119. Physician Burnout And Hope For Change With Kim Downey

We have to reimagine medicine together because everyone knows what we're doing isn't working. We're not going to change medicine ourselves, but we're going to connect the change makers that do. That's a huge thing that I do. Help foster connections, doctors with each other.

Are you a woman in medicine feeling overwhelmed and disconnected from the personal fulfillment that you desire? You're in the right place. Join doctors Joanne and Erin as they rewrite the rules for women in medicine. Let's begin.

We are extremely excited today as we have a very special guest and our very first repeat guest. She gets that award. Kim Downey. She's a physical therapist, three time cancer survivor and passionate advocate for physician well being. She amplifies voices through her powerful anthology, her book White Coats, Courageous hearts and her YouTube series stand up for Doctors. She helps physicians connect with each other and we were just talking about that before we started recording of all the people that we have in common that, you know, she's been such a good connector. And you guys need to go back to episodes 82 and 83 where she talks about transforming physician well being and medical culture. So I'm gonna like applaud.

Yay.

Welcome, Kim.

Well, thank you very much. And I am totally honored not only to be on once, but to be your first repeat guest. So thank you. It's quite an honor and I'm very happy to be here.

We love you. Thank you so much. So I'm going to go straight to business. So your background is as a physical therapist and cancer survivor. How did that inform your vision for this anthology for your book?

Well, as far as being the physical therapist, not directly, but the fact that I have been a healthcare professional for all these years, I fully resonate with a lot of the things that doctors have been through over the years. PTs face some of the same challenges and things that we never talked about either. So things like if you have a patient die and then you have to go to the next room and put a smile on your face. And that happened to me many times and I was just speaking with one of my college friends who's also a physical therapist. We got together and I said, did you ever talk about that with anybody? Because there's this unwritten thing that you're supposed to be like professional and when you don't see anybody else getting upset, you don't feel like you're supposed to be upset, so you just hide it. So that's just like one example and that's how I just fully empathize with doctors. And then I also see the extra layers of struggles that doctors have, even on top of what I would have had as a physical therapist. And one is, of course, you don't often need a physical therapist in the middle of the night, right? So we never had a poll, 24, 36 hour shifts and things like that. So those are a lot of examples. And as far as the cancer, how that is related is I never felt like a patient before. Like years ago, I had emergency appendectomy, but I just felt like, okay, this thing happened, somebody helped me with that thing that happened, and I went back to my regular life. But when this, it was two straight years of health issues because the three cancers, I found out within a period of a year and a half, there were complications from the first surgery, you know, that impact me to this day. So it was just one hit after another hit after another hit. And then when I finally thought I was going to be moving forward and I showed up, you know, and my beloved doctor wasn't there. And I found out he took his own life. And that just threw me under the bus. Like then I. I didn't have as much resilience at that point. I was well resourced starting out, but by then I was not. And that's when I felt a calling to support doctors. So after I was on LinkedIn and talking to doctors, and then really, that started two years ago April. And then by that October or it was like September, people were telling me, oh, you should have a YouTube channel. So three weeks later, I was interviewing Dr. Todd Otten, who you just interviewed. So he had interviewed me. I was his first guest on Ripple of Change. So then I invited him to be my first guest on Stand up for Doctors. And we kept going. And then I was approached by Emmy Vida Estacio. She's a health psychologist who helps people publish their books. And again through Todd, because we're both involved with Medicine Forward and she was helping with our newsletter, our Medicine Forward newsletter. So I thanked her for helping and that's how we connected. So she suggested I reach out to the first 20 doctors who were guests on my YouTube channel. So I did that. Fifteen wrote chapters. One wasn't a doctor and he didn't have the bandwidth. And the others wrote beautiful endorsements inside. And that's how it all came together.

Well, as someone who is almost all the way through the book, I have been so moved by the powerful stories. And for those of you on YouTube, this is the book White Coats, Courageous Hearts. And it tells heart, heartfelt Stories. Some of them are heavy stories, and yet with this splash of hope in each of the stories. So I felt uplifted even when reading about some of the challenging times. And I wonder from your perspective, Kim, what was the most surprising or most emotionally resonant story that you encountered with these 15 stories that are in the book?

