A transplant physician faces facts about his career [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“Continuing to do this work the way I was doing it was not sustainable. I needed to get off the merry-go-round. I just didn’t know how. I didn’t think I could stop myself—transplant was my duty, my responsibility, and what I was trained and programmed to do. It was hard to imagine leaving my post, but I needed to find a graceful exit, an elegant off-ramp that would satisfy my need for a tidy conclusion. One way or another, I wanted off the roller coaster, so I could never again be crushed by a patient like Tina. That had been my life for nearly twenty years. That was enough.

I felt yanked around by the ups and downs of the job, my emotions seesawed, and all the while I had to make rational decisions for my patients. But for me, the job was no longer a pure and simple exercise in rationality. I had mastered the mechanics of being a transplant doctor— that was the easy part. But now, from an emotional standpoint, every wife was my wife, every child was my child, and every father was my father. And I needed to save them all.”

David Weill is a pulmonary and transplant physician and author of Exhale: Hope, Healing, and a Life in Transplant.

He shares his story and discusses his KevinMD article, “A transplant physician faces facts about his career.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

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 David Weill. He is a pulmonary and transplant physician, and he’s the author of the book Exhale: Hope, Healing, and a Life in Transplant. David, welcome to the show.

David Weill: Thanks for having me. I appreciate it.

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

David Weill: Sure. I’m a transplant pulmonologist, so I trained in pulmonary medicine and then ultimately got interested in lung transplant and advanced lung disease. I spent most of my career running the lung transplant program at Stanford University and also was the director of the Center for Advanced Lung Disease. I got off the front lines a few years ago and now have a transplant-related consulting business, where I help transplant programs that are struggling.

Kevin Pho: So tell me some of the reasons why transplant programs are struggling across the country.

David Weill: You know, Kevin, it’s a wide variety of reasons. Some of them are clinical, and some of them are financial, and some administrative. I also work with teams regarding their own internal dynamics, and about teamwork, and, these days especially, about the resiliency of the team and work-life balance. So I work with the teams in a variety of ways now.

Kevin Pho: As a field, lung transplant, what are some of the specific challenges facing lung transplant physicians today?

David Weill: I think the majority of the challenges are trying to control an inherently uncontrollable process. So the field has moved well past its experimental phase, but there are still, obviously, patients that don’t do well, and I think that that’s the difficulty physicians caring for these patients are facing. And in fact, the survival of lung transplant isn’t quite what kidney, heart, or liver transplant is. So we deal with a field that’s still rapidly evolving, and I think that that’s one of the main challenges, to try to stay ahead of the learning curve.

Kevin Pho: So I hear sometimes in mainstream media about the pandemic potentially leading to lung transplant. Can you talk about how the pandemic, over the last year and a little bit, has affected your field?

David Weill: Sure. I think that there’s been a lot, and I’ve been interviewed about the very subject. So I think there have already been around 100 lung transplants across the country for COVID-related pneumonia. Those have mainly taken place, Kevin, in the acute setting, where patients are acutely ill with COVID pneumonia and they can’t be weaned from the ventilator or ECMO support. There have already been 100 of those transplants performed, and I think there are going to be many more of them. But what concerns me the most is what I think is going to be a tail of lung transplants that follow after the pandemic, when many of the patients who recovered from the initial infection are going to be left with lungs that are scarred and may ultimately need a lung transplant.

Kevin Pho: All right, so let’s transition into your book, and there’s an excerpt on KevinMD. The book is titled Exhale: Hope, Healing, and a Life in Transplant. Now, can you share with my audience a little about that book?

David Weill: Yeah, so Exhale is a book that peels back the curtain of a transplant program, and I think that it would be applicable to all complex areas of medical care. I think our patients perhaps don’t understand what’s going on on the other side of the physician-patient relationship, and I wanted to show how it feels, not only from a patient perspective, the emotion of receiving a transplant, but also what it feels like to deliver that care day in and day out. And so I wanted to give readers an idea of the roller coaster that we live on.

Kevin Pho: Can you share a particularly poignant story that really illustrates some of the tribulations that you had as a transplant surgeon?

David Weill: Yeah, I think that some of the stories that I write about, and that I’ve actually excerpted on your website, include those where patients who are on our waiting list simply run out of time. These are patients that we got very close to but who died on our waiting list before they got a shot at the transplant. Having the family discussions and telling family members that their loved one is not going to get a transplant is actually probably the most difficult part of the job. Losing patients after transplant is obviously not easy either, but I think losing patients before they even get a shot at the transplant hit me particularly hard.

Kevin Pho: I talk about things like physician burnout and moral injury as themes on KevinMD. That’s been going on for, you know, years now. Now, as it relates to your life as a transplant surgeon, where did you go for support? What kind of things did you do afterwards to help you through these difficult times?

