White Coat Wellness Podcast | Episode 12 | Beyond Physician Burnout

Posted by Dike Drummond MD

stop-physician-burnout-podcast-dike-drummondStop Physician Burnout Podcast with Shane Tenny CFP

The financial planning firm of Spaugh Dameron Tenny hosts the whitecoat wellness podcast. I was a guest last week and we covered a lot of ground. Here's the podcast link. The transcript is below and here is some of what we covered.

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Stop Physician Burnout Podcast Transcript:

Shane Tenny CFP and Dike Drummond MD, CEO TheHappyMD.com

Topics:

  • Symptoms, complications and prevalence of physician burnout
  • The causes of our modern physician burnout epidemic
  • How to prevent burnout
  • Coaching as a treatment and prevention method
  • How organizations can play a role in burnout prevention

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TRANSCRIPT

Shane:                        

Dike, it is great to have you on our White Coat Wellness show today. Thanks for being here.

Dike:                           

Right on. Great to be here, Shane. Thanks for inviting me. I appreciate it.

 

Shane:                        

Absolutely. Well, I know you've got a lot of information to share and a lot of passion around this topic. Can you just start by giving us a little bit of your background?

How did you get drawn into medicine? What were those early, early years like for you?

quadruple-aim-physician-leadership-retreat

Dike:                           

Yeah. My story is a little bit different. Everybody's got a different story, but mine is multigenerational.

So, for me, my grandmother, my mom's mom in the 1930s went to the University of Illinois and wanted to be a doctor. And she would have been one of the first female doctors around if she had accomplished that feat, but she came back as a teacher which was a common diversion for somebody who wanted to be a helper. My mom, when she went to the University of Illinois in the `50s wanted to be a doctor, came back a teacher.

And here I was 3 generations in, the first born male grandchild. And so, from the time I was born, I was gonna be that doctor. But in my family, it wasn’t something they were verbal about. They didn’t say, “Dike, you are always gonna be a doctor.” And I thought I had an interesting idea as a senior in college and said, “This biology honors degree is perfect for premed. I’ll apply to some schools and see if I get in.”

I got in at Mayo and graduated in 1984. And I went on to be a full service family doc in a little town called Mount Vernon, which is halfway between Seattle and Vancouver B.C. on Interstate 5. Have you ever been to or heard of the American San Juan Islands? It’s where you get off to go to the Anacortes Ferry Terminal.

So, there I was a full service family doc for 10 years and I loved. I feel like being a family doctor is half detective figuring it out, half teacher. Teaches a person how to take care of themselves. I always felt like my 3 doors, my 3 office doors in the back corner of our little wing were like Forrest Gump's box of chocolates. Right? You just never know what's in there. And I was a physician leader in our 40-doctor multispecialty group, chairman of the executive committee, that kind of stuff, and a full service family doc. Second highest producer.

Loved it, loved it, loved it until I didn't.

And then for me— I’ve never heard anybody tell this particular story. Again, everybody is different. For me, it was a very powerful physical sensation that started when I was 40 in `99. Over about 3 weeks, when I went to the office, it felt like somebody was putting me in a chokehold. In the UFC, they called this a rear naked choke. They get on your back. They put their elbow around your neck and choke you out. I didn’t know what it was.

I thought my batteries were running down. By the way, that's one of the misperceptions of burnout. We can talk about that later if you’d like.

And I took that 30-day sabbatical, shaved my head, did a bunch of yoga. I didn’t do any health-related stuff hoping that I would be better when I came back and I wasn't. The very same morning that I started to see patients, again, that feeling returned.

So, what I did and I don't recommend this as a transition strategy is I walked into the CEO's office at lunch time that day and I signed my resignation. I walked away from my medical career.               

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Again, that's not a great transition strategy, but it’s a common sentiment if you're really burned out. You know, fight or flight. Get out of there. Preserve yourself. So, if anybody listening to this podcast is feeling that way like you have to quit and you're considering walking away from your medical career, I don't recommend that you do that.

And what we've developed as a coaching capacity where we could in a free phone call talk to you about what options are there and show you some other ways forward ‘cause me walking away like that set me up for about a decade's worth the struggle. I put food on the table as a walk-in clinic doc.

