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Join Kim Downey, a physical therapist, and Anthony Avellino, a pediatric neurosurgeon and author of Finding Purpose: A Neurosurgeon’s Journey of Hope and Healing, as they explore the critical topic of physician well-being. Through candid conversations and shared experiences, they offer valuable insights into overcoming challenges, finding purpose, and promoting resilience in the medical community.

Kim Downey is a physical therapist. Anthony Avellino is a pediatric neurosurgeon and the author of Finding Purpose: A Neurosurgeon’s Journey of Hope and Healing.

They discuss the KevinMD article, “A patient reached out to a doctor, and they helped each other heal.”

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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 back two veteran guests. Kim Downey, of course, is a physical therapist and physician advocate. Anthony Avellino is a pediatric neurosurgeon, he’s the author of the book Finding Purpose: A Neurosurgeon’s Journey of Hope and Healing. Kim and Anthony, welcome back to the show.

Anthony Avellino: Great, Kevin, we are very, very happy to be here. And I say that your KevinMD platform has given many the chance to actually share their stories, and you and your team have done a remarkable thing.

Kevin Pho: Well, thank you both for coming on the show, writing and sharing your stories. So Kim, you are, of course, a very passionate physician advocate, and I always ask you, how did you find Anthony, and what about his story resonated with you?

Kim Downey: Sure. Well, I think that Tony is the very first doctor I reached out to after Dr. Michael Hersh. I had found him on Facebook with his blog, but I had been following the posts on your site, Kevin, for a year.

And so it was a year ago January, I saw an article that Tony had written, and it really touched me. My doctor had died just a few months prior. And I went to his website and I ordered his book, and I read it right away when it arrived, from cover to cover. And then I went to his website and I saw that he had contact information, an email address, and I sent him a message.

And a few weeks later he responded and said that it had accidentally, I guess, gone to spam. So Tony, I’ve never actually asked you, what made you go to your spam? I never go to my spam. So thank goodness that you did, because he sent me a really nice message back and asked if I wanted to talk, and he called me, and we had a beautiful conversation. And that’s how it all started.

Kevin Pho: All right, wonderful. Tony, do you remember the first time Kim reached out to you, and tell me how your relationship developed from then?

Anthony Avellino: Oh sure. I remember that the first time that we met, I was sitting in my car and it was a long day. And I must say that just connecting with Kim gave me a sense of hope.

Because what Kim has done, she’s been a relentless advocate for physician well-being, and her podcast, Stand Up for Doctors, has over 30 episodes. And what she does is, she really connects physicians and their stories, and it really helps physicians and other providers really find hope, be their best.

Because I often say, you have to listen, you have to learn, you have to heal. And what I mean by that is, listening, everyone has their own story, but it’s how you learn from it, but also how you sort of heal from it. And Kim’s relentless connections with physicians, and hearing other physicians’ stories, really gives us that we’re not alone, and it gives us hope to do what we really want to do.

Kevin Pho: Now, Tony, you’ve been on the show before, you’ve talked about your book, it’s titled Finding Purpose: A Neurosurgeon’s Journey of Hope and Healing. For those who didn’t get a chance to listen to your past episode, just tell us a little bit about your story, and why it’s so important for your story, or physician stories in general, why is it important for those stories to be heard?

Anthony Avellino: Yeah, for me, once I came forward with my story, it took me a long time, because I was very, very afraid. Because for me, going to medical school, training as a neurosurgeon, I was afraid to tell anyone that I was not doing very well.

And when I tried to take my life, that really gave me the opportunity to pause. And nine years later, I vowed that no one should ever hit rock bottom. Because listening and reaching out, and for me, having a family and support systems, and being an ultra endurance runner, has really given me the ability to pause and take a break and really appreciate what’s important.

And so for me, over the last eight or nine years, is just sharing my story, sharing how one heals from it, has been very, very important. Because for me, I vowed that if I’m going to come forward with my story, no one should ever hit rock bottom like I did.

Kevin Pho: Kim, when you heard Tony’s story, you wrote about it, of course, in your KevinMD article, which is titled “A patient reached out to a doctor and they helped each other heal.” How did Tony’s story help you heal, Kim?

Kim Downey: Well, I was just so grateful. What I told him during our conversation was that he’s OK. And because obviously it had a personal connection with me, I shared that my own doctor had taken his life, and was an incredible doctor.

So just to be able to have a conversation with Tony, and to see that he’s OK, and all the ways that he’s helped other people and helped his colleagues, that just meant the world to me, that we could actually have a conversation.

And then we even found out we’re the same age, and he was at Cornell University while I was at Ithaca, so we were in the same college town the same year. So we might have even crossed paths in the Commons or Collegetown. So, having those connections, it’s all about making connections and hearing each other’s stories.

Kevin Pho: My daughter is a freshman at Cornell, so I’m very familiar with the whole Ithaca area. I’ve never made so many trips to upstate New York in my life over the last year.

Kim Downey: Oh wow, OK.

