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

Join Kim Downey, a physical therapist, alongside Brittany Lamb, an emergency physician, and Adam Harrison, a physician, lawyer, and leadership coach. Together, they share their unique journeys and discuss common themes of empowerment, resilience, and advocacy in the medical field. Tune in as they delve into their personal experiences, professional transformations, and innovative initiatives aimed at improving health care and supporting fellow professionals.

Kim Downey is a physical therapist. Brittany Lamb is an emergency physician. Adam Harrison is a physician, lawyer, and leadership coach.

They discuss the KevinMD article, “Physicians turn feelings of frustration and powerlessness into purpose and hope.”

Our presenting sponsor is Nuance, a Microsoft company.

Together, Microsoft and Nuance are leveraging their rich digital technology and advanced AI capabilities to tackle some of health care’s biggest challenges. AI-driven technology promises to revolutionize patient and provider experiences with clinical documentation that writes itself.

The Nuance Dragon Ambient eXperience, or DAX for short, is a voice-enabled solution that automatically captures patient encounters securely and accurately at the point of care. DAX Copilot combines proven conversational and ambient AI with the most advanced generative AI in a mobile application that integrates directly with your existing workflows.

Physicians who use DAX have reported a 50 percent decrease in documentation time and a 70 percent reduction in feelings of burnout, and 85 percent of patients say their physician is more personable and conversational.

Discover AI-powered clinical documentation that writes itself. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo.

VISIT SPONSOR → https://nuance.com/daxinaction

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

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

GET CME FOR THIS EPISODE → https://earnc.me/6rfmui

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 back Kim Downey. She’s a physician advocate and physical therapist, and she’s brought together two physicians, Brittany Lamb, an emergency physician, and Adam Harrison, a physician lawyer and leadership coach. Kim, Brittany, and Adam, welcome to the show.

Kim Downey: Thanks, Kevin.

Kevin Pho: All right, so Kim, I’m going to start with you. You’ve brought together so many physicians on the show, so tell me, what about Brittany and Adam’s story resonated with you?

Kim Downey: Sure. So I’m so happy to introduce you to Adam and Brittany. Adam, I met him on LinkedIn in June, and he asked if I wanted to Zoom, and we did, and we just started chatting like we had been old friends.

I actually initially asked him to collaborate on one of the articles. Initially there were four that I was working on, and the timing didn’t work for him, so I had him in the back of my mind, because he does a lot of work with workplace bullying and I thought that was such an important topic to address.

And I also met Brittany in June, and when I had reached out to her to connect, she was so nice and she said that she’d be happy to chat at some point and to drop her an email. So I did, and then we chatted in August. And we started in conversation because I was really pleased with what she was doing, working with families who had a patient with dementia. And I had worked in a nursing home for seven years, and what she was doing really resonated with me.

So I had them both in the back of my mind, and then we thought to collaborate on an article together.

Kevin Pho: All right, so Brittany and Adam, I’m going to ask each of you to briefly share your story and journey. So Brittany, why don’t you go first.

Brittany Lamb: Yeah, so like you guys said, I’m an emergency medicine physician. I’ve been practicing now as an attending since 2017, and I got pretty burnt out prior to COVID, really I think ever since I was in residency.

But I noticed that I was complaining about the same things at work, that I kept seeing people who were aging who were coming into the ER for foreseeable medical issues. And I thought, why is no one helping people plan and prepare for making big medical decisions in advance?

So I decided to come online and help the medical decision makers of people living with dementia actually plan out what’s OK and what’s not OK, and talk about goals of care and all that. So that’s how I treated my own burnout, was creating my own business helping people. So I’m a champion of talking about burnout and addressing it and shining a light on it, but also empowering physicians to remember that we’re not just doctors.

Kevin Pho: All right, Adam, you’re a physician lawyer and leadership coach. Just briefly share your story.

Adam Harrison: Thanks so much for having me on the show, Kevin. Yeah, I’m British, originally trained as a doctor, since 2000. Did surgical training for a while, experienced burnout and a lot of workplace bullying from the attendings I worked for in different disciplines.

So I went into family medicine because I thought, you know, more autonomy, and there’d be less of the challenging interactions, shall we say, that I’d experienced then. And I was a little naive, to be honest. So yeah, I kind of struggled a fair bit over the years with being on the receiving end of workplace bullying.

