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Join Sarah Samaan, a retired cardiologist and physician development coach. Discover how burnout is a response to workplace stress, not a personal flaw, and how it relates to grief and compassion. Gain valuable insights into distinguishing burnout from compassion fatigue, navigating systemic challenges, and practicing self-compassion. Explore actionable strategies to promote well-being and hear expert advice on seeking coaching services for transformative change.

Sarah Samaan is a retired cardiologist and a Master Certified Physician Development Coach. She can be reached at Mindful Physician Coaching and LinkedIn. She is the author of DASH Diet for Dummies.

She discusses the KevinMD article, “Burnout and compassion fatigue: chronic workplace stress and emotional withdrawal.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Sarah Samaan. She is a retired cardiologist and a Master Certified Physician Development Coach. Her KevinMD article is titled “Burnout and compassion fatigue: chronic workplace stress and emotional withdrawal.” Sarah, welcome to the show.

Sarah Samaan: Thank you so much.

Kevin Pho: So we’ll get into the article in a little bit. First off, briefly share your story and journey.

Sarah Samaan: Great. Well, I’m a cardiologist. I retired last year, in 2022. I graduated from medical school in 1988 and practiced full time as a cardiologist from 1994 to 2022. I was part of a large cardiology practice, I was affiliated with a busy heart hospital, and I cared for adults with the gamut of cardiovascular disease, ranging from very straightforward preventive care to extremely complex cardiovascular cases.

I was really fortunate in my practice to care for a broad range of patients of virtually every socioeconomic, racial and ethnic background that you can imagine. Even though my practice was in a fairly affluent area, we had people from all walks of life and from all over the world. One real benefit, and one of the things I really enjoyed about my practice, was the ability to get to know people and to be part of their lives.

I can talk a bit about what I did in practice and how some of these experiences led me to develop some of the ideas that I was able to put into practice, both as a cardiologist and in my personal life. One thing that came up again and again was how to prevent heart disease. People really wanted to know what they could do to stay well, and that actually drove me to write my first book, The Smart Woman’s Guide to Heart Health. In that process, I learned a great deal about communicating with people and making the language of medicine more accessible to people from a wide range of backgrounds. Subsequently, I wrote several more books, and so that’s one part of my story.

The other part is that I’m a competitive equestrian. I compete in dressage, and a riding accident in 1997 led me to yoga in an attempt to heal myself and improve my mind and body. Then, through yoga, I inadvertently discovered mindfulness, and in fact I was practicing mindfulness before I realized what it was. I eventually became a yoga teacher, had an opportunity to train as a mindfulness coach and then, early this year, became a Master Certified Physician Development Coach.

So I retired in 2022 with the intention of pursuing my education in the fine arts, and currently I’m enrolled in a Bachelor of Fine Arts degree program, hopefully entering a master’s degree program when I finish. All of these experiences have developed in me a keen sense of compassionate curiosity and a drive to go below the surface in exploring the ways that we communicate with and care for our patients.

Kevin Pho: You mentioned the term compassionate curiosity. Talk more about that. What does that mean?

Sarah Samaan: Yes. When we have a sense of compassion, it often does lead to more curiosity about the people that are in our care and about the people that are in our lives, maybe our staff members, our co-physicians and other colleagues. And yet sometimes it feels in practice as if the time for experiencing compassionate curiosity has just become so constricted.

In fact, my article for KevinMD was sparked by the burnout that I witnessed in medical practice, and which I feel I came precariously close to experiencing myself. I think that a big part of that is that inability to express that compassion and to explore our curiosity.

Kevin Pho: So let’s explore your KevinMD article. It’s titled “Burnout and compassion fatigue: chronic workplace stress and emotional withdrawal.” Tell us how your article came together.

Sarah Samaan: Yes. As I said, I witnessed burnout in my medical practice and in colleagues, and I feel that I came very close to experiencing that. Thankfully, I don’t think I technically met the criteria for burnout, but the factors that have led to burnout are enormous and are currently really unrelenting, with a number of different issues driving that sense of burnout.

Often it’s a matter of the bottom line becoming such a focus. Corporations have taken over most medical practices, corporations or hospitals that are focused primarily on the bottom line. These are businesses, and so they approach health care in a different way than most of us were trained to do. At the same time, reimbursement is declining. The AMA recently reported that Medicare physician payments have dropped by 26 percent, relatively, since 2001.

So doctors now are asked to do more, supervise more people, more mid-level practitioners, give up more autonomy, spend more time with their electronic health records instead of the clerical staff, fight harder for pre-authorization, forego their own personal benefits and time off, and do it all with high patient satisfaction scores. At the same time, with these organizations recognizing that about 60-plus percent of physicians are experiencing burnout, they’re also being required to attend these workshops that are supposed to tell them how to deal with their own burnout, as if the burnout is somehow their own fault and something they’re responsible for fixing. As a coach, I see physicians truly in anguish over these circumstances.

Kevin Pho: You mentioned that you yourself came precariously close to burnout, and you witnessed your colleagues experience burnout as well. Maybe you could share some anecdotes and tell us some stories, either from your past or from your current coaching clients, just to paint a picture and illustrate what exactly a burned-out physician would look like.

Sarah Samaan: The technical or typical description of burnout includes symptoms of exhaustion, cynicism and inefficiency. When you look at these factors, these are very common in medical circles these days, and the cynicism especially has really grown. I believe that’s because people just simply don’t have the time to step back and experience their patients and their patients’ situations with the same amount of compassion and curiosity that in years prior we would have had the time to.

