How to decrease your dread of being on-call [PODCAST]

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“Have you ever wondered how much time we spend worrying about call, versus the amount of time that we actually spend being on call? What about the Monday after a long weekend, returning from vacation, or an overnight shift? Is it as bad as we think it’s going to be, even a fraction of the time? Is it worth all of that anticipation?”

Katie Townes is a physician and founder, Physician Lounge Online.

She shares her story and discusses her KevinMD article, “4 ways to decrease your dread of being on-call.”

This episode is sponsored by Elsevier Health. Looking to update your personal or professional medical library? Shop Elsevier Health’s Holiday Sale and save up to 35% on your purchase of medical books! Plus, you can take an extra 5% off your order with code KEVINMD at checkout. Take advantage of the biggest sale of the year from Elsevier, the world-leading provider of medical books and reference materials. Shop us.elsevierhealth.com now through December 31.

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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 Katie Townes. She is a neonatologist, and she wrote the KevinMD article “4 ways to decrease your dread of being on-call.” Katie, welcome to the show.

Katie Townes: Hi, Kevin. Thank you so much for having me here.

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?

Katie Townes: I am a neonatologist. I am board-certified, and I am a DO. I trained in medical school at Touro University in the Bay Area, California, and then I did my pediatric residency and neonatology fellowship at Oregon Health and Science University in Portland. I then decided to come home, basically, to southern Oregon, and that’s where I have practiced neonatology for going on seven years.

I also am delving into the world of physician wellness. I have spent a lot of time developing my own wellness and my own mindfulness over the past several years, and I have become a leader in wellness at my institution. With the onset of COVID, I decided to channel my energy into creating a website for physician wellness called the Physician Lounge Online. There I have a lot of resources for physicians. I’m working on starting a blog, and I also have coaching opportunities there for doctors.

Kevin Pho: As a neonatologist, I can imagine things must have been pretty busy. Now, was there an inciting event that made you transfer some of your professional energy toward wellness?

Katie Townes: You know, I think I was first introduced to the concept of mindfulness in residency, when there had been a lot of really intense patient experiences, like I think we all have in residency. That’s where I first learned about the concept of mindfulness, but like so many other trainees, I didn’t feel like I had the time to really implement a practice.

In the couple of years following fellowship, my first years as an attending, I definitely got to a point where I was getting burned out, and I decided to really dig in at that point. We took a trip to Japan, and I think I saw a lot of the potential for self-care: creating awareness, living intentionally. After that, I just continued to build my mindfulness practice over the years, and I started to see what a big impact it made on my ability to have satisfaction with my job, and also in the other parts of my life, really living in the moment and being present, which is really important to me.

Kevin Pho: Now, what exactly is a mindfulness practice, and how do you intertwine that with what you do professionally as a neonatologist?

Katie Townes: For me, mindfulness revolves around meditation. I meditate actively, and it’s maybe not as hardcore as what some people might consider, but I use meditation apps. I know that there’s a direct correlation between when I meditate daily and the way that I feel and the way that I’m able to show up in my life and in my job when I’m having a routine practice.

The other ways are through journaling. I think that’s really helpful: just reflecting and getting a lot of the thoughts that are swirling around inside your brain out onto paper. When I’m able to do that and be more actively engaged that way, I notice that I am able to show up in a better way for my patients, in terms of really being present with the patient and with the families, taking a breath, noticing everything that’s going on, and then having a peaceful or enhanced sense when I’m at work, getting less frustrated by some of the little things that I really used to get quite upset by.

Kevin Pho: So let’s transition into your KevinMD article, “4 ways to decrease your dread of being on-call,” from software. Can you explain why you dread being on call, and then summarize the article for those who haven’t read it?

Katie Townes: Sure. So there wasn’t one particular event that happened, but it was really a series of experiences that I had, particularly on call. I think that we tend to have some middle-of-the-night experiences that may be more intense, with patients being really sick, and maybe feeling alone, and I think that probably amplifies that feeling.

When I was becoming more aware of my feelings, you know, we were taught as doctors to just stuff them down and not really acknowledge them, and with developing a mindfulness practice, I was becoming more aware of what I was feeling. Then I realized, “Man, I really don’t like call.” In fact, it probably was leading to some of my feelings of wanting to leave medicine early. I was thinking about how early I could retire, and I had a lot of thoughts about trying to exit.

So when I really dug in and was trying to figure out what that was, having angst around call, having this dread of being on call and of something bad potentially happening, it made me realize that something needed to change with that. I thought that the only way to change was to just stop taking call, which for neonatology just means stop being a neonatologist, because that’s what we do, right? And that didn’t seem very palatable to me.

Anyway, I started to dig into different ways to troubleshoot that, and that’s when I came across life coaching. I met a coach at a retreat, and I said, “You know, you want to try to coach me on this?” And she was like, “Yeah, sure, let’s do it.” The way that she was able to help me reflect on the thoughts I was having, and how irrational some of them were, and how much I was creating my own suffering, was really helpful. That was just the first piece.