And ultimately, my now ex-wife and I— and I can complete that circle for you in a second— my now ex-wife and I actually started a training company where we were faculty to the U.S. Navy's Lean 6 Sigma Black Belt certification program. And Lean and Six Sigma are things that are used in healthcare for process improvement.

And in 2010, that business and that marriage went away. I was burnt to the ground for the second time and I had been a coach for about a decade.

I got certified as a coach right after I quit practicing medicine. So, I opened a little website that was supposed to be just for me to build a coaching company and I called it the Happy MD. And it’s supposed to be an oxymoron. It has a little smiley face, yellow ball in a field of frowny balls as my logo across the top of the page.

But 2010 is when we started and that's an auspicious date because that's when EMR started to really kick in and overload the doctors. Burnout started to crest. A lot of interest happened around burnout.

So, we've been riding a little bit of the wave. And at this point 10 years later,

And so, what I've done is focused on helping people recognize and prevent burnout for the last 10 years. I’ve got my 10,000 hours under my belt. And I’m super driven about the whole issue because fundamentally it doesn't have to be this way.

 

Shane:                        

Yeah. So, you’ve just laid out an enormous trailer to the conversation that we're gonna be having here and I got to ask you to rewind because I'm struck by something that I think is a really important part of your story. I wanna make sure I'm hearing it right and make sure that our listeners are, which is you were loving your practice.

 

Dike:                           

Oh yeah.

 

Shane:                        

You were in a large group. You were in leadership position. You were loving the patients. And it sounds like the symptoms that you began to manifest came acutely and from nowhere.

Is that accurate or were you progressively feeling overwhelmed, stressed, burned out, that sort of thing? Talk a little bit about that.

 

Dike:                           

I don't recall it being that way. But again, my history is multigenerational. I came upon medicine almost as an afterthought as a senior in college, but it had been my grandmother and my mother's core desire. So, at the age of 40 in 1999 when this all happened, my grandmother and my mother were dead.

And the other thing that happens and it's one of the causes— it's one of the key factors to burnout in primary care doctors is a primary care doctor often will have a connection with a passion and excitement. They'll feel most involved in their practice when they’re occasionally seeing things they've never seen before. So, for us, this is cool.

"I've ever seen this before"
... which in some cases because the psychology is different between a specialist and a primary care doc, primary care doc can rely on the relationship with the patient to bring them back if we don't get the diagnosis right the first time. We're okay with that. We like to see new things.

A specialist would like to be able to wrap their brain around a confined body of knowledge and maybe get more routine things. They like routine rather than excitement or new things.

So, for a family doc, typically about 10 years in, 10-12 years in depending on how many patients you see a day, what will happen is the frequency of those new patient encounters you’ve never seen before will start to drop off and you’ll start to get bored with your practice. So, my Forrest Gump’s box of chocolate sensation had started to taper.

At the same time, my mother and my grandmother died and it was just this perfect storm where, yeah, I really love to be a doctor. And for whatever reason, that chapter in my life closed.                            

And it closed. The lid cracked down on it. It didn’t take hardly any time at all.

 

Shane:                        

And in 1999, the topic of burnout didn't have as much global awareness as it has now. What was it like socially for you among your peers, your family when you said— you know, going to the CEO’s office and saying “I can't take it, I'm out”? That sounds like a big change and a big stressor.

 

Dike:                           

Now, people thought I was crazy. I wondered whether I was crazy, lunatic. Right? You give your 20s up and you only practice for 10 years and now you’re gone. Really?

Most doctors at some point in time have to make a decision whether or not they're in this for the long run. And that decision point typically comes in your 40s and 50s. And most financial planners will say, “Hey, you know, you're in the catbird seat on still what is a traditionally high income. I wouldn't throw that away without some financial plans to take care of yourself, and your family, and your legacy.” But for me, I knew that I couldn’t physically continue to do what I had been doing.

It felt like an act of self-preservation. And what's interesting is there is a common perception that doctors are leaving the profession in droves. That's absolutely not true. If you ask doctors if they'd like to find another way of making a living, a bunch of them will say yes, but they’re not leaving.

For most people, I'm the only person that they know that actually has created a parallel career to their clinical activities down the road. And just to be really clear, burnout was known and studied and known to be 1 in 3 amongst physicians prior to the early 2000s to 2010 or so.