Kevin Pho: So Kim, when your physician tragically took his own life, how did you react as a patient when you first heard that news?

Kim Downey: Well, I was at a visit and I thought I was going to see him any minute. And when they told me he had died a month ago, and I asked what happened and they said they didn’t know, in that moment in my heart I knew what I believed happened. And I literally kind of fell apart. I started shaking, my arms and legs went numb, I couldn’t stop crying. It was pretty bad.

And so then, at some point after that, I just felt a calling to support physicians. And that’s what I do all day every day, between LinkedIn and doing the podcast and listening to doctors and hearing their stories.

Kevin Pho: And Kim, when you saw your doctor during your regular visits, did you have any signs, any tip offs that something like this would happen, or was it a complete surprise to you?

Kim Downey: It was a surprise. Now, what’s so special about him is, he was a radiologist, and you don’t usually even know the name of your radiologist. But because of the things that had happened, the couple times he had had to insert a magnetic seed, he actually performed a couple of feats of miraculous technical skill on me.

The first time, he said it was the hardest magseed placement he had ever done in 30 years, and the surgeon later said it was like looking for a needle in a haystack. And the second time, he got the magnetic clip to pierce the metal clip, which our surgeon said was like threading a needle, and you can’t even see the needle.

So we had just developed a little bit more of a relationship. And then when I sent him a thank you note, he actually called me on the phone to thank me for my thank you note. So I just felt like, for a radiologist and a patient, that we had developed a beautiful relationship in a short period of time.

But I didn’t know him that well personally. I didn’t know anything about his personal life, or that he was suffering. So no, I didn’t know that he was suffering.

Kevin Pho: Tony, if anyone heard your story, you’re a very successful pediatric neurosurgeon, and obviously trained many, many years, worked very, very hard, and someone hearing your story would think that you’re at the pinnacle of your career. But then you said that you weren’t doing very well. So let’s explore that a little bit. What exactly do you mean by that, and what would you want people to know when you said that you weren’t doing very well, even as a successful pediatric neurosurgeon?

Anthony Avellino: Yeah. So for me, as you know, being a physician is an incredible opportunity that brings an enormous amount of joy, happiness, but it also always brings a burden of incredible guilt.

Because I often say, as a pediatric neurosurgeon, what keeps me up at night is not the hundreds of kids that I treated that actually have a really good outcome, but it’s the two or three children every year that I make an honest mistake with, or the disease is so devastating that I can’t do anything about.

And I’ve been in practice for a while, and people ask me, does it get easier over time? And I would say no, because I’ve been in practice for a long time. So if you say that I’ve been in practice for 20 years, I have 40 children out there that I hurt, or the disease was so devastating. And that’s an incredible guilt.

And for me, physicians are sort of type A people, and we try to keep things in. And for me, telling my story is really telling people to listen, because physicians go through a tremendous amount, dealing with death, dealing with patients not doing well, dealing with the EMR.

And for me, I vowed that no one should ever hit rock bottom. And for me, I didn’t know what the resources were, but most importantly I didn’t really know what the signs and symptoms were. Because for me, playing football, I always said, OK, well, you just have to grind it out, you have to work, work, work, work. And for me, I didn’t realize that I was becoming burnt out, and I never told anyone.

And so for me, it’s really having my story allow physicians to really reach out, because there are resources out there.

Kevin Pho: Tony, when you said that you were burnt out, you were feeling that guilt, you had no one to turn to, or you didn’t know where to find those resources, just take us into those dark moments. What exactly did you feel? Just describe it for some of the audience members who may not be familiar with that.

Anthony Avellino: Yeah. So for me, I felt that I was not doing good for people. I felt a tremendous amount of burden, that I had to carry the weight of my patients on my back.

Two is, I was really afraid to tell anyone about my story, because I was afraid of what my friends, what would my colleagues think, would they think I’m weak? And working so hard through college and medical school and eight years of residency training afterwards, I was afraid that I was going to lose everything.

But for me, I realized that the employee assistance program at various places is actually a big help, and I’ve been through the EAP program twice. And I must say that, having physicians really seek help, because your life is worth it, and no one should ever hit rock bottom.

And I think having patients like Kim, I mean, Kim has been an unbelievably relentless advocate of really connecting physicians. And just hearing on her podcast, over 30 episodes, a lot of the physicians have the same stories, the same feelings.

And for me, it’s really having people reach out. And I often say that listening is the most powerful thing that one could do.

Kevin Pho: So as Tony told you his story, and as you hear his story again, Kim, what were some of the things that were going through your mind as he was telling you his story?

Kim Downey: Well, just that it shouldn’t be like this, and that there shouldn’t be any shame in seeking help. And that’s why I think that what he’s saying is so important, is for all of us, for doctors to know the resources that are out there.

So last summer I shared a post of free and confidential resources for physicians, and I’ve re-shared that. And then also, as Tony said, knowing the signs and symptoms.

