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Doctors at Work Podcast.

Episode #94

How to deal with burnout. With Ami Foster

Mat Daniel


Burnout affects many professionals in healthcare. In this episode, Ami Foster and I discuss how to spot when you are in the middle of it, and what can be done about it. Better than dealing with burnout would be prevention. We talk about how as doctors we are constantly on sympathetic system over-drive, but actually we need to invest in our wellbeing for the sake of the future including our own career success and longevity. The reality is that the world will always want more from us, so it is for us to put in some boundaries and strategies to help set us up for short-term and long-term success.  It’s not selfish to practice self-care, and you can be both patient focused and interested in your own wellbeing.

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Podcast Transcript

Mat: [00:00:00] Welcome to Doctors at Work. My name is Mat Daniel and this podcast is about doctors careers. It’s part of my mission to help doctors create successful and meaningful careers. Today’s topic is burnout and of course this affects many people in the health professions. In this episode, Ami Foster and myself talk about how you spot burnout when you’re in the middle of it and what can be done about it.

Better than dealing with burnout would of course be prevention. And we talk about how as doctors we’re constantly on sympathetic system overdrive, but actually we need to invest in our well being for the sake of the future, including our own career success and longevity. The reality is that the world will always want more from us than we have.

So it is for us to put in boundaries and strategies to set us up for success. both in the short term and in the long term. It is not selfish to practice self care, and it is quite possible to be both patient focused and interested in our own well being.[00:01:00]

Welcome, Ami. Tell me a little bit about yourself. Hi, thank you so much for having me. Yes, I’m a board certified family medicine physician. I have been practicing since I finished residency in 2003. Actually, I sold my practice in 2020 during the pandemic. Um, due to a lot of burnout, which we’ll get to. And, um, the last three years I’ve been working in utilization management, uh, for the payer side with Humana and UnitedHealthcare.

And then most recently I joined the physician advisor team at HCA Healthcare, doing more of the, um, physician advisor role, uh, with peer to peers for the medical, uh, directors on the payer side. So. And the topic for us today is burnout. So, you know, what is burnout? I think burnout, there’s maybe a lot of different definitions.

I think, I think for me, burnout was the point where I just got to the point where I felt. [00:02:00] Completely desensitized and almost as though you can’t foot put one foot in front of another, both with your daily life and your professional life. And I think especially in the medical profession, it just becomes increasingly difficult to to take care of your patients and to juggle everything, mainly because I think we put ourselves on the back burner too much.

I think from the beginning of medical training, we’re taught that That you know, you kind of go on a shelf and what you do is you serve those that you are are moving forward to becoming a doctor. And I think that’s kind of where the challenge lies is that we, we kind of put that self care on the shelf when we start medical training.

And unfortunately that leads to over time with increasing stress from medical training and then obviously as you get into practice. It just leads to a situation where the body. for a lot of people, um, just can’t handle it anymore. So that’s, that’s in a nutshell what I, I feel like burnout [00:03:00] is. I’m interested in this idea that, that we put ourselves on the back burner, that, you know, you go into medical school and you train and you go in there to serve and to make a difference to others.

And you know, that’s, that’s so ingrained in us, isn’t it? You know, we’re there to serve others and, and that’s, That’s, that’s, that’s what matters. And of course, there’s lots of good in that because, you know, it’s great that we’re there to serve others. It’s great that we’re altruistic and that we want to make a difference.

So I suppose it’s a bit strange to say that, that. You’re trying to make a difference to others. You’re trying to serve others, but then by the same time that then leads to burnout Can you tell me a bit more about that relationship? Right. I think I think you know, we all go into medicine I think if you looked at everyone’s personal statement it is to say because you want to help people But I think you don’t really truly realize What you’re getting yourself into in terms of the physical, mental, emotional demands that it puts on the body.

And, um, [00:04:00] I think even in my medical training course, I’m a little bit old school and I think things have changed and maybe improved a bit now, but back then it was, it was almost as though it was a rite of passage to say, you know, I didn’t eat today. I didn’t sleep today. I, I waited forever to go to the bathroom today, whatever it was that is, is a little bit, um, crazy because we’re putting our basic needs on hold in order to progress through our medical career.

