Stop Physician Burnout Key Personal Defense Skills Podcast with Taylor Brana MD at TheHappyDoc

Posted by Dike Drummond MD

physician-burnout-podcast-dike-drummondPhysician Burnout Key Personal Defense Skills Podcast - Complete Your Medical Education 

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Lower your stress levels, build more life balance and a more Ideal Practice. Complete your medical education and learn to recognize and prevent burnout in yourself and others.

Had a really good first conversation with Taylor Brana over at TheHappyDoc. In it we go over a number of the basic patterns in burnout risks and burnout prevention we have learned in our work with thousands of burned out physicians in our coaching practices. Great to be able to share and Taylor is allowing me to mount the podcast here on our website as well. Enjoy,

 

TRANSCRIPT:

Welcome to The Happy Doc, the voice of fulfilled physicians. This show is about bringing inspirational, creative, successful and happy health professionals to you. Get ready to learn how you can be a happy doctor too.

Taylor: Hello, everyone and welcome to another episode of The Happy Doc, really excited for our next guest, Dike Drummond, he has a website called, thehappymd.com and I think we're ready to go for this episode. Dike, can you introduce yourself?

Dike: Sure, Dike Drummond from thehappymd.com, I want to bust a myth though right away. I'm not ‘The Happy MD, that's the name of the website. It's ‘THEhappyMD’, it's a place where you can go to get the tool so you can be a happy MD and you have to put the ‘the’ on the front because if you just put ‘HappyMD’ that's a porn site.

Taylor: That is one way to start off this episode. What's something that gets you excited in the morning?

Dike: Oh gosh, well since I started this work helping to prevent burnout, I've been on pretty much of a mission. And so I wake up excited for what's going to be in my inbox. I love the Internet, I love what it makes possible for people to connect that are looking for help and it's like Forrest Gump's box of chocolates when I walk in my office here. I get to work from home and I get to make a huge difference I think for a whole bunch of different people which is very, very different. I loved to see patients, I love being a family doc, but the leverage that you have in this kind of a world that's connected by the Internet to help the profession is so much different than helping one patient at a time. It's really apples and oranges but no, I wake up excited and I work probably harder now than I did as a practicing doc and I was a pretty, pretty darn busy doctor, but I'm my work as a mission and it's what I'm going to do till I can't do it any longer.

Taylor: Wow, I love that. So if you were to sum up kind of what your mission or what you want to try do in this world, what would you say it is?

Dike: Well, what I do is focus a hundred percent of my professional energies on figuring out ways to help individual doctors recognize and prevent burnout and help organizations create a work environment that plays its role in in the physician’s health not the physicians stress level. So the culture and systems of an organization can either contribute to burnout or protect you against it and 95% of them actually contribute because the leadership team really doesn't know what to do to build a healthy culture. And an organization that employs 500 doctors is a brand new thing in the history of humanity, so everybody's trying to figure it out. I've just got a little bit of a head start on them because I've worked with so many doctors in so many organizations.

Taylor: Wow, you know I am extremely excited about this conversation like truly. One of my really good friends, Jay is actually working on the culture scene in terms of the entrepreneur’s kind of space and I think that this is something that's still really fresh in medicine and healthcare and I love that you're at the forefront of this. You know…

Dike: Well, I'm picking up the pieces on the far side.

Taylor: Well, there you go I love that you're kind of picking up those pieces. And so in a bigger sense, you know I checked at your website, I have a good sense of kind of what you're doing. For the listeners who aren't aware of who Dike Drummond is, can you kind of tell us a little bit more about the ways you're helping physicians and kind of the training and the camp as well did you have, some of those things that you're doing?