I actually went to work for a medical legal advisory organization. That’s when I got a taste for the law, so retrained as a lawyer in 2013. And since then we’ve had our family, and I’ve kind of used the dual qualifications to go into leadership. And now I do leadership coaching, I’m an advocate for people who have been victims and targets of workplace bullying, and I’m a podcaster myself. I’m very much inspired by the female leaders that I’ve worked with over the years, so my show is called “Inspiring Women Leaders.” And yeah, I’m kind of coaching and training in the well-being and leadership spaces now.

Kevin Pho: Adam, when you said that you were the victim of workplace bullying, what are some examples of that?

Adam Harrison: So it sort of ranged really from the, what I call the overt stuff, the kind of, you know, what we would think of as schoolyard bullying, kind of name calling and belittling and berating and shaming in public by attendings, in front of the whole team, sometimes in front of patients themselves. Where if you had made a little error, which, we’re only human so we do these things from time to time, but they would make a big deal of it and kind of demonstrate their authority, if you like, in a public setting. So that has happened quite a few times.

To the more insidious, what I call covert types of bullying. So people, rather than actually addressing things in the open, I mean, for all the unpleasantness of being berated in front of other people, it led to at least you kind of knew why they were shouting at you. But in the more covert forms, people were kind of almost creating a dossier and collecting things where you made misdemeanors or whatever, and then presenting you with 15 things or whatever in a closed room in private. So kind of over monitoring your work, restricting you from doing certain things, undermining. Sometimes there was a bit of gaslighting, even by fellow doctors, kind of telling you that you had done something when you hadn’t, and so on. So the whole gamut really of workplace bullying in settings.

Kevin Pho: Brittany, when you were sharing your story, you mentioned that you were burnt out as an emergency physician and you created your initiative to empower individuals in medical decision making. Talk about the genesis of that. One of the themes that I have on my show is that we are more than our degrees, physicians are more than our degrees. So you actually took that next step and did something about that outside your normal scope of practice. So talk more about that.

Brittany Lamb: Yeah, I mean, I feel like it was just something that was really bothering me at work. I think that our patients are capable of making medical decisions for themselves, but I think we don’t have enough time to actually educate them so they can make informed choices in the moment.

And now that we have access to online education, I just saw this opportunity to create a space where people could learn on their own time, and then use that information in real time to ask the right questions, to feel like they have a better sense of this medical issue that’s happening, and that the team is actually offering them reasonable treatment.

And so I think it was just, I was so frustrated seeing over and over again, you know, like just with one example, respiratory failure. I mean, we all know there’s so many different pathways to the lungs failing, and people can plan in advance for the things that they’re most at risk for based on their personal medical history. I just think people are more capable than what we’re giving them credit for, but we also just don’t have the space to educate. So I just saw these issues and thought, instead of complaining about them, I would try to make things better.

Kevin Pho: And Brittany, by creating this program and helping patients outside your normal scope of emergency medicine, how did it help with your own feelings of burnout?

Brittany Lamb: Yeah, I feel like it made me realize that I have a lot of skills that I didn’t give myself credit for. Teaching is one of them, breaking down complex topics, being able to navigate emotional situations and being empathetic, listening. I mean, when we go through training there’s so many soft skills that we don’t realize that we have.

And so it’s really helped me see myself not just as a physician, but to potentially do other things in my life. I don’t feel as trapped anymore by medicine, which I was feeling that way. We get on this pathway and you’re just climbing to the next rock, climbing to the next rock. And then once you kind of finish and you’re practicing as an attending, I feel like it’s the time that you can actually sit down and assess what’s going on and see what you want to go from there. So instead of me just sitting in burnout, this is what I did for myself.

Kevin Pho: Yeah. And Kim, after talking with Brittany and Adam and hearing their stories, and I know you talked to so many physicians and you’ve brought them on the show, is there anything unique about their stories that really resonated with you and made them different from the other doctors that you talked to?

Kim Downey: Well, Adam shared so much of his journey with the workplace bullying, and I hadn’t really had personal experience with that. So him sharing that really resonated with me, and I wanted to spotlight that. And I think we need to bring that to light, because since then I’ve heard many other stories, and some pretty bad and serious ones. And people don’t know that that’s going on, and it helps to bring light to it, it reduces the shame, and to let other doctors who have gone through that know that they’re not alone.