David Weill: You know, I talk a lot, when I give talks about my career arc, about the three F’s of family, friends, and faith, and I relied on all three to get me through some of the tough times. I think that the best thing that we can do as health care providers when we are struggling, and there are many out there that are struggling, is to make sure that we don’t isolate ourselves. I think one tendency that I had when I was feeling down or emotionally distraught was to stick my face in a book or watch a sports game by myself. I think you should actually do the exact opposite. You need to stay connected not only to your work colleagues, but especially your family and your friends, and, for those that are inclined, your faith as well.

Kevin Pho: Sometimes that places the burden of burnout on the clinician himself or herself. Now, how much of the responsibility is on the medical institution itself to help address some of these symptoms of burnout and moral injury in health care staff?

David Weill: No, it’s a great point, one that I’m looking at pretty closely and I’ve written about. I think that there’s the tendency to think that a burned-out health care provider has an internal problem, either an emotional or mental health issue. But I think, as your question suggests, that most of what I’ve seen out there, and people that I’ve interacted with, it’s actually due to external causes. So I’m not even crazy about the term burnout. I wish we would use another term for it, because often it’s disillusionment with a health care system that, frankly, I don’t think is working anymore for either patients or the providers. So I think your question is a good one.

Kevin Pho: Was there a specific event or incident that caused you to leave the front lines of transplant medicine, or was it a culmination of years of trials that led you to step away?

David Weill: I think it was a culmination. It was the empathy depletion that I talk about in the book. And I think that one indication that it was time for me to step back was my inability to focus on the successes that we were having in transplanting people successfully. I tended to focus, toward the end of my time at Stanford, on the patients we had lost and the so-called failures, instead of focusing on the entire context of patients that we transplanted. Once I started doing that, I knew that it was probably time to step away.

Kevin Pho: We’re talking to David Weill. He is a pulmonary transplant physician and is the author of the book Exhale: Hope, Healing, and a Life in Transplant. Dave, one of the things that I like is to really track the journey from clinical medicine into things outside of clinical medicine, and you mentioned you are now a consultant to transplant programs across the country. Tell me a little bit about that transition from the front lines into what you’re doing now.

David Weill: It happened rather seamlessly, Kevin. I had done a fair amount of work while I was at Stanford helping other transplant programs, because I thought it was a great way to get back to the community, and I actually just formalized it as a business after I left Stanford. We’ve branched out into other things as well. I help with physician and surgical recruitments, for instance, in the transplant space. I help centers with their entire pulmonary and ICU practices now and how to set those up so that they run better. And I also serve on some boards in the transplant and pulmonary space as well, and then do a little bit on the investing side, in some of the companies I’m interested in in that space.

Kevin Pho: And when making that transition from clinical medicine to what you’re doing now, did you have any mentors in business to help you with that transition?

David Weill: Yeah, I really didn’t. I mean, some of it came fairly naturally to me, but some of it was trial and error, I would say, the first year. And I would advise your listeners to really take stock during that first year out of clinical medicine, to try to figure out what they do well and focus on that. I thought program building was something that I had done well during the course of my career, so I wanted to focus on that.

Kevin Pho: Do you miss clinical medicine?

David Weill: I do, I do. I’d be lying to say that I didn’t. I miss it, but I think that the time I get to spend with my family and friends has replaced that. Fortunately, I’m able to hear from a lot of the patients that we worked with at Stanford, and they have been wonderful, I think, in supporting me, and that interaction is incredibly meaningful to me.

Kevin Pho: Now, what would be your advice to residency programs, or hospitals, medical institutions across the country, to prevent, you know, physicians from leaving because of what some may call burnout or moral injury? What’s your advice to these programs?

David Weill: I think the first step is what’s already happening out there, I think, to some degree, which is understanding. I think that when we were coming up in the field, all we were told, really, is just to get out there and tough it out, and that was basically the advice. I think now there’s a lot more attention paid to the work-life balance among health care providers, and I’m convinced that that’s going to pay off for the next generation of physicians. Maybe not so much for my generation of physicians, but I think the next generation will benefit from that.

Kevin Pho: And for those physicians still in clinical medicine, what’s your advice to them?

David Weill: I think just make sure that you carve out enough time to stay connected to the people that you care about. I think that that is absolutely key. In some of the tragedies that we’ve seen during the COVID crisis and before, physicians who isolated themselves are the ones that really got into trouble, and I would hate to see that. I think that it’s connection. You’ve got to stay connected, and you’ve got to tell people if you’re struggling, and I think that’s another important message.

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

David Weill: Take care of yourself while you’re taking care of others.

Kevin Pho: And how can people reach you?

David Weill: You can go to my website at davidweillmd.com. It’s got my writings, my contact information, all about me.

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

David Weill: Thanks, Kevin. Appreciate it.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes