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We dive into the critical issue of physician burnout and the challenges facing primary care providers with family physician Santina Wheat. Discover practical strategies for reclaiming joy in medicine, setting boundaries, and rediscovering purpose amidst the demands of the health care system. From leveraging technology to cultivating positive relationships, we explore how small, intentional changes can make a significant difference in both personal and professional well-being.
Santina Wheat is a family physician.
She discusses the KevinMD article, “Reclaiming joy in health care: Taking control amidst systemic challenges.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at kevinmd.com/podcast. Today we welcome Santina Wheat. She’s a family physician. Today’s KevinMD article is “Reclaiming joy in health care: Taking control amidst systemic challenges.” Santina, welcome.
Santina Wheat: Thank you so much for having me.
Kevin Pho: So let’s start by briefly sharing a story and journey.
Santina Wheat: Sure. So I am a family physician, and I have been working hard to become a family physician for my entire life. And to be honest, I just thought that one day I would be there; I would be practicing; I would have that role that I wanted; and that I would be happy. And it didn’t really go that way. And I really wondered why it was that other people were happy and I wasn’t.
And for me, it really came to a head when my mom was dying, and I was watching all of the frustration in health care. And I was trying to just sort of get through on both the caregiver side and the physician side. Ultimately, after she passed, the pandemic also hit, and so that was a horrible time for everyone. And I realized that if I wanted to stay in medicine, I had to figure out a way to reclaim my own joy and look at how I could make things better in a system that is definitely broken and needs a lot of change.
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Kevin Pho: All right. So during that difficult time where you were struggling as a caregiver but also working where joy wasn’t necessarily there, just take us through that thought process. What exactly were you feeling during that time that made you think that medicine isn’t quite what you expected?
Santina Wheat: So I’m an educator, and every place that my mom was going, it was a residency hospital. And so I was really just watching that when she was ill, they were treating her as just somebody else to learn from. They weren’t getting to know who she was, all of the amazing things that she did, or even potentially cared about the fact that I was a physician myself and understood what they were talking about. So much so that I watched other attendings sort of stop them and be like, “Hey, you really need to pay attention here.”
And for me, that just sort of brought up this idea that medicine has lost its humanity. It’s lost the fact that we care about the people that we are looking at. And as somebody that really felt called into medicine, that was a really hard realization. It was hard to realize that some of that empathy piece, that human piece, was floating away from what I thought it was going to be. And I just really wanted a way to get that back for myself and hopefully for the others around me as well.
Kevin Pho: You talk more about that in your KevinMD article, “Reclaiming joy in health care: Taking control amidst systemic challenges.” For those who didn’t get a chance to read your article, tell us what it’s about.
Santina Wheat: I think this article is really getting to the point that we have autonomy in this. We don’t have to just look at health care and be like, “It’s broken. I can never be happy. I can never be fulfilled anymore.” And sort of like you might need to make a plan to work out and stay healthy, you can also take a plan and have action steps to have more joy, both at work and at home.
And so I walk through some strategies that individuals can use to really help them find more joy, particularly if they want to stay in medicine, because that was the hard thing for me. I thought about leaving medicine, and that felt bad when I had really felt called to do this. And so the things that I walked through helped me rediscover my own fulfillment and joy in this really harsh environment.
Kevin Pho: Now, before talking about some of these strategies, about the medicine itself, what in particular about it was causing you to rob joy from you practicing in the field?
Santina Wheat: I think there were a lot of things that were robbing away from it. One was the feeling on the caregiver side of knowing that I knew a lot about medicine, and I still didn’t feel like I was experiencing what I had hoped for my mom, that it was just sort of a battle against everything. Some of that had to do with insurance issues. Some of that had to do with just not enough people being around. We know that there’s never enough nurses, never enough support system for anybody that’s there. Some of it just had to do with seeing people at their worst. We all know that in the hospital, particularly, residents are exhausted, and sometimes that feels bad.
And I was experiencing that on the other side, too. I was taking care of my mom, had two young children, an amazing husband who was helpful, but that didn’t mean that I wasn’t exhausted at all times. So I wasn’t at my best either. And so every complaint, everything I was running into against an insurance challenge, not being able to get a medicine for my patient, or some random thing that administration was saying, those all were just sort of adding up to this feeling that health care was kind of horrible. And that’s really how I felt at that time. I still think that there’s a lot that needs to change, but I still am able now to find the opportunity to still be fulfilled in this system.
Kevin Pho: Now, you talked about some strategies that you use yourself to turn things around. Where did you go for help? How did you find out about some of these strategies?
Santina Wheat: I really just started by asking for help. I talked to my mentors, and I really did think about leaving medicine. That was actually the first step for me, was to figure out if I really should leave or not. And then I did go to some different conferences that were about well-being and trying to figure out what to do. And honestly, most of them encouraged me to leave medicine, and I didn’t really want to do that. I had spent my entire life getting here.
And then I did find coaching, which was absolutely amazing. I actually was finding coaching for my faculty, not for myself. And I was trying to be the good leader and model that you should do those things and found true value in it myself. And this reminded me of when I was an athlete and I had a coach that helped me get better. It really is a valuable step to helping live a better, more fulfilled life, both at work and at home, because I really think that they’re intertwined.
Kevin Pho: Now, you went to these conferences that were supposed to help with burnout, and for the majority of these conferences, their solution was simply to leave medicine. Is that true?
Santina Wheat: It felt that way. It really was the most. It might have just been the ones that I happened to go to that that was the theme, but it was, “Go to real estate. Go to something else. Consider another path.” And that just felt wrong in my gut for me. And I think for some people that’s right. For some people, medicine isn’t the answer, especially you’d been pushed there. But it really was part of my journey for my entire life, so letting go of that just could never feel totally OK for me.
Kevin Pho: So talk to us about some of these tips and strategies that you implemented in yourself and as well as your colleagues.
Santina Wheat: So I think that the first part is to recognize that it’s a process and that these really are strategies that you have to continue to work at, and that it’s not a one-time thing. But the number one is to rediscover your purpose, to remember why you’re doing this and to see if this is still the reason why you’re doing this. The thing that you said on your medical student application or your residency personal statement might not still hold true, but to really find out why it is you want to be there. So that’s number one.
The second is really to think about boundaries and realizing that boundaries aren’t just about saying no to someone else, but prioritizing the things that are important to you.
The next, what’s really hard for me in medicine, I think that people will relate to this, is celebrating the win. We tend to be perfectionists and be really hard on ourselves. And so learning to celebrate the small things that were going well, even if it was the, “Oh, that patient said thank you today,” or something that was really small, when you keep track of those, then it really helps increase your joy.
I also think that the pandemic made us not stick into our relationships a lot. So really thinking about recultivating some of those relationships that are meaningful, and not just being surrounded by people that are venting all the time, but finding the opportunity to have the relationships where you can talk about happy things, where you can laugh, and you can find the good sides.
And then the last one, but by no means the least important, is to prioritize self-care. I can’t be happy when I’m not sleeping, when I’m not taking care of myself, when I’m not finding that way to refill my cup and to go on vacation.
And so really, it’s all of these things together, and they each sound really simple, but I find that most of us forget to do them. I think that we forget to prioritize ourselves in this pathway. And we have to remember that all of that is important, especially in this caregiving role as physicians, to really look for how are we taking care of ourselves so that we can show up the best for our teams and our patients.
Kevin Pho: So let’s talk about the first thing that you mentioned, or one of the first things, which is about boundaries. I talked to a lot of physicians who have gone through coaching, and coaches themselves, and that seems to be a recurring theme. So specifically as it relates to boundaries, how do you go about setting those boundaries or prioritizing what you need to do or what’s important to you? What are some specific tactics that you use to do that? And I understand it’s a process, but how do you approach that?
Santina Wheat: Absolutely. So it actually starts with the first thing, which was knowing what my purpose was. And so I actually created a personal mission statement. Just like your organization might have a mission statement, I have one for myself. And so as something new comes up, I ask myself, “Is this going to support my personal mission statement?” And my personal mission statement includes my work and home lives.
And so if it doesn’t support something in that large vein, then it’s easier for me to say, “Well, this is not right for me right now, but maybe I can provide this other person, or maybe come back to me in six months.” So it’s not necessarily a hard no at the time. It’s a, “This is not right for what I’m trying to accomplish at this moment in time,” and that is it. And I think that that was the hardest part for me, was understanding that the boundary wasn’t about the no. It was about helping me achieve my personal mission.
Kevin Pho: And in terms of working through each of these particular tips that you mentioned, is it something that you work through yourself, or did you work with a coach or with a team or with anyone who was supporting you?
Santina Wheat: So I did a lot of this on my own, and I think that the fact that I did a lot of it on my own meant it took way longer than it needed to, and I probably sat in burnout much longer than I had to. I did, however, go through some leadership development where some of these things were coming up, and I was able to look back and be like, “Oh yeah, this is when I started to feel better. These were the things that helped me feel better.”
