[00:00:00] Mat: Welcome to Doctors at Work. My name’s Mat Daniel and this podcast is about doctors’ careers. Today, I’m having a conversation with Kim Downey. Kim is a physical therapist in the US and she’s also a patient. She is a fierce advocate for physician well-being, and in this episode, she tells me what doctors can do to prevent and manage burnout.
I particularly like the idea of patients being advocates for doctors’ well-being, something I hadn’t really previously thought about. And of course, it makes perfect sense because at the end of the day, patients want doctors that are good at their job and doctors that are good at their job need to be well to be good at their job.
So, it makes perfect sense. Also, she talks about this idea that all of us have far more power than we think that we have. And in that, of course, she’s right. Often, it’s difficult for us to see what is in our power to do, but the reality is there’s probably almost always more than is in our power than we realize.
Hope it’s useful.
Welcome, Kim. Tell me about yourself.
[00:01:16] Kim: Hi, Mat. It’s nice to meet you. I’m a physical therapist and I’ve had cancer three times in the past few years. And I’ve had a lot of experiences running the gamut from wonderful to not so much. And recently physician being has become my life’s purpose.
[00:01:36] Mat: Thank you. And why does physician well-being matter?
[00:01:40] Kim: To me personally I have seen the results of burnout personally for myself being a physical therapist and then the toll it takes on physicians because I’ve had a lot of doctor appointments in the last few years and I was concerned about my doctors and I just feel that it’s very important for the physicians to be able to be engaged to provide good quality of care to their patients.
And we have to take care of the doctors so they can take care of us.
[00:02:13] Mat: So, I like that. So, there’s a kind of a two-way traffic there that You know, of course, we all know that it’s important for doctors, physicians to be well and to be healthy, but actually that in turn means that they then provide really high-quality patient care because they are and healthy because if you burnt out, you don’t provide that good quality care.
[00:02:35] Kim: Exactly.
[00:02:36] Mat: And. I know that you worked in healthcare settings, so you know an awful lot, and you’ve observed, you’re not the physician, so you’ve observed a little bit, not quite from the outside, but also not quite from the inside and you’ve seen the other side as a patient, and from your perspective, what would you say are the common reasons that burnout happens?
[00:02:58] Kim: I know for myself, which I can relate, and it seems to be the things that I hear from physicians as well, is a loss of autonomy and frustrations with electronic medical record, I, and also a moral injury, and I believe that’s different from burnout, and I feel like I understand the difference between the two as well.
[00:03:21] Mat: Can you tell me a little bit more about loss of autonomy and moral injury?
[00:03:25] Kim: Sure. So, when I was working in my last a couple of jobs ago, that was during the period that we switched to the EMR and that’s when I feel like things changed and got worse. And there was a time when I would walk into work, and I would be able to say how long when I evaluated a patient how long their session should be and how long I estimated that need therapy.
Okay. Great. So, one day I walked in, and my schedule was already made for me with like, how long I should see each patient. And I was like, wait a minute, you don’t tell me how long see the patients I tell you. But that wasn’t the way it was anymore. And sadly, it also related to insurance.
So, if you had somebody that was around my age, that was on Medicaid and had a knee replacement, you were only allowed to see them for 30 minutes. But you could have a woman in, like 70s, 80s or 90s with COPD on oxygen and they were put on your schedule for an hour and 15 minutes because they had good insurance and so that’s so I could see as far as now that it’s the same thing with the doctors that they don’t have control over their own schedule.
And it’s very frustrating.
[00:04:38] Mat: Okay. What do you think are the solutions?
[00:04:44] Kim: Some doctors are having success going to like direct primary care or concierge medicine where the patients are paying them directly and they seem to be very happy doing that. So that could be part of the solution, but for patients that are complicated, such as myself, that can’t be the full answer because I could never afford to pay all those doctors, because now I have a medical oncologist, a radiation oncologist.
A surgical oncologist, a gynaecologist, an endocrinologist, a nephrologist, and so you can’t, that’s just, that’s the short list, right? And so, I think there just needs to be, drastic changes in the healthcare system, but also, I would know that you would say that even like universal healthcare, because some people think in America we should be going to universal healthcare, but then you all struggle in.
Similar ways where your patients might be waiting for a year and we have some people, like some people might think we should be modelling our system after Canada, but then sometimes you have people from Canada coming to America, so they don’t have to wait two years for a hip replacement. Yeah.
[00:05:56] Mat: It’s no. Systems perfect. Yeah. What about it would be lovely, of course, if you and I could fix the system. And that’s I think that’s my tomorrow’s job, I think. But for today maybe what can we as individuals do?