And the thing that’s driven a lot of the interest in burnout is, #1, the contribution of digital overload and the EMR to a physician’s workload when the organizations they work for don’t staff up for that workload.

And two, all of a sudden the majority of American doctors are employees. So, their employers have to worry about how to tend to a group of doctors and doctors are not easy to tend to. It’s not easy to keep them happy and productive.

 

Shane:                        

Let’s elaborate on this a little bit. I've got 2 questions forming in my mind.

One is for all our sake, what is burnout? Can you give us a level set there? What is burnout?

And then if you were talking to your 40-year-old self and knew then what you know now, what would you have told yourself?

 

Dike:                           

So, burnout. Classic symptoms of burnout, there are three and they go like this.

One, exhaustion. Physical and emotional exhaustion. In your head, you’ll typically hear a voice that says something like this in English. I'm not sure how much longer I can keep going like this.

Symptom #2 is compassion fatigue. It's when you lose the ability to be empathetic for your patients and you finally become cynical and sarcastic.

And symptom #3 is what's the use. You begin to lose the connection with the purpose in what you do.

And so, if somebody is feeling I'm exhausted; I'm not sure how much longer I can keep going like this; I'm cynical, sarcastic, and complaining about my patients; what's the use of my work; I'm really not making a difference, usually their energy is in a downward spiral and you may actually have— And this is very common fantasy. I wanna put it out there because it’s a big red flag for anybody who is listening here. You may actually on the way to work have this voice in your head and go, you know, maybe if I’m lucky I’ll get hit by a car in the way work and I won’t have to see patients today.

Now, most doctors chuckle when I tell them that, but that’s a really big red flag that your energy reserves are in such a negative state, right, that you'd rather get a soft checkout and avoid seeing patients and you rather continue to do what you do.

So, that symptom complex and you don't have to be suffering from all three. Most of the people that hire me as a coach, what they tell me is “I'm exhausted. I hate my practice, but I still love my patients.” So, what they're doing is they got symptom 1 and symptom 2, but they still see purpose in what they do, right, and they still can connect with the patient now and then. It gives them some juju, some good energy.

But that constellation of symptoms in a physician has been absolutely and rigorously linked to a number of terrible things. Terrible things for patients and terrible things for the doctor. So, for the patient, burnout has been linked to low patient satisfaction, medical errors, malpractice suits, low care quality, staff turnover, doctor turnover.           

For the doctor, it's linked to depression, alcohol, drugs, and suicide. And as a matter of fact, physicians have doubled the rate of suicide of nonphysician people. Regardless if they’re men or women, their rate is double at the point where you made the choice to become a physician you doubled your suicide rate.

So, that’s burnout and that’s why it’s important. And your second question again was?

What would I say to myself, yes.

Shane:                        

Yeah. Absolutely. Because your manifestation was very physical and acute and in fact it sounds like significantly contributed too by the external factors of your mother and your grandmother passing. Those were things—

 

Dike:                           

Well, again, those did occur. You know, this little game of what would you do if you could go back— Well, hang on. First of all, I forgive myself because I didn't know then what I know now. Now, certainly from this position of 20 years later, yeah, I could go back and give a lot of advice, right, but I didn't have those tools back then.

Burnout was not something that was acknowledged in the workplace. There wasn't any focus on it. And again, our culture as doctors, people didn’t reach out to me and asked me how I was doing. They just were thanking their lucky stars it wasn't them. Pretty straightforward stuff. Right?

 

Shane:                        

Yeah.

 

Dike:                           

So, knowing what I know now, I’m glad I did what I did.

I got out of there. It took me 10 years to figure out to be handed from a divine source— The works that I do today took me 10 years to put myself in that place. And the struggles that I've gone through since I quit practicing medicine are all things that I used today every single day in the work that I do.

What I do as a coach consultant, as a helper in this particular field is often known as wound work. Right? There’s 2 things you can do when you've been wounded. You can be ashamed and you can hide away or you can say, “Look, I have survived the wound and it looks like you've got the same wound. I'd love to share with you my journey so that hopefully it would help you with yours.” And that’s what I do.

 

 

Shane:                        

You were describing a few minutes ago how your work as a coach I guess around the 2000-2011 timeframe has coalesced almost with a perfect storm through the mandatory adoption of electronic medical records and other type factors.