And, um, you know, I think Not, not only just the basic needs, but then exercise time with enjoying hobbies, time with just doing things that you want to do outside of medicine, because it’s as though you, you have to always be there and be on for your patients, for your colleagues. And then obviously you’ve got the physical and emotional and mental demands of, of whatever you’ve got going on in your personal life.

If you’re, you know, you’re married, you’ve got children. aging parents, [00:05:00] anything like that. I think, you know, the body can only handle so much. And I think, you know, we feel like we need to go into medicine to help people, but we’re never given the steps in the beginning. To say, here’s what you’re going to go through.

This is what it’s going to do to your body. This is what it’s going to do to your brain. That’s what it’s going to do to your heart. And here are some tips that you should start from day one. You know, it’s almost as though you start medical school and instead of talking about your standardized patient classes and your anatomy and neuroscience and all of that, they should have a meditation course.

Where you say, okay, let’s have a meditation course to literally teach you how to be in the present moment. So that when you encounter those situations that are going to stress you, because they always are, you know, whether you’re coding a patient, whether you’re telling a patient that they, you know, have a terminal diagnosis, or, you know, You’re working through them with their chronic conditions, and maybe they’re noncompliant, all of these things that we’ve all [00:06:00] experienced in medicine, especially for me being primary care.

We don’t have the tools in our own toolkit to start with, in order to handle those demands for our own body. And then I think what happens is the more you then Put yourself on the backburner, on the backburner, on the backburner. There’s only so much you have to give before you’re pouring from a completely empty cup.

Is this about, you talk about the body and the toll that it takes and I’m, I’m interested, is this a physical thing or psychological thing or, or are the two things the same thing? I, I honestly think it’s both really, I think, you know, it depends on, on the person maybe. I think, you know, for me, it was very physically stressing on my body to the point where it just literally almost killed me in about 2015, 2016.

And that’s when I started my, my journey of thinking, Oh, how, how do I get out of medicine? I started coaching at [00:07:00] two or three different physician coaches on burnout and trying to find the tools, like, can I stay? In the, in the profession, because I love what I do taking care of patients, but your body can only handle so much.

I do know that for some people, obviously it becomes mental anxiety, depression, substance abuse. Um, and, and I think that can be a very slippery slope as well, but either way you look at it, whether it’s physical, Or whether it’s a, you know, mental, it still is taking a toll on, on our body and our ability to care for ourselves, our patients and the ones that we love because we just don’t have the toolkit.

And I think once you are, are in the burnout, it’s, it’s almost like trying to climb up a wet mountain without the right tools. you, you can do it and you can go through coaching and all of that. But, um, I think it’s, it’s just a little bit harder. So I think learning those tools as early on as you can [00:08:00] in your career, I used to tell patients even that weren’t in medicine, you know, learning these tools, the irony was I was teaching the patients what it was I needed to be doing myself, but, uh, yes.

I’m interested in, in the body because when I, when I was coming towards the end of my training. I weighed 107 kilos, um, and I don’t know how much of that is, I think in US you use pounds. I think it’s probably twice as much of that in pounds. Um, so a lot, a lot. And, um, And I wasn’t particularly heavy when I started sort of in medical school.

But, um, but that, for me, that was the toll on my body that I just ate rubbish and food, food, food was there for stress. Food was there instead of sleep. Food was there for anxiety and everything else. And, you know, I did, I lost it and it kind of stayed on, but it’s interesting how, It comes out in different ways.

Yeah. Cause you said for some people it’ll be depression or it’ll be anxiety, mental health related, [00:09:00] you know, or it might be a very physical thing, but, um, you kind of said that when, when you’re in the middle of it, I mean, how, how does one know that one has burnout when you’re in the middle of it? For me, obviously retrospectively looking at it, you know, we, we all know that we’ve got our sympathetic and our parasympathetic nervous system and that sympathetic nervous system is meant to be there for us to run from a bear, which we really never need to do or lift a car off of your child if they get stuck under it.

And the parasympathetic nervous system is our, our calm system, but I think. You know, this, this driving and driving and driving and putting ourselves on the shelf and in the back burner, it leads to an overrun of the sympathetic nervous system. And I think that really creates that just internal stress and strain that you feel.

I think not only that, you know, physically, maybe that, Those symptoms of like butterflies in your [00:10:00] stomach, like just, you know, nausea, Oh my gosh, I can’t do this another day kind of feeling. It can also be, um, you know, compassion fatigue. I think when you start, um, you know, getting frustrated at your patients, frustrated at your colleagues, frustrated at other people, and, and it really, I think is because you are not able.