Dike: Sure, let me also go back and earn the right. Right, so I'm a family doc, med school at Mayo, residency in the UC Davis system, went to the Redding Family Practice program when it was a 1/2 program. We managed a little community hospital last two years of my residency, delivered 254 babies, went out and was a full-service family doc and a member of a 40 doctor multi-specialty group for a decade. I was the managed-care medical director; I was the chairman of the executive committee; I was the second highest producer; I ended up delivering 500 babies in the end. When I was 40, 1999 a long time ago now, my practice basically came crashing around my ears when I became incapable of continuing to see patients on a physiologic level, it felt like something in my middle sort of snapped and I couldn't do it anymore. Up until then, I had really enjoyed it. My story is three generations old, I had mom and mom's mom who both wanted me to be doctors so it's a long story. But after I quit seeing my patients in my practice full-time, I struggled for a little while to put food on the table as a walk-in clinic doc. And then ultimately, my now ex-wife and I developed a successful company where we were actually faculty to the United States Navy's, Lean Six Sigma Black Belt certification program, a successful little training company.

When that marriage went away, that business would away in 2010, I was burned to the ground for the second time. So I remember my dark night of the soul too, I remember curled up in the fetal position on the carpet and the floor of my home office, covered my own tears and snot wondering what in the world do I do now? And I was handed this mission in that moment through a stroke and divine inspiration, I've been doing everything I can to live it since that time. At this point, it's been eight years that I've been at this and I have about 2,000 hours of one-on-one physician coaching experience. Several hundred doctors and I have hooked up arms and walked out of burnout together I've worked with 140 different organizations, employer organizations, hospitals, associations, societies, trained about 25,000 doctors on how to recognize and prevent burnout.

When I saw patterns, I wrote blog posts, I turned that into a book. We've sold 36,000 copies of the book now and at this point in time, I also offer retreat. So our latest retreat is the quadruple aim physician leadership retreat. So it's where physician leaders who want to be wellness champions can come to learn how to prevent burnout at three different levels for themselves personally, for their teams, their intimate work teams and for the larger organization. And then I also do consulting with organizations to help create a healthier culture and systems that work more effectively soup-to-nuts, top to bottom so that when you join an organization, it isn't what's the right word, when you decide to leave a physician controlled and owned group, a small group and join a bigger group or you're an employee in a larger system, it's not a step upward in your stress levels.

Taylor: Alright absolutely, and I'm really you know you're such a large picture person but you're also not only hitting it at the bigger levels, you're really taking one-on-one as well and I think that that's kind of the perspective you really need to make change at the multi-level kind of thinking and also the coaching and all those things. So I'm really excited about what you do and I took a look at one of your documents and I really think it's a good start for our conversation in terms of some of the definitions we're working with and kind of the way you communicate what's going on in healthcare. So I looked at this document is the matrix 2.0 and if you go to thehappymd.com website, you can log on and you put in your email and you can get this kind of information sheet and I started looking at it. And right away, I was very excited because you kind of flip the whole burnout problem into a kind of very different conversation, so can we first…

Dike: It's not a problem.

Taylor: Right, so can we first touch on that, so why are you saying it's not a problem?

Dike: Well, when you understand what burnout is, it opens up a window on to all sorts of difficult challenges that we face in modern life that are not problems but in the English language for some reason, we use that word. And I would say especially for a doctor, for a patient because medical illness, those are issues that are not problems either. For doctors, for patients, for anybody in a leadership role, the word problem 95% of time is used incorrectly, so let's just start at the beginning. Problem comes from mathematics it's a very finely defined box. A problem by definition has a solution and if I apply a solution to the problem, what's supposed to happen to the problem?

Taylor: It gets solved.

Dike: It goes away, right. So let's just be really clear, two plus two is what?

Taylor: Four.

Dike: Give me another problem, four plus four is what?

Taylor: Eight.

Dike: Give me another problem, solution to burnout is what? And you're going to hesitate there, right? Because burnout is not a problem, as a matter of fact, the list that we call a problem, list on a patient's chart is not a problem list. Example, problem, things that have a single shot solution in clinical medicine are very rare, but one of examples is a pointing abscess. So if you've got a boil the size of a golf ball with a white head on it the size of your pinky fingernail -- what’s the solution? Right, what do you do? You open it up.

Taylor: Right, okay.

Dike: Incise and drain, right open up just like if you have a pimple on your face, you squeeze it and get the pus out right, done, okay. And I swear to God, family docs would pay me to drop three boils a day on their schedule because it's the one thing in the day you can solve and be done with real quick.