And with Brittany, like I said, since I worked in a nursing home for seven years and I worked with a lot of patients with dementia, when we had our initial conversation and the things that she was saying, I could just fully relate to that and know how, when the family members would come in, they either had a lack of knowledge or they would disagree amongst themselves, and it really impacted the care of the patient. It depended what you could do or couldn’t do. And Brittany had shared those stories in the ER, when they show up and sometimes she has to do things that she might not want done to herself, if the patient hasn’t shared their wishes clearly enough.

Kevin Pho: So Adam, talk about how bullying may be pervasive throughout the medical profession, whether in the UK or the United States, and tell me a way that you’ve moved the needle in terms of helping to improve that situation.

Adam Harrison: I mean, it absolutely is a ubiquitous phenomenon globally. I’ve worked with quite a few American physicians and it’s clearly a thing over there. I mean, until I started working with my colleagues across the pond, I hadn’t heard of the concept of pimping. It goes on in the UK but we don’t call it that. And it is, you know, not just pimping but bullying by colleagues, medical and otherwise, is really prevalent in the states, in the UK hugely. I’ve lived in Australia and I’m currently living in New Zealand and it’s a massive thing here as well. And all physicians I talk to will either have experienced it personally or know of colleagues who experienced it as well.

And actually, there was a study in JAMA, I think it was in 1990, that followed a decent sized cohort of medics from medical student days up until attending. And by the time that they’d become attendings, I think it went from something like four out of 10 of them had experienced some form of bullying up to eight or nine out of 10 of them.

And it’s just this unspoken thing that is just happening all over the place. And we all think we’re alone because no one really wants to talk about it. We just kind of keep our head down and get on with things, and it becomes the norm, doesn’t it? We just have to accept it because it happens to everyone. And, I’m too ashamed to talk about it with my peers.

And I’ve actually over the last couple of years joined a band of people, if you like, of activists and advocates. And now we make it very prominent when it’s workplace bullying week, or International workplace bullying day, or something like that. And we kind of push out articles and things on LinkedIn, and through my podcast, through my leadership podcast, a lot of my guests will talk about their challenges and some of them will have experienced that. So I’m kind of getting the message out there slowly.

And then I do work with individual doctors and in hospitals around just how we can be kinder to each other. I mean, the thing about workplace bullying is that no organization wants to admit they’ve got a workplace bullying problem, because people aren’t going to want to go and work there. So you just have to tackle it in a way that makes it more palatable for them, to talk about being kinder in the workplace, kind of the flip side of the coin. And they seem to kind of get on board with that, they’re happy to talk about that.

So I can use that as an entry to kind of drop the little bombs in the training sessions about workplace bullying, and how people can deal with the acute stress of the situation, and techniques and strategies for coping with it longer term, and how to deflect it and see things from another viewpoint, and so on.

Kevin Pho: So Brittany, I talk to a lot of emergency physicians and they tell me a similar story to what you told me about how they’re burnt out by our current medical system. Now, you took the next step and created a program outside, like I said, your scope of practice. Now tell me, what kind of advice do you have for these other physicians who may be listening to you, who may feel stuck and burned out and may not know what to do? What kind of advice can you share with them?

Brittany Lamb: Yeah, I mean, I feel like the first thing is really just recognizing that it’s happening, and being open and able to talk about it and just acknowledge it. And then I think trying to find some place that you can go to talk to other people who are experiencing that.

I myself went and got some coaching. It wasn’t super expensive, I had several sessions with a coach, and really it’s just someone to listen and validate what you’re feeling.

I would just say, to really look at what you value and what you want and what you want out of your life, and to start kind of thinking about yourself as not just a doctor, and why maybe even why you went into medicine in the first place. I think a lot of us lose sight of that.

And I think just finding what you’re passionate about, finding something that you can be passionate about, whether or not it’s related to medicine or health care or something completely separate. For me, I know a lot of emergency medicine physicians, we kind of are planning our exit strategies, that’s how we roll, it’s normal for us to all talk about it. So for me this is kind of something that I know I can transition into doing instead of being in the ER.

But I’ll say that finding this mission and purpose, and embracing entrepreneurship as a physician, even, it felt a bit weird in the beginning but I’m getting better at it, it really just opens a lot of doors for you. And it’s actually made me happier at work, so I feel like I can stay longer in the ER because of this other thing that I’m pursuing, because I know I can leave.

