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Welcome to another installment of the X-ray Beam series.
As promised, I was granted a second phone interview with the Happy MD, Dike Drummond, and continued to do a deep dive into burnout and the medical profession.
Feel free to view Part I to bring you back up to speed.
When I was researching burnout there were a couple of preconceived myths I had that were subsequently shattered:
- I used to believe burnout only happened to late career doctors.
- I used to believe the “lifestyle medical specialties referred to by medical students as ‘the ROAD to success’ (Radiology, Ophthalmology, Anesthesiology, and Dermatology) were immune to burnout.
What are some of the other myths physicians believe about burnout that you have subsequently disproven?
I bust 3 great myths of burnout in my lectures.
The first one is that burnout is not about your batteries being run down because a lot of people use that analogy and it is totally inappropriate.
Just to illustrate this:
If I am the Energizer bunny and I am going across the floor pounding my drum.
Well if my batteries run out what do I do?
So when does a doctor ever stop?
What happens is we learned in med school and residency to keep going even when our energy is less than zero (this used to be a lot worse when there were no work-hour restrictions).
Remember all your friends when you went to medical school and they didn’t?
Those people would call in sick and not show up and stop.
But you don’t.
Because you are taught that you must continue, that the patient comes first.
We have to become better at detecting when our energy becomes negative so that we can take corrective actions.
Because if we don’t, we will be asked to push ourselves beyond zero over and over again.
We start to think that is normal.
It is a normal experience but simply “gutting it out” is not a normal thing to do.
Your state of energy determines the quality of care that you put forward.
The second thing I teach is that burnout is fundamentally not a problem.
By definition, problems have a solution.
If I apply a solution to a problem, the problem goes away.
Problems in healthcare are exceedingly rare.
Something that comes along that you can do one thing to, one time, and it goes away forever, is rare.
The only example that I can think of right off the bat is a pointing abscess.
We all know what to do with that and we all sleep like a baby when we treat one of those.
But the typical patient is a 465 pound, out of control type II diabetic, and she has one foot amputated and both eyes lasered and she’s here because she has blood in her poop.
You can’t squeeze the pus out of any of that.
Burnout is just like that.
It’s a dilemma, not a problem.
A never-ending balancing act.
You are trying to create balance, like a teeter-totter.
On one side is the amount of energy you burn over the course of your life, and that includes home and work, and on the other side is your ability to recharge your energy to maintain a positive energy balance.
Because burnout is not a problem but a dilemma, that means, by definition, it doesn’t have a solution.
But that is what everyone looks for, the magic pill.
It is one of the core human urges, the urge to snake oil.
The urge to solve something that is not solvable.
Instead of a solution you have to use a different “S” word.
You can maintain the balance you seek but you will need a Strategy.
A strategy is always more than one step.
It is usually not a lot of steps, but it is 3-5 different things that you do to recover from burnout and maintain your energy.
Everyone already has a couple of these things, otherwise you would have crapped out in residency and actually stopped and walked away.
For me one of the things that I did was I played rugby.
Rugby gave me the excuse to stay fit with a couple of practices a week and then bang heads on the weekend and get drunk and blow off some steam.
I know if I didn’t have rugby during medical school, I would not have ever made it.
Everybody has got things they do to take care of themselves.
Otherwise they would not have made it this far.
So the 3 myths are:
- Burnout is not batteries. It’s a bank account and we are taught to live below zero. It’s not healthy.
- It’s not a problem. It’s a dilemma.
- There is no solution. Instead have to work out a strategy.
In your experience are there certain medical specialties you have found that carry a higher burnout risk for its practitioners?
Conversely, what are some of the specialties you have noticed that rarely have issues with burnout?
Well first of all, you can draw generalities about the depth of the pressure that is put on you during the training experience.
For instance, anyone who has survived a surgical internship, especially the surgical internships before work-hour restrictions, has had a whole bunch of pressure put on them.