Taylor: I see what you saying, so there's, yeah.

Dike: Real quick though that's not the normal patient, right, the normal patient is a 465 pound out of control type 2 diabetic like they're missing one foot, had both eyes laser, they're in for 90 oxy and oh by the way on their way from the parking lot, they had a little bit of chest pain and you can't squeeze the pus out of any of that because those issues for that patient and the issue of burnout for a doctor, those are all perfect examples of dilemmas. Never-ending balancing acts, you can't solve them, so let's stop using the word problem and the word solution we're talking about burnout. You can address a dilemma only, you could do it really well, but you can only do it if you use a different S-word not solution, the word is Strategy. A strategy is always multiple steps usually just three to five and if I want to reduce the whole conversation around burnout to the simplest form possible, you can't have just one strategy, you have to have a personal strategy. So every doctor needs their own personal things that they do to take care of their energy levels because burnouts about being below zero in your energy tanks. So everybody has to have their own personal strategy, we go ahead and call that resilience if we want to but resilience is never adequate by itself, because we have to remember the situation is like a canary in a coal mine. Everybody who works in a health care organization is a canary, an indicator of the health of the mind, but what about the mind? We have to have an organizational strategy to lower the stress on the doctors and other caregivers in the system.

So if you look at it there's a couple of ways to maintain energy: you can lower your drain, lower your stress level, you can increase your ability to recharge, you can do some of that for yourself, the organization's going to kick in too. So if we do lower stress increase recharge personal organization, we get a two by two matrix and what ends up happening is that our organization now has a list of 235 different ways that doctors and organizations can work together to prevent burnout. If you thought you were looking for the solution that would be really confusing. But if you know you're just looking for three to five things that are unique to you that's a big smorgasbord to choose from and if somebody explains this to you, it should be relatively reassuring. Real quick, the boil that I lanced on that patient, would you put that on the patient's problem list, yes or no?

Taylor: I mean in this case, yeah, I would it’s a problem.

Dike: You're not a primary care doctor, are you, okay.

Taylor: I’m not. I’m not.

Dike: That ever goes on the problem list, all the docs that are listed in here that are primary care like the boil never goes on the problem list. The things that go on the problem list are the things you can't solve. It's actually if we were to be true about the definitions I face in the chart, it would be a dilemma. Either it was a simple problem we can fix it, it never goes in that list. So the labeling error with regards to burnout is pervasive. So if you hear anybody talk about solutions and problem when they're talking about burnout, they fundamentally don't understand the nature of the beast and they've never worked with doctors as a coach, I promise you that.

Taylor: Well and I've never heard you know it's sad actually, I've never heard this conversation talks like that and actually when I was reading some of the matrix, you know some of the topics we were talking about, I was surprised that I wouldn't have heard any of this before and not in this format and I think it's really sad. So, yeah…

Dike: It’s my illusion, man, that's what I say when I'm in front of a group I haven't even talked about the energetic bank account too and the programming of our medical education, these are three things everybody needs to hear as a resident but nobody's teaching it.

Taylor: Yeah, and I feel like it's almost a prerequisite like I feel like this is the first conversation you're going to have to have in medical school. And so just to kind of summarize a little bit, what you're saying is there's different levels to the game, there's the personal stress level you have, there's the personal recharging that you have and then there's the organizational stress level and there's the organizational recharge. And then now let's go on to kind of that next logical step for us which is the energetic bank account, can you explain that to us?

Dike: Well, people often will use the metaphor of the battery. And when we talk about batteries, the image that always comes up in my head as the Energizer Bunny. And the Energizer Bunny comes pounding around all the time but the metaphor of a battery is when your battery runs out, what would the Energizer Bunny do if his battery actually ran out, what would it do such as that?

Taylor: Drop dead let's say.

