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Join Preyasha Tuladhar, a family physician, as she shares her unique approach to primary care. She delves into the integration of biomedical, psychosocial, and cultural considerations in developing personalized treatment plans for her patients. Discover how mindfulness practices, positive psychology techniques, and lifestyle modifications play a pivotal role in fostering holistic well-being. Gain valuable insights into the importance of setting boundaries to prevent physician burnout while nurturing authentic patient connections.

Preyasha Tuladhar is a family physician.

She discusses the KevinMD article, “Primary care’s role in your wellbeing.”

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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 Preyasha Tuladhar. She’s a family physician. Today’s KevinMD article is “Primary care’s role in your wellbeing.” Preyasha, welcome to the show.

Preyasha Tuladhar: Thank you so much, Kevin. How are you doing today?

Kevin Pho: I’m doing well. Thank you for joining me and for writing on KevinMD. And we’ll talk about your article in a little bit. First off, just briefly share your story and journey.

Preyasha Tuladhar: Sure. So I’m actually originally from Nepal. I lived there until I was 11, then my family came to Northern Virginia. I went to University of Virginia for undergrad, then I went to med school in St. George’s. I did an internship with the New York Department of Public Health, then I joined the family medicine residency in Lynchburg, did hospitalist work for a few years, a little bit of urgent care, and now I’m in primary care.

Kevin Pho: All right, excellent. And we hear so many difficulties and challenges facing primary care today, and I’m a primary care physician myself. So tell us what keeps you going in primary care today.

Preyasha Tuladhar: I think it’s the relationships. I think that there’s so much focus right now and energy is going to all the negative things, but I may be in the minority, but I actually really love my job. I think I work for a great organization that supports me, understands me, but I think I’m also really fortunate to have great patients.

The nice thing about primary care is you take care of whole families, so you get to understand the family dynamics, you get to take care of Grandpa, Grandma, brother, sister, and so that aspect is really nice.

I think I’m also really lucky to have a group that works really well with me. We have a lot of fun at work. Sometimes we even get shushed because we’re having too much fun. But overall I think who you work with and what you bring to the day is so important.

Kevin Pho: So I’m hearing that not all hope is lost when it comes to a career in primary care.

Preyasha Tuladhar: For me it has not been the case, no.

Kevin Pho: All right, so I am going to talk about your KevinMD article, titled “Primary care’s role in your wellbeing.” Now, for those who didn’t get a chance to read your article, just tell us what it’s about.

Preyasha Tuladhar: Sure. So it’s a funny story, actually. Diane Shannon, she’s my physician mentor, physician coach, and so I was actually telling her the things that I wanted to manifest this year, and one of the things was getting an article published. And so she mentioned you.

But basically the article is just about what the crux of primary care is, and what, as primary care physicians, are we trying to do. And yes, there’s a list of medications and treatments and interventions, but I think sometimes we overlook maybe some of the simpler lifestyle things, and it’s oftentimes the lifestyle changes that really make an impact and make a difference in patients’ lives.

Kevin Pho: All right, so give us a story or a case where you really moved the needle for that patient by focusing on things that are outside of just treatments and medications.

Preyasha Tuladhar: So I’ve had a lot of patients. I can remember a specific one that had really severe depression, anxiety. Over the couple of years we talked of a few interventions. We talked about starting meditation. I’m a big fan of the Calm app, but honestly YouTube has some great ones. She downloaded it, she really loved it. I saw her again in follow-up for three to six months. At that point she’d been pretty much meditating every day, and I could sense the change in her energy, and she just seemed like a completely different person. And so with somebody like that who’s open to maybe trying new things, that was something that really made a big difference.

I also had another patient that initially had come with an A1c of like above 11, made a lot of dietary changes, met with a dietitian, and I think her last A1c now was around six. And so yes, were there medications in place? Certainly. But I think sometimes personal awareness and responsibility also goes a long way.

Kevin Pho: So in your article, you talk about some of the holistic things that you try to implement. You mention things like meditation. In your article you write about yoga. Now, with primary care physicians so time crunched, how do you introduce some of these holistic elements into the exam room when a patient has about 10 to 15 minutes to see you?

Preyasha Tuladhar: So for me, that time is fluid. What I mean by that is, some patients will need 45 minutes but then other patients will need 15 minutes. So I think recognizing which patients need your time, and sometimes that might be 90 minutes. Does that make the other patients unhappy? Yes. But I think it’s important to focus on the patient that is in the room. So I think that’s priority.

