Take back the power and joy of being a doctor [PODCAST]

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“What can we control? Our behavior and our responses to circumstances. Focusing on what is in our power to control and putting all our energy and efforts in the right places and for the right reasons seems to be a step in the right direction to make positive changes and avoid burnout.

Now, imagine not only surviving medicine but also enjoying it, using it as an opportunity for personal growth and development, as a catalyst that transforms challenges into amazing outcomes.

Close your eyes and remember why you decided to be a doctor. How did you feel the first time using your white coat, hearing the ticking of a heart, saving a life? It’s time to recover the power. It’s time to reassume the responsibility, the privilege and the joy of being a physician. Be healthy, be happy — and keep helping people and saving lives!”

Miriam Zylberglait Lisigurski is an internal medicine physician. Yudith Furman is a psychotherapist.

They share their stories and discuss their KevinMD article, “Take back the power and joy of being a doctor.”

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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 Miriam Zylberglait and Yudith Furman. Miriam is a veteran of the show; she appeared last year. She’s an internal medicine physician, and Yudith is a psychotherapist. Together, they co-wrote the KevinMD article “Take back the power and joy of being a doctor.” Miriam and Yudith, welcome to the show.

Miriam Zylberglait Lisigurski: Thank you very much.

Kevin Pho: So we’re going to get into your article in a little bit, but I’m going to ask each of you to share your stories and journeys to where you are today. Miriam, why don’t you go first?

Miriam Zylberglait Lisigurski: So I am an academic physician. I do internal medicine and geriatrics, but really my heart is in academia. So I work all the time with residents and medical students, and I can see firsthand how challenging medical education can be and how challenging our complex health care system is today. So I am very interested right now in focusing my career on developing my wellness and leadership skills, so I can’t provide those to my residents and my students, so they can have brighter futures and be able to really enjoy medicine and be happy and healthy.

Kevin Pho: So, Miriam, we are talking, actually, at the beginning of September now, and you’ve had new residents. Certainly you’ve seen them over the last few months. Tell me some of the challenges that new interns are facing, especially in light of COVID in the background.

Miriam Zylberglait Lisigurski: Normally, July is a very interesting time of the year for any academic physician, for academic hospitals. Interns need to face many challenges. First of all, if they are immigrants or they are coming from another city, they need to adapt to the transition, right? To be in a new place, with new people, sometimes understanding the medical system, right? Which is already complicated. The long hours are not helpful. The stress right now of getting sick, or knowing that if they go back home, they can get someone that they love sick, is adding extra.

And I feel like there’s something that is even more important. We tell residents, and we tell physicians and medical students, that they will be in front of that. And we kind of know that that will happen, but the amount of sick people, and now young people, that are dying or are on a ventilator, the emotions around that, the stress that they’re discussing, is unprecedented, and I don’t think that we prepared our residents, our interns, for that. I don’t think that we were prepared for seeing that either.

Kevin Pho: And Yudith, can you share your story and journey to where you are today?

Yudith Furman: Yes, of course. Thank you for having us. So I’m originally from Lima, Peru. I’m a clinical psychologist and systemic family therapist. I moved to the States 15 years ago, and I needed to kind of reinvent myself again because of the differences between education and degrees in the different countries. So I had the opportunity to do something different, but I actually have my passion in well-being. So I went back to school. I got my master’s in mental health counseling, and I got a specialty in positive psychology. That is something that I’m very passionate about.

Right now, I work in private practice, and I’m also the director of counseling at a school in Fort Lauderdale, so I’m very passionate about working with students and trying to increase their well-being. We all know that it all starts at a young age. So I’m trying to make an impact and really make sure that the kids have the skills that they need to develop themselves and be able to handle whatever the world throws at them. And right now, resilience is a big topic, and I know that we’re going to be discussing it a little bit more later on regarding the article, but I think there’s so much that needs to be done on the preventive side, and not focusing only on the intervention in the future, when things are going wrong, but more on preventing and providing the skills that are needed.

Kevin Pho: And Yudith, of course, we’re entering a really uncertain school year, especially with what we’ve been through over the last 18 months. So what kind of advice are you giving to these new students who will maybe be coming back from a year of remote learning and now going into in-person learning for the first time in what could be over a year? What kind of advice are you giving them?