Dike: He would stop right so if that burnout is something about my batteries or run down I need a recharge, what that would mean is when your batteries run down, you would stop but the problem is doctors never stop, right. If that were actually true this is what I say and I believe it to be true for sure. If that were true in every residency program everywhere in the country, every morning you'd come in and there'd be dead residents lining the hallway and you'd have to scoop them up and throw them on the dead resident pile up front and recruit a new class every single stink a day, but that's not what happens because the truth is it's an energetic bank account and I'm going to get out a pen here and oh, that's a check, I’m going to write at the check. Here it is right, it's an energetic bank account, it's got a full mark, it's got an empty mark that's right here and then it also has the ability for you to be below zero. So what happens is residency in medical school are an environment in which you become very skilled at continuing to function, it's not at your best, we could show that it's not your best work. But you keep showing up and you keep doing the work even when your Energy's below zero. I call medical residency at least it used to be it's not quite the same as it used to be. It used to be the educational equivalent of waterboarding but we would literally hold you under not on purpose, nothing's ever on purpose, but if you look for the justification of why are we trained the way we are trained, it all goes back to I'm going to train you this way because that's the way.

Taylor: That's the way I would it.

Dike: Right, that's the way I was treated. If we go back into the mists of time, nobody can tell you why that is, right. But what ends up happening is we get taught how to function in a negative energy environment. We show up no matter what because if you don't show up even once, you are gone. And everybody knows at least one person who didn't show up in med school or didn’t show up in residency. They got disappeared. What do they call it? Ghosted, they got ghosted, as if they never even existed, right. And so what ends up happening is inside of us are three energetic bank accounts. There's a physical one or an emotional one or the spiritual one. They can be in a positive balance but they can also be in any pattern of negatives too and if you go triple negative physical emotional spiritual energy below zero for any period of time, there are physiologic and emotional and relationship consequences to that because that's what burnout is. Nothing to do with batteries, it's about trying to maintain, figuring out how to maintain a positive account balance for your energy in all three channels.

Taylor: I'm just really excited that you're talking about energy. It's interestingly enough you know in my podcast, it's actually something I bring up a lot. I have asked the question of most of my guests which is what brings you energy in your day and I think is just such an important question. Now, you've kind of broken down and said physical emotional and spiritual energy kind of bank accounts or levels of who you are as a personal perspective, can you tell me like some signs and symptoms, let's talk about the negative side first. Like what are some signs and symptoms of negative physical, emotional or spiritual parts of a human?

Dike: Well, this is where it all starts to interlock because it's basically the three symptoms of burnout, the three symptoms of the Maslach Burnout Inventory, right? So symptom number one of burnout according to the MBI which has been around since the 1970s is exhaustion. So exhaustion that doesn't respond to reasonable rest, physical and emotional exhaustion where you say to yourself there's a little voice in the backyard often says, I'm not sure how much longer I keep going like this. That's a sign of physical exhaustion. That's the first thing that you're pressed on. Sleep deprivation and we could go on and on, it's not nearly as bad now as it used to be across the board but surgical interns still pretty much have it as bad as they ever used to. Surgery is the thing where in the internship year, they literally try to kill you, literally attempt to rub you out just to see if you can take it. Emotional, if you look at the second symptom of burnout, it's cynical, sarcastic, compassion, fatigue, venting, that kind of stuff that is an emotional defense mechanism when you have nothing you're tapped out. And part of the reason that it happens, well, let's just go back. Physical, the reason that that happens is that time demands take away most people's ability to carry out good health habits and we're in an environment where we're surrounded by unhealthy things: sleep deprivation, bad food, you know I can keep going, sick people. So we learn a whole bunch of coping mechanisms that are based on simple survival of residency that are not useful in the long run. They're only for survival and you can survive four years of residency but then what, you're thirty and you got the rest of your freaking career to figure this out and you didn't learn any useful things in terms of self-care habits as a resident.

Emotional energy comes from relationships. And what typically happens is we cone down our relationships to just a couple of colleagues and maybe our first-degree relatives, but a larger group of people that used to interact with and friends and go out and have a social life goes away right, so it's really easy to get to the point where you feel like you haven't got any emotional energy for yet another needy patient. So exhaustion, compassion, fatigue and then the last symptom of burnout according to the Maslach Burnout Inventory is what she called lack of efficacy. Basically, it's where you say to yourself, you know, what's the use I'm really not making a difference here? What that means is that the persons become disconnected from their purpose and if you can't feel a connection with purpose in your choice to give your twenties to a career as a physician, that's a spiritual disconnect. And you have to be able I think to maintain physical and emotional homeostasis in order to be able to nurture that spiritual connection. Because if you whack somebody hard enough, physically and emotionally, you can break anyone and a lot of people are broken along the way to be getting their board certification.