So when doctors are sharing their stories, because it looks different for everyone, burnout, from physical manifestations. And also, doctors are human, and they have all the problems that humans have, and there’s no less incidence of anxiety and depression in doctors than there is in the average population. So doctors are on medication for anxiety or depression, so if you’re burnt out and you’re feeling low, you might think it’s you, or how you’re really feeling, and it could even be a side effect from the medication. So that’s really important to know.

And Dr. Amna Shabbir has shared that when you’re really in a low place, even asking for help is exhausting. But you have to do that, and just take that step to talk to anyone and ask for help.

Kevin Pho: We’re talking to Kim Downey and Anthony Avellino. Kim is a physical therapist and a physician advocate. Anthony is a pediatric neurosurgeon, and he’s the author of the book Finding Purpose: A Neurosurgeon’s Journey of Hope and Healing.

Tony, one of the things that you said is that you were worried about the reaction from your colleagues, and that they thought, quote, that you might have been weak. Now that you’ve told your story, you’ve written your book, you’ve appeared on my podcast and written on KevinMD, and people know your story, what is the response from your colleagues after hearing what you had to say?

Anthony Avellino: Yeah, I must say that it’s been an incredible response. I have a folder of hundreds of letters and notes, and I can honestly say that, even though I’m a pediatric neurosurgeon, I’m really affecting more lives.

Because notes that I received were, Tony, your book and your story really gave me an opportunity to pause and maybe realize what’s important. I’ve had other physicians say, well, your story truly resonated with me, because it really gave me the opportunity to seek help.

And for me, that’s more gratifying. Because for me, I often say it’s not what you take in this world, it’s what you give back. And we need more compassion and more love.

Kevin Pho: So Tony, for those physicians who may be sometimes feeling that guilt, if a patient outcome doesn’t go the way they thought, and it may not be pediatric neurosurgery but lower stakes cases in medicine, and you said that you didn’t know where to turn to, tell these physicians who may be listening to you now, where can they turn to if they’re feeling those thoughts of guilt, or if they hit the proverbial rock bottom?

Anthony Avellino: Yeah, so, telling the chair of your department, or telling your dean. Because I think what the COVID pandemic has done, it’s really raised awareness, and I think more and more health care systems today are really focusing on physician wellness. Because physician wellness is essential, because if physicians don’t find meaning in the work, it’s going to be really difficult to achieve the triple aim of providing great care, improving the patient experience, and lowering cost.

Kevin Pho: All right. We’ll end off with each of you saying your take-home messages to the KevinMD audience. So Kim, we’ll start with you. What are some of your take-home messages?

Kim Downey: Sure. So I thought I’d spotlight several things that we talked about when Tony was a guest on my YouTube channel, and that are in the article.

Including the importance of pausing, which Tony has mentioned today, and that can mean anything from taking just a moment to breathe and center yourself before entering a patient’s room, to bigger pauses, such as giving yourself a period of time when you intentionally say no. No to more committees, more roles, more of anything, to give yourself some white space, which everyone needs in their life.

And I also talked about the importance of being a continuous learner, and you need to learn what truly energizes you, including things totally unrelated to medicine. Anything that fills your cup, from trying a new grilling technique to playing an instrument, and I know more than one doctor who has joined a band.

And also being able to stay in the present moment, and the power of true listening and connecting at the heart. And those are all key when we talk about the experience of the sacred doctor patient relationship. And it can be quite healing for the patient and the doctor, and I’ve been privileged to have those experiences, and it feels really good, I believe, for both of us.

And I’ve had other experiences where it feels like you’re just a number and the doctor is just going through the motions, like time to make the donuts. And when I leave those visits it feels disappointing and hollow and empty, and I think that’s a loss for both of us.

And as Tony says, we need more compassion and love in medicine, including for ourselves. That’s critically important, and we need to shout it from the rooftops.

And lastly, my heart is filled with gratitude to Tony. He’s done so many hard things, only one of which is being a neurosurgeon. And as we say in the article, sometimes beautiful things can rise from the ashes of the saddest of things. So thank you, Tony, for all that you are. I appreciate you and I feel incredibly blessed to know you.

Kevin Pho: And Tony, we’ll end with you. What are some of your take-home messages?

Anthony Avellino: Yeah, so for me it’s staying connected, to avoid the isolation. And I often say, listening, sharing your stories, connecting at the heart.

But my wife and I made up this word, and so if you take the word tactics: T is take time for yourself and lead a peaceful life. A, always eat healthy, exercise, and sleep, because sleep is one of the most powerful things that one can do. C, continually self-improve. T, treasure family and friends. I, I choose the day. C, control disappointments. And S, smile and laugh.

But like what Kim has done, she’s been a relentless advocate. And so I would just end, we must all listen, learn, and hear each other, because we must find hope. Because even in the darkest moments, the lessons learned can give us insights in how to bring light to others.

And Kim, connecting with you and sharing our stories, you are doing incredible work, and so thank you for what you are doing.

Kevin Pho: Well, thank you both again for coming back on the show and sharing your stories, perspectives, and insights.

Anthony Avellino: Thank you, Kevin, for having us.