How physicians can address pain and recovery with empathy and resilience [PODCAST]

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Amelia Bueche, an osteopathic physician, discusses her KevinMD article, “This perspective will change how physicians address pain and recovery.” Amelia explores the interconnectedness of trauma, pain, and recovery, emphasizing the importance of addressing pain’s root causes on physical, mental, and emotional levels. She shares her personal journey of overcoming substance use, injury, and career challenges to embrace transformation and self-compassion. Key topics include the stigma of substance use among physicians, the systemic barriers to sustainable care, and actionable insights for fostering empathy, connection, and systemic change in health care.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Amelia Bueche. She’s an osteopathic physician. Today’s KevinMD article is “This perspective will change how physicians address pain and recovery.” Amelia, it’s been many years since you were last on. Welcome back to the show.

Amelia Bueche: Thanks so much for having me back. Glad to be here.

Kevin Pho: All right, so we’re going to talk about your latest KevinMD article. Before talking about the article itself, what made you write it in the first place?

Amelia Bueche: Yeah, well, I was thinking back to when I did write articles, back in 2020, around coaching in the transformation of my practice from clinical medicine to that space. I experienced this film, which was kind of the impetus for the article, and it just dawned on me that the way to share the experience on the broadest scale was here. I was so grateful for that return to that platform, and it felt like a rejuvenation. It’s another pivot of my current work, and it just feels like the formula presented itself.

Kevin Pho: All right, fantastic. So tell us about this film. Tell us about the article for those who didn’t get a chance to read it.

Amelia Bueche: Absolutely. So Tipping the Pain Scale is a documentary somewhat about the opioid crisis, also about substance abuse, but really it’s about how we address pain. It follows a number of different stories throughout the film, and there’s a psychiatrist who speaks to how we’re mismanaging pain and often not asking those deeper core questions. I watched it from the perspective of support for people that I know who are in the experience of recovery from substance use, and also because, as a neuromusculoskeletal medicine physician, pain is the primary chief complaint that walks through the door, and as a coach, thinking about how we connect all those different pieces of past trauma and feelings.

As I sat watching this documentary, it was really talking about the approach to others, so I was thinking, “OK, for patient care, there are great opportunities here.” What really dawned on me was how deeply this impacts physicians for their own care. In the practice of coaching, many of my clients and participants are physicians and other health care professionals, and pain looks a lot of different ways. Helping people to identify how pain might present, the questions we might ask better, and how to treat it, process it, and integrate it more effectively was so profound.

I left the film, went home immediately, and wrote probably four different articles and reflections. The one that came through, that really presented itself for the platform, was that encouragement to, yes, bring more compassion, awareness, and curiosity to how we approach patients, but please, let us also bring that to how we care for ourselves in the practice of medicine.

Kevin Pho: So talk to us about some of the cases that you’re seeing in your coaching practice. These clinicians who see patients in pain all the time, how does it affect their professional psyche, and how does it affect them, from the stories that you hear?

Amelia Bueche: Yeah, absolutely. I think it’s both ends. When you are a physician who is seeing pain presented to you lots of different ways, and that could be emotional pain or physical pain, acute or chronic, we’re faced with: How do we properly manage this with medications? Do we have the time to ask those deeper questions? Do we have a team in place for that? So it’s just recognizing that we have an opportunity, and also that we have to look at our own capacity. Do we have the time? Do we have the resources? If we open up this wound with this patient, are we going to be able to help them handle that, and perhaps put them with the people that might connect and be able to support them longer term? So I think it’s that piece, knowing we don’t have to hold it all. But also, if someone isn’t getting well or they’re noncompliant, these different phrases we have in the practice of medicine, maybe it is: Can we ask some different questions, right? Can we get a little deeper on what is at the root cause of that?

And then the other piece is really what I hope for, which is how we take care of ourselves. Pain, like I say, looks lots of different ways, and what I’ve noticed in working with lots of physicians is that personal pain, particularly for high achievers, doesn’t always look like dysfunction or an inability to perform. Many times it comes in the way of overworking and high achievement, and we look at physician suicide rates and how we can address those effectively. So it’s checking in with ourselves and with one another: How are you, actually, right? And having some space to answer and look deeper into those questions.

Kevin Pho: One of the things that you mentioned earlier is that sometimes clinicians aren’t asking the right questions about the root cause of their patients’ pain. So tell us about some of the obstacles that prevent them from doing so, and give us some tips in terms of the approach that clinicians can take to get at that root cause.

