S2 Ep 31 Have You Asked Your Doctor How They’re Doing? Doctors are People Too: Addressing physician burnout, embracing post traumatic growth, and forging the future ‘new normal’ in healthcare.

12:51AM Mar 29, 2022

Speakers:

Shelli Ann Garland

Dr Sherman

Keywords:

burnout

patients

physicians

pandemic

people

doctor

health care providers

experienced

medical provider

important

medical

healthcare

care

community

training

realise

provider

teachers

medicine

nurses

Hello, and welcome to A Dash of SaLT. I'm Dr. Shelli Ann and I'm so glad you're here. Whether you stumbled upon this podcast by accident, or you're here because the subject drew you in welcome. SaLT is an acronym for society and learning today. This podcast was created as an outlet for inviting fresh discussions on sociology and learning theories that impact your world. Each episode includes a wide range of themes that focus on society in everyday learning, whether formal or informal. So let's get stuck in shall we.

Welcome to A Dash of SaLT. Today I'm joined by Dr. Joe Sherman. Joe Sherman, MD is a board certified paediatrician, master certified physician, development coach and consultant to individuals and healthcare organisations in the areas of cross cultural medicine, leadership and provider wellbeing. He has held faculty positions at several universities and is currently associate clinical professor of Paediatrics at the University of Washington. He's helped countless numbers of healthcare professionals find relief from burnout, and rediscover the joy of practising medicine. Today, Joe, and I'll be discussing the journey of that healthcare professionals have had on the frontlines during COVID. And what the new normal for healthcare providers is in this post in a post COVID world and what that looks like. Welcome Dr. Sherman.

Thank you so much. It's great to be here with you Shelli. Thanks.

So, would you start off telling us a little bit briefly about your background and how your own life experiences led you to your work with physicians and healthcare organisations?

Sure. I am a general paediatrician and was trained in Richmond, Virginia at the Medical College of Virginia, Virginia Commonwealth University. I went to four years of medical school after my undergraduate education and stayed on there for residency in paediatrics. And I have spent my entire career as a general paediatrician working at the at the junction of medical education and community health. So bringing trainees whether they be medical students and residents training in paediatrics into the community to actually see where the families of their patients live, and become more present to the actual lived experiences of their patients and families. And that's been my passion, I would say, especially with underserved communities, in inner city settings. I grew up in Washington DC, in the city, in the city of Washington, third generation Washingtonian. So that's kind of where I live and where I grew up. And also, my training was in an urban environment. So I've always been dedicated to that. I spent also a large chunk of my career working internationally, mostly in East Africa, as well as in South America, Bolivia, other parts of Latin America. So there's a great part of what I do and what I've done as a paediatrician and physician that has to do with international health. So during all of these jobs that I've had around the world, as well as in the United States, I've always found myself feeling very comfortable in certain jobs and very uncomfortable in other jobs. And I really didn't exactly know what it was, I just thought, wow, this is what I really enjoy doing. And I thrived. I love the work. I was able to walk away from it because I had a team that worked with me, we work together, and we were able to kind of fill in for each other. If if one of us was wasn't up to the task, someone else was always ready to step in. And so that sense of a team working together, a sense of having relationships with trainees, as well as with patients and families, is what I really love about being a physician. Whenever I was in a position whenever I had a job, where those things were extracted, where they were not part of the, the paradigm and part of my situation, and it was just strict medical care, recording what I did, providing the diagnosis and treatment, and moving on to the next patient, in an environment that was not conducive to creating community and relationships with both my co workers as well as my patients and families, that's when I found myself shrinking, contracting, and really, to be honest with you becoming anxious and depressed. And that was all because I was misplaced. I call it burnout, I guess people would call it burnout. In some ways, I call it misplacement. I call it losing my sense of purpose, losing the sense of who I am, and just becoming what I do. And I think that's really what brought me to wanting to work and accompany other health professionals in trying to discover that joy of who they are, in what they do, and not the other way around, not doing what you're told, and just scrambling to try to see if you see some sense of purpose within what you've been told to do. And so now I work as an individual coach for physicians and other health care providers, and also facilitate workshops and retreats for physicians. And these, this is what I love doing now, I still enjoy being a paediatrician on my terms. So I fill in here and there at couple of clinics that, that I feel practice medicine in a way that I feel most comfortable. So it's it lets me keep my hands in there and at the same time, be able to accompany other health professionals.