So, Speaking to Surprising, Dr. David Alfrey talks about substance use disorder amongst anesthesiologists. And he shares about a nurse anesthetist, you know, that they had to have, like, an intervention for. And this person left, got treatment. And again, he shares it in the very end, really how his last day of practice, how this nurse came up and just gave him the biggest hug and told him that he saved his life. So, yeah, I won't share any more details. So you read the chapter. But that I never thought, you know, the average person walking around is not thinking about substance use disorder and anesthesiologist when I interviewed him, because, you know, now that I've. We've been able to have YouTube episodes with all of the authors, we had a celebration video that was narrated by Dr. Tamar Beckford, and we captured eight. And then I did another episode, captured three more, and David was part of that. And then I just published the last one yesterday. They captured the last four. And I said, I feel like there should be a warning, like when residents choose that specialty. I says, almost like a warning on a pack of cigarettes that. Because the drugs obviously are available to you all the time and you have the means to use them right at your fingertips. And he shared, and I believe in, when we recorded the episode that one doctor had said to him, you know, that he felt like a kid in a candy store and that it's just. Or if you're bored or if you're depressed, you know, some people turn to alcohol, but others turn to drugs. And I just think it's. It's this horrible hidden secret that it really is quite a problem amongst anesthesiologists. And the horrible thing is if you're an alcoholic and you go to aa, you can try to stay away from alcohol. But if you're an anesthesiologist and you get treatment, you're right back with those drugs every day, all day. So sadly, the risk of recurrence is quite high. But you can't just say, okay, well, I'll be a pediatrician instead, because you went to all the years, because that's a whole other residency. And then that's how sometimes anesthesiologists feel. Low or even worse because then they have no profession either. They're not allowed to go back. You know, they have a recurrence else up there. So you could, you know, comment. But that was one thing that was very powerful and moving to me, the.

Collateral damage that's so common in any field in medicine.

Right.

They're not talking. When you apply to medical school, there's some risk going into this field, whether it's, you know, I learned from another guest of ours, panel at Buchanan, that women physicians, the extra seven years we usually have over men goes away. It tends to be even risk of when we pass away this collateral damage with being an anesthesiologist, there's a lot of collateral damage that goes into being a physician or a healthcare provider that sometimes we go in blindly. Yeah. Joanne, you were gonna say.

No, I was gonna say, you know, as, as a psychiatrist, you know, like it's. I'm so passionate about these conversations about mental health and how high of a problem it is in medicine and that we're not talking about it. And there's so much shame already. And there's an extra layer of shame when talking about any kind of substance abuse. And.

Right.

Like, we don't necessarily always think of alcohol or we don't think of it as a problem because we're almost always so functional and there's a lot of misuse as well. And how incredible that, you know, someone would be courageous enough, like your book says, to speak out loud, knowing this might help someone else, which is obviously what we're here for as well. So, yes, I'm glad that that stood out for you as well. I know, unfortunately, personally, several physicians, and some of them are anesthesiologists who have had. And it was exactly how you said it, exactly. Like they didn't have the typical backstory that we tend to kind of, you know, explain that would lead to some. It was very smart, hardworking, and it was like, oh, let me see. Yeah, we, we can go on and on about that one. So. Yeah. Thank you. It's a important topic. Maybe that should be a whole interview one day. I, I wanted to ask you, Kim, also in, in talking about this wellness overall, that you've been such a incredible ambassador for physician wellness foundations. What trends have you observed in how healthcare systems respond to burnout or moral injury?