Two, every patient before they leave my room gets a list that I hand write for them. And oftentimes they’re physicals, so while I’m asking their physical questions I’m writing them down notes. So if they’re having poor sleep, we talk about maybe sleep supplements. If they’re having issues with their gut, we talk about a probiotic. So what I try to do is, I try to do my exam, my questioning, the assessment, and while I’m doing that I’m writing a list for them. So it’s kind of an interactive process.

And I do not document in the room. I think making that eye contact, seeing if somebody’s buying in, makes a big difference. I personally find that when you are staring at a screen, patients just don’t feel as connected to you. And so even if it is five minutes, but if patients feel like their voice is heard and that you’re listening to them, it makes a world of a difference. And that’s how you build relationships, or that’s how it’s been successful for me.

Kevin Pho: So in your article you talk about some positive psychology techniques, gratitude journaling, self-empowerment. How do you incorporate that into your daily life?

Preyasha Tuladhar: So a few things. One of my rituals that I like to do is, first thing I wake up in the morning, I try to think of all the things that I’m grateful for. Even though it’s not recommended, I do co-sleep with my three-year-old toddler, so most nights, or most mornings, I’m waking up with a foot in my face. But that foot is so cute, and so I try to wake up grateful for everything I have in that moment, right? So it might be silly things like the sheets, or the bed, or my legs, my eyes, things like that.

And then I’ve kind of ritualistically set up practices where I do my 10 minute meditation in the morning, and then while I’m walking into the office, again we kind of go through the gratitude list, then I focus on the people that I care about the most.

And then when I listen to the patients, when I do a physical exam, I in my mind kind of do the loving kindness meditation, which is, may you be happy, may you be at peace, may you be healthy. So while I’m listening to them, I’m not blessing them as such, but it’s basically like trying to focus on the positive.

And then in terms of some of the physical aspect, taking my goldendoodle out for a walk, doing some yoga poses, or even when you’re in the bathroom, doing some wall push-ups, things like that. So trying to find ways that you can do things.

The other thing I love doing is grounding. I have a lot of med students that work with me, so we take bubble breaks. I think bubbles are the most underrated fun thing that adults can do. And so I take my bubbles, I blow them outside of our office while we’re grounding in bare feet. So some of them sound silly, I’m sure, but it really makes a difference when you’re looking at the grander thing.

Kevin Pho: So with all the obstacles and bureaucracy that threaten primary care today, and I’m sure that you’ve read so many things that primary care doctors are under pressure for, if you read some studies, if they were to do every single suggested intervention with a patient it will take like 26 hours in a day or something like that. How do you manage to maintain some of these holistic practices, and how do you manage to maintain your joy in primary care despite all the external pressures that take away from it?

Preyasha Tuladhar: So I feel like so much of life and being human is about contrast, right? And it’s about the external pressures. But I found that the people that have found the most peace is the ones that focus on within and not on the outside. Because do I have a gazillion things every day that make me upset and unhappy, if I were to choose to focus on those? Yes. But I find that if I can focus on what brings me joy, what brings me peace, what I can do to give the best care possible for my patients, that’s kind of what I choose to focus on.

And does that make all the problems go away? No. But I think that my responsibility in all of this is increasing the vibrational energy that I bring to my patients, and I think happy doctors make happy patients. And so do I have a solution for our broken health care system? No. But do I feel that in general we could all focus on within? Certainly.

Kevin Pho: So you mentioned that you had a physician coach, Diane Shannon. She’s been on the show and is a regular writer on KevinMD as well. Talk about the role of a physician coach in terms of your professional guidance, because not every physician has a coach. Tell us the impact a coach made on you.

Preyasha Tuladhar: Sure. So I’m also on the medical board of the medical group here, and so part of the leadership things that I’m doing is this leadership program, through which they encourage you to find a coach. So it was through that that we get like six free coaching sessions. Our company has something called VITAL WorkLife. I’m sure other companies have similar things set up, and it’s really instrumental.

I think coaches can help you identify your blind spots. I think they can give you resources in terms of ways to thrive. I think personal awareness is so important and so key, and it’s something that we are continuing to grow as people, right?