To give to yourself what you are giving to everyone else. And I think it does become a bit of a spiral. So I’ve, I feel like, you know, we all know that adrenaline rush, you know, you’re running a code, you’re saving someone’s life. We obviously need that, but we don’t need that 24 seven to where we are always, always going with that because it will really disrupt the body.

So I think, you know, for me, it was just that ability. Well, the inability rather to never be kind of present. Um, I was always worried about the future. I was [00:11:00] always worried about the past, thinking about patients. Did I do that right? Did I do that thinking about my schedule for tomorrow? Oh, I’ve got this many patients scheduled.

I’ve got to juggle this, you know, I owned my own practice. So I was obviously juggling not only the patients, but the business side of the practice. And so that was equally, you know, your mind was always in. Every which direction. And I know as physicians, we’re always that way because every different patient that we go to see, we’ve got to sit there and think about the differential and what have you.

And, and so some of that is good because we need that to function in our career. But when it starts going to where it’s just a spiral all of the time, and you really feel like you’re in the middle of a whirlwind and you can’t just. Center yourself, get grounded and take a deep breath and take yourself out of that and recognize for it, for what it is.

It’s very hard to do when you’re in the middle of it. You just know that something’s wrong and I can’t do this anymore. It’s just, I [00:12:00] can’t handle it. You know, when you’re having, I saw someone the other day on Instagram, a physician coach talking about, do you have, dreams of wishing you could work at Starbucks or something, you know, that type of thing, literally, like, you know, I’m just going to go to work at Target instead of being a doctor.

It’s those kinds of things where you just realize that I just cannot do this anymore. So that that’s kind of a really, really good insight there. So, you know, if somebody is out there and they find themselves thinking, I can’t do this anymore, then, you know, that’s, that’s You know, that’s, that’s a kind of a real, a real key thing.

And if I think, you know, maybe for myself, when I, you know, when I sort of had my very, very first lot of coaching, um, and a lot of that, you know, burnout was a big element of that, you know, it was actually exactly that, which was, you know, like, what, what am I going to do? What, where’s my career going? Yeah.

Um, so, you know, maybe, maybe not in the sense of, you know, I’m going to work at Starbucks, but you know, like, what, [00:13:00] what am I going to be doing? Am I going to be working like this for the next 20 years? So it kind of, it precipitates, you know, that, okay, now I can’t see myself doing this for the next 10, 20, 30 years, whatever it is.

So that kind of strikes me as a really, really, um, important insight, but it’s interesting how it kind of, it comes out. in different ways, um, with different people when you are, um, kind of, um, in the middle of it. Um, you’ve, you’ve, um, you said that, that, that there’s a set of skills that kind of, it’s a shame that people are not, taught that right at the beginning.

So, you know, maybe if I, let’s sort of, let’s say that, that I wave a magic wand and, you know, and you’re in charge of designing a medical school curriculum that’s based around future physician’s wellbeing. What, what would undergraduate education on this topic look like? Well, I, you know, I went to a spirituality and [00:14:00] medicine conference very early in my.

Professional career after I finished residency and they had us in a room and it was very profound. This is this is what I think they should do in medical school. They had us sit there and take our pulse. And then they had us run through about, I don’t know, maybe five minutes of just calming meditation.

And then they said okay take your pulse again. And it was profound the difference. And the drop in the pulse, I think even just starting like that and teaching, teaching young physicians how to get grounded, how to get centered, how to number one breathe. I think a lot of times we we hold our breath, when we get in stressful situations, and even something as simple as a deep breath and for for holding it for three breathing out for seven.

Doing that three or four times. I know when I was in coaching, um, one of them, [00:15:00] which of course I, I know we all probably did this with people that we’ve coached with. You get frustrated at their tips because you think how in the world can I employ this in the middle of this? But they’re right. You know, one of my coaches said the minute right before you go into a room with a patient while you’ve got your hand on the door, take a deep breath in.

And a deep breath out and then go in the room. Same thing on the way out, little things like that. Um, starting the day with meditation, you know, teaching, there’s so many apps out there, there are, uh, you know, people on YouTube, there are people on Instagram, all over the place that you can find that you can find your style of what type of meditation works.