So it’s just, I think just looking inwards and finding help is where I would start. But knowing that, I mean, everybody who works inside of health care is going to experience some form of burnout at some point. It’s incredibly hard to watch people suffer, and especially in the ER, and feel like you’re not actually moving the needle, you’re not actually making a big difference, because you can only operate within the confines of a system that we have. So, but yeah, that’s what I would say.

Kevin Pho: Yeah, both your stories certainly resonate with me in terms of things to get you unstuck from medicine, right? And Adam, it sounds like what you’re doing, certainly with your workplace bullying coaching, that in a way has healed your own wounds from your bullying experiences as well, is that right?

Adam Harrison: Yeah, I think so. I mean, I think as Brittany alluded to earlier, there’s a real difficulty that physicians have in first of all admitting to themselves that there’s a problem, acknowledging it. We don’t want to kind of tell the world that we have an Achilles heel. We’re supposed to be perfect, these machines who can just kind of cure and cure and help people. And with things like anxiety and depression we’re very high functioning, we just get on with it and people don’t necessarily know.

So yeah, just kind of letting it all out there. And I’ve done it on several podcasts now, talked about it and written about it. I’m hoping that people will just see me as an example that, yeah, this guy’s talking about it, it’s OK to talk about it.

And my mantra really, for the people I work with, is that it’s not your fault, you’re not alone, and there’s no reason to feel ashamed. And I’m hoping that just the more I kind of push this stuff out there, that people will start to realize that and get the help that they need.

Kevin Pho: We’re talking to Kim Downey, Brittany Lamb, and Adam Harrison. Kim is a physical therapist and physician advocate, Brittany is an emergency physician, Adam is a physician lawyer and leadership coach. We’re discussing the KevinMD article “Physicians turn feelings of frustration and powerlessness into purpose and hope.” Now I’m going to ask each of you just to share some take-home messages to the KevinMD audience. Kim, why don’t we start with you.

Kim Downey: Sure. So earlier this week I interviewed Dr. Simon Craig from Australia for my YouTube channel, and many of the issues facing health care are global. We discussed the need to rethink how we train people, relate to people, and communicate. And Simon says there isn’t enough communication in a positive and friendly manner.

And we’re all struggling, doctors and patients, and we can all try to be kind. Like Adam and his Kindness Club on LinkedIn, like Brittany and her support of patients with dementia and their families, and like me, I do my best to try and radiate kindness. And I’ve been told it’s making a difference.

Kevin Pho: And Brittany, what are some of your take-home messages?

Brittany Lamb: Yeah, I mean, I think we’ve hit on most of it. It’s definitely, as a physician, remember that you’re not just a doctor, ask for help, and find and follow your passion.

And then also consider putting in a plug for talking to your patients about what quality of life means to them, so that we can start putting bugs in people’s ears and planting seeds about really starting to help them figure out what their goals of care are as they age.

Because I really do feel like advance care planning, improving it as a whole, is one way to help with physician burnout. Because we want to be able to provide care to people that they actually want, and helping them realize what they want and how that translates into actual medical care, practically speaking, can make a huge difference. I mean, I’m a little bit biased because of the work I’m doing, but I would just like to put a little bug in people’s ear for talking about quality of life with their patients.

Kevin Pho: And Adam, we’ll end with you. Just please share your take-home messages.

Adam Harrison: Thanks, Kevin. You know, much like you said about, we’re more than our degree, and as Brittany said about having these soft skills that we didn’t really realize that we had, I would just say to people, things I wish I’d realized sooner.

And I only kind of came to the realization, the epiphany that doctors were not just one trick ponies, according to a doctor you’ve had on your show, from listening to her podcast in 2019. That there’s way more out there for physicians than we’ve been brainwashed by medical school to think that there is, that we can do more than just clinical medicine, and that we need to realize that ourselves, that we have these transferable skills.

And I think just, if you’re not happy with, I really do wish I’d realized this sooner, if you’re not happy with an aspect of your life, we’re talking about work here but it applies to any aspect of your life, just make a change. Make a small step. It’s not magically going to improve of its own accord. Don’t wait, there’s never a good time, just crack on and go for it. What’s the worst that can happen? I would say don’t fritter your precious time away by waiting for the moment.

Kevin Pho: Well, thank you all for sharing your time, perspective, and insight, and thanks again for coming on the show.

Adam Harrison: Thanks, Kevin.