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Join us as we explore the world of clinician wellness and mental health with three remarkable guests. Kim Downey, a physician advocate, shares her insights on supporting health care professionals. Betsy Gall, author of The Illusion of The Perfect Profession, opens up about her personal journey and the challenges faced by physicians. Pamela Marie Hobby, CEO of My Doctor’s Meds, discusses her mission to bridge the gap between patients and doctors.

Kim Downey is a physical therapist. Betsy Gall is the author of The Illusion of The Perfect Profession. Pamela Marie Hobby is CEO, My Doctor’s Meds.

They discuss the KevinMD article, “Voices for physician mental health.”

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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 Kim Downey, Betsy Gall, and Pamela Marie Hobby. Kim, as you know, has been on multiple times. She’s a physician advocate and physical therapist. Betsy Gall is the author of the book The Illusion of the Perfect Profession, and Pamela Marie Hobby is CEO of My Doctor’s Meds. And together we’re going to talk about the KevinMD article “Voices for physician mental health.” Kim, Betsy, and Pamela, welcome to the show.

Kim Downey: Thanks for having us, Kevin.

Kevin Pho: Perfect. So Kim, I’m going to start with you. And you’ve been on multiple times, bringing together so many voices to talk about difficult issues as it relates to the clinician profession. So Kim, how did you find Betsy and Pamela?

Kim Downey: Sure. So actually Dr. Amna Shabbir sent an email connecting Betsy and I, and she’d come across Betsy and her book I believe on Instagram, and she knew that Todd and I would want to be connected with Betsy. So then Betsy and I messaged and we had a beautiful conversation.

And then Todd had shared a post featuring Pamela, and I said, oh, she sounds like somebody I should meet. And he said absolutely. So I think, Pamela, did we connect on a Friday and then we decided to talk on a Saturday, and we talked for two hours? And then she was in her car, like Hollywood Studios, literally. And then I think that’s how I found out that Pamela knew Betsy.

And then we had a Zoom, and as beautiful as it is, we zoomed in Rose, who is the wife of my doctor that died. So we all zoomed together, and Betsy had sent me her book and I passed it on to Rose, and that’s how we decided to write this article.

Kevin Pho: Excellent. So let me ask Betsy and Pamela. So Betsy, we’ll start with you. Just briefly share your story and journey. You’re the author of the book The Illusion of the Perfect Profession, right?

Betsy Gall: Yes. Thank you, thank you so much for having us on. My husband Matthew Gall was an oncologist for 16 years. We were married for 20, and I just had no idea how stressful the job really was. He ended up taking his own life on Thanksgiving Day 2019, and it’s actually still a shock. It’s still a shock. Really loved life, we have three beautiful kids, a great marriage, a beautiful home, a lake house.

And so after he died, you know, you instantly become an investigator when there’s a suicide involved. What did I miss, how did this happen? And I just started researching and reading everything I could. I couldn’t believe that there was a whole book titled Why Physicians Die by Suicide. It was by Dr. Michael Myers. I got that book and I read it in, you know, one day, highlighting so many similarities of physician burnout and unfortunately suicide that my husband shared with some of Dr. Myers’s examples in the book.

I connected with him and wrote a book of my own, and just felt very called to do that, to raise awareness, because I had no idea that physician burnout and suicide was as rampant as it is.

Kevin Pho: So Betsy, first off, let me just say how sorry I am to hear that, and so sorry for your loss. One of the things that you said is that after this experience you turned into a little bit of an investigative reporter, looking into some of the things leading up to that. What were the main things that you found during that investigative period?

Betsy Gall: Well, you know, Matt loved being a doctor. He knew he wanted to be a doctor by the age he was three years old. So most of his identity was wrapped up into being a doctor. We had made a move across the country for him to start a new position, and it wasn’t a good fit.

I just, when I started realizing how many similarities there are, I mean, things like the perfectionism. You know, Matt never didn’t have an answer for something, he always wanted to be right. He had a huge heart too, he was super compassionate for his patients. And the thing that gets me most choked up when I talk about the situation that happened was, I think that every little patient death took a piece of his heart, eventually, just because he cared so deeply. And it’s hard, you know, he’s oncology.

So I found that to be something that was similar throughout. But just the high demands that physicians put on themselves, and it’s a very exclusive club, it’s hard to get into, it’s rigorous, the financial demands, the EMR systems, you know, pressure from insurance companies. I mean, it just doesn’t stop, it just never really stops.

And then what ultimately happened with Matthew was he stopped sleeping. He was so stressed out about his patient care, and like I said, the job wasn’t a very good fit. So he stopped sleeping, and was saying things like, this was career suicide, I made a fatal mistake. And in my mind I’m like, it’s just a job, you know, we can find a different job. But looking back on it, I think it was the career as a whole that ended up kind of just overcoming. And then the shortage of sleep, and he ultimately took his own life.

I mean, his depression was very short. That was not a depressed guy, you know. It was only three months. So it’s been quite a journey. We’re going to be coming up here on five years, and as you can see, we miss him. It was his birthday two days ago. I mean, we miss him. So it’s hard.

Kevin Pho: So I’m certainly going to get back there to talk about some of the lessons that we can share with some of the other clinicians who may be listening to this. Next I want to introduce Pamela Marie Hobby. You’re the CEO of My Doctor’s Meds. So just briefly share your story and journey.

Pamela Marie Hobby: Thank you so much, Kevin, for having this time to share. Medicine saved my life. And so when I hear Betsy get choked up about Dr. Matthew Gall, those very same people saved my life. I’m a childhood cancer survivor and I was hospitalized from the age of two to five.

And in 2019 I had an experience where I met a resident, and I shared my medical success story with him, and I saw something in his eyes that scared me. I saw already, like, signs of burnout were in his eyes. He said to me, I’m afraid I’m becoming numb to it all. And I knew I had to do something.

I started researching, similarly to Betsy. You know, I didn’t know that a doctor a day dies by suicide. And so my team and I, we craft compelling stories. We find patients that want to reach back and say thank you to the clinicians and physicians that saved their life. And it’s a cathartic thing for the patient, but we believe it’s actually making such an impact on the physicians and clinicians that don’t get to hear thank you. Some people don’t get to come back and visit. So we bring some of those medical success stories back to medical institutions.

Kevin Pho: So Pamela, when you were telling that story about looking into that resident’s eyes and seeing that that resident was burnt out, and then of course hearing many stories after that about how prevalent burnout is, are there any themes that you feel can connect all these stories of burnout and can potentially explain a reason why so many physicians are burning out?

Pamela Marie Hobby: I was just thinking about this last night, and there’s sort of like an image that comes to my mind. I believe most people get to see the quote unquote payoff of their life’s work, and although in medicine I don’t know if you always get to see the payoff.

If I could give it an image, it’s this deep canyon between the burdens that medical professionals bear for society, and then the meaning on the other side of the canyon, of the patients that do get better, that my parents got to see me grow up.

And so I think in that canyon, if I were to put a label on it, I think it’s a little bit of HIPAA, because the physicians and clinicians cannot reach back, it’s actually illegal to do so. So the patients that want to, if they can kind of bridge that gap over that canyon and say these simple thank yous, even a handwritten note, to look in the eyes of your lab tech the next time you’re getting lab work done and say thank you, what you’ve done and what you continue to do with these labs keeps me alive.

So I think there is a theme of a need to see a payoff of some sort, and it could just be as simple as thank you. That is our ultimate goal, just to help and say thank you. But I think there is definitely a theme of just helping so many people and then they disappear.

Kevin Pho: And I think that certainly resonates. I am an internal medicine primary care physician myself, and a lot of times when we hear from patients it’s often in the context of a complaint or a bad outcome or something didn’t go well. And whenever I hear a thank you or get a thank you note, it really does provide that spark, that lift, that energy to keep on going.

Pamela Marie Hobby: I was just thinking today driving here, I got really emotional thinking, I’m so passionate about this because I have two beautiful children because of medicine, and all of the physicians, assistants, and everyone that took the time with my care. We have to thank them, we have to make sure they’re not taken for granted.

Kevin Pho: So Kim, when you heard Betsy’s and Pamela’s stories, and I’m sure you’ve heard so many stories from clinicians across the health care spectrum, how are their stories different from some of the other clinicians that we talk about on this podcast and that you’ve met?

Kim Downey: Well, you know, the first thing you can say is how similar they all are, and then the next thing you can say is how different they all are, right? Because, as Pamela said, there’s themes, and there’s themes that so many doctors that you wouldn’t believe are going to work every day not knowing that they’re making a difference, or feeling that they’re making a difference. Even emergency room physicians have told me that, when they’re literally saving people’s lives every day.

