We are humans first and gifted healers second [PODCAST]

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“If I knew back in training and practice what I know now, I would have looked for the support and mentoring that would have helped me to forge a path in clinical medicine. But I saw help as an admission of weakness. I felt too much shame and guilt to even consider asking for any.

While I regret that I didn’t access help before leaving practice, I am grateful to have learned an important lesson early and had the chance to course-correct my life. I’m a happier, more balanced person because of it.

I am awed by my physician colleagues who have known all along to put their human needs first—the old oxygen-mask-on-the-plane analogy. Thank you for the example you set for our profession.

Over time, perhaps there will be a new message that we all embrace: We are humans first and inspiring, gifted healers second.”

Diane W. Shannon is an internal medicine physician and physician coach and can be reached at her self-titled site, Diane W. Shannon.

She shares her story and discusses her KevinMD article, “We are humans first and inspiring, gifted healers second.”

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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. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today, we welcome back on the show Diane Shannon. She is an internal medicine physician. Her latest KevinMD article is titled “We are humans first and inspiring, gifted healers second.” Diane, welcome back to the show.

Diane W. Shannon: Thanks so much, Kevin. It’s great to be here.

Kevin Pho: So Diane’s been on multiple times, so for those who are interested in hearing her story, just go to KevinMD.com/podcast, go to the search bar in the upper right corner, search for her name, and you can find out more about her background. But today I want to jump right into that article. It’s titled “We are humans first and inspiring, gifted healers second.” Now, for those of you who get a chance to read that article, just walk my audience through it and share the story of why you decided to write it.

Diane W. Shannon: Yeah. So why I decided to write it: First, I think I had a birthday coming up, and I was thinking, as you do when a birthday’s coming up, about the past, and really realizing that my experience with burnout really changed the trajectory of my life. That was a negative for many, many years. There is a piece that I finally saw that was a positive, which is that it really forced me to look at what I am doing to take care of myself. That’s not to say that we are responsible for burnout. Burnout is caused by system factors and by excessive stress in the workplace. We know that. But I was also able to see that I made choices then, because of that, that led me to having a healthier, happier life now.

And I think the other thing that led me to write the article was that I’ve seen, just over the past six months, I feel like everything has become more severe: the burnout I’m seeing, the degree to which people are impacted by it, having to take time off. It really made me think about what it takes to get help earlier, before having to make a decision like I did to leave practice, or having to take time off just to heal. So that was it.

Kevin Pho: All right. So before you summarize that article, just go through that transition. You mentioned that you were burned out, and there was a period of time, and then you decided to go and seek some of the changes that make your life better as it is now. How long did that realization take for you?

Diane W. Shannon: Gosh, well, I think it’s a process, right? So I burned out in residency, pushed myself to keep going, and then finished residency, took my boards, and practiced. I was somewhat better. It wasn’t as severe as in residency. But when I looked ahead, I thought the only options I saw were either to burn out again or to leave. That was me not knowing that help, something, would have helped: a mentor, counseling, something would have helped me to see more options. This is 25 years ago, when there was little discussion about burnout, especially among physicians, and there wasn’t the access to help that there is now.

So I think that was the beginning of saying, “I don’t want to burn out again. It really took a toll. I don’t want that experience.” And then over time, I worked with a coach myself, and I began to see some of the places where I was getting in my own way. I think it’s just been a gradual process, and it continued to change even two years ago, when I started with a mindfulness practice. I had really shunned that sort of thing for years, thinking, “I don’t have time to sit down and meditate for 60 minutes.” But I found something that’s much more short bursts of mindfulness, something that I can fit in my day, and I’ve suggested it to other physicians, and they find that even in a busy clinical practice, they’re able to do that. So that begins to make a change.

Kevin Pho: So let’s talk more about your article. How are we humans first and inspiring, gifted healers second? Talk about your article.

Diane W. Shannon: Right. Well, what I realized as I began writing this was that I really bought into that notion that we’re not human, that we are superhuman, we are heroes, that we can sacrifice and continue sacrificing. Maybe that’s who we are, why we’re drawn to medicine, and maybe it’s our training, but I think a lot of us begin to sacrifice just to make it through and then continue to sacrifice. It was a lot easier for me to just continue doing that than say, “Wait a second. I’m actually human. I need to sleep. I need time to connect with people that I care about. I need to exercise.”

What I believe is happening over the past 10 years, five years, and now with the pandemic, is the environment is getting so much more pressure-filled, with so much more productivity pressure and less time with patients, that those who were able to keep some of those pieces in their life that made them human, that refilled them, those are getting squished out. There are many more physicians, I believe, who are experiencing burnout now because of that.

Kevin Pho: So tell me, what are you seeing? You have a coaching practice. What are you seeing in your coaching practice and in talking to other physicians? How is that humanity being squeezed out of them, and what can they do about it?

Diane W. Shannon: Right. Well, one of the things I start with is to ask the question, “What do you look like at your best? What do you feel like? What are you thinking? How’s your energy? How do you interact with people? How do they interact back with you?” And then, “What is it like when you’re not at your best?” And then I ask the question, “What are the preconditions that make it more likely you’re going to be at your best?” The answer that comes out first, most of the time, is sleep.

There are lots of preconditions that we can’t control. If you come into work and you’ve been double-booked, or your surgery got moved, right, there are things we can’t control. But there are some things we can control, and by starting there, we begin to have the bandwidth to actually show up as our best at work, have a better experience in our day, and maybe have the energy to fix some of the system problems in our immediate practice environment. We may not be able to fix reimbursement as an individual, but we can begin to make maybe the patient flow more efficient, or our use of the EHR more efficient. Maybe our perfectionism is getting in the way, and our notes are taking twice as long, right? There are some things that we can do.

