them and they can just handle things. But I think other people can be taught to a degree not completely, I think just what you mentioned.
Speaker 2:I think every day you need to, even if it's a long day, you need to have something you look forward to, one, even if it's just a few minutes, taking a deep breath, listening to some favorite music, closing your eyes and relaxing. I think all those are important. I think other things that are important are life maintenance, getting a good night's sleep. Now, you can't do that every night as a physician if you're on call, but you have to try and catch up with it. Make sure you don't lose context with the important people in your life, whether it's your spouse, your family, your colleagues but keep those connections. Those are really important. And then try and have something that in your off time that you enjoy. I like to run, I like to garden, I like to read. Those are all things I like to read. Those are all things.
Speaker 2:And one of the things I mention often is also take a step back. This is a profession where almost every day you do something good for somebody. Two almost every day, unless you're oblivious, you learn something. And sure, some of our classmates who weren't at the same level as our academic performance are making more money than we are. But the babies have shoes, we have food on the table, we live in a nice, so we have a profession where we do good, we learn and we make a living. Yeah, there's not very many opportunities when you look around that you have those options and and you know, at the end of the day, when you're there at eight o'clock at night and everything's going wrong, sometimes you have to take a deep breath and say yep it's still an honor to do this job.
Speaker 1:You should still be grateful it could. You know the alternative would be worse. And you know you can be a bank president, for you know 25 years. And uh, you know the alternative would be worse. And you know you can be a bank president, for you know 25 years. And uh, you know grandma still don't bring you pies and come kiss you on the cheek, and that's worth something you know.
Speaker 2:Right, um, and that's the other thing you made the comment about, uh, being grateful. Um, sometimes you have to listen for the thank yous, but they're often there.
Speaker 1:Yeah.
Speaker 2:And it's also worthwhile saying thank you. Listen for the thank yous, but they're often there.
Speaker 1:Yeah, and it's also worthwhile saying thank you. Those will make the day better and you can lose sight of it too. You know, the hug from the patient amidst the hugs can kind of drown out and just become normal. And it's important to kind of take a step back and take stock of the situation and say, no, this is special, we just had a good, honest conversation, maybe a very difficult conversation, but you know, I did it the right way.
Speaker 1:I actually think this I deal with cancer patients, you deal with patients with kidney disease, but we both have very tough conversations with patients and I actually think that where you really have to pat yourself on the back is the conversation where you go in and you tell somebody bad news, but you're very honest with them and you do it with compassion.
Speaker 1:And nobody walks out of the office feeling good and it's very difficult to do, but any amateur can come give good news. Any amateur can walk in the room and say, oh, your cancer is cured and high five and walk out. I mean, it's hard to screw that up, but where you're really going to differentiate yourself is by doing the heavy lifting and being honest and doing it the right way, with compassion, and so you know otherwise the patient's better off seeing the guy down the street than you. And you know you don't want to be below average, you know you want to be better. But it's important when you walk out of that room to pat yourself and say you did good, because you don't feel good but you know you did the right thing.
Speaker 2:And I think you learn with experience that it's always nice to cure the patient or make them medically better, but sometimes the greatest thing you can do is make them comfortable and show compassion, and sometimes that's all you can do and in reality, sometimes that's what the patient really needs.
Speaker 1:Yeah, there was a New York Times article and the article's old and the guy he was a physician and his dad was a physician and this was back. I think it was in the 20s or 30s and they had like digitalis leaf morphine and epinephrine and that was it and he said my dad never gave the epinephrine to anybody and the morphine only lasted two hours. And so he was like, what was my dad even doing? But he was talking to patients, he was explaining their disease to them, he was treating them with compassion and that's all he was doing. But that was a lot, and it's important to remember that with all our fancy tests and all our fancy drugs, don't forget, you know to to do those things right too.
Speaker 2:That's exactly right. The other thing I think is important it's always important that we focus, when we're talking about burnout and wellness, on the individual, but we also need to keep in mind that a lot of the problems that lead to the burnout are institutional. Yeah, and I think that's a little bit where some of the emphasis is starting to go nowadays is that don't lose sight, we're still taking care of a human being, but it's not the human being's fault. It's often institutional issues that we need to address. Yeah, yeah, it's often institutional issues that we need to address.