So there’s a lot of similar themes, but then every single story is individual. And you know, Matthew was a hematology oncologist, right, and that was the first story I heard of a hematology oncologist. And Pamela was sharing stories of, you know, when she was little, and back then you couldn’t get sedated under anesthesia for some of the procedures that she had, so as a young child there was a group of people holding her down. And that was the first time I had heard that story as well.

Kevin Pho: So Betsy, since you wrote your book, and in the intervening years since, do you think we’ve moved the needle when it comes to addressing some of the potential causes that may lead to some physicians contemplating suicide?

Betsy Gall: Well, I would love to, I mean, hopefully yes. You know, I’m an ambassador for the Dr. Lorna Breen Foundation and I do speak all over the country. And one of the things I say is, listen, I just simply wrote a book telling our story just to raise the red flag, but people like Corey and Jennifer Feist are doing that really hard work, you know, going to D.C., having laws changed. So I would like to think their work really has made a big difference.

And it’s funny, once you start doing work like this, I mean, there’s definitely a niche market that the general public just is unaware of. And so I feel that just even with my Instagram page, that’s really what I use it for. I mean, I share family tidbits and stuff, but Instagram and Facebook, just being able to raise awareness.

And you know, I always say thank your doctor. I mean, it’s such a little tiny thing to do. And after Matt died I was going through his desk, and I found a whole file of cards. It makes me cry because he saved them all. And to be honest with you, Kevin, I wouldn’t think of sending my doctor a card. Before this happened, I would just think that, oh, they’re too busy, you know, they don’t care, whatever. But it really just makes such a big difference.

And so yeah, I mean, I hope things are headed in the right direction. It’s got to start in med school. I mean, I think, you know, and residency, it’s brutal, and I think we need to start there. And hopefully as time goes on this is a non-issue.

Kevin Pho: So Betsy, you said one thing that really struck me, is that patients and the general public still really aren’t aware of this issue. And maybe I’m a little bit in a bubble, because on KevinMD we’ve been talking about physician burnout and physician suicide for what seems like years, even decades now. And I’m sure, Kim, you see these stories every day. So Betsy, just talk more about that. You really feel that the general public, when you go out to these conferences and when you speak to these people on the street, they’re generally unaware that this is such a large issue in the medical profession?

Betsy Gall: I can speak, I mean, when I’m out speaking, I’m speaking to that niche group. I’m speaking to spouses, I’m speaking to physicians, so there, yes, people are aware of it.

I feel, when I was married to Matthew early on, there was this buzzword of burnout, and so I was kind of like, OK, you know, burnout, yeah, it’s a stressful job. But it wasn’t until after he died that, well, that even me being married to a physician, that this was like a thing. You know, I didn’t know physician suicide was a thing.

So I would say that, you know, I don’t have a huge following, but I would say the majority of people on my Instagram had no idea that this was an issue until Matthew died. And Matthew’s patients were completely shocked. You know, we had over a thousand people at his funeral, standing room only. And we did address depression head-on at his funeral.

But I feel like, you know, I didn’t talk about it in the obituary, and that’s something that I kind of wish I had done. Because the more we keep it close to the vest, we can’t learn from it, we can’t grow. So that’s why I wrote the book, you know. It’s a culmination of my letters to God, my personal journey. It was very personal.

I kind of always, I don’t think things through all the time, because when my publisher was pushing me to get it done, I thought, oh my goodness, like, what have I done? And she really pushed me hard, and I published it, and I felt called to do so. And it’s been just really eye opening, and I’m glad I did it. I’m glad I did it, because I have people reach out and call all the time and send me notes and emails. And I had a friend from college whose husband died by suicide, he was not a physician, but she said the book helped her too.

Kevin Pho: Pamela, tell us a story. You mentioned one of the things that you do, one of your passions, is to really let clinicians know sometimes how thankful patients are. Tell us a story where that show of gratitude really moved the needle.

Pamela Marie Hobby: I was able to reach back in time 30 years and reunite with my physician assistant, who I called Dr. Pam, because I was a five-year-old and didn’t know that she wasn’t a doctor. But she was always in the room and kind of leading the team between all of the doctors that were assigned to me.

And I didn’t know if I could get a hold of her, and I was really excited to think about the possibility that, you know, is she still living in Oklahoma, is she still, what is she doing today? Did all my digging, reached back out to her, and we met at a Panera Bread. And she got to meet my husband, which chokes me up, because I have a picture of us on my last day of treatment for chemo, and I was just this little girl, and then we retook a picture, you know, fast forward decades later, of the two of us in kind of a similar situation.