Taylor: Wow, wow, so that was really thorough, I appreciate that response. And as I'm hearing this and I know all my listeners like I have medical students on here at residence are physicians, they're totally going to connect this is exactly what I see every single day. I can think of an example of a resident today who is absolutely exhausted inventing and doing all that stuff, so it's not. You know this is something where I'm seeing every single day, so it absolutely. Now, let's switch this to the positives.

Dike: Can I make one quick point?

Taylor: Absolutely.

Dike: When everybody's burned out the culture will say that you have to vent and that venting is healthy. That's a sign of the level of burnout in that water wing or that service. So when you find yourself justifying things that you know are our signs of burnout because venting is a sign of burnout, if you feel like you've got to vent or you can't go back out there, that's a sign that's not healthy, okay, that's a sign. If everybody's doing it, I know there are plenty of services around the country where the burnout rate is 100% across the board from the ward secretary all the way to the custodial staff. So just watch for that when it becomes pervasive.

Taylor: Yeah, yeah and it's interesting you're saying this. I haven't like opened up to many people about this but I think this is a perfect conversation to say this. In my culture sometimes, I feel uncomfortable to be happy. Because…

Dike: Right, what makes you think you're so special?

Taylor: Yeah, yeah, so it's almost like because the people around me are very exhausted all the time, when I'm in a positive mood, it looks unusual, like there's something wrong that I'm not participating or that I'm not doing something right as if like smiling is a problem. And…

Dike: Well, just think if you let them know that you like EMR and you're getting home with your charts done on time oh my God, they'll stone you.

Taylor: Oh my gosh, yeah, it's just you know and I'm not trying to bash the people I work with, it has not to do that. It has to do with the fact that on a kind of global level, I think there's a problem and we got to figure out solutions and that's exactly why I'm kind of talking to you obviously.

Dike: There's that it's a dilemma, we need some strategies, the tool that created a strategy.

Taylor: There's a dilemma and we need some strategies to kind of solve this dilemma, I love that. So now let's flip this conversation to the like upper tiers of energy in terms of what we might see physically, emotionally, spiritually, what is our ideal example, what does that look like in human being?

Dike: Well, set the trigger for thrive not survive. Set this trigger for optimal not minimal, right. Most people only learn how to take care of themselves physically, emotionally, spiritually in recovery from one of their episodes of burnout because the incidence of burnout across the lifetime of a medical career is well over a 100%, I'd put in at 200 or 300% but I got 2 going, right. Most people I know with my amount of gray hair of two or three episodes of burnout, but hopefully, they’re learning experiences and you come out a better adjusted, healthier, happier person on the far side, but I think that there's an inner aspect this. So for instance, gratitude is super important because we're trained to notice disaster all around us.

Taylor: Right.

Dike: So there's an inner game of how you're being and there's an outer game of what you're doing and the what you're doing is fairly straightforward, right: eat good food, get plenty of rest, exercise, stay healthy, right, keep connected with your friends, have time outside of work, have a boundary ritual so you can let work go and separate yourself from the worries and all that kind of stuff. But one of the most fundamental things that is hardest to get a doctor to do is to see anything worthwhile going on in the world and I want to just point out just right now. Because again, there may be medical students and residents that are listening that are in the act of being conditioned. I just want you to know the act of a differential diagnosis it's pure abject paranoia. And what I try to do is help people throw differential diagnosis in reverse because it can be used in reverse as a gratitude tool. So for instance, differential diagnosis. See this purple spot on my wrist, what are eighteen ways I can die from that? Okay. So what I tell people is if but Taylor and I became good friends we went on a vacation to New York City and if we were in the balcony over Grand Central Station, looking at where all the people are down below, right, we would look out as doctors, we would look out over that scene down below and it would take us each about ten seconds and at the same time, we would see the one person down there who's limping. Now, there might be 10,000 people down there but we'd see the one who's limping and then we'd get in an argument about whether it's a hip or their knee and only doctors do that.

