To better take care of patients, we need to take care of ourselves [PODCAST]

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“I wonder what keeps us physicians going? What makes us show up to work every day? Even though it might sound clichéd, for most of us, it’s the love for medicine; it’s the love to be there and still be able to make a difference. And maybe money too. Here I have some self-help tips/tools that could potentially help us through these tough times. We cannot change our surroundings. We can certainly adapt.”

Manju Mahajan is a family physician.

She shares her story and discusses her KevinMD article, “To better take care of patients, we need to take care of ourselves.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Manju Mahajan. She is a family physician, and she wrote the KevinMD article “To better take care of patients, we need to take care of ourselves.” Manju, welcome to the show.

Manju Mahajan: Thank you, Kevin.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Manju Mahajan: Yes, of course. First of all, thank you for having me. I am a family physician, so I work in primary care in an office-based setting in Groton, Massachusetts. I was born and raised in India, and then I came here to the United States several years ago. I was in Texas; that’s where I did my residency, and then I moved to Iowa. I spent a few years there in a rural health practice before finally settling down in Westford, Massachusetts. Like I said, because I’m a primary care doctor, I see all ages, and I do a different variety of things with my patients. So, yeah, I love what I do.

Kevin Pho: Fantastic. And we’re talking in the middle of October. How did the pandemic affect your practice?

Manju Mahajan: Yes, it affected my practice. Well, I guess it has changed everybody’s world altogether. In the beginning, the offices had shut down, and we were doing telemedicine mostly, and then later on we started to open up and see patients in the office. So partly now I’m doing telehealth and office visits as well.

Kevin Pho: All right, let’s move to your KevinMD article, “To better take care of patients, we need to take care of ourselves.” Now, for those who haven’t read your article, can you walk my audience through it and share the story of why you decided to write it?

Manju Mahajan: Yes, definitely. Thank you for asking that question. As I mentioned before, I love primary care. I have done it for a number of years, and I enjoyed doing it. I love taking care of patients. But when this pandemic happened, it just felt like everything changed around us. In the past, when I would see a patient in the office, we would talk about their fears in general, their values, what were the factors that were affecting their health, and now everything was about COVID and the stress around that.

In the beginning, when I did telemedicine, which I think is a great option and has its place in our system, there were times I felt like I didn’t connect to patients. So the visits would go just kind of unsatisfactory on my end, and so I didn’t feel that I was loving my work as much as I did before.

And then we opened the clinic, so we started seeing patients in the office as well and did some telehealth, but most of our talks used to be around COVID, because it had affected everybody in some way. Somebody had the infection; somebody passed away because of the infection. The youth, I felt like there was a high alcohol rate in our young population, and just high-risk behavior, just to distract themselves. So all my visits would be about how to address that anxiety and depression, just a lot of sadness in the whole day.

So then I felt like I myself started to have a sense of isolation, not because of that, just all of it, how to take care of them and how to take care of myself. In the office, people were just kind of keeping their conversation to the minimum. You’re not talking to your neighbors. Kids are not going to school. And then, because you’re a working parent, the question comes: What am I going to do after this? Am I going to the office? Who’s watching my kids? There’s this whole gender equality, gender role questions that come on.

So there was one time I was dealing with allergies and was just really congested, but I knew it wasn’t COVID. I mean, just congested. I went to the office, and I was wearing two masks, and patients were talking about how uncomfortable they feel with their own masks and how it makes them feel short of breath, which I totally understand. So I encourage them to keep it on, because it’s keeping everyone safe. But I was so congested that I was like, “I want to take this thing off me.”

So I just went through the day, and at that time I felt like, “Well, what can I do to take care of myself better? Because this is really going down. I’m in a downward spiral here, and things are not looking better.” At that time, it just didn’t seem like there was a way out. So then I started journaling, writing down my thoughts, and I felt that was very helpful to me. So I did some of those things that were in the article, and I felt that those were helpful. So that’s when I decided, “OK, I’m going to write everything and put it in one place.”

Kevin Pho: Now, you mentioned journaling is one way. What are some of the other specific ways that you described in the article that have kind of helped you with how you were feeling?

Manju Mahajan: So one other thing that I feel like really helped me is something called present-moment awareness, which I had practiced since my residency, but I feel like it has helped me a great deal now, because back to back, when you’re seeing patients, your mind has so many thoughts because of what’s going on. And just in the past, the physician burnout rate was so high, and now it is even worse.

So what I do is, before entering the patient’s room, I just pause for a moment, just maybe five seconds, and I take a couple of deep breaths, and I try to kind of feel my sensations in the body, try to feel my breath going in and out of my nose. I feel like that just brings me to the present moment. So that kind of tells me, “OK, the past is gone. That previous patient has been taken care of, and now this is where I have to give my 100 percent, on the other side of the door.” So that’s another thing that has really helped me.