Speaker 1:Yeah, yeah, In my life, or in my view, it seems like it's. They're both issues, and I would say as a society, I mean like physically. My guess is, you know, our sleep isn't as good as it used to be and our diet isn't as good as it used to be. And so there is fertile ground, whatever you do, to really tune your instrument and become a better, stronger person with a greater capacity to deal with stress and just straight-up strength and stamina, and so eating a healthier diet is. I mean, our obesity rates are. I think it's something like 40% of adults are obese. It's up there, Okay, higher than that. And so we have fertile ground to make some improvement.
Speaker 1:And I think the way you make changes in your life are slow, incremental changes. But you could do it fast too. You know you could start off fasting for 24 hours if you want, but I think to develop positive habits it takes time. And so exercise. So this is tough, because you're saying I'm overwhelmed, I'm burnt out, and then you're saying what's the solution? The solution is to do more work and hard stuff that you don't want to do. It's exercise, eat right, develop these habits. That aren't fun, but it's a bargain with the future that I will suffer more today so that in the future I will suffer less.
Speaker 2:But some of those are also right now. Investments yeah, the thing they tell you when you get on a plane is if the air, if the pressure, the cabin depressurizes, you put the oxygen on the person next to you first I mean on you first and then them. Yeah, why is that? Because you have to take care of the person who's taking care of everybody else first, and there's plenty of data that shows if you can improve, make your improve resilience, decrease your burnout, those that your efficiency improves and that your care improves, because compassion fatigue, you don't. You know the person's a number, they're not a human being anymore, and that's a big, a big issue.
Speaker 1:One of the easiest things that you can do is drink more water. As a kidney doctor, you can do is drink more water that that. That, as as a kidney doctor, you can. You betcha, but but. But I'm second that one. I've.
Speaker 1:I've seen that in my own life because I would get home from work and by the time I was home I was so tired that I couldn't play with my kids and I said I can't. I've got to do something differently. I've got to make some changes in my life because I don't have enough horsepower to get through the day. Easiest simple change drink more water. You don't notice it in the morning, but in the afternoon, when you typically fade, you notice you got a little bit more horsepower to get through and it's good for your skin and it's good for your bowels and it's good for your brain, it's good for your kidneys. I can tell if somebody drinks a lot of water. I can tell by looking at their face, because they have good skin, and so I'll look at a patient and I go I bet you drink a lot of water. You can tell, and so that's cheaper than Botox.
Speaker 2:Those are the self-care issues that we have, right.
Speaker 1:Yeah, and so that's a good start, and then sometimes you start something like that and then you kind of start to view yourself as a little bit healthier person, and so maybe you parlay that into a walk and you start walking a little bit and then you know, then you get the salad instead of the steak and you get some positive momentum in life and so. But I do think, with obesity, lack of sleep, you know all this stuff, there's this energy crisis, where people don't have enough energy to get through the day and so, and so the good news is is these are fixable things, these are things that we can make better, and I do think that if we fine tune the body, that the mind would follow and the mental health would be better and our work capacity would get better. Now we don't want to just, you know, turn ourselves into working. You know widgets that just, you know, go, go, go.
Speaker 1:I think it's important to see the art and beauty in life, and I think I think music or art, um, can be, um, well, it's really the most valuable thing in the world, really. You know the, the uh, I mean literally the. You know the paintings, uh, you know, some of them are priceless, but it's, it's, it's. It's good to step back and see the beauty of this world Cause it's there.
Speaker 2:Step back and the whole line about taking a deep breath. Yeah, it really makes a difference.
Speaker 1:Do you meditate or have you ever meditated before?
Speaker 2:I actually have, and so I have a series of about 15. So there's different ways to meditate. I found out one is the Buddhist way to clear your mind. I can't clear my mind, it's just not possible. So I put things that I think would make me better in there and I try to do that pretty much every night when I wake up in the middle of the night and I do those kind of a series of things that these are things I should make myself better. So are you thinking about certain things? Is that what you're saying? Just a list of things that I kind of go through and I have them and I go through them and kind of take inventory of where I am?
Speaker 1:Yeah, yeah. Meditation is thinking about what you're thinking about, or that's mindfulness, mindfulness meditation is a type of meditation that's very popular, and there's all sorts of stuff Transcendental meditation, which is TMorg, and then they have the call app, or there's another one I can't remember the name of it, but there's many resources.
Speaker 2:So, actually, if you go to the St Luke's website and wellness. They have a list of little meditation videos that can help you do those things and they have different kinds of meditation videos. They have the clear your mind or they have think of something beautiful or think of something that you enjoy. And you know I've got into the habit of doing it at night or early in the morning, but in the middle of a really rotten day, taking three minutes or five minutes and just taking inventory will help.
Speaker 1:Yeah, it helps immediately. But it also you. You start to carry with you the ability to kind of stop for a second and within one second, say I'm tense. I'm tense right now. I can feel it right between my shoulder blades, I'm tense, and you take a breath and you let it out and you say you know you're going to be okay, but just calm down, don't, don't, don't hold all your energy so tight, right, and it helps you be more present and be able to talk and look at the person in front of you and not be thinking about all these things, and you have better control about what's coming in and out of your mind. But it's like practice, it's like you know if you're like golf, like it's going to take some time to get better.
Speaker 2:But it gets easier. Yeah, bad habits are hard to break. Good habits are hard to break too. Yeah, so if you can make it a habit, you don't have to think about it as much. You don't have to put the time aside because the time's aside to decide.
Speaker 1:Yeah, yeah, I was talking I was having dinner with one of the board members, actually and I was saying you know, everybody knows about diet and exercise. I think the two next big things that people will start talking about are sleep and mobility. I think, like you know, I don't know if you can, you know, buy stock and sleep and mobility, but I think you'd do well if you did, because it's I think those are two really important things that'll that'll make a big difference. And I've started taking, you know, sleeps very seriously, um, over the past couple of years too, and that's something that there's no magic bullet. You, you, you develop a routine and you slowly get better at it and, um, and so do you sleep pretty well.
Speaker 2:Yeah, I have. I do have semi magic bulletsic bullets. I love to read, yeah, and I like to read medicine, and medicine will put me to sleep in a minute at night. Now, during the day I can read longer, but at night, and so if I'm having trouble falling asleep, I just pull out the New England Journal or pull up an article. I try and stay off, try and completely stay off of screens before bedtime and I try to, but you know it's probably my age, but I like to have a piece of paper or a magazine or a book in my hand. And you know I said this isn't working and the next thing I know I'm asleep. I literally I'm falling. So I guess it is working.
Speaker 1:Yeah, the blue light on the screen tells your pineal gland to wake up and that. So that's not good and so, yeah, so we got drink water, stretch, sleep, I think, for exercise, the best way to go about it if you don't exercise is to set some goal that's shamefully low, like walk to the end of the driveway and back, and do that every day at two o'clock until you've developed the habit, and then add volume to it after that, and so there's many ways you know to do it, but I think that's a good way is just get the habit down first.
Speaker 2:There's a number of physicians that I notice, since I get here early, who park far away from the doors. They can Totally empty parking lot. Yeah, good for them.
Speaker 1:Yeah, yeah, it gets your mind right too. That's not a bad thing to do in the wintertime either, because it's uh and uh I don't know what book it was, but uh, they called it. Um, uh, practice poverty is what the book called it. But so so I've done that a few times just to remind myself that, like everybody doesn't, you know, have a warm spot, and it kind of Right.
Speaker 2:But then the thing that's also nice about it is when you add those up, it adds up steps. Yeah, and you're right, you don't. I think exercise, dedicated exercise, is important, but if you can't do that on a busy day, taking the steps walking to things, making a reason to get up and walk, even if it's just walking around the office to get some exercise.
Speaker 1:Yeah, the, the blue zones, people work with communities and designing communities to make them so, where people, the easy choice is the choice that's good for your health. So, like the grocery stores, like you wouldn't, it's close enough that you wouldn't get in your car and go to it, but it's far enough where it's a little bit of a walk but it's just easier to just walk there instead of back. Or you know the way they would design cities and communities and so, and so I think a lot of these cities, where you know the percent of people making it to a hundred was is way above the norm, um, they're kind of set up in a way, um, and then you know as. So, aside from exercise, friendships, I think as people get older and their children are out of the house, friendships just become so, so important to your health and your mental health, and they just become more and more important as we get older. That's my opinion. Have you found?
Speaker 2:that true. I think friendships throughout life are important. I think the friendships and what you're leading to is the friendships change, how you obtain them and how you maintain them change, and you know I have more time to try and do those now, but you know, one of the things that used to be nice in medicine is that we all got together periodically you went down to x-ray, you went to this. Now we're siloed with the computer and that's the real problem and we're trying to break down some of those silos. Some of the silos in medicine per se are not going to be break it downable, but if we can put back that camaraderie, the personal part of medicine, both between patients and providers and between providers.
Speaker 1:That's one of the things I love about St Luke's so much and I've said this before is that it's a small enough hospital. I mean, we have many specialties almost every specialty is here but it's a small enough hospital that we all know each other, and so most of my good friends are people I work with. That we all know each other and so, you know, most of my good friends are people I work with, and that's a nice thing. You know to go into the lunchroom and see a friendly face and have a good conversation or ask somebody advice. You know, if something's going on with my kid and I can say, tom, you've had kids, what am I doing here?
Speaker 2:You know help me out and that's really a good piece of advice is that keep in mind, all of our problems are ours, but there's somebody else out there with a similar problem and a similar experience and asking and peers and colleagues. Many have gone through it or are going through it and you don't know it.
Speaker 1:Yeah.
Speaker 2:And that's really important.
Speaker 1:Yeah yeah, just mathematically it works out. If it's an old problem, you can look in old places and find it, and just if you consider old, 50 years before now and back, that's a lot of years and a lot of writing, and odds are, the answer is going to be there. If it's a new problem, you got to look at new places. But you know, you can find some nice texts that tell you a lot of truth about life, whether it's the Tao Te Ching or whatever it may be, and so I think reading can be huge too.
Speaker 2:I think those are very helpful, and then I don't think they need to be separate. Yeah, human interactions and the reading. I don't think they need to be separate. Yeah, human interactions and the reading.
Speaker 1:The first step in any problem is kind of defining the problem and saying that, hey, I have burnout or I'm starting to move towards burnout, and so do you think there's value in that?
Speaker 2:Absolutely, and I think identifying that is really important. It's now fairly widely accepted but for an individual it's sometimes hard. There are actually very nice metrics on how to do that. So the Maslach survey is the kind of gold standard. But there's shorter surveys and we've put some of them in the wellness tab and we've actually offered in one of our surveys we didn't get a really a big response but I think identifying we'd like to identify people before they're burned out, when they're starting to show those manifestations, and intervene because burnout can really be destructive to the person individually. Intervene because burnout can really be destructive to the person individually, to their family and to their patients. And so, yes, it's really important to identify it, to admit it and to seek help for it.
Speaker 1:And my guess is that if you take the time out of your day to go online and fill out the burnout survey, I mean there's some reason that you're doing that, and it doesn't mean that we have to do some maximal intervention, but it could just be time to kind of take some, you know, take a step back and reanalyze your life and say what are the external things I can change and that may be a lot or it may not be and then what are the internal things I can change to to develop more resilience and and to to kind of increase my physical and mental capacity to deal with the stress.
Speaker 2:And you can change.
Speaker 1:That I mean for sure. You can make a big difference.
Speaker 2:When you're significantly burned out, you don't have the energy to do even much of that. That's right, and so we've actually. If, if you have the energy to do even much of that, that's right, and so we've actually. If you have the energy to go to the wellness tab, those resources are face up. Okay, they're right there, so we try to do make that available.
Speaker 1:Yeah, and so the idea is you know, catch yourself at the you know burnout one out of 10 stage, because it's going to be harder to deal with this the closer you get to 10.
Speaker 2:You're just going to pass it, and we all have bad days. Burnout is not a bad day. Yeah, burnout is a persistent deterioration in how you look at life, how you get enjoyment out of life and how you perform your major task, and this is we're physicians. But this has been looked at, and in the entire healthcare industry, from the top to the bottom, this is an issue, and so we need to address all of us.
Speaker 1:Yeah, yeah for sure. It's like what's the health of healthcare? And actually this became an issue in COVID too, with, like, our physical health is you know, the the the healthier we are, the better we can serve ourselves and our families and our community. Well, tom, thanks so much for joining me. It was a it was an interesting conversation. I like talking about this stuff because you have to read about it and you always learn something new, and so I very much appreciate you and everything you do.
Speaker 2:Yep, thank you very much, I enjoyed it as well.