Yudith Furman: So it’s interesting, because I work with students K through eight. So we have the whole range, and with the little ones, it’s a little more difficult to really process with words what is happening. So a lot is going into also helping the staff, like the teachers and the administration, and also helping the parents to support the students and to really give them the tools that they need.

In terms of the advice, I always say, “Feel your feelings. It’s OK.” Not everything is going to be happiness and rainbows and butterflies. But it’s just being able to feel it and to do something with it. So instead of just trying to avoid the negative, if you’re having a negative feeling, just seek help. Use your tools, use your strategies. There’s a big support system around you. So I think that the message is more about, “We’re here for you. We’re in this together,” and just providing them all the tools that they need to be successful.

Kevin Pho: All right, now both of you co-wrote the KevinMD article “Take back the power and joy of being a doctor.” Miriam, I’m going to ask you, for those who didn’t get a chance to read that article, can you just walk my audience through it and share why you and Yudith decided to write it?

Miriam Zylberglait Lisigurski: When I started writing this article, I was going through a frustration mode. And again, as I mentioned the last time that we were together, I write as part of psychotherapy. And I was trying to convince myself, and also those that are around me, that we have power, we have the power to control what happens to us; that we are not victims, and that it is easier to blame the system. I will agree that the system is absolutely corrupted; there are many things going wrong around us in the medical field. But I just can’t accept that the medical system will decide how happy I am, how healthy I am, how good a physician I am.

And the idea was to empower others to recover that control, to know that they can make their own decisions. And there are, as you mentioned, certain tools, right, from support, psychological support, to having friends around you. But probably the most important are the ones that we have inside of us, right? Our resilience, our ability to grow even when we are in front of adversity, which is called post-traumatic growth; our emotional intelligence, which allows us to be self-aware and to understand where our gaps are, and to understand also what is happening around us, and to be able to adapt. And something that I learned actually from you, that was very interesting for me, is your locus of control, right? What you can control, and what to do with those things that you cannot control, and knowing when to let go of that thing, so you keep your sanity.

Doctors, we are privileged to have the opportunity to save lives, to help people, to always be there for others, to teach, to research. We are just chameleons. We can transform ourselves into so many things at the same time. But if we don’t take care of ourselves, if we don’t recover the power, if we are not happy and healthy, we will not be able to continue helping others, and we need to recognize that.

Kevin Pho: When it comes to clinician burnout, there’s always that tension, right, between the system and our resilience and what we can do to control that. So what are some ways that clinicians can really take control? What are some internal things that could change that framework, where they can better survive burnout?

Yudith Furman: Seeing it from the outside, because I’m not a physician, but I have a relationship with someone that is a physician, I think that a lot of pressure goes onto doctors. They have that responsibility and the privilege of saving lives. But also, many times, we see them as these kind of superheroes or gods that have all the answers and that can’t do everything and anything needed to help people. And that puts a lot of pressure on themselves.

And I think that it’s very important to recognize what is in your hands, what you can do, and what is in your control, and what is not. The system, maybe you can modify the system, but you can modify the way that you handle the situations, or the way that you react to the injustices or to things that are happening that maybe you don’t agree with. So I think that it’s more about really looking into yourself and recognizing what you can do, how you can do it, how you can contribute, and also taking care of yourself.

There’s a lot of “I’m going to do this for you,” but not “What am I going to do for myself?” And we tend to be very kind to other people, but we are not kind to ourselves, and I think that that is one of the main reasons why there’s so much burnout, because they are focusing so much on others, and they are not focusing on themselves. I always give the example of when you’re in an airplane and the oxygen comes down: First you need to put it on yourself, and then you can help the person that is next to you. So this is exactly what physicians, and honestly anyone, should be doing. It’s not selfish. The only way that you can help others is to make sure that you are OK first.

And in terms of resilience, I think that everything is kind of related. Resilience is something you can learn. For some people, it comes more naturally, and they are just able to bounce back really quickly, maybe because of the way that they see life, their past experiences. For others, it takes a little more work, but I think that in general, it’s something we can learn and that we can practice and that we can get better at. So I think that at the end of the day, it’s just recognizing that we’re just human and that we do the best that we can.

Kevin Pho: Miriam, sometimes in the heat of the moment during a busy day, or if something doesn’t go well clinically, it’s sometimes hard to think back to your article and think back to some of the things that we can do to kind of help remove us from the situation. Can you give us a case study or an example of how a busy physician or medical student or resident, for that matter, can implement some of these techniques in the heat of the moment, when everything isn’t going the way they want?