For, for you. Um, I always envisioned when I was in the depths of it and people said, Oh, you need to meditate. And of course, when you don’t really know what that means, or you don’t, you’ve never been exposed to it. It feels overwhelming to think, Oh, I need to go [00:16:00] like a Tibetan monk or something and meditate and you don’t even know what that means.

So, for me, I’ve always found that guided meditation. Has been super helpful because it’s someone walking me through it and it gets me out of my own head to where I don’t. Obviously, you’re going to have some racing thoughts potentially in the beginning, especially when you’re in the middle of burnout, but I think it gives you something else to focus on.

Outside of yourself to progressive muscle relaxation, those types of things. So I think teaching those types of skills, one other tip that I have found, um, especially in the last couple of years, um, with just trying to rebalance the parasympathetic nervous system is called yoga nidra, which is a relaxation technique.

It’s not yoga. Like people think of, but yoga nidra, which gets you into a profound relaxation state during it’s, it’s almost like a guided meditation, but the, the people that are skilled at these [00:17:00] topics will guide you into a state where you’re not asleep, but you’re not awake and you’re in the middle of that.

And I have a couple that I have employed over the last couple of years that are 15 minutes. And if I’m exhausted during the day, I do that 15 minute. session, I feel like I’ve had a two hour nap. So I think those just simple tools, maybe learning that early on so that when you do have a challenging situation, maybe you’ve just lost a patient, maybe you delivered a stillborn baby, you know, all these things that we’ve all been exposed to, uh, maybe you’re worried that you’re going to be in a lawsuit.

Um, you know, those types of things, you, you can get yourself grounded, get yourself centered, um, and, Um, because I think when we’re in medical school, we don’t know what we don’t know. Even when we’re in residency, we don’t know what we don’t know because we haven’t been exposed to it. So although you can experience burnout in those levels, which I think we all do to a certain extent, cause it’s so [00:18:00] rigorous.

I think really, when you get out in the real world, that’s also when it really can rear its head because then you don’t have the the backdrop of, of your faculty in residency or your faculty in medical school to, to kind of lean back on, you’re kind of it. So, um, learning those tools later on in your career, like I’ve actually had to do, it’s a lot more challenging.

It’s definitely doable, definitely is doable. Um, and I think it’s something that is absolutely imperative for those that, that are in the middle of burnout is to learn to get centered and, and to get comfortable back in your own body, uh, rather than it being such a stressful feeling to be in your body, if you will.

You think when it comes to burnout, is this something that pretty much every one of us will face at some stage in our careers? Or do you think, are there some people that have never had it and never will? You know, I’ve wondered that same thing as I look at different [00:19:00] colleagues and, you know, you’ve got colleagues that are well.

Well, older than you and, and, and seemed to just be so happy practicing. And you wonder like, have they ever experienced that? I think maybe we all do to a certain extent. I, and I think it’s not necessarily just physicians. I think it’s anyone in, in a service profession. I think it can be nurses, physical therapists, teachers, you know, uh, EMS workers.

Uh, uh, I think anyone is, is subject to it, but I think those of us that are presented with having to constantly care for others and constantly be on high alert with our decision process and everything. I think that just is, it’s a difficult, it’s a difficult place to be. So I do think we are, we are certainly in the statistics show that we are much more likely obviously, um, to have burnout and, and as we know, physician suicide rates and everything.

But I always wonder how much [00:20:00] of that could be, could be improved if we had these skills in the beginning to where we knew how to, when we recognized, hey, things are getting a little out of control with how I’m feeling. This is what I can do to get back grounded. I hope you’re enjoying the show. Please click subscribe so you’ll be notified when new episodes become available.

This podcast is part of my mission to help doctors create successful and meaningful careers. You can be part of that mission too by forwarding this show to one person who you think might benefit from listening. Thank you. Now on with the show. The word that’s coming up for me here is balance. In the sense that, that You know, if you have a cardiac arrest, it’s great that you have an adrenaline rush and you go running.

You know, if you need to look after your patients, it’s great that you’re altruistic and you put your patients first. You know, they’re great characteristics for all of us to have. It’s great that we care. It’s great that we [00:21:00] reflect. It’s great that we worry whether we’ve done the right thing for the patients.

