Subscribe to The Podcast by KevinMD. Catch up on old episodes!

Join Wendy Lau, an emergency medicine physician, as we delve into the world of health care burnout and the moral challenges faced by medical professionals. Discover valuable insights, practical strategies, and the importance of inner practices to thrive in a system often driven by corporate greed. Wendy shares her experiences and expertise, shedding light on how individuals and the medical community can navigate these complex issues and stand up for positive change.

Wendy Lau is an emergency medicine physician who has worked in some of New York City’s busiest hospitals. She is the author of Inner Practice of Medicine, a primer for working and thriving in the challenging space of modern medicine. She can be reached on Twitter @wendylaumd, Instagram @innerpractices, and Facebook.

She discusses the KevinMD article, “Resisting burnout in health care: Empowering inner practices.”

Careers by KevinMD is your gateway to health care success. We connect you with real-time, exclusive resources like job boards, news updates, and salary insights, all tailored for health care professionals. With expertise in uniting top talent and leading employers across the nation’s largest health care hiring network, we’re your partner in shaping health care’s future. Fulfill your health care journey at KevinMD.com/careers.

VISIT SPONSOR → https://kevinmd.com/careers

Discovering disability insurance? Pattern understands your concerns. Over 20,000 doctors trust us for straightforward, affordable coverage. We handle everything from quotes to paperwork. Say goodbye to insurance stress – visit Pattern today at KevinMD.com/pattern.

VISIT SPONSOR → https://kevinmd.com/pattern

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/P1QJzu

Powered by CMEfy.

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 Wendy Lau. She’s an emergency medicine physician. Today’s KevinMD article is titled “Resisting burnout in health care: Empowering inner practices.” Wendy, welcome to the show.

Wendy Lau: Thank you so much for having me, and thank you so much for all you do for our physician colleagues and for the general public. It’s so amazing.

Kevin Pho: Well, thank you so much for writing and for coming on the show. I’m excited to hear your story. Before getting to your article, just briefly share your story and journey.

Wendy Lau: I’m an emergency medicine physician. I went to school and trained in New York City; I trained at Kings County in Brooklyn. It was wonderful training, very rigorous, but even right after residency I was starting to see myself getting burned out. Then I started working and realized I would like to combine my spiritual journey, which is the meditation practice I’ve had since med school, with my medical training, because those have felt like two different worlds. I felt like I haven’t been able to really bring the kind of compassion I’ve been trying to cultivate in my sitting practice and other practices into medicine. I felt like the system wasn’t supporting it, and I wasn’t able to do it myself. So I got more and more into my spiritual practice in order to really figure out how to be a better physician, and that’s where this whole thing came from. The book I just wrote, Inner Practice of Medicine, is really about bringing those two worlds together, and I feel like it fills a hole in medical education that we haven’t really resolved.

Kevin Pho: So talk more about your spiritual and meditation journey.

Wendy Lau: At the beginning of medical school, I had a feeling that I needed something more. I knew there were courses out there, like narrative medicine and Rachel Naomi Remen’s courses, but I just didn’t feel like I was able to connect with my humanity through medical school. So I started meditating at the beginning of medical school, and also doing yoga, and on the side I was also doing kickboxing and competing, all of that just to find a balance with my medical education.

Right after residency, I met my Buddhist teacher. It was when I decided I wanted to do a medical journey, like a pilgrimage, and I found her. She had been doing these high-mountain journeys in Nepal and Tibet, bringing Western medicine to places where it didn’t really exist at that time. I was able to join that journey, and through it I realized there were things I really needed to learn to be a better physician. That journey showed me that there are ways of practicing medicine where we can be more connected and more compassionate, in ways that are not transactional. That’s how I got to the point where I decided I needed to deepen my spiritual journey in order to be a better physician.

Kevin Pho: Now, your KevinMD article, and your book of course, intertwine your spiritual and medical journeys. The article is titled “Resisting burnout in health care: Empowering inner practices.” Tell me how your article came together.

Wendy Lau: It actually started with an email to my residency program director, Chris Doty, who is now in Kentucky. I had sent him my book and said, “This is what I wrote, and I wanted to see what you think.” He read it and thought it was amazing, but he said that one of the things he struggles with is that whenever he brings these kinds of practices and ideas to people, they tend to say, “But the system is a big problem. How are we going to overcome that? Are we really bypassing what is happening in the system with that whole thing of having resilience classes and mindfulness classes? What is that? Is that really helping us?”

And I said, “I totally hear you, and I agree.” A lot of that push for mindfulness classes and resilience classes doesn’t really look at the fact that we are still working in a system that has a lot of problems, a system that is creating moral injury. So my book is more about seeing that clearly first: seeing how our education system and our training actually make it difficult for us to take care of ourselves, to have these inner practices and to really connect with our patients, and not forgetting or bypassing that part of it. I came out of this conversation with one of my mentors, and that’s how I started writing this article. I figured other people would need to hear it too.

Kevin Pho: So when you say inner practices, and of course you have a book on this, Inner Practice of Medicine, tell us exactly what you mean by inner practices.

