If Simone Biles were a doctor she would be vilified, not praised [PODCAST]

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“Just as Simone Biles has her detractors, there will always be physicians unable to empathize with their mentally ill colleagues, believing psychological struggles are a constant state of being human. But if taking care of oneself means temporarily leaving the workforce to receive professional treatment, then so be it. Physicians are beginning to feel empowered to protect themselves. Their acts of self-care can be seen as the first step in protecting and preserving mental health. Being mentally tough for practicing medicine is no different than being mentally tough for competing for a gold medal. In either case, it does not mean sacrificing your sanity. It’s time medical schools and institutions were on board with this notion.”

Arthur Lazarus is a psychiatrist.

He shares his story and discusses his KevinMD article, “If Simone Biles were a doctor she would be vilified, not praised.”

Read his story mentioned on the show: “The Most Memorable Patient I Never Saw.”

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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 Art Lazarus. He is a psychiatrist, and he wrote the KevinMD article “If Simone Biles were a doctor she would be vilified, not praised.” Art, welcome to the show.

Arthur Lazarus: Kevin, thanks for having me. It’s a pleasure to be here.

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

Arthur Lazarus: It’s a circuitous type of journey. I started out very traditionally, trained in psychiatry at Temple medical school in Philadelphia, and stayed on faculty there. I didn’t know there was another life outside of academic medicine, but I had a lot of other interests other than practicing, and one of those was medical management. So after practicing for about 20 years, I entered industry, and I’ve worked for the last 20 years in both the pharmaceutical industry as well as the health insurance industry. And then about a year and a half ago I retired, but I was actually seeking an encore career, so currently I do consulting. I work about 20 hours per week.

Kevin Pho: So there are a lot of physicians who are getting burned out with their clinical jobs and maybe looking for options outside of clinical medicine. Now, what would you say are some of the things that people don’t know about some of these non-clinical options that maybe they should be aware of?

Arthur Lazarus: There’s a tremendous variety of non-clinical career options, but I think what I’d like them to know most of all is not what those options are, but to keep in mind that the grass is not necessarily greener on the other side. It’s just different. So the take-home message is, if you’re burned out, it doesn’t necessarily mean you should enter a non-clinical career. You have to be drawn to non-clinical careers, as opposed to being pushed into them.

Kevin Pho: Now, what are some examples of common non-clinical careers, and what would you say are some of the challenges that these physicians face in transitioning to them?

Arthur Lazarus: The most common type of non-clinical career is going to be working in the health insurance industry, which for the most part is somewhat limiting for physicians, because most of the physicians in that type of industry do utilization review and peer reviews, and there’s very little movement outside of that area. Of course, quality improvement activities are also on the plate of insurance company medical directors. I did that type of work. It wasn’t very gratifying. I’m a patient advocate, so I wasn’t pleased about having to deny care, and that’s why I transitioned out of the health care industry and into the pharmaceutical industry.

I’ve always had a lifelong interest in medication and pharmaceuticals. My own specialty of psychiatry was revolutionized by medication. So I enjoyed working in the pharmaceutical industry the most, and I’ve done everything from clinical trials to reviewing advertising and promotion for medical accuracy, so in other words, medical marketing. But those are the two most common non-clinical careers, and there’s a variety of others as well.

Kevin Pho: Like you said before, someone who is burned out with clinical medicine may not necessarily be suited to a non-clinical option. Tell me what kind of characteristics a physician should have if they’re able to successfully transition into some type of non-clinical career.

Arthur Lazarus: I think they need to, number one, obtain business skills, because they are working in a business environment, and they are dramatically outnumbered by, as we call them, the suits. They also need to learn how to navigate between medicine and management. They need to realize that they have to advocate for patients regardless of the nature of their job, and not cave in to political or business pressures. So they have to have strong leadership skills.

Kevin Pho: All right, so let’s transition now into the KevinMD article that you wrote. It’s titled “If Simone Biles were a doctor she would be vilified, not praised,” and this article clearly resonated with my audience, with over 3,000 social media shares. Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Arthur Lazarus: Well, Kevin, I work at home, so I had plenty of opportunity to view the Olympics. I like sports, and obviously the spotlight was on Simone Biles. I’ve written a lot about physician wellness, including my own experiences through medical school and residency, and how I think that culture can be improved. And don’t ask me why or how, but I had one of those aha moments that we refer to often in psychotherapy. When she just bowed out, and there was no reason forthcoming immediately, the first thing that I thought of was that it’s not a physical issue; it’s some type of mental issue. And sure enough, that’s what it turned out to be.

And so, again, thinking about medical students and residents in medical education, and the culture of medicine not necessarily being favorable to allowing physicians to bow out, so to speak, I came up with the idea that if she were in medicine, in the practice of medicine, or even in medical school or a resident, it would be much more difficult to take the actions that she took.

And then again, the focus of the article was really on citing other physicians who have had extreme difficulties throughout their careers, whether in medical school, residency, or practice. I had read about these physicians and others on the internet through various blogs and websites, including yours, and I thought it would all come together nicely as an article with a take-home message to not withstand an abusive environment.

Kevin Pho: Now, can you give me an example, or maybe even a case study, from your experience or from a colleague perhaps that you knew, that really illustrates some of the pressures medical students, residents, and physicians face when it comes to mental health issues and persevering through them?