But starting with that question, people begin to say, “Oh, sleep makes a big difference. When I haven’t slept well, I show up and I’m cranky with my staff, and I feel terrible about it. But there are things that I can do, whether it’s ‘I’m not going to look at my screens after 9 p.m.’ or ‘I’m going to have a set bedtime.'” For others, it’s exercise, starting with “I’m going to exercise 30 minutes once a week,” right? We’re starting small. But then once people see that they actually have some agency and some control, and can put those things back in that make them feel better as humans, then it builds on itself.

Kevin Pho: Now, you mentioned earlier that doctors are expected to be invincible heroes, right? They’re expected to be superhuman, and that’s not a realistic expectation. Do you ever get pushback from physicians who say, “If I’m not superhuman, if I’m not taking care of patients 24/7, I’m less of a physician”? Do you ever get responses like that, or similar to that?

Diane W. Shannon: No. I think what I hear more often is this kind of moral dilemma of “I want to spend more time with patients. I know that relationship is important, and yet I’m being asked to see difficult, complex situations in 15 minutes. And when I then can’t finish my notes, I’m getting dinged because I have so many open charts.” So that’s where I’m hearing it more. I’m not getting that kind of pushback, no.

Kevin Pho: So if physicians are in that exact position that you just described, a scenario where physicians are being dinged for open charts and they’re expected to do more in less time, what can they do next? What are their immediate next steps?

Diane W. Shannon: Right. Well, often with folks, I start with, “Let’s free up some time immediately, so that you have more space in your week.” Sometimes that starts with looking at efficiency with documentation. There are some things, and usually, walking through it, physicians find a place or two where they could try to tweak. I think tending to please others can get in the way, and perfectionism can get in the way.

So one of the tips for EHR efficiency has been to try to finish that note before you see the next patient. But that involves getting through the discomfort of knowing that the following patient is waiting for you. But you’re much more efficient if you do it then, rather than wait till later. So again, it’s not always pleasing the patient. You’re actually going to give better quality care if you finish the note and then move to the next patient completely clear-headed, rather than worrying about “What am I going to have to remember about that note?” Right?

Kevin Pho: I completely agree with you. As a primary care physician, it’s imperative, really, to finish your note before seeing that next patient. Sometimes that can lead to less-than-ideal notes, and you mentioned that feeling of perfectionism that a lot of physicians have: “If my notes aren’t perfect, then I can’t do that.” How can physicians get over that?

Diane W. Shannon: Well, one of the things I point out is, “What’s the trade-off?” Right? And, “Are you willing to try something simple, like using bullet points, or not worrying about the grammar so much?” And asking, “What is the trade-off? What is the cost to you, to your practice, and to your family of you being perfect, that perfectionism coming in in the notes?” And often, when they make that connection to what the cost is, they say, “OK, I’m willing to try something different.”

Kevin Pho: I feel like you’re talking to me when you say bullet-point notes, not necessarily grammatically correct, because you just accurately described my notes. And I think that is a key to charting efficiently and charting in less time. One of the things that you mentioned earlier on is that over the last six months, everything in general has become more severe. Give us an example of what you mean by that in a clinician context.

Diane W. Shannon: Well, I see it in two ways. One is that the folks coming to me have had more severe burnout symptoms than previously, and by that I mean they literally have to stop work and take time off. The other piece, in terms of severity, is when I ask folks to go through “What does your week look like? What does your day look like? What time are you getting up? How much work are you doing outside the work hours?” That description is getting more and more, I’ll just say, ridiculous, like untenable.

Kevin Pho: What’s an example of that, just so you can really paint that picture for my audience? What’s an example of how ridiculous that is, something that you’re hearing?

Diane W. Shannon: Yes. So getting up at 4:30 in the morning to have a little bit of time, maybe half an hour of time to yourself, maybe to exercise, maybe to make plans for the rest of the day, do your emails. Go into work, pre-chart, great. Spend the day flat out trying to get through the clinic hours, if you have admin that you need to do, meetings. And then it comes to be six, 6:30. You leave because you have family, and you’d like to eat dinner with your children. You get home, and then you put your kids to bed, and then you spend two, three hours on the EHR, get to bed at midnight, and start all over again. And then there are weekends where you’re also catching up, doing charting, and looking at your inbox messages. So you think about that. And also, if you go to take vacation, then you’re slammed before you leave, and you’re slammed when you get back.

So if you think about us as a human animal, that is not a way to have a sustainable career. We need sleep. We need time off. We need to not be accessible to all the devices attached to work, yes, at some period in our lives.

Kevin Pho: We’re talking to Diane Shannon. She’s an internal medicine physician and physician coach. Her latest KevinMD article is titled “We are humans first and inspiring, gifted healers second.” Diane, what are some of your take-home messages that you want to leave with the KevinMD audience?

Diane W. Shannon: I think that one of them is this word vulnerability, or humility, and humility in a good sense, not humiliation. I think that’s what I learned from my experiences. I am human, and there are drawbacks to that. I can’t just power through. But there’s also the reality and the wonder of that. So I think one of the lessons is: Can you embrace your humanity, your humanness, and make sure to put some of those needs into your week? Because it’ll make for a much happier and more sustainable career.

Kevin Pho: Diane, thanks again for sharing your time and insight, and thanks again for being on the show.

Diane W. Shannon: Thank you, Kevin.

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