Amelia Bueche: Yeah, absolutely. And again, it’s if we have the time, which can feel very compressed in the clinical space. But for example, if it’s a misuse of medication or someone struggling with substance abuse disorder, can we find out when this began and what was happening then? Many times it is tied to a childhood experience or a certain traumatic event for that patient, and that was this self-medication, this tool, this outlet that they had. It’s more of a symptom, right, than the actual root cause. Can we begin to allow ourselves to say, “What is it you were feeling?” Maybe you didn’t have the tools to allow yourself to have those feelings, and a support network to be there.

So it’s getting a little deeper, because we are tasked with symptom management, prescribing, and all those pieces, but it’s finding out the why behind it. And again, it can be really imperative to have a team. Maybe you have a social worker in your office. You schedule a longer session and know you’re going to ask those questions that go a little deeper with the patient. And like I say, it is tough, because sometimes you open that door, right, and it takes more time, and you have to unpack it, and you might feel like we’re destabilizing a patient to get there. But especially with those where you just feel like you have the same appointment over and over again and we’re never making any progress, maybe that’s the invitation to say, “Let’s take it from a different angle, right? Let’s just look a little deeper, or peel back a new layer, and see what might actually be here.”

Kevin Pho: In your article, you said that physicians who treat pain need to practice some self-compassion to manage their own personal pain. What exactly would that look like?

Amelia Bueche: I think it is, again, a willingness to answer those questions for ourselves as well, and to decide: What does it look like to take care of me? So often we are the ones taking care of everyone else. We’re not given the chance to even talk about what our needs might be, and then we don’t even know what they are. Many times, in a group coaching session in particular, if we say, “What is it that you need, or that you want?” it’ll be crickets, because we’re just not even given the space to talk about that, because we’re so often tasked with taking care of everyone else.

So it’s being willing to see: I have needs. They might not be being met, and I can have compassion for maybe where they weren’t met by other people, and then I might be able to start meeting them for myself. Then I start to shift the lens and notice perhaps those needs are being met, but I just don’t even recognize it when it’s happening. Not a lot externally might even have to change, but our perspective can begin to shift to open that up and make some of those connections. It’s normal to have needs, and it’s OK to want them to be met, and, “Oh, hey, here are some ways it might be happening,” maybe not on the grandest of scales. But if we can build that, then there’s more space to continue to have success and to ask for our needs to be met more directly.

Kevin Pho: Now, some of these concepts, what would they look like in a typical coaching session, when a clinician comes to you with some of the issues that you’re talking about? What would you say or do, or how would you coach them, to help them move past some of these obstacles?

Amelia Bueche: Yeah, the beautiful thing about coaching, and what really helped me pivot from my practice of medicine to that space, is that it’s connecting them with the why that’s within. That’s true for us, and that’s true for our patients, and that inherent self-healing capacity, as an osteopathic physician, is a core component. So it’s holding space, letting them tell their story, and then drawing out: “I heard you say this. Can you tell me more? When you said that, what did it mean for you? What did it feel like for you in your body?”

That was really new for me when I entered into coaching, as a training and a practice. I really was out of touch with feelings. I spent a lot of time in the logical space, which seemed really helpful. And it’s allowing people to have the opportunity to feel what it is they’re feeling, including pain, because sometimes we don’t even know, right? We might have just built up a really high tolerance to pain, and we’ve just allowed ourselves to be in that space, and then to say, “Oh, actually, right, this does hurt. It doesn’t feel good. It’s not sustainable, and let me address that.”

So it’s really holding space for them to have some recognition and find the answers. Sometimes that’s frustrating, because we want answers and a prescription and a rubric, and there isn’t, truly, right? It’s one beautiful way that’s within you. But the good news is that it also means it’s custom for you, and it’s going to be the most effective, because it is your actual answer. That’s what I love the most about coaching: connecting people back to themselves, back to their source, and back to those origin stories that we sometimes forget through all those years of training and practice.

Kevin Pho: Another thing that you touched upon in your article would be the use of substance abuse in the medical field and the stigma surrounding that. Tell us about some of the things you wrote about that.

Amelia Bueche: Well, it’s interesting, right? We just most recently had an article noting that with alcohol, there’s no safe amount, right? We’re looking at the carcinogen impacts, and there have been lots of different dialogs among physicians regarding that. We know there are harmful aspects to the substance, but it’s also very normalized, socially and culturally. We can think, “Yes, I get to the end of the day and have a glass of wine,” and there can be factors that are useful in there. But it’s checking in to say, “Is this me avoiding or masking, and utilizing this to escape my life?” which sometimes can feel helpful and useful. But are there opportunities, perhaps, to have other coping mechanisms to be able to handle what’s happening to me?