I think it really depends on the system. There are some out there who are trying to do a really good job and Dr. Gabe Charbonneau, he's one of the co founders of Medicine Forward he's stepping aside for now. He's a family medicine doc in rural Montana and he's becoming involved with orchid Health. And if you Google them or research that they're really focusing on the well being of the healthcare workers. And like Dr. Amna Shabir said recently in one of my posts, I believe it was physician advocacy equals patient advocacy. Because as I say, everyone wins when physicians are well. And if physicians are well resourced, physically and emotionally and even with the actual tools and instruments, which even that didn't happen like during the pandemic, then if they're well, they can care for patients well. So that's, that's one play, you know, one organization that I feel really is trying to make a difference. Then there's others who might have what mission statement that says they care about the well being of, but they don't walk the walk. And so that's even to the disparity. So then I think that can be very upsetting for the people that work there if they go and show up and think they're getting into one thing and then they show up and it's entirely different. And then some, even private practices, even around the world, like don't even fake it. Like once you get in. I've talked to doctors who they thought they're finally in attending and this is in the, in America and around the world, I've talked to doctors and even in family medicine or if they're orthopedic surgeon, and then they're disparaged even in their own practice, even in their own specialty and there's no doctor, say you're a surgeon, a brand new surgeon, you're not perfect, like that's impossible. And to not be supported by your senior colleagues, that's just horrible. So there's the whole range from organizations who really are trying to do a good job in a system I'm involved with through one of my medical issues. I had a conversation with the president and he seems to do a very good job. He knows every employee's name, which is like maybe 3,000. He walks the halls, he even does an overnight shift even in the or. And they'll be asking the people in there, what are your pain points? You know, he'll put on scrubs, he'll walk with the janitor. So that's. And they're. Have you heard of Plane Tree Hospital? The Plane Tree philosophy. It actually started in Griffin Hospital here in Connecticut. And that's something else that you could look up because it's really, it's patient centered Care. So there are some plane tree hospitals around the world, but it's not super popular. But what's so interesting is my last three surgeries out of five were at this hospital. And you can tell it's patient centered care. But since they have a good president, they take care of the healthcare workers, so the healthcare workers can take care of the patients.

That's fascinating. And, and I know as a patient in my own cancer journey, I sought my care at Stanford. And I don't know what they do, what magic they put in the water there. Every single employee, whether it was the phlebotomist, the imaging specialist, the physician, the front desk personnel, they the on the phone, every single person has this amazing, just patient centered customer service care philosophy. And it's palpable. You can tell it when you walk in the room, my physical therapist office, the same way you can tell the energy when you walk in there. And as a patient, it makes such a difference. And yet I think those are so much the exception, not the rule.

Yeah, absolutely. Because my first surgery, I know it was during like the heat of the pandemic, so that might have had 50% or more to do with it, but that in retrospect was the opposite. It was like a night from hell from the second I walked in till the second I walked out. And you're absolutely right, Aaron, especially after if you have to stay overnight. And I found the same thing, everyone from somebody coming to clean your room, you know, to the nurses. And I actually said, is this a good culture? Because it almost seems surprising, like the way health care is today, like, how is anything going well? Or how are any people happy where they're working? And she said, yeah. And she says they initially used to be an independent hospital and then they were bought out, and then they were bought out by a larger system. And I says, well, is this the whole health care system or just this hospital? And of course, she couldn't speak to every hospital, but she knew, she says, well, just our hospital and because we had a good culture to start with. And then they were able to, generally speaking, maintain that culture even as they got bought out twice. And I asked her, if you could change one thing, what would you change? And she said, well, the staffing ratio is because the nurses are just responsible for too many patients. But other than that, she, you know, seemed pretty happy there. And so my perception, like yours was reality. You know, it was a good place for people to work and it's a good place for people to be a patient. And it makes all the difference. And that's the culture, the culture of medicine, the culture of healthcare organizations. That's everything.

And what message would you like our listeners, whether they're clinicians or members of the public, to take away after reading your book White Coats, Courageous Hearts?