They’re all great characteristics, you know, of a doctor or a nurse or physiotherapy, whatever they might be. Um, but the problem is that I heard you talk about is that when that becomes all the time, when 24 hours a day, you’re, you’re worrying, you’re caring, you’re catastrophizing, you’re having an adrenaline rush all the time, um, which, which lots and lots and lots of people do probably outside of healthcare as well as in healthcare, because I think that’s, The world seems very, very fast at the moment.

I think very, whether you’re in healthcare or not, everything seems to be very fast and, and very, very polarized. You know, the, much of the world, you know, you, you, us is a great example of sorts of very polarized, but it’s, I think in an awful lot of other places, sort of, so even if we step outside of our healthcare context, the world around us is all very stressful and very fast.

Um, but it, it, it’s that it’s, [00:22:00] What you’ve outlined is, is maybe balancing the, the stress, the altruism, the patient focus, the reflective worrying, all of that’s good. But what you’ve outlined is you’ve outlined that being balanced with some specific deliberate practices specifically designed to tap into that parasympathetic relaxation system, um, as a counterpoint.

Absolutely, because, um, you know, it’s not normal to get up first thing in the morning and your heart rate Is 150 beats a minute. It’s just not normal. And that’s, that’s unfortunately what, what was happening to me was I within about 10 minutes, I would get up and, and it would just be racing. And, uh, so you’ve got to reprogram that.

Actually, and I think these techniques, especially the yoga nidra, um, that that is something that again, you can put your headphones in in the [00:23:00] call room or wherever you are in your car in your office and just close your eyes for 15 minutes. Let someone else guide you through it and come back out a different person on the other side.

I think there’s a lot of other, um, you know, if people like a more hands on approach, there are some, uh, holistic regimens, such as things like Reiki healing and, and all of that, which, um, are energy balancing in the body. I know places in the U. S. like Sedona and other Um, kind of more, um, healing centers, spiritual centers, um, use those, even some cancer centers use Reiki, um, you know, for, for balancing energy and the body.

I think that can be helpful. Um, not everybody is obviously going to gravitate towards those types of things, but for me, I think for me, I, I really looked for any and every, thing I could get my hands on to, to try to get things back in balance. So I’m, I’m guessing that, [00:24:00] that maybe if, if you went back and sort of said to your, to yourself 20 years ago, and that kind of sort of said, Amy, don’t just do this all the time to do some yoga, NITRA, and, you know, sign up for some wellbeing meditation.

You know, I’m guessing that Amy of 20 years ago would sort of say, What on earth are you talking about? I’ve got this. I can do all of this. I don’t need any of this well being rubbish, you know, sort of, you know, I’m, I’m at work, you know, I’m going to push through all of that. Is that, does that resonate?

Absolutely. And I think most of us would, because again, we don’t know. What we don’t know even when I was in the midst of burnout and working with different coaches I’ve I did that I would think Meditation who has time for that? You know? Well, we we don’t not have time for you know, like we we’ve got to make time for it Yeah, yeah, and I think even first thing in the morning, you know a lot of people and I’m [00:25:00] sure physicians, you know Grab for your phone.

Like let me see. Did I miss any calls? Did I miss any emails? Did I miss any thing? If we would just say, you know what, let’s just get up. Let’s maybe do a 10 minute meditation. Every morning, 15 minute meditation before I, maybe before you even get out of bed. If it’s a challenge, once you get out of bed to say, okay, I’m going to park myself and I’m going to do it because I think we are as physicians, we’re inherently overachievers and we are, um, very, uh, type a about what we do, which is great again, for our careers.

It’s a good character trait to have because it makes us conscientious, but I think we can be. overachievers at not taking care of ourselves too. Um, and, and then, you know, it, it almost becomes like we’re perfectionists at our work. We’re perfectionists at not taking care of ourselves. Whereas we just say, let’s, [00:26:00] let’s start the day every day and reframe that.

One of my other coaches used to say, Structure your day as how you want to see it. And in my mind at the time, because I was in the throes of burnout, I thought, well, how can I do that? Because my patients dictate that because my schedule is this, my schedule is that. But now again, that I’m, I’m out of it a bit more and can look back and say, that was absolutely correct.