And then, if you are noticing it is entering into the overuse or abuse category, how can you find those safe outlets to address it? Because it does come with different punitive aspects. There can be shame. There can be licensure risk. Can we do better in those practices? The film touches on different policy development, not necessarily specifically around this, but as a health policy fellow myself, I ask: How can we, on a broader scale, have better systems, so it’s safe to ask for help and it’s not a threat to you or your practice of medicine?

Kevin Pho: So from a policy standpoint, from that film or from your experience as a health policy fellow, what are some policy suggestions that we can implement to help this?

Amelia Bueche: The one that was key and core in the film was allowing people to have inpatient admissions, even involuntary, for substance use. That was really interesting and somewhat new to me, that oftentimes, if you’re threatening harm, or if there are other reasons, you can be admitted, but if it’s specifically for over-intoxication, that always doesn’t qualify. It would often get people kicked out of the system and then back to the streets, and the cycle would continue. There were success stories around making that more accessible and available, so patients could get the help that they need.

From the physician standpoint, this is a newer frontier for me, in investigating: What are the options? What are those safe reporting routes? I included in the article some links for places. There are some physician-specific AA groups, for example, right? So there are some rooms where you can maintain anonymity specific to the profession and get the help that you need. And then it’s looking at how some of these more formal systems aren’t always super safe and effective, and can we do better? I don’t have the answers just yet, but that’s a place to begin to learn.

If those who are listening do have more experience, or have had better success themselves or with a colleague, I would encourage them to make that known. We have lots of different social media platforms, yours and others, of course, as well. Let’s offer up what those meaningful and safer spaces are to get the help that we need, and yes, formally, but then also, can we open dialog to say, “I notice I’m utilizing these substances. Maybe that’s not the best option”? And even though it’s socially acceptable, can we encourage each other, perhaps, to seek reform in self-care and compassion, without that as the primary tool?

Kevin Pho: The last thing that you touched upon in your article was addressing pain at a cellular level, and that sometimes can contribute to systemic recovery and change. So exactly what does that mean?

Amelia Bueche: For me, some of that’s experiential. So I say, sitting in that film, it was like my whole self was called into being, and that’s on the pragmatic level: the physician, the health policy dev, the coach, the parent, the friend, the supporter. I felt like everything was saying, “Bring everything that you do together. This is calling you to action in this space.” It feels transformative, and it really is a sensory experience. It was like, “I’m going to be changed from having watched this film and by what it called me to do.”

I had a similar experience a few weeks prior at a concert with Yo-Yo Ma. I’m a cellist myself. I’ve followed him my whole life, and he’s a brilliant human on many levels, but in that space, he called us to a work of planetary humanism, saying we could do better. I remember just sitting in that space, and I felt my whole body shift and change and say, “Yes,” right? The music was helpful, and the dialog was helpful, but it was just this sense that all of me was integrated.

I invite us to allow ourselves to experience that. So where are those spaces and times in your life when you have felt like all parts of you were brought online, right? Everything was activated, and not in a reactive way, but in this invigorating way, where you connect all those different pieces of you and allow that to guide you forward. That does happen in coaching sessions, right, when we’re able to connect with our feelings and those core thoughts and recognized patterns that we’ve had. There’s just this resonance that happens and says, “Oh, right, this is what I meant to be doing,” or the question I want to ask, or the next step for me. What I would invite listeners to do is just to be open to that, right? Be open to resonance, and maybe track back to see where that could happen, and then look forward to creating spaces for ourselves and for each other to invite that in.

Kevin Pho: We’re talking to Amelia Bueche. She’s an osteopathic physician. Today’s KevinMD article is “This perspective will change how physicians address pain and recovery.” Amelia, let’s end with some of your take-home messages that you want to share with the KevinMD audience.

Amelia Bueche: I think it’s just enhancing your barometer for sensing pain in others and in yourself, and being willing to see that it might look and feel other ways. It’s not to be detrimental or derogatory, but it’s to say, “Here’s an opportunity for me to recognize this so I can take care of it better in myself, and to show up in a space with my patients with a more robust capacity to ask, and to hold space for the answers to, these meaningful questions.”

Kevin Pho: Amelia, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Amelia Bueche: Thank you for the opportunity.

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