I think with many people, when they dread anything, there are lots of layers to that onion that you have to peel back. For different people, it might be that they’re worried something bad’s going to happen. There’s also oftentimes a lot of, “I don’t want to lose sleep. I don’t want to lose time with my family. I find it so annoying when I get these texts.” There are just so many different parts of it to peel back.

So I started to really dig into working through my feelings about being on call, and then I realized how much better it was and how much it really impacted my career satisfaction, feeling like, “OK, now I have some longevity. I really do feel like I’m going to be able to continue doing this as long as I originally wanted to.” I felt like I really had to share that with others, because I don’t think it’s very well acknowledged. I think it’s the culture: Everyone kind of hates call, and whatever.

And I wasn’t aware that the feelings, I had some pretty impressive feelings about not wanting to be on call, but there are lots of other people that actually feel that way, and that’s what I’m discovering now. Realizing that there are others that have that is validating, for one, but it also led me to want to help others deal with this as well, and hopefully help people stay in medicine longer, if this is one of the things that’s contributing to them not wanting to be in medicine anymore. I think I have a duty to share this with others.

Kevin Pho: Now, what kind of actionable tips do you have for physicians to make call more palatable?

Katie Townes: Yeah, so I think one thing is just awareness, right? Being aware of how you feel. Again, oftentimes when we feel things, we don’t tend to acknowledge them. We just stuff them down, and then they come out in other ways. For me, I’d be irritated or annoyed easily, or, as you know, people will overeat or overdrink. There are lots of different ways. So number one is awareness, and that’s why I really do recommend some sort of practice in mindfulness, because I think that can be really helpful for just knowing what you’re feeling.

From there, write about it, explore your thoughts, and be curious about it. And also, because it was so effective for me, and because it’s one of my new passions now, get help. Get coaching with it, because it can be really difficult to understand. When we just sit with our own thoughts, it’s hard to see them clearly. It’s hard to really see what we’re creating for ourselves until someone’s able to bounce that back on you.

Kevin Pho: Now, is there anything that hospitals and medical institutions can do to make call a little bit easier for physicians?

Katie Townes: I mean, yeah. None of this is to say that we shouldn’t also be advocating for ourselves, and advocating to have more humane work hours, or anything like that. It’s just that in the current circumstance as it is, I think that there are things that we can do to manage our minds around this.

But certainly, yeah, I think the whole culture of medicine could use a major mindset shift, because of the way that it’s been created and the way that we have been expected to be superhuman, work these incredibly long hours, be perfect, and make no mistakes, even when we’re sleep-deprived, even though we know there’s evidence that that is not a rational expectation. And so, yeah, I think that for sure, shifting potentially toward more shift work and having realistic expectations of work hours is really important.

Kevin Pho: We’re talking to Katie Townes. She is a neonatologist, and she wrote the KevinMD article “4 ways to decrease your dread of being on-call.” Katie, in your coaching practice, when you talk to other physicians, what are some of the challenges that they most often express?

Katie Townes: I focus a lot on call, but also on all sorts of career challenges that come up, or items surrounding their job that are a challenge for them or a struggle. Specifically with call, we talk about the anticipated sleep deprivation and how to manage our thoughts around that, and what to expect. There’s the anticipated time away from family, which oftentimes creates a lot of angst for people. There is the pager, or the Vocera, or, you know, we have DocHalo secure texting.

So there are ways that you can change the way you think about those in order to make them all more neutral. In the end, all of those are neutral circumstances, but what we end up thinking about them determines how we feel, and then what we go on to experience, and our results. Those are some of the common ones when it comes to call. Then I talk about other struggles that they may be having with their career, or things like going up for promotion. There are lots of different potential ones.

Kevin Pho: What is your number one tip for dealing with that anticipation that you talked about for being on call?

Katie Townes: So my number one tip for dealing with that anticipation of being on call is to be aware of it and try not to resist it. There’s this Buddhist concept of pain times resistance equals suffering. We have this feeling, or this pain, right? And then we try to push it away and resist it, and that’s what creates suffering. That’s what creates ongoing pain and ongoing suffering. So for me, I think this whole mindfulness journey has really led to understanding acceptance and not resistance, and that has made a big impact on all areas of my life.

Kevin Pho: And my final question, Katie: What’s your take-home message that you want to leave with the KevinMD audience?

Katie Townes: I just want physicians to know that we don’t work in a perfect system, that you are important, and you are a valuable member of society. If there is something that you can do to manage the way that you feel, and to improve your career satisfaction and improve your fulfillment with your job, then please try to do that before you consider leaving medicine.

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

Katie Townes: Thank you, Kevin. I appreciate it.

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