In the same span of your eyes there's a man on his knees, proposing to his girlfriend that she's crying, right. There's another one like the soldier scene after the Second World War, he's kissing the girl and her foot is up in the air. There's a little girl with the dog we don't see them at all. We see the limping one, right. So to get doctors to be grateful is difficult. To get them to see how magnificent the world is … that’s difficult. For instance, do any of your teeth hurt, Taylor?

Taylor: No.

Dike: Are your underpants dry at this moment in time?

Taylor: Surprisingly yes.

Dike: Excellent, so we could just as easily right now is do anything else, we could be grateful for your non toothache, your dry underpants. Let's just keep going. Indoor plumbing, hot water, right roof over my head, clothes on my back, I could keep going it's a reverse differential diagnosis. How many ways are things perfect right now? And you know that you're entering at that place where you become stronger and stronger as an individual when it takes more and more to knock you off center into being Eeyore or and seeing only what's not working and more and more robustly about yeah, that was unfortunate. But you know what, things are in balance are really pretty damn good. And it's not about trying to convince somebody in a bad situation to do positive pop psychology and just blow it off, yeah, you do things in your own interest, you create your strategy but you'll also have some room and your psyche to overcome your programming and notice what's going right in this moment.

Taylor: Yeah, wow and you know as you're saying that, again, this conversation is not happening. You know there's nothing about this reverse thinking in terms of what am I grateful for right now, what are the good things that are going on? And you know often even in terms of feedback, when you ask for feedback, we're not, there isn't always a lot of positive talk in that feedback. It's usually focused on well you really should have done this in your physical exam and you should have done this, you needed to consider this in your differential. And so I think you know there's definitely some room in terms of kind of adding in a lot of positivity for sure.

Dike: There's a room for mentorship and feedback and feedback is not always critique, right. So the habit of hammering somebody, right, belittling somebody, bullying somebody – ripping them a new one because they didn't get something right in the differential diagnosis, that's just a habit and it certainly is not the best way to learn, but it's quite common.

Taylor: Yeah wow, so you know we're talking about burnout as a dilemma. We talked about the fact that part of that dilemma or issue that arises is the energy that an individual has and also the energy within the organization, the stressors and recharging. We talked about those parts of it and you kind of already gave us some almost strategies within this, what are some of your favorite strategies that you talk to people on a personal level?

Dike: One of the big ones is simply to acknowledge that we're conditioned along the way, usually I mean I'm a family doc four years in medical school, three years of residency: seven, I've seen people with as many as 16 years in medical education system. But we're conditioned to be workaholics, superhero, lone ranger, perfectionist. It's part of the reason we applied to medical school in the first place because we had those as character traits: superhero, workaholic, lone ranger, perfectionist: they were some of the things when you use them as tools, they gave us the grades for us to be optimistic that we could make it through the medical education system. But then for the rest of your career from that point forward, you're going to use those every single day we tend to become those things. And the conditioning leads to automatic behavior. So for instance, a workaholic only has one coping mechanism.

Taylor: More work.

Dike: Work harder and workaholics aren't particularly creative, they double down doing the same thing each time. And so typically, when I meet somebody and I'm coaching them, they've done the same thing for so long that they've literally busted themselves against the wall, they can't go any farther. So it's important to know that a lot of the behaviors that you have and your significant other will tell you this. I mean they don't understand it, either most time when I'm training about burnout prevention, it's with significant others in the room so their couples are there so they can help each other out. But these automatic it's important to recognize them, it's also important to figure out a boundary ritual, meaning figure out a way to leave work at work especially if you're not on call that night. So for instance, you know you have not gotten an effective boundary ritual when you find yourself sitting at home thinking about work. Has that ever happened to you, Taylor?

Taylor: All the time and also when I am not responding in timely manner sometimes I've been punished.

Dike: Of course.