I guess I'm curious is physician burnout an issue that is unique within the U.S. or is it affecting providers globally?

 

Dike:                           

It's affecting providers globally. My experience in other countries is that everybody else is having at least as much struggle as we are and many areas are much worse because, in United States of America, at least we still have a reasonable size healthcare sector to our economy and we’re still 17% of the GDP. We still spend 5 times as much on healthcare as any other country.

If you take money out of the system and you take doctors’ salaries down to that of a midlevel government employee like in an NHS in England or if you go to South Africa, if you go to a second or third world country and imagine being a doctor, it’s just awful.

So, I always think about the healthcare issue with burnout in the United States being sort of like environmentalism in the United States. If we can't be environmentally responsive, no one can because we don't have people burning down forest to plant sugarcane. Right?

So, if we can’t figure out burnout here with 17% of the GDP involved in healthcare delivery, then nobody's going to be able to do it.

And I know from my experience 23 years of playing competitive rugby, I know how to lead, and motivate, and go to battle with a team and I know that what we're looking at is just a massive failure of leadership in the healthcare branch. It doesn’t have to be this way. It just happens that way.

And it's more than EMR. It's actually, like you said, a perfect storm. For me, it appears as a tidal wave of demand for what we do, but the perfect storm is one of digital overload. The workload for a physician to cope with the digital overload, which comes from multiple different locations.

It's not just EMR— I have clients who have scribes that do all their EMR work, but it's still not enough ‘cause they got patient portals and you got all these quality indicators you got to do. You’ve got texts, and you’ve got emails, and you've got all this stuff coming at you from different directions.

And EMR was designed by somebody who’s never seen a patient. It’s not designed for ease of data entry. I don't know that we've seen any benefits from the big data that we’re promised.

But EMR and the fact that you typically don’t own your practice anymore, you've got an administrative structure above you of nonphysicians oftentimes that think that a spreadsheet can tell them what's going on in the frontline of healthcare. People have never had anybody bleed on their socks, right, or cough on their face, that kind of stuff except their own kids. So, that’s this loss of autonomy.

And we have the acceleration of the advancement of treatment and diagnostic options. I mean look at your television at night. All the different drug commercials. The biologics. I love whatzit-dumab and all these crazy names. Right?

You've got Google in the pocket of every patient who comes in to the office. So, they're absorbing the true and false narratives about what they’ve got and how you treat it. Right?

You've got 25 different kinds of healthcare insurance that your patients used to pay for their treatment and I’m supposed to understand that stuff. By the way, go to a single payer country and just watch how they work. Go to Canada. They don’t have a business office. They bill the government and they put in their bank account a week later. Why do I need a business office? Right?

So, there’s all of that.

 

Shane:                        

I wanna pick up on a question. You bring up the topic of just administrative oversight, right, the shift within medicine from independent practices to now hospital-owned practices. Is there any data that you're aware of on the rate of burnout amongst private practitioners versus hospital owned or group practices?

 

Dike:                           

Yeah. There is some data on that. I am not the person to ask the questions about it, but there was a study that I recall from a couple of years ago that the headlines off of that study in the press said that doctor were less burned out when they’re still on their practice.

Let me just point out. They don't teach you how to be a business owner in medical school. So, there’s nothing to suggest that there's less burnout if you're also trying to run your practice.

And what I have seen is that I have seen a certain percentage of physicians in the past— These are people my age. I'm 61 at this point. These are boomer style people who did have business savvy, and they were entrepreneurial, and they were able to create practices that had a physician leader, but I find that those kinds of people appear to be becoming more rare.

 

Shane:                        

Uh-huh. Uh-huh. Yeah. I was gonna say running your own practice has its own level of stress.

 

Dike:                           

I’m talking about somebody who— You know, like the practice I worked for, it was 4 guys came back from Korea and made a group practice. And 3 years later, there were 40 of us. We still had physicians at the top. I find that story is not— It was generational and it doesn't appear to be being repeated right now. 

 

Shane:                        

Yeah. Now, among the causes of burnout, is it always— always is not a fair word to use. Is burnout a multifactorial issue that needs to be thoughtfully considered or are there consistent themes or causes that you see as you’ve worked on the issue?

 

Dike:                           

Yes. It is always multifactorial and there are themes.