And I had hired a coach for my faculty team, and when we were doing our group sessions with her, I was really able to put some of those things together. That was where some of the realization came through for me. And all of this really led to me thinking about positions that I would have never considered in the past and allowed me to feel so much happier in my clinical life.
Kevin Pho: Now, can you tell us a story that contrasts what you were like before implementing some of these tips and then after, just so we can see some of these things that you mentioned play out in practical purposes? So what were things like before and then after you implemented some of these tips that you described?
Santina Wheat: Absolutely. So I am by nature an introverted, serious person. And so I am that person that used to walk around with a super serious face, and people did not necessarily want to be around me. They thought I was just being mean. And some of that had to do with me being introverted, and some of that had to do with the fact that I was in burnout and I was frustrated.
Now that I have done a lot of work on myself, and I have used some of these things, and that I use gratitude in my life a lot more, I recently had somebody come up to me and be like, “Oh wow, you are the most positive person to be around.” And I sort of was startled back. I was like, “Oh, I have never received that feedback in my life.” And it really has changed how others are willing to interact with me. And it has meant that people are able to come to me with different questions that they wouldn’t have before, and it’s really allowed for a more productive workspace.
And the truth of it is, it means that I don’t have to work as hard to accomplish the amazing things that I always have wanted to accomplish. It just makes that feel so much more possible and obtainable.
Kevin Pho: Now, it came to a point where you were seriously considering leaving medicine before you had to work on yourself and implement some of these tips. For a lot of physicians, hopefully it doesn’t come down to that point. So what can you share with perhaps early-career physicians to help sustain their practice in medicine, and specifically in primary care, without them having to face quitting medicine before turning around? How can we help them before it gets to that point?
Santina Wheat: Absolutely. I think that the most important part is to know that many of us reach this point where medicine is not quite what we expected. It’s not quite what it looked like on TV before we got here. So acknowledging that first is really important. And then the second piece is not necessarily thinking that it’s going to be the exact job that you thought. What your faculty looked like, what the early physicians around you are doing, is not necessarily the right path for you.
And so I would encourage you to find someone who is a mentor, find someone who is a coach, whatever that might be, and make sure you’re being honest and open about how you’re feeling. One, because they may have gone through it and might be able to help you, but two, could also potentially help you find a different path. What we learn about in our education is not all that’s out there. There’s so many people that are finding ways to do clinical medicine in other ways, whether it’s DPC practice or locums. Different things fit for different individuals, and that’s not what is presented to you at the beginning.
So taking the opportunity to find out what else is out there and checking in with others that have faced what you have has been extremely meaningful for folks that I have found that have been happier much earlier in their practices.
Kevin Pho: Now, like you, I’m a primary care physician. I’m internal medicine, and you don’t need me to tell you all the challenges that primary care clinicians are facing today that lead many to burnout. Now, for those medical students or prospective students who may be considering a career in primary care, just tell us what you love about primary care and what keeps you going in primary care today.
Santina Wheat: Absolutely. And it’s actually, unfortunately, a statistic that I had read that prompted me to write this article. But I think that there is such amazing joy in being a primary care physician when a patient walks into the room and is so thankful about the care that I was able to take care of for their family. I had this happen last week. I saw multiple families where there was an older parent, and the children were there, and I could just relate to the experiences that they were having after my own experience with my mom. You can really connect with those things, and patients bring us into their lives. I don’t think that all of my colleagues in other specialties get to see that, but we really do get to pull back the curtain and be an amazing part of our patients’ lives within primary care.
Of course, there’s challenges. There’s insurance barriers. There’s paperwork issues. I am thrilled that I see some companies thinking about this in a different way and are starting to think about how to prioritize primary care. But when that patient comes to you and says, “Wow, you solved this for me,” or, “You really took the time to listen to me,” if you love people, then this is an amazing field to be in because you get to experience that.
Kevin Pho: We’re talking to Santina Wheat. She’s a family physician. Today’s KevinMD article is “Reclaiming joy in health care: Taking control amidst systemic challenges.” Santina, let’s end with some take-home messages that you want to share with the KevinMD audience.
Santina Wheat: Absolutely. Just remember that the pathway to joy is absolutely a pathway. You need to continue to implement strategies that work for you to keep yourself there. You wouldn’t expect to run just one marathon and then be healthy for the rest of your life. In the same way, you need to continue to work at making sure that you have joy at home and at work.
Kevin Pho: Santina, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.
Santina Wheat: Thanks for having me.
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