My experience of watching a surgical intern is that their program members, the residents who are ahead of them and their faculty, were literally trying to kill them for a whole year.
That has a couple of consequences:
- You become more often traumatized by the stuff that happens.
- The conditioning becomes driven in a lot deeper.
You tend to be even more of a workaholic, superhero, lone ranger, perfectionist than even an ordinary doctor.
The other thing is that there is a huge overlap between burnout and trauma.
If you have chosen a specialty where bad things happen frequently it can sometimes be difficult to recover, depending on the nature of the bad things that happened.
If you are a trauma surgeon, ER doc, an intensivist, a NICU pediatrician, potentially this is more likely to produce burnout.
The challenge is that all of these things are unpredictable.
You can’t look at the nature of the work and predict whether a person will be burned out or not.
Because everybody has a different work hardening and everybody has a different level of ability to cope with things.
I can have someone who is a pure outpatient aesthetic dermatologist and they still can burn out.
For instance, plastic surgeons are not dealing with things that are life threatening everyday but are dealing with a whole new set of stresses for people who don’t like their bodies and are perfectionists.
That can drive them crazy too.
So as much as we might want to single out certain specialties, I don’t find that those trends are particularly useful because what really matters is you and how you are doing.
What is your level of the 3 symptoms of burnout?
How’s your energy level.
How exhausted have you been recently.
How well are you keeping connection with your ability to be empathetic and compassionate and caring about your patients.
How well are you able to maintain the connection with the fact that you are really making a difference here and that your work serves a purpose.
Because if you can stay dialed in with those 3 things, no matter what you do, then you’re not burned out.
Can a physician fully recover from burnout and subsequently regain the ability to once again find fulfilment in his or her medical practice?
Burnout has the highest and best use.
The highest and best use is to knock you back on to a path with more purpose.
When I talk to people about burnout, I am trying to show them that they have been through it before:
“Can you remember a time in your life when you were doing what everybody expected of you: Following orders, coloring inside the lines, working hard trying to be a good team player?
That it got so uncomfortable that you literally had to make a change in your life and your practice?”
When you look back on it, that change is responsible for who you are now and it is better than what it was before.
What I just described, that place where you had to make a change, that’s burnout.
Burnout is meant to teach you things.
Burnout is when you play the game by somebody else’s rules and it fries you.
Somehow, rather than kill yourself with guilt and disappointment, instead you switched to a life that makes more sense for you and the symptoms go away.
Burnout is how you become wise.
Burnout is how you become strong again.
Burnout is how you make it your own.
For instance, for me, even though it wasn’t conscious at the time, I became a doctor to please my mother and her mother.
It was a generational thing.
I played that role.
I did it all.
I was successful.
I was a high biller.
I was part of the leadership team.
I loved being a family doc, until I didn’t.
My mom and grandma are now dead.
And look what I do now.
It’s still medicine.
It’s completely different from what they had wanted me to do.
And it makes sense for me and my life and my purpose, and I am totally dialed back in again.
Here’s what I suggest if you want to hear a story of burnout put to its highest and best use: Go find the doctors you look up to most.
Grab them a cup of coffee and say tell me your burnout story.
More often than not they are going to say which one.
Often times they will have run into this wall and changed their practice and change their life and recovered from it to find more purpose and meaning several times in the course of their lives.
The Happy MD team consists of burnout coaches that tailor treatment plans for individual physicians.
What is the typical timeframe for a physician entering this program to go from being burnt out to the point where he or she can indeed be considered a “Happy MD”?
You can be happy and be burnt out.
Being happy is a choice.
The way we work is like this:
I have seven colleagues who are all physicians.
Between us we have 176 hours of clinical experience.
We are also all certified coaches from the International Coach Federation.
All of them have been hand picked and trained by me in the Burnout Prevention techniques.
The first call is always free.
We call it the Discovery session because you have to find out whether you like this coach person and they have to find out whether they like you and whether they think they can help you.