So, when I started to coach people after I worked with about 40 docs, I started to see super strong patterns in five distinct areas that I called universal causes of burnout. So, these are things that everybody has to understand and cope with. Again, you don't learn this in your education though, but it's what I teach.

And if outside of those five there are hundreds more things that could be your last straw, but everybody's got to cope with these five.

I'm assuming you'd like me to go through ‘em here.

 

Shane:                        

Most certainly.

 

Dike:                           

Okay. One, you chose to be a doctor.

And the doctors who are listening right now, remember that point in time when you were at the fork in the road where you were trying to make a decision to go to medical school or not? You were thinking about going to medical school and all your friends were thinking about doing anything else. You’re crazy going to medical school, right, ‘cause you knew it was gonna be long and hard.

And you may not realize this, but the choice to become a doctor means you chose to work with people who are sick, hurting, scared, and dying and their family members are crazy. It tends to deal with that stuff for the rest of your career and that's not easy.

And you're gonna lose every patient you've got.

You're gonna kill some of ‘em by your own hand even though you're not trying to and you're gonna be traumatized along the way.

And oh, by the way, you just doubled your suicide risk. So, that choice to be a helper, to be a light worker has consequences. And much of the time when you go in to work just because of the nature of your work, you're not making widgets, serving hamburgers. Right?

My son's a digital artist. You're not making digital art. Right? You’re going to sick, hurting, scared, dying people and their crazy family members. Right? That's one of the major stresses or burnout that nobody prepares you for.

Talking to doctors about this is like talking to a fish about water. Right? None of your patients wanna come to see you. Oh, yes, they do. My patients love me. Your patients love you because they have a disease. If they could go back in time and not get their disease, they would gladly have never met you. They don't even wanna come for a physical ‘cause you might do what. Now, you might find something. And do you find good things? Have you ever hold a winning lottery ticket out of a random orifice of one of your patients? Yes or no. So, that’s #1.

Second is you’ve spent your 20s trying to become a doctor and now you’re gonna jam your practice into a job and it doesn’t matter what job you take. You could be employed by a large group. You could have a solo practice that’s concierge and takes cash. But jamming your practice of seeing people who are sick, hurting, scared, and dying into any job situation adds layers of stress to your day like the EMR, your call rotation, your compensation, your relationship with your boss.

So, jobs always add stress.

The third one I’ve seen over and over and over again is poor leadership causes burnout.

There's a phrase in industries outside of healthcare that says people don’t quit the company, they quit their boss. So, we've actually have research data that shows that your relationship with your boss, if you have one, is primary determinant of turnover and burnout.

And so, one of the things I teach is how doctors can manage their boss because you didn’t graduate from medical school to be stuffed into the middle of a bureaucracy with a whole bunch of layers above you. So, that's a skillset that’s important to learn.

The fourth cause is life because we all have a life. It would be nice to say, “Hey, after I go to work, I can recharge every night because my life is just awesome.” But everybody's also got a life. And so, you know, just talk about kids for a second.

Things change when you have your first kid or your eighth kid or you’re an empty nester or what if you have a special needs kid, or twins or triplets, or twins in driver's ed. And money can come in here too.

Money is a part of your larger life. If you're worried about money, it could be a stressor that tips you over into burnout.

And by the way, my simple advice is I'm gonna say 2 words. Those 2 words are net worth. And if you're listening to this and you’re saying what's that, then you need to see a financial planner.                                   

Get a plan. Get a retirement trajectory because I work with a lot of doctors who are afraid of money because they've never sat down and looked at what's in all the buckets. And when they do that, they typically feel better.

So, the first four, the decision to be a doctor, your job, leadership, life.

And the last one is the conditioning of our medical education system.

We were selected. We selected ourselves to be doctors because we had certain personality traits that were different than our colleagues in high school. It's why we chose to go to medical and they decided to do anything else. And those character traits, a list of them are super hero, Lone Ranger, workaholic, perfectionist. Superhero, Lone Ranger, workaholic, perfectionist. We have those traits and we use them to get the grades that gave us confidence to go to medical school. But as a doctor you're gonna use those things every day for the rest of your life. And we tend to become superhero, Lone Ranger, workaholic, perfectionist and that has consequences. Workaholic only has one coping mechanism. What is it?