[00:06:11] Kim: I’m trying to figure that out myself.
For as one person, I want to support physicians. So, I’m trying to figure out how locally if you’re not working within the health care system, how can you support your local physicians? So, a couple of things I’m thinking about doing is we have a local cancer centre. And I was thinking of giving a talk like there or our library places like that to just raise awareness because the, a lot of people just have no idea how difficult things are for doctors.
They think they’re, walking around doing their doctor thing and being happy and doing well and they just really don’t have any understanding. So, I think if you can raise community awareness. Because a lot of, patients are upset when they show up and their doctor’s looking at their computer and they don’t understand that even after they go home the time, they’re spending reviewing lab work and that they have to answer all the portal messages and still do the more charting and things like that, that there isn’t an understanding.
I think if you raise awareness, then… The, if you’ve got a groundswell of community support for physicians and you let the, then the hospital system knows that the patients care that might make a little bit of a difference. And if I could find something that I can actually do, that makes it help.
And I’ve also been a big advocate of rating doctors. Thank you notes. And I started during my own after my own procedures and everything. And there have been people. who have told me that because of me that they have written thank you notes to their own doctors. And I know sometimes there, and even not doctors, there’s been other healthcare professionals that I’ve written a thank you note, and one told me it like made her whole month, so it really can make a difference. So even those little things to just raise awareness about so that would be like what I think feel like an individual could try to do locally. And if that could be replicated, it would be great. Then there’s more again, system changes and we have to figure all that out.
So, I’m collaborating with medicine forward. Are you familiar? With that group. Okay, so that’s yeah, it was a group started about 4 years ago and they had a town hall about, I think, at least 30 people showed up on zoom a couple of weeks ago. And I just had another meeting with some of them this morning and.
We’re trying to figure out again, the things that can be done to try to move the needle. And things like amplifying our voices, meaning physician voices. Pat, there’s power in numbers, just connecting to connectivity sharing resources decreasing repetitive efforts, things like that.
[00:08:58] Mat: So, this is fascinating because I would, I was expecting that we were going to talk about. What we can do ourselves, but this is great to hear that actually patients can help us, and I suppose we all want the same things, healthy doctors make good doctors and patients want good doctors.
So actually, when you put it like that, we all want the same thing the patients want the healthy doctors, and we want to be healthy, and we want to do a good job. Yes, I mean in the I’m old enough to remember the days when people brought in wine even yeah, I’m old enough to remember those days and chocolate.
And yeah, it’s not that common that sort of, that one gets even a thank you card, certainly not in UK, or maybe it’s just me perhaps everybody else gets lots of thank you cards, but yeah, but it’s interesting to think that that. That patients can help. And in some ways, almost a reversal of hierarchy.
Because typically we think, as doctors, we are patient advocates. So, we have the power, and we advocate for the patient. Whereas what you’re saying is the patient has the power and the patient advocates for us. So that’s quite nice.
[00:10:01] Kim: Yeah, and I think that we have to work together. And I think that was because medicine forward was initially a physician only organization.
They’re just starting to realize that they can’t do it alone, that you almost need patients to help. And we all have to care, even if we want legislative changes. That’s it’s going to be raising awareness for the issues on a very broad basis and getting the politicians and who would support the things that you think are important.
So, I can’t just you, if you just take on only the doctors go to the voting booth, that’s not going to get you very far.
[00:10:37] Mat: So, I know that I, I do have non doctors listening, so I think the top tip for the non-doctors is every now and then do a thank you card for your healthcare professionals that are looking after you or social care or social services, whatever.
Whoever in the public sector is looking after you every now and then it’s good to say thank you and write them a card. And you’re right, sort of those kinds of things, they go a really long way, don’t they? Those little thank yous. So, I know that you talk to lots of doctors, and you’ve written lots of articles and in terms of what, what can doctors as individuals, what can we as individuals do for ourselves for our own wellbeing?
[00:11:18] Kim: A hearing them talk about like in residency training, how they were all primed to put the patient 1st and even to hold back on their own self care needs as far as, eating and sleeping and going to the bathroom and they just get in their heads that the patient comes 1st and that these basic.
That you have to take care of your own basic needs, make sure that you have time to eat, make sure that you have time to sleep, make sure that, you have time to go to the bathroom, like that you shouldn’t be holding back on those basic needs. And that’s the start and it’s just time with family is important now.
I know some physicians will say when, because of the demands. And that’s also where myself that I see that coaching can come in because I think when you’re in a position of burnout or when you’re depressed. You can’t think clearly, and you don’t see options and you would think look, it’s the system.