Taylor: So you know not only it has that happened obviously, I'm encouraged to respond quickly in those types of things, and that I think that's true for a lot of hospital systems.

Dike: Well and I'm not talking about a time when you're carrying a beeper or you're on call in house. I'm talking about you're off, you're off right, you're legitimately off, if you were a shift worker you would have punched the clock and this was a day when you're off the clock and you're at home, are you still thinking about work? Yes, because nobody's ever taught you a way to segment, to provide boundaries between work and home and it's basically a boundary ritual, I teach, there's any one of a hundred of them but all you have to do is at some point on your way home from a day of work, especially know if you're on call or you're going to chart later on that night we can talk about that at some other time. But I'm just talking about on the days when you come home and you're not on call and you don't have anything else to do with work, to do something where you say to yourself, with this action, I'm coming all the way home. Take a big breath, use your OB lips if you want, right with this breath I'm coming all the way home.

Taylor: I love it.

Dike: Right and it doesn't matter what it is, right. So for instance, a lot of people do this spontaneously already. So I talked to a guy the other day, you know sixty-year-old guy, said for ever since I graduated from residency, my whole family knows that until I come home and change my clothes and look at the mail, you don't talk to me. That is boundary ritual. Takes him about 15 minutes but nobody even looks at him until after he's done opening the last envelope and he's changed his clothes. It could be any one of a thousand things, but the mentality is with this action I'm coming all the way home I'm letting the doctor off my back.

Taylor: Wow, I love it, I love that. So you mentioned the boundary ritual which I think you know you're mentioning you coach a lot of people that sounds like a really, really big issue and you mentioned earlier being grateful as some of those strategies. And when you're looking…

Dike: Just noticing what's going right because our whole profession is noticing how many different ways that little spot on your skin could signal something going horribly wrong.

Taylor: Right and like you're talking about before in terms of habit forming and conditioning, we're creating this habit of just focusing on the negatives. Now, we're doing it to our patients but I'm sure that reflects in our self-talk as well.

Dike: When we become Eeyore, if you remember Eeyore right, all well where's my tail? And I would say, another thing that's really important to your listeners who are in medical school or residency is to maintain as much breath as you can in your relationships and your interests. So for instance, when a person decides to go to medical school, they may have a very well-rounded life, lot several hobbies, large groups of friends associated with the hobbies. For me, what got me through medical school and residency was I played rugby. I was a captain of the rugby team in the towns where I went to medical school and residency. And if it wasn't for banging heads and drinking beer on the weekends, I don't know how I would got through it, right. But what ends up happening is when you cone down your life to just your studies, you jettison all your friends and your hobbies, there's this act that goes on where I always imagine it like this. Imagine a deck of cards fanned out in your hands and these are your friends and your hobbies and what you do is you fold it up into a deck and you give it a kiss and you go, I'll get back to you one of these days. One of these days, I'm going to get back to you all and then you slide it in your back pocket. And what happens when you burn out at the age of 50 is you notice that it's still in your back pocket and you get out your old SLR camera and you start doing photography again and join the photography club downtown and start to become more of the person, the trajectory you were on before you entered the black hole of the medical education system. We got to make doctors, we got to imbue everybody with all the skills and the awareness of being an effective doctor, we just need to do it in a way that doesn't take such a toll.

Taylor: I love that no, absolutely and you know one of the things we talk about on this podcast is maintaining those creative parts of yourself. You know we talk about like the left side, you know logical side and the artistic side and we're just all logic and then there's none of that artistic creative, none of those juices that really got us going. Actually, you know for me, I talk about this a lot is that the podcasting and stuff like having this conversation, like opening up my doors to networking and making friends and talking to people online is just energetically very exciting for me and it's one of the reasons I can smile at work and they don't get it, It's like come on, anyways.

Dike: Well, let me let me slow it down and show you what's going on, okay.

Taylor: Yeah.

