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What if the cure for physician burnout isn’t a wellness workshop but a 10-minute exercise you can do alone in a quiet room? Brian Sayers is a rheumatologist in Austin, Texas, with nearly 40 years in private practice who founded an anonymous counseling program that has funded almost 4,000 visits for fellow physicians. In this episode, based on his KevinMD article “Finding meaning in medicine: Reconnecting with your childhood calling,” he makes a case that reconnecting with your origin story in medicine can realign you with the purpose you may have lost under paperwork, frustration, and systemic pressure. You will hear how he traces his own calling back to a homemade doctor’s smock his mother sewed him as a child, how watching physicians care for his dying father shaped his vision of what a doctor should be, and why he asks physicians in small groups to write and share the moment they first wanted to practice medicine. He also tackles the controversy around calling medicine a “calling” and whether that language enables exploitation. If your daily practice no longer resembles the dream that launched it, this conversation will remind you where to look.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Brian Sayers. He’s a rheumatologist, and today’s KevinMD article is “Finding meaning in medicine: reconnecting with your childhood calling.” Brian, welcome to the show.
Brian Sayers: Thank you. Yeah, it’s a pleasure to be here. I appreciate the invitation and all that you do.
Kevin Pho: All right. Well, thank you so much for writing and taking the time out to appear. So just briefly introduce yourself and then talk about why you decided to share this story and article on KevinMD.
Brian Sayers: Great, thanks. Yeah, so I’m a rheumatologist here in Austin, Texas, and this summer I’ll be celebrating my 40th anniversary of being in practice here. I’m in a two-doctor practice, privately owned, and I guess that’s one of the last ones like that here in Austin, and across the country for that matter.
About eight years ago through our county medical society that has about 5,000 members, I founded an anonymous counseling program for our colleagues. And so far, almost 4,000 visits have been funded and arranged. I’m also chair of a committee that follows, supports, and advocates for physicians in recovery. So during those eight years, we’ve put out a weekly newsletter, and part of that newsletter is an essay written by either me or one of my physician colleagues about our life in medicine, connecting with patients, how things match up with our family life. And so over the years, I just accumulated scores of these essays and picked the ones that meant the most to me, and put them together in a book that’s just been published.
One of the essays that I came across really speaks a lot to what we’ve done in the program and how I think all physicians can benefit from, and that’s reconnecting with your origin story, your creation story of how you came to be a doctor, how you wanted to be a doctor, how you felt that calling, and then made it happen.
And creation stories are just, they’re everywhere. About our civilization, our organizations, our friendships, things in our personal life. I mean, this essay has an origin story, but origin stories are just, so you think about it. And ancient civilizations, mythology had its origins with dueling gods and cosmic eggs and chaos being tamed. Religions have stories about how the world was created and how man encountered God. We have creation stories in our friendships, how we came together as friends, what we had in common, the stories that bind us together over the years. That’s a foundation for a long-term friendship. And with couples, how did we meet? What was the courtship like? If we’re married, what was the proposal like? What happened at the wedding that is funny or didn’t go right? And what those first years in marriage were. These are all foundations for these things.
They’re threads that connect what we were hoping for in life, how things started, with what’s happened, where we are now. Creation stories are foundational. They’re a link that connects the past with the present. It ties us together. It gives context to things that happen in our life, and it connects our original dreams with our present and our future to help realign those things. Staying connected to these stories and retelling them just has great power.
We’ve, in meaning in medicine and other small groups that we’ve done over the years in our program here and in workshops, one of the things that I really like to stress is these creation stories. So I’ll have physicians spend 10 minutes writing out their creation story, the origin of how they came to be a doctor, and then read them or recite them to their colleagues. And there’s just such power in connecting these things from your mind to a written form right in front of you, and then retelling the story both to yourself and to those around you. And connecting with that origin story really helps you to kind of take a look at what’s going on in your life now. Does your practice of medicine look like you thought it would when you were that young person hoping to go into medicine?