Wendy Lau: Perfect. I’ll take you from the beginning. The first chapter is a primary survey, using the language of emergency medicine: really looking at where we are right now. Just like the primary survey when a trauma patient comes in, what is going on with this patient, and what is going on within myself? Am I burned out? Are my tendencies to push past my limits part of the way I was educated and trained? What kind of moral injury is present in my work environment and my experience? What kind of burden am I holding on to? Every chapter has a practice that brings you deeper into how you’re doing.

The second chapter talks about mortality and morbidity, a different way of looking at death and dying. We face this all the time, especially in specialties like emergency medicine or critical care, but in any specialty you face losses and illness. We’re never really taught in medical school and training how to deal with it within ourselves. We’re just taught, “OK, push this away. On to the next patient.” We’re resilient. Yes, we are resilient, but we’re not taught how to work through this within ourselves, how to see our own fear of death, which is present in every human being, unless, I guess, you’re enlightened, I’m not sure, and how it plays into our practice of medicine when we have to face death all the time. So looking at that clearly is one of the chapters.

Then there’s looking at moral injury. What does it mean to have moral injury in a system that is geared toward profit, unfortunately, and the way it pushes us into doing things we are not aligned with, like seeing our patients way too quickly, and not being able to take care of other patients who may not have the means? How do we deal with situations that are difficult, look at them clearly and not blame ourselves? A lot of the physicians I talked to when I was doing one-on-one sessions with physicians during the pandemic were very morally injured, but they didn’t even have the language to explain it and work through it within themselves. So that’s what that part is about.

Other parts of my book talk about compassion, our misunderstanding of compassion, and our thinking that not having compassion is our fault. Really, it’s because our environment is not set up to elicit our natural compassion. And compassion is a trainable skill. I have another article that just came out in MedPage that talks about this. Compassion is a trainable skill. It’s not a personality type, and it’s not something we should feel shame about not having. We need to recognize that the system is not set up for us to bring it up within ourselves, so we need to train ourselves to use it as a resource for our patients. But also, if you can feel compassion for your patients in your interactions, it fulfills you, too. It’s a resource for us, and we feel more fulfilled in our work if we can feel it and are trained in this skill.

Kevin Pho: Now, you mentioned earlier that so many physicians come to you morally injured, and I talk to a lot of physicians in that same scenario as well. Walk us through a situation where you would advise them to use inner practices to address some of that moral injury. It could be a real-life example or a hypothetical scenario of your inner practices in action, so my audience can see how it plays out.

Wendy Lau: I’ll give an example from just the other day. I spoke to an emergency medicine physician in Kansas. I had opened these sessions to talk with people who may have read the book and have questions. His question was that the other day he was running a code, the patient died, and he didn’t have time to go back and talk to the patient’s family. He said, “So what do I do about that? I was so busy in the ED, and I had to see so many other patients. Now I feel bad, and that’s part of my baggage of moral injury. What do I do?”

I said, “Yes, that’s a really good example.” Of course, there are times when we really don’t have time to talk to them. But there’s also a prioritization of our time that has been conditioned by the priorities of the system. In emergency medicine, for example, we have to see the next patient, and there are so many things we have to do, so in our minds, talking to the patient’s family is not at the top of our priority list, and afterward we feel bad about it. But what if we remember that this can cause us moral injury? What if we remember in the moment that this is important, not just to the patient but also to us? Maybe we can find two minutes to go and talk to the family, or call the family afterward, not just for the patient’s family but also for us.

But if we really, really can’t do that, can we forgive ourselves? Can we take a moment and remember that we did the best we could in the code, and the best we could in our work that day, because we needed to see the next patient and really couldn’t go back? How can we forgive ourselves, so that we don’t take that burden on and keep feeling bad over and over again? My advice to him was to take a moment, review that day and really feel into the sense that “I’ve done the best I can. Even though it’s not perfect, and it’s never going to be perfect, because we’re dealing with high-stakes and very busy environments, I’ve done the best I can, and I forgive myself for all those things that were left undone and left unsaid. Now I can go on without holding on to this burden.”

Kevin Pho: Now, what kinds of resources are available for physicians who want to investigate how to apply some of these inner practices? There’s obviously your book. What other resources can they turn to if they want to pursue this path to dealing with their moral injury?

Wendy Lau: I think there are a lot of really good resources out there. Wendy Dean has a lot of resources about moral injury, and other physicians have been writing on it quite often. I’ve also really wanted to connect with physicians, so I’ve opened my calendar for 20-minute sessions if you want to talk to me, just like the physician who talked to me the other day; he signed up on my website. But I think the biggest resource is to give yourself time to ask yourself these questions: Why am I here? Why did I do this? Why did I go down this path in the first place? What are my intention and my motivation? That time with yourself, maybe walking out in nature, just giving yourself the time to connect back with your intention, is so important.

Kevin Pho: We’re talking to Wendy Lau. She’s an emergency medicine physician. Her KevinMD article is titled “Resisting burnout in health care: Empowering inner practices.” Wendy, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Wendy Lau: The take-home message is that you are doing the best you can in whatever environment you are working in, even if it’s not perfect. Just know that, and forgive yourself for anything that is not perfect.

Kevin Pho: Wendy, thank you again for coming on the show and sharing your time and insight.

Wendy Lau: Thank you so much for having me.