That’s the problem. I have no control over this, but we all have more control than we think. And sometimes it takes a coach or a mentor or a therapist or somebody that’s not you to reflect back to you some things that you actually do have control over. And I feel like that’s an important point because when I started, I had stumbled across KevinMD a year ago, March, and I was started reading about that’s when I became concerned about my doctors.
There was all the statistics about. 400 physicians a year die of suicide, and they were talking about burnout. There were all these doctors and a lot of it. So, I saw it was the first time I really saw a coaching reference, but I at first was thinking why should my doctors have to pay for a coach?
When it’s the system, that’s a problem. Like I could see that it was the healthcare system, and my poor doctor shouldn’t have to pay money. So then comes last December and as now I have my own physician coach, Michael Hirsch, right? So, once I ended up as luck or fortune or whatever way to have it and I did end up being coached that all of a sudden I did a 180 and I could see the value like how he helped me process and think about some things that had happened to me over the past few years that I had, one view of it, but.
he could help me see other things. And then I was, I went from thinking nobody should have to pay for a coach to everybody needs a coach, because everybody has things in their own life that’s happened that it would be helpful to have someone else. To reflect it with and especially if you’ve gotten certified in coaching like you’ve taken the training, and you know how to do it and the questions to ask and it’s not giving advice or telling anybody what to do.
It’s asking the right question. So, you can open up your own mind. So, I feel like for some physicians that could be just really important to have someone they can trust because it’s totally confidential. And even if they don’t want to pay, there’s, I don’t know if the resources in the US, it would also be for UK physicians, or if you have your own resources, but there’s a number in the US and I made a whole page of free and confidential resources for physicians that they could try first.
And then if they wanted to continue on to coaching.
[00:14:44] Mat: And why is it so difficult to recognize what’s in, what is in our power.
[00:14:52] Kim: I think that you, like people just get stuck in the day to day because I think of my doctors, if you walk in and you’re expected to see patients, every 15 minutes and then you have to do all the lab work and you have all the administrative tasks and you think all this has to be done.
And you would think as far as setting down, I think sometimes it comes down to setting boundaries and you might not think that you have power to set any boundaries that some of these things are expected and demanded of you, but everyone personally can set their own boundaries to some degree.
[00:15:36] Mat: And then you said that it’s really valuable to have somebody else to talk to and somebody to reflect with.
So, I’m wondering, what can we do for our colleagues? So, when I go to work, or when you go to work, what can we do for our colleagues to help them?
[00:15:53] Kim: Hopefully be a good listener. And I know our local healthcare system during the pandemic started something called PACT I believe it’s for like peer associate care teams and they were training clinicians to check in on each other. So, they trained some people to become almost like trained listeners. And interestingly enough, it hadn’t quite made its way up much to physicians, though it was very helpful with other clinicians. So, whether the physicians thought I don’t have time for that doesn’t apply to me, but it absolutely does.
So just caring and saying because when you say, oh, hi, how are you right? Or how are you doing or something like that, right? The everybody thinks they’re supposed to just say, oh, I’m fine. But sometimes I know, even for myself, like, when I was going through my health struggles, and you’d see somebody in the grocery store parking lot from church, and they’d say, oh, how are you?
And I’d say, fine. And every so often, somebody would say, no, how are you really and that just opened it up because sometimes like I wasn’t in the best place. And when they actually, when they said that, then you knew that they. were engaged and had the time and interest to listen and they really did care.
So even asking a second time or in a different way can really make a difference.
[00:17:19] Mat: So, it’s giving people permission to talk and making it clear that we’re open for a discussion, that we do care, that we are there to listen. And giving people permission to actually talk and to offload.
Yeah, no, I like that. Okay. And then my final question, what would be your top tips for doctors at work?
[00:17:40] Kim: Okay. You were part of that article, the Kevin MD article reigniting after burnout to be physician stories. And I just love that. I thought the three of you did a wonderful job. And you did that article also with Sue McClellan Tolbert and with Michael Hirsch.
So, I thought it would be helpful if I shared their takeaways because they are also physicians and coaches as well. Sue McClellan Tolbert’s takeaways she said, for those interested in coaching or becoming a coach, immerse yourself in the space, embrace vulnerability. Learn, trust, network, step out of your comfort zone, and always remember your innate wholeness, creativity, and resourcefulness.
And Michael Hirsch said never stop learning, evolving, or challenging the stories you tell yourself about yourself. His favourite self-inquiry is that even true? You’d be astounded by what you can learn about yourself through this simple question. And another takeaway is if you don’t do something different, nothing will change.
[00:18:47] Mat: That’s wonderful. Thank you very much, Kim.
[00:18:50] Kim: You’re welcome.