Well, I feel like for physicians, any doctor reading it is going to see themselves. And I believe Dr. Michael Hirsch writes a beautiful foreword and he also writes a chapter in this book and said so he read it ahead of time to write the forward that he saw parts of himself in so many of the chapters. So that's why I genuinely feel like every single doctor and even a resident or med student would love to read this book. Because if you're, if you're a med student or a resident, it kind of shows you some things to be aware of or, you know, like it alerts you that any of these things can happen. Some of this will be your journey. But the message that goes through about seeking help is truly a strength, not a weakness, and having self compassion and setting boundaries. So I feel like those critical messages are woven through the book. And Erin, as you alluded to that there's also a message of hope. Like we talk about some hard things in the book, but that's even my whole message with Stand up for Doctors is basically we need doctors. We want to make things better for doctors, so we need to have hope. And I feel like all of those would be very important messages for doctors reading the book and then for everyone else. For patients, a lot of them are walking well, they're not thinking about their doctors, right. And they show up and like doctors will sometimes just say in private conversations, you know, we're not machines, we're not robots. But people are just like, think they're going to walk in and be presented with whatever they want on a platter. Right. And not realizing. So I feel like these stories show as doctor is. You know, Dr. Kevin Poe writes the endorsement on the back and he says it's a must read for anyone seeking to truly understand the hearts behind the stethoscopes. And I love the way he put that and that's what I think. So. And it's there, I think. Aaron, you shared and thank you so much for sharing some posts and encouragement about the book that you said that there. It's easy reading too, right? Whether you're a doctor or a patient, it's easy. It's almost like a chicken Soup for the Dr. Soil kind of thing. And so there's, there's small bites, they're short Chapters. And I think that people will be moved and. And like me even having had these conversations with many doctors a couple years, like what David Alfre chose to share, I hadn't been thinking about that at all. Or the shame Dr. Susan Baumgartel shares when she was a resident and there was this quite famous attending that was above her and one morning she had to share grand rounds case. But she had had a group of veterans and she didn't know which to pick because they all had heart issues. So she did her presentation and then he looks at her and he goes, you know, not a grand round, but not a grand round, not a ground rounds case. Right. And he turned around and took off. And she just felt like so much humiliation and shame, which there is no reason for that. And then how that stuck with her all these years later that she chose to include it in this book. So just that each of you, if you're a resident med student, those things are going to happen that are kind of like watershed moments for you, for good or bad, and just to know you're not alone, it's not you. Or like Adam Harrison shares about bullying in medicine, he shares some specific examples. So then people won't be as ashamed thinking, oh, my God, I'm trying to be perfect. I'm trying to do everything. It's like they share that no one is perfect. Set boundaries, get help. You're human. And they all share that in the book.

And I would love to share a quote from your chapter in the book. Your first chapter in the book, Kim. And you say, embracing my new identity. Today, I no longer see myself just as a patient. I am a fierce advocate, an ally, and a voice for the very people who have helped me navigate the most uncertain moments of my life. Doctors save lives every day, but they shouldn't have to lose themselves in the process. If I can be even a small part of changing that, then everything I have endured has led me exactly where I need to be. And you have made such a powerful impact on myself and so many physicians and people across the country and around the world. And I just can't thank you enough for all of the hard work and tireless efforts you are putting into helping make the landscape of medicine a better place. When some people are like, this is too overwhelming, and you just show up every day with energy and a smile on your face, even when life is hard, even when life is messy. So I just want to thank you from the bottom of my heart. And I'm so thankful that our lives have crossed And I look forward to continuing to connect. And I actually bought more of these books for my coaching clients. I will be sending them their way so that everybody has a chance to read this in my community.

And I did. Oh, everything that Erin was saying, I was going to say the same thing. So grateful of all that you're doing because this is not common. This is not common even within medicine. And I think that we can talk on and on and on about the different examples of the difficulties, but then that there's hope, as you said, all these places that are doing a great job and we write like it brings hope and then we should use them as models. And yes, I cannot wait to share your book with the women in medicine that, that I work with and colleagues as well. And I wanted to ask you that we talked about this a little bit in our. Your previous episodes, which were 82 and 83. Please go back and listen because they were great in. Because we always talk about how we're creating meaning in medicine or how we are rewriting the rules, which I think it's part of your advocacy. Tell us more about that, like give us some examples.

Well, I think that in a way we have to reimagine medicine together because everyone knows what we're doing isn't working.

And.