We talked at Panera for probably almost three hours, and I heard things from her like, she said, Pamela, after your spinal taps, which were my spinals at the time, they couldn’t sedate children at that time, or they really didn’t know what was healthy at that period of medical history, to sedate or not, so I was awake for my spinals. And she said, I would close the door and cry, because I knew it took part of me, but it was also making me a better physician assistant, it was also making me better at spinals, and I would learn.

And I needed to hear that humanity. I never as an adult, I never in a million years would think that she on the other side of that door was in pain and feeling burdens, because she was always so tough and strong. And she also said something to me, I still worry about my patients. I never stop worrying about them, I love them, but I never stop worrying about them.

So it was good for both of us to see each other. But then the best part, that chokes me up the most, is I called my mom and dad and I said, let’s go to dinner. And so we had my parents seeing Dr. Pam after 30 years, and seeing those camps of people, the families that physicians help and clinicians help, get to see each other again. It was family. It was like a family reunion is the best way I could put it. We took pictures, had a great time, I met her husband.

And that’s when I really felt like the circle had been completed, right? Because we leave your life, and if we can, we get to go on and live a healthy life. And something closed that day for everybody. Some sort of ecosystem was closed, because physicians and clinicians give, we receive, but then this thank you, this moment together, as the patient I was giving, and that physician assistant could receive. So that’s probably the best way I could describe my personal story, but one of my favorites.

Kevin Pho: Well, thank you so much for sharing that. We’re talking to Kim Downey, she’s a physician advocate, Betsy Gall, author of the book The Illusion of the Perfect Profession, and Pamela Marie Hobby, she is CEO of My Doctor’s Meds. We’re talking about the KevinMD article “Voices for physician mental health.” Now I’m going to end just by asking each of you just your take-home messages that you want to leave with the KevinMD audience. Kim, why don’t you go first.

Kim Downey: Sure. So I just shared a timely episode of my own yesterday featuring Dr. Jose Mendes. He’s a local pulmonologist, critical care physician, and sleep specialist, and we talked about physicians and sleep issues. And reading Betsy’s book, I knew that Matthew hadn’t been sleeping.

And Dr. Jose Mendes shares some important wisdom, and I wanted to share a few of his takeaways. One of them is that sleep is his number one priority. And he shares that until the pandemic, even though he’s board certified in sleep medicine, he never understood the implications of what sleep deprivation could do for somebody’s career.

He says that studies show adults really need about seven hours of sleep, however, getting less is associated with poor health outcomes, including hypertension, stroke, AFib, dementia, depression, anxiety, and diabetes. He says try to align with the circadian rhythm for sleeping and eating as best you can, even if you’re on call or working at night, with a pitch black room and cool temperature for sleep, and get some early morning sun. Avoid blue light at night. And if you snore, have a sleep study done. Snoring is not benign, you need to uncover if you’re experiencing sleep apnea. Jose says that many physicians think of it for their patients but not for themselves.

And in conclusion, Jose shares that we’re all the same. We can all have the same diseases as our patients have. Why would we be any different?

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

Betsy Gall: Well, my take-home messages to the physicians are, please take care of yourself. When you start to go down that rabbit hole, think of me and my family. You know, we miss our dad, and fun guy. We’re up at our lake house right now and we feel his presence, but it’s hard.

So I would say take care of yourself. Exercise, put medicine away when work is over, enjoy your family time, take your vacation, read a novel, and just, you know, take care of yourself.

And to the general public, I would say your small thank you can make a huge difference in our health care workers’ lives. So I would urge everybody, the next time that they’re at their doctor, just a simple note, a thank you. I bring Starbucks gift cards. I mean, whatever you can do just to brighten somebody’s day. I always say, if we don’t have healthy physicians, who’s going to take care of us? We all need them. So that’s what I would say.

Kevin Pho: And Pamela, we’ll end with you. What are some of your take-home messages to the KevinMD audience?

Pamela Marie Hobby: As a former patient, we talk about you at the dinner table for years and years and years to come. You’re very much still alive in our life, and we thank you for all of the sacrifices, the on calls, the I can’t, I have to work. We appreciate that. And continue to save lives, continue to do what you’re doing.

If anyone wants to reach out to us, we’re at My Doctor’s Meds, we’d love to be of service to your institution and thank them. Just like Betsy said, at your next appointment, your next checkup, just send a thank you.

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

Kim Downey: Thank you.