For example, in my practice and in many others, and I know I’m not speaking simply for myself, the number of patients that I had to see in a day increased significantly. What that meant was that the small amount of time that I had as wiggle room, to maybe extend a visit by an extra five minutes or so, was no longer available unless I would be running late. And again, we don’t have time to run late, because we have all these people waiting. Physicians are also concerned about patient satisfaction, which is often determined by the amount of time the patient has to wait, without regard to why the doctor might be running late.

So, for example, among some of the stories that I’ve heard and the things I’ve experienced, I’ve had clients tell me that they’ve been reprimanded for taking too much time to talk to their patients. I’ve had people be told, “You need to put your patient under anesthesia more quickly. You don’t need to ask and answer all those questions.”

On top of that, of course, dealing with the pandemic led to a lot more mistrust among many patients, and finding the time to create that connection with our patients became less and less available. So there’s this sense of distance between doctors and their patients that in years past didn’t exist to the same extent that we see now.

Kevin Pho: In your article, you compare the experience of burnout to grief. Talk more about that comparison.

Sarah Samaan: Well, when we think about burnout and we think about grief, the two have several key features in common. Both are a response to loss, in a sense. Burnout is a response to the loss of autonomy and of the ability to provide the care that physicians imagined and expected to be able to provide when they began medical school and finished their residency.

Both burnout and grief can result in fatigue and in difficulty thinking clearly. So sometimes you find colleagues talking and expressing their frustration in ways that really don’t align with who they are. It’s just the sense of loss of that compassion, and of that ability, again, to express the compassion, that I think is driving so much of this.

Kevin Pho: So take us into your exam room, or your office. If you have a physician come to you for a coaching session and they show signs of burnout or grief, what are some of the things that you coach them through? What are some of the techniques that you use to help them out?

Sarah Samaan: Well, many physicians are ashamed of feeling burned out. They don’t want to express it. They feel as if it’s their fault or a failing on their part. We can describe it as a type of disenfranchised grief, which is grief that can’t be openly acknowledged, publicly mourned or socially supported. So if a physician tries to share these feelings with, say, even family or friends who are not in the medical profession, they’re not necessarily understood or supported.

So often we’ll explore, first of all, what are the factors that are underlying the sense of burnout? What has led to the burnout? Sometimes there are ways to work within the system, and hopefully there would be ways to work within the system, because we can’t expect that physicians are going to leave en masse. We need physicians. We need doctors to do the work that they have worked so hard to create, and to be the physicians that their patients need.

As a coach, I don’t necessarily give advice, but my goal is not that everybody is going to leave their practice and go off in a different direction, though sometimes that’s the right thing to do. So for each individual person, it’s a matter of exploring what the factors are that have led to their burnout, understanding that they are still a compassionate person, and getting back to the core values that led them to become physicians in the first place, and the core values that guide their lives, both in their professional life and in their personal life, and how to honor those values.

Sometimes, because of the constraints of the systems that we work within, we have to take a step back and perhaps adjust our expectations. Perhaps you do need to cut back hours, and perhaps that does mean less money. But there are also ways to manage time in a mindful way, delegating. There are certain techniques you can use in time management that can free up blocks of time. So it’s not an inflexible box that we often find ourselves in. Sometimes it’s just being able to define what we can change. Where can we ask for help? Where are the possibilities for help and change within the systems that we work in?

Kevin Pho: I was wondering if you could share a success story or an anecdote where a physician came to you for help, you intervened and gave them some coaching tips, and it really moved the needle for that particular physician. Is there a story or an anecdote you could share with us?

Sarah Samaan: Yeah, I think a lot of times when we’re working with time management, we think of it as such a technical sort of process. I can think of a case in particular where a physician, a surgeon, was just overwhelmed with so many things to do, and with that sense of responsibility, which is something we want a surgeon to have. But it got to the point that the surgeon was feeling responsible for doing the nurses’ work and the assistants’ work, going back after hours to make sure that the things the surgeon had ordered had actually been done, and not having trust in the people they were working with.

What the surgeon was able to come up with was a process for training the people who were under their supervision, rather than expecting them to do the work and then going back to make sure it was done correctly. They really created a template, which took a little time at the outset, but with this template they were able to describe step by step what they wanted done in, say, a particular post-op situation, and give steps for addressing it if something went wrong. What are the bullet points that would lead perhaps to the surgeon being called? When could perhaps a nursing supervisor be involved? How could these processes be put in place to really make the post-op care more efficient?

At the same time, this also created more buy-in and a sense of control on the part of the people that the surgeon worked with, so creating this template also created more cohesion within the group and ultimately freed up a lot of time and reduced the surgeon’s stress and burnout.

Kevin Pho: We’re talking with Sarah Samaan. She is a retired cardiologist and a Master Certified Physician Development Coach. Her KevinMD article is titled “Burnout and compassion fatigue: chronic workplace stress and emotional withdrawal.” Sarah, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Sarah Samaan: I’d like physicians to remember that burnout is not a failure on your part, but rather it’s a symptom of a system that’s not working for you. Remember that the health care work world is shifting, but the work that you do really matters. Don’t allow yourself to believe that you don’t have options. As a physician, you’re highly intelligent, you’re highly skilled, you’re compassionate and you’re well trained.

Sometimes you might need to get out of your current situation long enough to get a wider view of what’s possible, but often there are ways to work within the system that you find yourself in to allow yourself more time and create a more compassionate, friendly and sustainable environment for yourself, your colleagues and your patients.

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

Sarah Samaan: Thank you so much for having me.