And I also do wanna thank both of you for what you just said. That means everything to me and that keeps me going. The gratitude of physicians and they just fill in. I think we're in each other's hearts all the time. If you heard of the two Loops model, the Healthcare Reinvention Collaborative, at some point you might wish to connect. I could connect you with Dawn Ellison, Denise Weissman, Paul Buhrens. They've started HRC Healthcare Reinvention Collaborative. And there they say we're not going to change medicine ourselves, but we're going to connect the change makers that do so every post I have, I tag Medicine Forward and I tag HRC and now Clinician Burnout foundation. Because I feel like that's the huge thing that I do is help foster connections, doctors with each other. And then, you know, Aaron, just when you think of what's come from me connecting you with Don Viselka, right? And we never know where these ripples are going to go. But hrc, when they talk about the two Loops model, so they say that any like system over time, it rises and peaks and then it collapses, but. And then something else will come of it. So if you think of two loops, there's like one that rises up and comes down and then, you know, it bottoms out and then something new emerges. But as you can imagine in medicine, because something people think like the system, like things are going to crash, they're going to totally fall apart, but in a way that can't. We can't let that happen. So what we need is a bridge from the way, the old way we're doing things now that's not working to. However, we're going to reimagine medicine together, and how are we going to build that bridge? So I feel like there are pockets like Orchid Health and other organizations like that who are doing it right. So we need to connect the people and find out what. Well, who's doing it right? Who's doing things that are working? Because there still are doctors who are managing to be in private practice. You know, where I know one doctor, though, was in practice between him and his relative for like, 40 years. But then he had to become part of, you know, the system because just all of the extra administrative burdens became too costly for, you know, a sole proprietor. But other doctors are doing it. So we need to be talking to those doctors. What are they doing, how are they doing it? And anything, you know, that's working. So then if we can do that, somehow we can hopefully form that bridge from what's not working now to reimagining medicine together. Because there's a lot of wonderful, brilliant people doing things out there. So we just have to find them and connect them and make it happen.

Love that. Kim, you have shared so much wisdom with us today and that theme of connectivity which we find so, so powerful in medicine. And we would like to know, is there one last bit of wisdom you would like to share with our listener?

Well, I just think if everyone tries to be kind to each other, the culture and medicine could change today. If healthcare leaders were kind to each other and kind to the people that work in their organizations, if physicians and other healthcare workers were kind to themselves, that includes yourselves, right? And kind to each other and kind to their patients. Because some patients don't have great experiences, you know, with their doctors, because the doctors might be, you know, burnt out or busy, etc. And then patients we know after reading this book, they'll understand some of the things that are going on behind the scenes and in the lives of the doctors and be kind to your doctor and say thank you. We've had a big campaign about that. Right, Aaron? And if we all said thank you to each other again, colleagues thanking each other, you know, I hear some ER doctors feel like they're going to work not making a difference when they're literally saving lives every day because they don't hear the thank you when they say somebody's life. But the next day they'll hear, remember Mrs. Smith, you know about some tests there, you know, they should have ordered or whatever. So to just thank, say, hey, thank you to your colleague for catching that or you thank you for being there for me. So I think if we can just in it, it sounds maybe cliche, but it's not. And it could make a world of difference right now. Before anything changes, just be kind and say thank you.

So simple and easy. We don't need to overcomplicate it. Thank you so much for sharing with us, Kim.

Thank you.

If you have not yet got Kim's book, White Coats, Courageous Hearts, order it. We'll put the link to order in the show. Notes. Fantastic. Easy read. And with that, we would love for you to also find Kim. Where can they find you if they want to learn more about what you're doing?

I'm on LinkedIn and my Stand up for Doctors YouTube channel and I have a Stand up for Doctors Monthly substack where I share monthly updates on my advocacy efforts for physicians. And I do have a website coming. It's not quite ready yet, but that would be standup for doctors.org so if you, if you look up Stand up for Doctors or Kim Downey, you'll find me.

Excellent. Thank you so much for being such an incredible inspiration to us all. And with that, stay tuned because next we'll be talking with Joanne about bringing more play, joy and connection to your life. Stay tuned. We're coming right back.

Do you want exclusive resources and the opportunity to connect with us? Then visit createmeaninginmedicine.com now where you'll dive deeper into how you can create meaning in medicine. And if you're serious about optimizing your results, take two quick steps now. Number one, connect with us on the website and number two, tune in to the next episode.