 

Shane:                        

Work.

 

Dike:                           

Work harder. Workaholics are typically not creative. We typically double down on the same thing, which is another way of saying do the same thing over and over again and hope for a different result which is Einstein's insanity trap. Are you with me?

So, doctors naturally and automatically when they fall into burnout double down and exhaust themselves.

And we also learned that there's two prime directives that are part of this programming. The patient comes first. Everybody acknowledges that. And I just always start my trainings by saying can the patient come first 24/7 365 and you have any hope of being a normal human being?? To which the audience says no and then I ask have you taken some off switch lessons on that so maybe you could turn that switch off when you get home and they say no. And so, that's one of the big things we teach.

And then the second of the prime directives of healthcare is never show weakness.

So, needing some time, needing to rest, needing to ask for a break, doctors will not do that because they're afraid it would be perceived as a sign of weakness.

So, all of that, we’ll call it superhero, Lone Ranger, perfectionist, patient comes first, never show weakness is our programming and it is a proximate cause of burnout. And residency is not a place where you’re learning to take care of yourself. It’s something you survive.

 

Shane:                        

Yeah. How are you and your fellow coaches at the Happy MD— How are you addressing this? What's the approach? What's the antidote that you are advocating?

Dike:

All of our coaches at the Happy MD are physicians. Together we have 173 years of cumulative practice experience. We're also certified by the ICF as executive coaches and they've also been handpicked and trained in these techniques by me, but the key is always this.

When we meet someone, they’re not doing well. A doctor asking for help from a coach by the way is a very extreme circumstance for them. It's not common for a doctor to ask for help because you would have to violate all of your programming and your medical education, although world class athletes have coaches all the time. So, there's a difference in attitude. Right?

But when we meet people, they wanna tell us all the stuff that sucks, all the things that are happening to them. And that’s natural because they're in distress. And what we do is we stop that right away.

We say, “Look, I wanna hear all the stuff that's happening to you, but I just don't want to hear that first.”

And what we do is we work really hard to torque the doctor’s awareness to in an ideal world what would you like your practice to look like and here's why.

Burnout has a highest and best use. It’s there to knock you onto a path with more purpose. It’s there to help you live a higher quality life if you survive it, if you don't become ill because of it. And here's the true that the point of contact that we meet people. I'm gonna say this twice because it takes a minute to sink in.

You can avoid everything you don't want and you still won't get what you want because there’s only one way to get what you want and that's to figure out what that is and then go get it. So, they're almost opposites of each other.

  • If you're talking about what you don't want, you’re facing in one direction and you can avoid everything you don't want and you still won’t get what you want now.
  • Now, I'm gonna turn 180 degrees and face the other direction because what you want, right— To get what you want, you have to decide what that is and go get it.

And doctors are ever since they started medical school, they've never thought about what they want. They just tell them what people expect of them or tell them they have to do. There’s no doing what you want in medical school. You do what they order you to do. And you know, it doesn't even really matter what your grades are. You just gotta follow orders because what do they call the person who graduates last from their medical school class, right? Doctor, right?

So, what we do is we say, “Let's talk for a second about what you really want in your practice so we know what you would run towards.

And now, tell me everything that's going on.” And what we find is over 6 to 8 months, 70% of people will recover from burnout without changing jobs.

The 30% who have to change jobs to recover from burnout typically have a pretty obvious conflict with their boss.

People don’t quit the company. They quit their boss.

And when we graduate somebody from a coach program, so they might come in with a satisfaction with their practice score of 2 or 3 and they’re gonna graduate at 6 or 7 and I ask them “look, what are the 2 or 3 things” because what you need is a strategy.

It’s not a solution. It’s never one thing. Burnout’s always multifactorial. You’d always have to put together a strategy of several different things to recover. When I ask them what are you doing differently now, it's always just two or three very simple things. Super simple. They're amazed actually. They go “Oh my God, that’s all it was?”

 

Shane:                        

And let me piggyback on that. Is burnout something that can be treated or cured or is it just acknowledged and addressed?

 

Dike:                           

Yeah. I think it's the latter. It's not something where, you know, you get cancer and then you're in remission. Right? What you have is burnout marks the important transitions of your life. So, let me just tell you what burnout feels like in hindsight.