Exercise has helped me a great deal as well. In the past, also, there was the role of exercise, but I feel like now it’s even more. One of the ways I used this was, there was a time when our office patient rate was low because we weren’t really seeing that many patients, and then even now, I kind of made a practice to exercise in between patients sometimes. So I would just go quick for a five-minute walk and come back, or I’ll just walk all around the office, or I’ll do like 10 push-ups and just go. I feel like it keeps you going. It feels like you did something for yourself and your health as well, and I felt that that helped me.

I have been recommending different videos to my patients, YouTube videos, because obesity rates have gone up. I see all of my patients, and before COVID, we were working on weight loss, and weight has just gone up. So we talk about how they can just walk at home, and there are YouTube videos, walking programs and stuff. So I share those examples with them, and a few patients have come back and said they have incorporated that, and it has helped them with the weight. So that’s another one.

And one other thing that really helps, I feel, is talking to a loved one. It could be your friend, a partner, a colleague at work, or your pet, anything, whoever is important to you. Just spending time with them, quality time, in your day can really relax you, and you release those good chemicals in your brain. So I feel like we owe it to ourselves to take care of us, because if we go down, then a lot of things around us can fall apart.

Kevin Pho: Now, a lot of health care systems are in financial stress just because there are fewer patients being seen, and telemedicine doesn’t pay as well. And now I hear a lot of pressure being put on primary care to see more patients and to see patients in less time. Now, for those doctors who feel like they’re being pressured to do more with less time, how can they balance that? How can they find time for themselves in an environment where they’re forced to do more?

Manju Mahajan: I think that’s when this whole communication part comes in, I feel, which we are lacking now, because in-person meetings are less. Now people are meeting over different platforms, on virtual platforms, and the connection is less. One thing one can do is first take care of your mental health, because it’s really easier to negotiate things with somebody else when you are feeling strong on the inside. So again, I would say the same thing: First, kind of make sure that you are centered in where your priorities lie.

And there has been a major cut everywhere, which is a huge thing, especially for primary care, because we were already fighting for a better pay scale, and now that has even gone down. So I feel like it’s a work in progress, and it has to be talked about. It has to come up together between different doctors. People have to discuss things with each other more, better communication, but still staying centered first, and also knowing that we’re still there for our patients.

Because, you know what, that was another thing that I wrote in the article: Why are we doing this? Because everything feels, no, because, like, for example, I have friends who are not in medicine. They get days off during their week, personal days off to learn different things, and our salaries will get cut if we take a day off. You know what I mean? Like, you have to be there. And so there is a reason that we are doing what we’re doing. It’s because we want to do this. We love this. That’s why we’re here, most of us. So I think starting from that place, what is the reason we are doing this, and then definitely moving on and asking for what is reasonable for us.

Kevin Pho: We’re talking to Manju Mahajan. She’s a family physician, and she wrote the KevinMD article “To better take care of patients, we need to take care of ourselves.” Manju, is there something that you’ve learned over the last few months that you wish you knew before the pandemic started?

Manju Mahajan: One thing that I have felt after the pandemic is that, since we started with office visits again, I have started connecting with my patients at a better level. I didn’t understand the suffering so much before, and now that I have seen so much of it, I feel that there is a connection. I also feel that with this, I have seen patients being more satisfied, that just a little talk about how they’re feeling in their day, just a one-minute, “Hey, how did COVID affect you?” and they just kind of feel like, “This doctor wants to listen to me.” It’s just a one-minute conversation, but I feel like when I do that, they are able to open up better and kind of explore different options of their health with them, because I feel like they develop that trust, because of just asking how it has affected you.

One other thing that I have started doing in my practice is talking to people, especially the immigrant population. I talk about isolation and depression more, that it is OK, because there is also a stigma in different cultures about accepting it, and I feel like this is the time when most people feel isolated, especially the immigrant population. So I always make it a point to ask them specifically, and some of them have come out and accepted how they’re feeling, and we’ve started treatment for that.

Kevin Pho: And my last question: I’m going to ask you for a few actionable tips that you could share with the clinicians who may be listening to this podcast.

Manju Mahajan: Yes, thank you. So the four things that I had mentioned in my article, I think it’s around that as well. If you are feeling low, first of all, it’s OK to reach out. It doesn’t make anybody weak to say, “Well, I’m feeling isolated.” I felt it, and I’m not ashamed of it. And so once you identify and label the problem, only then can you go towards finding a solution for it. The second would be, I think, the exercise part, just to release good hormones, good chemicals in you. Journaling is another one. And spending some time with your loved ones.

Mindfulness, or present-moment awareness, as we sometimes call it, is a huge part of my lifestyle and my practice. And if somebody wants, if you Google it, there are lots of resources on mindfulness. I feel like right now is the time when we should practice it more, because if we are present, that’s when we can really make informed decisions and stay happy, because so much is going on. If we stay in the past, that causes depression. If we think about the future, then that leads to anxiety. So practicing more mindfulness techniques, I think, can help us go a long way.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Manju Mahajan: Thank you for doing this, Kevin. Thank you.

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