Miriam Zylberglait Lisigurski: I am not in my office right now, but if you were to go to my office, what you would see is that all my walls are full of pictures of my residents, cards from my patients, and I have a special wall for my family. When I’m having a very challenging day, I take a few seconds and I go around and I see those pictures, and I try to focus on why I am doing what I am doing. I go to my core values. I go back to my dreams and who I am. And that’s my best technique: to recognize that even on the challenging days, I know who I am. I know why I’m doing this. I know why I’m sacrificing, and I know why I’m tolerant. And I use that as a motivation also, because I kind of understand that it’s not just me. I cannot throw a tantrum in the middle of the day. There are people around me that depend on me, and I need to be the role model. So I will say that that’s number one.

Number two, I just recognize my gaps. I am very transparent with that. If I don’t know, I don’t know. If I am afraid, I am afraid. If I know that I am going to a difficult encounter, you will laugh, but I will shake myself before I go through that door and into that room, knowing that I will need to have extra energy, and I prepare myself. I guess if you are self-aware and you understand that the situation is complicated, you admit that, then you put those feelings, negative feelings, in a box, you close that box, and then you go into a room and you interact with your patients, you will remove bias, which is such an important thing to do. You will have more control of what you are doing and what you are saying and how you are acting, and you will be the physician that you want to be.

And if you need to come back to your office and remove those feelings from the box and start crying or doing whatever you need, do it. But keep it professional, and be sure that priority number one is to take care of your patients, and for me, the same level of priority is to take care of my residents and my students.

Kevin Pho: Yudith, I’m going to ask you that same question from your perspective as a psychotherapist. Are there any specific psychotherapy techniques that you could advise clinicians if they’re in a heated moment and having just a terrible day and may lose perspective and may not think about some of the things that you wrote in the article?

Yudith Furman: So in the heat of the moment, it sounds very simple, but it could be difficult: Just breathe. Sometimes it’s just taking a moment. Take a deep breath, center yourself, connect with yourself, and just give yourself those 10 seconds that maybe are going to make a huge difference. So I said that it’s very simple, but it’s very complicated, because I think that we forget about the power of breathing and just centering yourself. But that would be my number one. That’s something that works with children, with adults. I think that we’ve all been there in some way, and just pausing. Probably you physicians know better than me, but your brain just needs that space to kind of activate and make better choices. So I think that that’s number one.

In terms of other things that you can do, maybe not in the heat of the moment, but in general, I think that some simple things, like practicing gratitude, just being thankful for what you have, appreciating what you have around you, the privilege that you have of being a doctor and being in that position of saving lives, which is so special. And also thinking about your relationships, the positive relationships that you have. I think that support systems are extremely important, and I know that sometimes being a physician and the long hours could be very lonely, but just knowing that you have a support system, and sometimes it’s your family, sometimes it’s your extended family, like your colleagues, but just relying on them and asking for help if you need it.

No one is expecting perfection. No one is expecting these kind of superheroes that I think that you are in many ways, but definitely you’re human. So it’s just going back to those basics and just connecting to yourself, connecting to the people around you, and just being grateful for what you have.

Kevin Pho: We’re talking about Miriam Zylberglait and Yudith Furman. Miriam is an internal medicine physician, and Yudith is a psychotherapist, and together they co-wrote the KevinMD article “Take back the power and joy of being a doctor.” Miriam, one of the biggest problems that I think people in medicine have is really asking for help, when to seek help. There’s a lot of stigma when it comes to burnout and behavioral health issues. So when you advise your medical students and residents and fellow clinicians about seeking help, what kind of advice do you give them, and when should they seek help?

Miriam Zylberglait Lisigurski: So what you’re saying is so true, right? We have many challenges, and this comes from not only the feeling of, again, being superheroes, so we are not allowed to be vulnerable, that that shows weakness, but also there are some limitations in the system. A majority of the states in this country will need physicians to fill in, when they are processing their licenses, if they were treated by psychologists or psychiatrists, right? So we need to disclose something that I don’t think, in any other type of career, a lawyer or a teacher needs to say, if they had any medical or psychological condition in the past, and that creates a lot of fear. Doctors don’t want to ask for help, or they don’t want this to be in records, so that limits the access to help. And there’s a big challenge. I guess this is something that we need to reconsider. I believe that there’s a group of people already working on trying to make some changes in this regard, but it’s something that needs to be urgently fixed.