Have you ever had a time in your life when you were doing what everybody expected of you, coloring within the lines, working hard, living up to other people's expectations, following the rules and it got so uncomfortable that you had to make a change and, as you look back from today, that change is responsible for who you are today?

That turning point was burnout and it’s when you decided to change your reality to match what you wanna get out of your life hopefully consciously, right, and it turned you towards a situation that had more purpose. The challenges that happens in a crisis and some people don't survive the crisis. Some people instead of turning towards the light turned towards the darkness and we lose colleagues at that point.

 

Shane:                        

There's another phrase that I know has kind of come into the conversation over the last couple years around moral injury.  Can you talk a little bit about the connection there or is there overlap there, different concepts? What's your perspective on that?

 

Dike:                           

Well, I'm always wanting to facilitate a person recovering. And there is always a big turning point when you recover from burnout. Exhausted, cynical, sarcastic, what's the use. And that big turning point is when you decide to take matters into your own hands.

You say, “Yeah, the system sucks. Yeah, I hate my boss.” And again, you may recognize this phrase. “I’m mad as hell and I'm not gonna take it anymore.” You stand up for yourself. You make the changes that you can be responsible for and you pull yourself out of the hole.

Moral injury is finger pointing. It is playing the victim. It's not about me. That guy is abusing me or this system is unfair. Anytime I hear somebody talking about the system, they're playing the role of victim.

  • There is a system.
  • It is unfair.
  • And what are you gonna do for yourself and for your family?

Because pointing fingers and railing at the system doesn't work. I'm reminded of Monty Python and the Holy Grail. I’m being oppressed. Who are you? I’m your king. Well, I didn’t vote for you. Right? They're digging in the hole. Right?

So, moral injury is a different way of stating that you're in a victim role because you're pointing a finger and believing there's a perpetrator. And one of the things I can tell you is with rare exception the stresses that cause a doctor to burnout are not being deliberately pushed upon you. There's nobody plotting your demise somewhere in your organization. Now, they’re clueless, but they're typically not vindictive.  

And there are exceptions. There are plenty of bullies in healthcare. It's part of the culture of some of our training programs, but it's typically not that that’s happened. So, what I always go is, you know, somebody comes into a coaching and they’re railing at the system; or they’re railing at the man; or they’re railing at insurance; or they’re railing at Obamacare; or they’re railing at Epic, or EMR, or whatever EMR they have. I say, “Okay. Yup. So, what do you wanna do about that?

How are you going even with a baby step to take matters into your own hands? ‘Cause there’s always wiggle room for what you do in your own self-interest when you know which direction you're headed in, which is why this ideal job description is super important. It's the target you aim yourself at.”

 

Shane:                        

I've got time for one more question. I wanna ask you. You launched a program I think last year called the Quadruple Aimed Physician Leadership Retreat. Can you tell us a little bit about that?

 

Dike:                           

Well, inside organizations that employ doctors, burnout is a leadership issue. It's how did the leaders of the organization create a work environment and a culture that is supportive of the wellness of the doctors. And what we’re missing is wellness leadership.

People who know how to do that. And so, we created a retreat 2-3 years ago call called Quadruple Aimed Physician Leadership Retreat. And what we do is we teach people how to be wellness champions.

So, in 3 days, we teach them how to take care of themselves, recognizing and prevent burnout for themselves so they can model and mentor a state of wellness. We teach them how to do the same thing on their teams and we also teach them an organizational strategy to prevent burnout.

We’ve presented it 5 times. We got 167 graduate students. Great work all over the world. And we have 2 dates in 2020. If you go to the retreats tab at www.thehappymd.com , the retreats tab, you'll see our 2020 dates and they're ready to be booked right now if you’re interested.

 

Shane:                        

Excellent. Well, in fact, we’ll make sure and link to that in the show notes. So, if you're listening to this and can't remember the exact name, you can just scroll down and find it in the show notes and we’ll link to Dr. Drummond’s site there on www.thehappymd.com . Dike, I'm gonna wrap up here and I so appreciate your time, your thoughtfulness, and your leadership on the issue and I think literally the lives that you are saving and changing through the work that you're doing. Thanks for being here today.

 

Dike:                           

Absolutely my pleasure.

 

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Tags: physician burnout podcast, stop physician burnout


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