And just as a brief example, this essay tells part of my origin story and how I came to be a doctor. When I was six or seven years old in the sixties, they let us watch TV in those days, and I just loved to watch “Dr. Kildare.” It was this soapy doctor drama with this dashing young intern who was caring and connected with his patients. And I just really wanted to be like that. And my mother, back in those days a lot of people sewed their clothes or their kids’ clothes, and she sewed this doctor’s smock for me. A lot of doctors back in that day wore a white sort of a turtleneck shirt with buttons down the side and could do this on their pocket. And she made me that, and I just shamelessly wore that thing to school until it just about wore out.
I watched doctors over the years when I was a child, and then when I was 12, my father was a really successful lawyer and politician, but he was also alcoholic, and he developed end-stage liver disease. And we watched him suffer with that for a couple of months in Austin before he went to a teaching hospital where he died. But I watched the doctors that were taking care of him, and I was impressed, even as a child, not really understanding medically what was going on, but I was just impressed with how attentive they were to him, how kind they were to him and the family. And that just reinforced that I really wanted to be a doctor.
And as an example of how that might circle back and connect in our lives, when I was a third-year medical student on internal medicine at Parkland in Dallas, at least a third to a half of our patients were there for alcohol-related diseases. And it occurred to me that some of the things that was going on with them looked really familiar. And one night on call, I went down to medical records, and in those days the old records were on microfilm, so it took forever. But I actually found my father’s medical records and his autopsy report, and he had been sick and died in exactly the same way that a lot of the patients I was caring for on the ward had died. And actually he was on nine West, the very ward that I was working on at that time.
And it reconnected me with that childhood vision of what a doctor should be like. And especially in that situation, that every patient you look at and take care of, you should have some sense that they may be the face of somebody’s parent or somebody’s family member. So anyway, creation stories I think are just really powerful for us to keep connected to. And that’s the point of this essay that I submitted.
Kevin Pho: So when in those small groups with other physicians, when you ask them to reflect and think about why they went into medicine, their creation or origin stories, tell us the difference it makes, because I can only imagine there are so many issues in medical practice today that makes physicians forget why they went into medicine in the first place. Tell us the reaction when they start reciting their creation stories, or when you reflect on your own creation story, what effect does that have on you and the other physicians?
Brian Sayers: Yeah, it’s interesting because in those groups, maybe a third of the physicians kind of get a puzzled look. They can’t actually remember exactly why they went into medicine. And some of them went into it because they loved science. Some of them went into it because it was going to be a secure living. But most people developed a sense that they wanted to be a doctor when they were younger.
And the thing that’s important about that, kind of recognizing the calling before you’re too far along in life, is that you’re still looking at the world through sort of innocent eyes, and you haven’t really been exposed to the realities of the business world and finances and things like that. It’s a pure dream about how you want to interact with other people and to help other people. And people forget that sometimes.
And that was a surprising thing about doing this exercise also, is that as they spent a few minutes really thinking about where that came from, while they may say that they didn’t decide until they went to college or even after, they really, if they look back, they can see at least pieces of that origin story when they were young that maybe they didn’t even really realize. But I really tell people to think about what that vision of practicing medicine would be like back then for them, and what’s changed. And if it has changed, why did it change, and how can you try to realign yourself with that dreaming young kid who was envisioning a life in medicine.
Kevin Pho: Now you used the word calling a few times. You may or may not know some of the controversy now surrounding that word. I know that I talk about burnout on my site and on this podcast many, many times. And there are some people who say that medicine is a calling is just code for administrators being allowed to take advantage of physicians. And there is some controversy now calling medicine a, well, I guess any word can, what do you think about that?
Brian Sayers: Yeah, I think any idea like that can be hijacked. To me, calling is, I think Chidester described this as, calling is recognizing what your gifts are, and adding that together with what you see is out there that the world needs, and bringing those two things together. I think that’s a calling. And that may not be exactly how other people look at it, but to me it’s not a trite term. It’s not a term that’s necessarily meaning a calling from God. It’s just bringing those things together for a life of meaning.