Arthur Lazarus: I’ll answer that in two ways, and I’ll be quick about it. One is actually through an article that was just published. I’m just going to give you the tagline here. It was published in JAMA Network Open. It’s called “Association of characteristics of the learning environment and U.S. medical student burnout, empathy, and career regret.” Essentially, they did a study of over 14,000 medical students in year two, and they found that those who felt mistreated in medical school at year two had burnout and career regret by the end of medical school, by year four, whereas those who experienced a positive learning environment beginning in year two had lower burnout, higher empathy, and less career regret at year four. So there is enormous pressure, as I said, beginning even in college, and then continuing through to practice.

And I’d also like to say that I’m interested in physicians speaking up and discussing their own experiences: one, because I think it’s healthy to write about that, and number two, because we would understand as physicians that we’re more alike than unlike, and we’ve all suffered through adverse experiences of one type or another.

In my own case, in my residency there was an incident where a patient attempted suicide. The patient was not under my care. In fact, I never saw the patient, but I did a telephone consultation regarding his treatment, and I felt very guilty about that. It triggered a lot of anxiety and depression in me, and I kept that hidden for many, many years. Finally, about five or six years ago, I wrote about the experience, and it was actually very therapeutic to do so.

And I actually think it’s a form of PTSD related to practice, where we as physicians are often second victims. There’s an actual individual or circumstance involving real trauma. I mean, any emergency room physician can attest to that. But then we are the second victims; we’re vicariously traumatized by that, and we carry that with us. And there ought to be more of an emphasis on allowing physicians to discuss those episodes, to share the burden with each other, and to put in place a lot of wellness initiatives to deal with the trauma that we all experience.

Kevin Pho: When you shared your story five to six years ago, what was the reaction from your physician colleagues?

Arthur Lazarus: It was overwhelmingly positive. Most had no clue whatsoever that I had gone through a really bad experience as a resident. It affected my performance. I was actually put on probation as a resident, and nobody, you know, I stayed at the university where I trained, and people were kind of shocked that I started out strong, and in my second year I seemed to have difficulty. But nobody knew that I was experiencing anxiety and depression. And then, with the help of a very wise psychiatrist, I was able to deal with it successfully, and I ended up becoming chief resident and having a very successful career. But that internal trauma continued to linger.

And I even had folks email me who had had similar experiences, losing a patient or making a medical error or medical mistake, and it was good for them to actually share their stories with me, because they had never shared them with anyone else.

Kevin Pho: The concept of burnout in health care workers certainly is not new. We’ve been talking about it on my blog for the last five to six years now. In medical school, they’re switching to pass/fail courses; in residency, they have work-hour restrictions; and even for attendings, there are all these wellness programs that are aimed at addressing burnout in health care workers. Are those initiatives enough to stem the tide?

Arthur Lazarus: They’re necessary but not sufficient. A lot of them actually just pay lip service to burnout. It’s become almost a commodity at this point. I think we really have to dig deeper, beneath the surface, and really aim at changing the culture of medicine and being more forgiving, which is a term that I used in my KevinMD article: that the medical culture was unforgiving. And look, I’m a psychiatrist. I know about wellness initiatives. I know about mindfulness and yoga, and I’m not disparaging any of those forms of therapy, but I know that it requires a lot more than just superficial initiatives and talk to get to the root of these problems.

Kevin Pho: We’re talking to Art Lazarus. He is a psychiatrist, and he wrote the KevinMD article “If Simone Biles were a doctor she would be vilified, not praised.” Art, for those health care workers and medical students who are feeling symptoms of burnout and perhaps are afraid of becoming vilified, what is your advice for them in terms of moving forward and how they can address this successfully?

Arthur Lazarus: It depends on the depth of the burnout. At the very least, they should seek a career coach, or an executive coach or counselor, and discuss where they are in their current career, what the symptoms of their burnout are, and what’s causing their burnout. If it’s deeper than burnout and it’s clinical depression, or, as you know, what we call major depressive disorder, they really need to see a professional. They need to see a psychiatrist or a psychologist who’s very skilled in dealing with medical professionals who have had burnout, and they need to be in therapy and address this first and foremost.

I’d also say that, as you know, one of the difficulties of any medical professional going into psychotherapy is that, for the most part, they don’t, because they fear that they’ll jeopardize their medical license, because these questions can be asked on licensing renewals. And so that’s another major change that needs to occur: to see physician wellness programs, and physicians who seek out therapy, as a positive, seen in a positive light, as a positive movement, not something that is negative and can be used against them.

Kevin Pho: So how do we go about changing that culture? Sort of sharing our stories and normalizing it? How can we change our culture and look at physician wellness more as a positive rather than a stigma?

Arthur Lazarus: Well, I think your podcast, and other people writing on blogs and websites and, so to speak, coming out more, is what will drive the point home. We have to recognize that 20 years ago we said “To err is human,” but I don’t think we actually fully believe that or allow that to occur. There have to be ongoing changes in patient volume, the amount of patients that physicians are expected to see, which is becoming more of an issue as now more than 50 percent of the physician workforce is employed. I mean, it’s a multifactorial, multipronged approach. There’s not just one. I think part of the mechanism needs to be oiled or changed.

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

Arthur Lazarus: I actually said it earlier. It’s a Maya Angelou quote, where she says, “We are more alike than we are unalike.” I want to encourage people to recognize that and realize it, understand it. I want them to write about their experiences. I want them to speak up and provide a voice to advocate for others who are not inclined to voice their opinions and share their experiences. We need more of a groundswell of an organic movement in order to make real change.

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

Arthur Lazarus: Thank you, Kevin. I appreciate it.

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