You can schedule your day. You can say, okay, I’m going to allow time for this. There are certain things that are not negotiable. You know, skipping lunch so that you can do your chart, skipping lunch so that you can continue to see patients, those types of things that are basic things for our bodies that we need, um, we shouldn’t do that.

We should say, let’s structure our days. To where we can, can do that. Now, some things are out of your control. Obviously, you know, a patient has a chest pain and [00:27:00] you’ve got to call EMS and send them off to an ambulance in the hospital. You don’t have control over that. And that might get into your lunch hour, but most days, if you can just say, I’m going to set a boundary and I’m going to take care of myself and it’s just not negotiable, you know, my meditation first thing in the morning.

Not negotiable, you know, my lunch break, not negotiable. And I think setting those boundaries to helps a lot with burnout, because I think burnout is potentiated by us letting people walk all over those boundaries. And it’s it’s your office staff it’s administration and the healthcare setting it’s it’s patients, you know, maybe taking taking too much time and.

You know, it’s just challenging. So I think setting those boundaries and setting yourself up for how you want your day to look with, with your self care is important. So I’m hearing here something about the importance of investing in your wellbeing in order to [00:28:00] guarantee or in order to help career success, because I think most of us will think, I want to achieve at all of these things, you know, whether that’s professional, academic, financial, whatever it might be, but sort of all of us want to achieve all of that.

But the reality is that how we go about it with this constant sympathetic overdrive, how we go about it, sabotage is the very thing that we want to achieve in the long term. a way of thinking for somebody who is early in their career would be to sort of say yes, you know, all of these things matter, but in order for me to have a, to have career longevity and career success, I’ve got to put some investment into my wellbeing because that is what needs to happen in order for me to still be on top of my game in 20 years time.

Cause otherwise in 20 years time, you’re just going to be burnt out. Absolutely. And one of my coaches again, the one that I think challenged me the most. He said, working harder is never the answer. [00:29:00] But we are trained and taught, keep working, keep plugging, keep seeing more patients, keep, you know, doing more moonlighting shifts, whatever it is.

But that’s, that’s really never the answer. Again, like you said, for, even for the short term, but especially for career longevity, it’s never going to be the answer to do, to do more cases. And even in my career on the other side of medicine in the non clinical world, uh, working for, for, That, you know, my last position, it was do more cases, do more cases, do more cases.

And that’s, again, it’s never going to be the answer in any profession, because if, if we do that at the expense of our own wellbeing, it’s like the definition of insanity, doing the same thing over and over again and expecting a different result. And, and again, I think. Being able to recognize that, I think for me, that’s what I was able to do finally was to say, okay, this is very familiar.[00:30:00]

This feeling in my body, this feeling, this is very familiar, and this is not something that is, that is doable for me at this point in my life, and I’m not going to go back to that. So I think once you’ve been through it and you’ve recovered from burnout, you are finally able to say, okay, this might be happening again, because it can happen really.

no matter you get out of medicine and you get into a different career, if, if you, if you don’t take care of what you need to take care of for yourself. So I wondered earlier when I asked, does this affect everybody? So I wonder the people that you talked about, that, that do seem to be happy and satisfied.

I wa I wonder if they are there because they have been through burnout and, and for what? And they’ve developed their own techniques, and importantly they’ve learned from burnout, which is, I think what you talked about is that there’s, you know, this, this, this, this stuff that happens that makes you recognize.

that, that, that [00:31:00] things are not as they should be. And, you know, sort of for, for me, a classic would be this, this, this telltale signs that I have that stuff is wrong in my life, which is, I’m not going out with the dogs and I’m not exercising and I’m eating rubbish, you know, and, you know, sort of start, you know, three things.

Yeah. So I know when I’m kind of sort of seen in a week’s gone by. And you know, not, not once have I taken the dogs out to go out with my other half. So, so, you know, and I think like the whole week’s gone by and I’ve not done a single dog walk. Then I kind of think, okay, there’s a, there’s a problem here.

Or, you know, sort of on a Wednesday, I have a personal trainer and when he comes around and I kind of, and I say, do you know what, I’ve done no exercise since you were last here. And I kind of think, okay, like, how did, how did I go? A whole weekend without managing to do any exercise, other than what I’m forced to do because, you know, because a personal trainer sort of is booked.

So, so like they, they, they, for me would be, [00:32:00] would be, would be telltale signs that something’s not right. Yeah. Although the personal trainer on Wednesday, that’s non negotiable. Yeah. Because, you know, because he comes on a Wednesday and, you know, and that, that does not change, you know, so, and it’s, and it’s that.

The non negotiable stuff. So yes, I wonder if if the people, the people that are doing well are people that have been through burnout and they’ve come out the other side and, and, and they’ve learned from it. Yeah. Which is they’ve learned, they’ve learned to recognize when, when, you know, and it, it’ll all be different for each one of us, won’t it?

But, but people have learned to recognize when for them, things are not. Yeah. Um when they should be I agree I agree but that’s difficult for people early on though because you know Because we could go and sort of say oh, you know in in your medical school You’re going to have one day a week that’s going to be devoted to your well being.

But if those people don’t recognize the importance of it. Like, you know, why, why, why would a [00:33:00] 25 year old want to bother with all of this? You know, what would you, what would you have to say to yourself from 20 years ago to convince yourself from 20 years ago that this kind of stuff really matters? Yeah, I, I, gosh, I, I think I would have to tell myself that, you know, if, if you don’t do this, you know, You’re, you’re gonna feel like you’re gonna die in about 20 years, you know, I mean literally, um, I don’t know that you would still believe it because you’re young and you’re, you feel like you’re invincible and you feel, you know, Again, that overwhelming sense of altruism.

Like I’m here to save the world. And I’m so excited about all of this and what in the world do I need to sit still for 15 minutes and do a meditation for, but I think somehow, some way, just imparting that wisdom, that these, these tools are just as important as learning about neuro anatomy, learning your anatomy, learning your [00:34:00] physiology.

It’s just as important as that. Um, I don’t know how we could drive the point home, um, unless they start feeling just in their own life, what a difference it feels. Like I said, in the very beginning, take your pulse at the beginning of the session, do the session, take your pulse at the end to show here’s what it does literally to your physiology of your body.

You can’t. You can’t deny that when, oh goodness, my heart rate dropped 20 beats a minute. I came in here. I was at 90 and now I’m at 70, you know, um, quite frankly, your heart rate shouldn’t be 90 when you’re resting. But I bet if we put, you know, 100 physicians in a room that are on sympathetic overload from our practices and what, you know, faculty, whatever.

role of life you do for, for medicine, if you put us all in a room and then said, okay, let’s tell, tell us what your pulse is. I bet a lot of people’s resting pulse is too high [00:35:00] because they’ve got that underlying sympathetic drive going When they shouldn’t have it, you know, they’re laying in bed at night, awake at three in the morning with their heart racing, that shouldn’t be happening.

So I think maybe using something concrete like that, that, that shows you that this is, this is what you’re going to get from it, I know for me, it made a profound impact back then. Obviously, probably still not enough to think that I needed to employ. I think I was about two years into practice at the time and I was intrigued by that.

Wow. That was kind of interesting, but I didn’t, I probably also didn’t have anyone guiding me through. Like if I had taken on coaching two years into my career and had a coach say, this is what you need to be doing. But I think if we’re in training and you’ve got kind of that coach, it’s your faculty, it’s whoever’s doing it.

Um, You know, I think then then it would be a lot more feasible to feel like you’re feeling the the impact from it. Again, I think that’s [00:36:00] what we get when we are are burned out and we hire a professional physician coach, because a lot of them have been through burnout themselves, and they, they’re going to be that.

Like your personal trainer, you’re accountable because you’ve got a session with them on Thursday at 6 PM and you’ve got your coaching session. So I think again, that accountability, maybe we have a meditation partner, something that keeps you accountable to say like, Hey, are you, are you doing what is good for yourself?

No one really asks us. How are you doing, Doc? You know, how are you? Like, really, how are you doing? Are you really doing okay? Are you eating? Are you exercising? Are you taking the dogs for a walk? Are you doing your meditation? No one really ever asks us. Because it’s always about us, like, How are you, Mr.

Jones, today? How’s your diabetes been going? No one really ever asks us. invest in us. And so we don’t feel like we need to invest in ourselves. So, so, [00:37:00] um, yeah, it’s, it’s, it’s interesting cause I was reflecting there that, that of course, obviously I have a personal trainer and lots of people will have. a personal trainer.

And for me, it’s, it is, I mean, it literally is that accountability that, you know, it will happen. Yeah. Because, because I know fully well, if I didn’t have a personal trainer, you know, months would go by without me doing any exercise. Yeah. Sort of, but, but at least this way, even if I’ve done nothing myself, at least once a week, sort of, I, I do exercise.

Um, but yeah, I mean, I sort of have regular coaching as well. And I would just reflect, Nick, you know, what, what I’ve done for myself. I have regular coaching. And that for me, that for me, isn’t coaching for a problem. So it’s not remedial coaching because there’s a specific question or a specific problem for me, coaching is long term support in the same way that I don’t have a personal trainer because I have a problem with my squat or my bench press.

So it’s not the problem [00:38:00] that I’m fixing. It’s that investment in my long term health. And a personal trainer is an investment in my long term physical health. And, you know, and my regular coaching, which I have now and will continue to have, you know, that’s investment in my long term psychological health.

But actually, as I was thinking, you know, for myself, what would have convinced me, you know, when I was 25, that this mattered. So actually, I’m going to go with your shock, with your shock tactic, which is that, that, you know, what would have convinced me at the age of 25, that this is something that I needed to invest in would be, would be a realization that, that, that if I don’t do this stuff, my career will unravel.

And, you know, and I’m going to have significant mental health problems, you know, or what happened in my case was that, that, you know, I mean, at medical, that, that, that like my weight was almost double what it was when I was at medical school, you know, and, um, and that, that, [00:39:00] that, that kind of shock tactic, if you don’t do, if you don’t invest in your own wellbeing.

there’s going to be a hefty price that you’re going to pay. And you might sort of say, I want to prioritize my career. I want to prioritize my career. You know, that’s fine, all very well. But if you don’t invest in your wellbeing, then your career will unravel at the other end. So that, that, that actually, that brutal shock tactic, that if you don’t invest in your wellbeing, your career is going to go nowhere.

You know, in, in maybe in the short term, but certainly in the long term, that’s really interesting. And actually, the other thing I was really interested in was, um, I wish I’d kept coaching right from the age of 25 onwards on a regular basis. Not, not that, you know, for me, it was something that I, I don’t know, I think I found it when I was 40 and I had a problem and I went for coaching and I’ve kind of had it pretty much ever since.

But I wish that I found coaching when I was 25 and I made a decision at the age of 25 that, yeah, a bit like the personal trainer, you know, once a [00:40:00] month or whatever, I’m going to have an hour with a coach and that’s an investment in, in me. And I do that now, but I wish that I’ve done that from the age of 25 onwards.

I agree. Maybe if I could, um, get us to wrap up and, you know, bring us to a close, what would be your top tips for doctors at work, for physicians at work in relation to this topic? I think, um, number one, it’s not selfish to practice self care. Um, it’s, it’s actually selfish not to practice self care, um, because you can’t pour from an empty cup.

So remember to take care of yourself, um, eat, drink, Sleep, exercise, do the things that make you happy, get, get some sort of a, a regimen where you do some sort of meditation, deep breathing, yoga nidra, maybe it’s regular yoga, something, uh, grounding in nature, walking your dogs in nature. Something like that to [00:41:00] where you are investing in yourself, your body, your brain, your, your mind, your spirit, your heart, make sure you don’t forget to do that.

And I think, um, you know, the other thing would be boundaries. And I think that’s something that, um, that can bleed over into every facet of our life. And I think, again, we are taught very early on. Not to have boundaries. And I think it’s a fine line with having boundaries and being able to live life but but I think it’s those non negotiable things that you say, you know, in my day, I am going to take a lunch break, I am going to do whatever, exerting those boundaries and just Then I think the third thing would be just remembering that all of these things that you do, yes, they’re going to take time, and they’re going to, it’s time away from your patients, it’s time away, but you can’t afford not to do it, as you said.

Um, if you want to be able [00:42:00] to continue to, to function in life and be able to practice medicine and, and, and just be there and present for your, your family and your friends, you, you’ve got to, you know, put those things into place. So I think it’s very worthwhile. I mean, get a coach if it’s, if that’s what you need.

I think that’s, that’s something, like you said, we, we all should probably have that and maybe, you know, Teaching that early on would be great, but I think those would be my top tips is just remember, put yourself put yourself on the front burner. You can still do that and take care of your patients. So wonderful.

Thank you very much. Amy. Thank you.

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