What I tell my residents and students: Number one is I am always available, that anything that happens in my office is HIPAA-protected, that they are not expected to be perfect, and that they need to ask for help. The first steps are to talk with friends and family, but it gets to a point that friends and family are not enough, and that they need to get psychological therapy or even to get in touch with psychiatrists, and that it is better to do that before things happen.

Part of our article mentions the rate of burnout, that is around 40 percent, which is very high. And this is not related to COVID. I want to clarify that these numbers are not because of COVID. These numbers are almost similar to before COVID. There is a recent survey: More than 10,000 physicians were asked about suicidal ideation, and 13 percent of them answered that, yes, they thought about committing suicide, and then you have 1 percent that attempted. We have 300 to 400 physicians that die per year in this country. And this is not only medical students or residents; actually, the average age of physicians who commit suicide is 40, 40 to 50s. And I don’t see that in the news. And it’s not that it’s something that we need to be proud of and we want to spread, but I don’t see people talking about this. And I don’t see people being concerned about this.

And my biggest concern is not only the lives and the suffering of those that commit suicide and their families, but I think also about what happened before that. One of the most frequent causes of mortality in this country is medical errors. And probably these are related, we are to assume that these are related, to physician burnout. So we are not only talking about 400 individuals that die because they are suffering as physicians. We are talking about what happened before: how many patients maybe they harmed while trying to be superheroes and multitask and be there for hours. So this is an epidemic, as bad as COVID. And this is a public health situation that we need to target, and we need to fix, because, removing myself from the position, I am a physician, but we need our physicians to be healthy, and we need our physicians to be in a situation where they can’t really keep saving lives and helping others. And I don’t think that that is where we are right now.

Kevin Pho: So, guys, each of you, now your take-home messages that you want to leave with the KevinMD audience. Yudith, we’ll start with you.

Yudith Furman: So I think that I’m going to go back to something that I mentioned before. I think that the most important thing is to give permission to be human. I remember when I did my certification in positive psychology, they told me, “If there’s one thing that we want you to take away from all this long studying, it is that we are humans, and we need to give permission to ourselves to feel and to live and to realize that we are not perfect, and that we’re going to make mistakes, that we’re going to need help.”

Going back to the stigma that you were mentioning before, I think that asking for help is always perceived as a weakness, and we need to change that narrative. So I believe that the most important thing is accept yourself, love yourself, be kind to yourself. It’s easier to do it with others, but not to yourself. So I would say that self-care is extremely important, and just do what you love, do it with all your passion. Take that joy back, like we say in the article, but really feel it and go back to the reasons why you chose that career.

Look back at what motivated you to go through so many years of medical school and so many sleepless nights, and what was really your motivation and your passion, and just recover that, because I think that as the days go by, the weeks go by, you get tired, it’s exhausting in many ways. Sometimes you get discouraged and you forget that, so going back to those moments is extremely important.

Kevin Pho: And Miriam, what’s your take-home message that you want to leave with the KevinMD audience?

Miriam Zylberglait Lisigurski: I believe that we need to recognize who we are, be self-aware, and understand and recover our values, our dreams, recover the power, and stop being victims. We are not victims. We are smart people, and we are good people, and we are doing amazing things. We need to be proud of ourselves, and we need to recognize that in a humble way, too, right? Because it’s such a privilege and an honor, but it’s also a responsibility, and we need to be responsible, and we need to take care of ourselves so we can do our job correctly.

I want to use this opportunity also to create some awareness. September 17 is the day of physician suicide awareness. Please pay attention to your colleagues, pay attention to your medical students, your residents, pay attention to yourself. Don’t be part of the statistics. Be someone that not only survives medicine or survives life, but actually enjoys it. We don’t need to keep seeing doctors jumping out of buildings; that’s not acceptable. Don’t be part of the problem, but also don’t be quiet and just ignore it.

We need each of us to collaborate, to help, to be proactive. We cannot just say, “This is not affecting me directly. I am not a victim of my profession today, or I have a good salary, or my schedule is good, so I will not get involved.” We are a community, the community of physicians, or the community of health care workers, because it really affects all of us. We need to act as a community. We need to have a family, and we need to advocate for each other.

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

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