Everybody gets a strategic plan depending on the challenge that they are facing.
You have a choice, if you want to, to hire a coach to continue to work with you.
Typically, that is an hour-long phone call about twice a month.
If you are facing something that is very straight forward like a decision or a particular relationship and there is just a few steps in the action plan, then we have a 4-call package.
If something bigger is going on, we have a 12-call package.
My experience is that 70% of people recover from burnout without changing their jobs.
The other 30% need to change their jobs to recover from their burnout.
That is actually simpler because it is fairly easy, once you know what your ideal job description is, to find a much better job and plant yourself there.
We specialize in helping people find and onboard into new job positions.
But if you end up staying at your job it usually takes 6 to 9 months to turn it around.
Typically that is a phone call about every two weeks.
What you are basically saying is my current balance is not good, my energy is negative, and I’m disconnected from why I do this in the first place.
What we are going to do is to tweak your strategy.
You tell us what you really want and we will work together to find some actions that we are going to test in the real world to see if they help.
And if they work we are going to turn them into habits and we are just going to refine your personal burnout prevention strategy.
Most of the people pick up a life balance tool or two.
Most of the people do something a little bit different on their documentation.
Most of the people in our coaching programs will end up being more effective in managing their boss if they happen to be an employee.
A couple little tweaks like that usually turns this around.
I usually think about 6 months.
Is there a certain type of personality you have encountered that makes preventing burnout in that individual unlikely?
The thing that you have to be is coachable.
You have to be willing to take different actions in order to get different results, rather than blame somebody else.
If you come and you are going to be a victim and you blame everybody else, I can’t help you and I will end up firing you.
You also have to be willing to look in the mirror.
Because a large part of what’s going on when you are burnt out has to do with you.
You have to be at a point where you are willing to change to the extent that you are willing to look in the mirror to notice what hasn’t worked and to change your actions.
Einstein’s Insanity definition is a law of nature for humans.
If you always do what you have always done, you will always get what you always got.
It will never change unless you are willing to do something different.
For those who are stuck in victim mode but they don’t have a psychopath for a boss, it comes down to the point where, do you want to be right, or do you want to be happy.
Happiness is within your grasp but you are going to have to let go of blaming everything on someone else.
The challenge is that there is so much outrage out there that it is easy to get lost pointing fingers and not changing what you do.
Everybody can recover from burnout, but you can’t do it by pointing fingers at somebody else and blaming them.
Staying there and pointing fingers and being outraged will only solidify the sides and make it worse.
One of the things that is happening is that there is a lot of chatter about a new term, moral injury.
That is a form of finger pointing.
You hate your job but you keep showing up and doing it the same way you always have and scream moral injury and point at somebody and say we need a union.
What you are is stuck in is victim mode.
Victim mode means, as long as you are just pointing, things won’t change.
You have got to take new action.
People come to see us at a point where they are not happy about what’s happening.
What I want to know is what you would rather be happening instead.
In an ideal world what would your practice look and feel like and then let’s make that happen.
Do you want to be happy or do you want to stay here and point fingers.
Take some moral high ground of outrage.
Your significant other does not care about how much you point fingers.
They want you to be happy.
So let’s aim for that.
Let us create a hypothetical scenario where I have the ability to grant you absolute power as head of The Burnout Task Force.
You have the ability to mandate a government policy for burnout prevention.
What would you most want implemented from your master plan?
Here’s my high dream.
Remember the movie the Matrix?
Remember that big plug they put in the back of their head?
I want that user interface for EMR.
So you walk into the office and you plug yourself in and you think your notes.
And your notes go as fast as your thoughts.
And you’re not dictating.
You are actually thinking a holistic picture of a patient and POW it’s in the EMR and you are on to the next one.
What we have to do is separate the chores of documentation and the big data nut cases from caring for patients because they are two different things.
There is caring for patients and learning and exercising your ability to practice your craft, to practice your specialty, and then there’s the documentation of that.