And so I think a physician coach, no matter where you are at in your journey, whether you’re starting off, whether you’re in the middle, whether you’re struggling, whether you’re thriving, I think they can only add, because they’re really a supporter for you and they’re really there to make you be your best self. And so I think, to me, she’s been incredible, and I would literally not be in this podcast right now if it wasn’t for her. So I definitely recommend it.

Kevin Pho: Now, for all those primary care physicians who may be listening to you but unfortunately not in as good a place, perhaps they’re burnt out and thinking of even leaving the profession, tell us what kind of tips, what kind of advice can you share with these other primary care clinicians?

Preyasha Tuladhar: So primary care is oftentimes like a death by a thousand cuts, right? So it’s not each task that is overwhelming.

I think that in general a lot of people that are type A go into medicine, right? And so we are the types that want to be perfectionists and want the mailbox to be empty. So I think one is accepting that the mailbox is never going to be empty, right? So anytime you take care of 10 messages there’s another 30 waiting for you. So I think having a sense of peace with the fact that you can never feel like the work is completely done, because it’s not done, right? So to be comfortable with a certain amount of work not getting done, that’s number one.

Two, I find a lot of my colleagues, or just in general in medicine over the years, they come early, they stay late, they don’t take a lunch, they work holidays, they work nights. So you can’t expect, we’re not machines, right? And so I feel like I work best when I take breaks and when I joke and when I laugh and when I have a sense of community at work. So I think that’s also important.

And four, I think when you take care of yourself, patients feel better too, because I think being a physician is not only you’re guiding them, it’s also an energetic exchange. And so when the physician’s burnt out, unfortunately I really think the patients then incur the collateral damage, right?

So can we all change the system in a day? No. But I think there’s small practices that people can do that can help. But I also don’t think burnout happens overnight, right? So I think it takes many, many days and years of not sleeping, not eating, and not taking care of yourself. But I think it’s having boundaries within yourself, saying, you know what, at 5:00 it’s time for me to go home, and I’m not going to stay till 11:00 p.m. And for some reason I’ve never stayed till 11:00 p.m. So it’s been in my mind, there’s work and then there’s home, and I will not compromise that.

Kevin Pho: Now, for those medical students or doctors in training who may be listening to you on this podcast, what are some reasons they should consider primary care as a career?

Preyasha Tuladhar: I think primary care is awesome. I did my residency in family medicine. I decided at that time I wanted to do two years of hospitalist. That was a great experience, and then I decided to do urgent care, where you see a lot of different things.

And the nice thing about primary care is the variety, right? So you’re exposed to a lot of different things, and it allows you various career trajectories. So some of the benefits of doing primary care is you can be a hospitalist, you can work in urgent care, if you wanted to you could only do a specific type of procedure, let’s say sports medicine or geriatrics, that’s an option too.

So I feel like primary care is the future. I think that people are maybe not seeing the big picture, in the sense that in the next 30, 40 years we’re really the foot soldiers. We’re seeing in this country that without primary care this is going to be a broken system, right? And so I feel like, why not be this amazing group of people that bring people together, and let’s work on making people healthier as a group, instead of, I mean, specializing is great, but it just was not for me.

Kevin Pho: We’re talking about Preyasha Tuladhar. She’s a family physician. Today’s KevinMD article is “Primary care’s role in your wellbeing.” Preyasha, let’s end with some of your take-home messages to the KevinMD audience.

Preyasha Tuladhar: Sure. So I think the take-home message is, take your time, each day is special. We oftentimes wait for vacations to celebrate our time or have a good time, but I think every day is an opportunity to laugh, every day is an opportunity to spend time with your family, and every day is an opportunity to make yourself a priority. And in general, I just want people to know that we can still save primary care, and I think it’s a great profession.

So as humans, we all have the same emotions, needs, and desires. We’re all creators of our own reality and master manifestors of our destiny, consciously or unconsciously. Everything we’re looking for as human beings can be found within only ourselves, and by being present in the moment. We must focus on changing ourselves, and when our collective vibrational energy changes, it creates room for inner peace, fulfillment, as well as potential for a kinder world.

So let’s all slow down, have a lot of fun, love each other, and accept ourselves and accept other human beings with all their perfect imperfections. I would like to end with a quote by Viola Davis, who said in her autobiography, “All I have is me.” And that’s it.

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

Preyasha Tuladhar: Thank you, Kevin. Have a great day.