Dike: So for some people, they insist that their creativity, their creative focus and their purpose come from their profession. It doesn't have to be that way, that's putting a lot of pressure on your profession, right. So one of the things that can sometimes happen as you get some practice experience under your belt is you can realize that I can go into work and I can have a great time being a doctor and I can do my job and I can draw a boundary when I'm done and I can find my creative outlet and I can find my purpose outlet elsewhere not at work. I don't have to push all of that into my career if it's not obviously there for me. And so you see people who I just talked to another guy, they’re training in New York just the other day, said yeah, when I turned 50, I started flying jet helicopters. Then there’s you with podcasts, right. You don't have to put the pressure on all of your purpose and all your creativity coming from your vocation.

Taylor: I love that and I think the difficult part is think about how much time is spent in the vocation right, like how much time do you spend in medical school, residency, surgeons like that's all their time and then to tell them that that's not who you are or that's not entirely your purpose, I feel like it's such a hard pill to swallow in some ways. That you're saying wait, I'm more than just a surgeon, I think that's you know a really difficult part.

Dike: Well, it's not like we're telling him they're more than just a surgeon, it's that you wake up in your 40s because you were in school until you were 35, right and you say to yourself, is this all there is? Because I can be a Rockstar surgeon, how whatever if that is the apex of my life before I die. There's a search that's going to happen for where that level of fulfillment comes from. And surgeon is in box, surgeon is you got it. I got the skillset, I got the 10,000 hours, I'm really good at it, right. I'm on autopilot when I'm doing certain things, it doesn't take a lot of investment of time and energy for me because I've reached a level of expertise. But you know my grandkids or where it's at or my jet helicopter or my podcasts.

Taylor: Yeah, well, I love that so you know Dike, I feel like I could talk to you for hours about this and I actually think I'm going to definitely need to welcome you back on again because…

Dike: I warned you.

Taylor: I know yeah, I mean I can tell you're going to have a lot of great messages for my listeners. And what I would like to say is it's been an absolute pleasure to have you sincerely. I think just like the information you're giving is definitely gold and I can tell you definitely, Coach because you're pulling examples from people's lives: that you know you've had those personal experiences and it's extremely helpful. So something I'd like to ask you know all of our guests that we have on is what is a tip or takeaway you want to have from this conversation today? You’re really thinking deeply about this one.

Dike: Well, I'm trying to think it's something that would be meaningful and I guess the most important thing is it's okay to be human. It's okay to cry to be in pain, to ache, to love, to pray, to fail, to miss a diagnosis, to sit with a dying patient all of these things that are human that are things that in some cases you may feel that people are asking you to ignore. So you're not supposed to feel things for your patients, you're not supposed to cry, you're not supposed to mourn, you're not supposed to do this, you can't not do it, you can't not do it, otherwise you're a robot and people can't heal, they can't have a healing encounter with a robot regardless of what you may have seen on Star Trek next generation, okay. So be human, honor your humanity, take care of your human physiology or emotionally, do that too even though most training programs have tried their best to beat that out of you, believing that that's the only path to being a functioning doctor, it's not. And you don't have to wait until you're a first or second or third episode of burnout to learn those lessons, you can practice your humanity now.

Taylor: I love that and in true preventative, you know medical practice and action. I think if we can start doing that as early as possible, especially for my medical student listeners, you know if we can start to practice, you know those principles I think we'll get a lot more out of our training and maintain a lot of our energy before we get super exhausted. So again, I really appreciate you being on today, sincerely a pleasure. And everyone, you can find Dike Drummond on thehappymd.com. Is there anywhere else that they can reach you?

Dike: Oh gosh, I've got Facebook page: TheHappyMD.com, I got a couple Twitter accounts, I mean I'm on YouTube, I'm all over the place.

Taylor: Fantastic, so we'll leave those notes on the website as well so people can come check you out and thank you so much for your time.

Dike: Absolutely, my pleasure Taylor, keep up the great work.

Taylor: Thank you so much.

CONCLUSION

Thank you so much for listening to The Happy Doc podcast, the voice of fulfilled physicians. If you enjoyed the episode, please drop us a like, comment and share, share through the social media channels we have on Facebook, Twitter and Instagram. The handle is @happydocpodcast, that's @happydocpodcast. You can find our website at www.thehappydoc.com. Again, thank you so much for listening to the happy doc, the voice of fulfilled physicians.

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