They should be separate.
EMR should have never caused the burnout that it has had.
It should have been a personnel issue.
EMR doubled the workload on the doctor.
They should have thrown twice as many people at it.
Sure there is 25-30% of the physician population that do not have a problem with that, but 70% do.
When you drop an EMR in my practice, you should have dropped a scribe in my lap too.
If we are going to blame one thing, what’s the biggest contributor to burnout that has peaked in the last 5 or 6 years?
It is absolutely the excess additional work that comes along with EMR and all the digital communication forms.
Ideally what you do is you staff up to handle the extra workload.
That’s what the latest and most successful team-based care projects are doing and are showing tremendous results.
If you want an example, the APEX program from the University of Colorado headed by Corey Lyons will show you the up-staffing process that takes away the burnout caused by digital documentation.
Going back to your own personal story of burnout, knowing what you know now, what would you have changed so that you would not become a victim of burnout?
These kind of questions are very popular.
If you can do it over, would you do it the same way?
What you are saying is if you could take your current awareness back in time and start over, knowing what you know now, would you do things differently?
Well of course.
But that’s a stupid question. [I am quite famous for these.]
Is there any way that I could have seen or done things differently?
I say no.
What I can also say is that stumbling from burnout to burnout and changing what you do several times over the course of your life, that’s called being a human being.
Because if someone tells you that they knew they were going to be a neurosurgeon since they were 5 and have never been burned out a day in their life, I have a lot of trouble believing that.
I could understand how you would want to appear to be that person but I have trouble believing that you truly are.
If there had been someone around like me for me at the time I needed a coach, while I was signing my resignation and walking away from my medical career, I would probably have ended up as some sort of C-suite leader in some sort of organization.
But I am not sure I would have been happier than I am now.
And I am not sure I would be making anywhere as big a difference as I am now.
My 13-year-old daughter has expressed her desire to become a physician “like her dad.”
I have written a previous post of all the emotions I went through when I first learned about this desire of hers.
I obviously want to protect her from job dissatisfaction and burnout that has permeated throughout the medical community.
If your child expressed a desire to become a physician, what would your reaction be? Would you encourage him or her to pursue another profession with a far lower chance of burnout or would you give your blessing?
I would never stand in the way of my child’s desire to do whatever it is that they think makes them happy.
My question would revolve around something like, “Well that’s awesome. What is it about being a doctor that you think that you would enjoy the most?”
And then just listen to what they say.
What I believe is that this applies to anybody contemplating anything.
I do this a lot with my coaching clients.
I work with a lot of doctors who are burned out who say that they think that they would like to do “X.”
What I will say is that that’s a fantasy.
The advice I give my coaching clients is that as soon as you get an inkling that you would like to do something different, go find someone who does that and shadow them.
So you can really see what it is like to do that for a living.
Don’t persist in a fantasy for any longer than you have to.
Go shadow somebody because you may take it off your list immediately.
For a physician unable to attend one of your lectures in person, what are some resources you recommend that can arm him or her with the tools necessary to combat burnout?
If you want the global picture of how all these fit together, I would recommend the book, Stop Physician Burnout: What to Do When Working Harder Isn’t Working.
We have sold about 40,000 copies of that.
It is everything in our philosophy that is wrapped into a unified theory of burnout prevention.
If you really want someone to help you make change, when you are truly ready to change, come do a free discovery session with one of our coaches.
Get an idea of what it is that you would need to do to get to where you want to go.
Whatever it is that is burning you out right now, what would you like it to be like, and how would you like it to be different.
That’s what we focus on in a coaching relationship.
We also offer, for physicians who want to lead physician wellness or be a physician wellness champion, a physician retreat twice a year.
I am also going to be recording and releasing videos onto the website in the fall of 2019.
If you are interested in checking out previous individuals that were brave enough to expose themselves to the beams of the X-ray, please check them out here.
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