Kevin Pho: Now, how can physicians honor why they went into medicine in the first place, and combine that with all the difficulties that prevents them from honoring that origin story? You’re in private practice. You know the difficulties of practicing in that setting, and there are so many physicians who run into those obstacles. How can they still remember why they went into medicine despite all the distractions and obstacles that surround them daily?
Brian Sayers: Yeah, I think it has to be something that is an intentional practice. Something where you just sort of make yourself step back and think about that periodically, especially on a day that’s really frustrating. Why am I frustrated? Why am I so pissed off about what’s going on in the office today?
And we’ve really found in our programs that storytelling with your colleagues, that just has a lot of power to help you unload some of those frustrations. But instead of it being just a complaint session, the things that are going wrong, this is not what I wanted medicine to be like, I wanted medicine to be like, and then from there. But physicians as friends and colleagues finding informal or formal ways in small groups to really tell that story. It just lets it out. It lets you put it in perspective in a way that just ruminating about it and being angry about the things really don’t help you to process it, like telling your story or writing down your story.
Kevin Pho: Now let’s talk about role models. I think that one of the things that I discover when I talk to medical students is that they often don’t have any good role models. You use the word complaint sessions. There are a lot of physicians in practice for many years, and they are very outspoken about what’s wrong with medicine, and that’s not always the best role model for younger physicians. So despite all the difficulties that physicians face, how can they still be good role models and inspire a younger generation of medical professionals?
Brian Sayers: Well, I mean, you have to set about doing it. In a practice setting where I am, I don’t, it is difficult to have that connection with younger doctors coming in. I think most medical schools have mentoring programs or shadowing programs where medical students, hopefully early in their medical student years, can be around other doctors who are in practice, and specifically doctors who have an interest in mentoring and demonstrating what has worked for them in their practice.
Not everybody has the experiences that I had as a child that made me really want to be a doctor from looking at how those people practiced. So it is difficult, and I think it does take some systemic opportunities for medical students especially to be around physicians who have been in practice for a while, who know how things are getting ready to change for those people, and sort of to prepare them for it.
Kevin Pho: Can you tell me an anonymized story where a particular physician reflected on why they went into medicine in the first place and really made a difference in their outlook on medicine today? Is there something that you could share with us?
Brian Sayers: Well, I don’t know if this is exactly the same thing, but it is a story that, one of the doctors who took care of my dad when he was so sick here in Austin, when I became a doctor, actually my office is in the same building that he was still practicing in. And he developed terrible rheumatoid arthritis it looked like, and came to me as a patient after all those years. And as it turned out, he actually didn’t have rheumatoid arthritis. He had a paraneoplastic syndrome from widely metastatic lung cancer that I diagnosed, and at least helped hold his hand through the process that went through there.
We became good friends, and he told me about his origin story in medicine. And he had come from a very humble rural background, and their country doctor made a big impression on him as well. But he said he always wanted to have that country doctor deep relationship with his patients. That’s so hard to do in the practices that we have today. So it kind of reinforced the fact to me that a lot of those feelings start when you’re really young, and you just have to really keep connecting with them.
Kevin Pho: We’re talking to Brian Sayers. He’s a rheumatologist. And today’s KevinMD article is “Finding meaning in medicine: reconnecting with your childhood calling.” Brian, let’s end with some take-home messages you want to leave with the KevinMD audience.
Brian Sayers: Yeah, so take-home messages are kind of what I’ve said over and over here. One is, if you don’t do anything else, taking anything forward from this, find a time in the next few days to really sit down in a quiet place, and even just for 10 or 15 minutes try to recall your origin story in medicine in some detail. I’d love for you to be able to write that down, or tell it to a colleague, but at least explore it in some way. And then compare that with what your practice is like now. And if the two things don’t line up, figure out what it is that’s not lining up, why it’s making it, why our practices are making it so hard to keep those dreams alive in the same form. And even small steps you can do towards trying to realign with that dream you had when you were younger.
Kevin Pho: Brian, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.
Brian Sayers: Thank you, Kevin.