Yeah, there's something that you said a little bit back early on. And you know, that overview, that overarching theme that you were talking about, but it's that idea of, you know, the the the lack of empathy that sometimes can happen. And, you know, being able to train people to actually think about your patients as human beings and getting that hand, not only getting that hands on experience, but also having an understanding of the community in which they're serving and practising as well. And, you know, seeing patients as human beings with lives that are messy on the outside, and, you know, why are they reacting and acting the way that they are, or, you know, the underlying health concerns that they may have, or these types of things. And, you know, when we all go through, you know, training, a lot of times, it does end up becoming a lot of tick box exercises, you know, you need to do this, you need to do this, and, and sort of that human elements can sometimes, you know, go by the wayside in training, but also, and this is something that we're going to talk a little bit more about today, is when things like pandemics and epidemics happen, when it is just a constant barrage of the same sick people with the same symptoms, and the same things happening all the time where, you know, physicians and health care, workers just end up, like seeing people almost feeling like it's an assembly line and endure that rotating door, in and out and how sometimes that that empathy for others and that thought about, you know, a human being and the relationships and what's going on in their messy worlds outside falls by the wayside, because you're just worried about getting them in make, you know, helping them to live. So we're going to talk a little bit more about that. I'm here today, but as you mentioned earlier, you've practice medicine, all you know, around the world, and you know, and you experienced that your own element of burnout or displacement. And you specifically, something that I I know about you is that you specifically struggled with your identity being defined by your profession, rather than who you were as a person. And so I guess my question or what I want to talk a little bit about there is what caused this and what do you feel that the cause was in, you know, what, what are some of the other symptoms of burnout or feeling displaced that you experienced? And then what did you do about it for yourself?

Okay, that's, that's a whole lot of stuff. But my first comment is just that as As pre med students as students that have decided that they would like to enter medical education. We, as those initial students that are entering medicine come from all walks of life come from all different backgrounds. And if you looked at measurements in the indices of mental health, entering medical students have some of the highest measures of mental health, they are very healthy psychologically and emotionally. And then if you did those same measures, as they exit medical education in the United States, they have some of the worst measurements of mental health. So when you see that there must be something that happens along that process, from the time we enter medical education and training, to the time that we come out. And part of that process is that we come in idealistic with a fairly good idea of our why, why it is that we want to be doing this, our sense of meaning and purpose. And what happens within our medical training is that we are told how to do things, this is the way that you are a doctor, follow me and do what I do. And that will make you the best doctor you can be. And so for me going through that experience, I struggled quite a bit, mostly because as I entered medical education, I also had a lot of interest in things like counselling, teaching, coaching, athletics, there were a lot of different things that I really was passionate about. And yet, when I thought about being a doctor, what many people would say is you can do a lot of those things as a physician. And I said, okay, if I'm able to integrate counselling, education, coaching, accompaniment, all of those things as a doctor, then I'll go for it. And I did. And I would say that for many of us, there are these other interests that we have. And I saw it in my, in my classmates in medical school, some were talented musicians, some were great actors, some were ministers, some were lawyers, all these different professions, before they entered medicine. And when they came out the other side, a lot of what happens is that sum of who they were, who they are, was taken away, and it was replaced with what you do. And that was modelled for us by our attending physicians, our teachers and our, our mentors. So I think that that's a big factor to think about, as people get into the actual practice of medicine, they are given a template of how they should practice. And then they enter the workforce. And then there is no finish line there. It's kind of like you're in it for the long haul, there's no end of your four years of medical education of medical school, and of your three to seven years of residency, whatever. Now you're in it for the long haul. So now for me, I like to try to work with physicians who have found themselves in a place that they were told this is the way that you become a doctor. And then they all of a sudden realise that they're uncomfortable, that they don't feel like themselves, that they're feeling kind of like automatons just trying to do what the system tells them to do. And they're losing a lot of their autonomy in the way that they think that they would like to practice medicine. Now, some of that is good, because we need to have some type of structure and some type of continuity in in metal, medical treatment in the way that we do things. But a lot of it at the price of, again, our sense of who we are why we went into the profession, being lost is not a good thing. And that's what I think leads to burnout.

And you know, I'm at as an educator as somebody who you know, is highly interested in education and teaching and learning I'm I'm hearing so many parallels between what doctors and training doctors experience and then when they become doctors, medical doctors, but also the parallels with educators teachers, and the same thing that happens you know, when you're a teacher, you're expected to you know, present this this personality that you are in front of your classroom and in your young students or adult students any you know levels of I'm you know, for lifelong education, but people forget that you're a human being with an outside life outside of the classroom or outside of the doctor's office or outside of the clinic or the hospital or, or that kind of thing. And so these parallels that I'm hearing, I, I'm just putting this out there, just because, you know, a lot of listeners, you know, would tend to be educators and to be able to hear this parallel and that this struggle is, you know, very real, I think in a lot of professions, you know, these these types of professions where, you know, you sort of forget, and then burnout can occur in that kind of thing. Um, but I, and one of the things that I think is really important, again, that you do keep bringing up is, you know, the, how you interact with community and how you're part of community or how that, again, falls by the wayside, and you're not part of, of community because you're like that automaton, you know, that you're just constantly going in and doing the same thing over and over again, presenting yourself in a specific way. Um, this brings me to the two, I want to talk to you a little bit about COVID-19. And, you know, it's now COVID-19, and its variants have really had a significant impact on the world, not just the US on the entire world, since it began, again, spreading in late 2019. And in early 2020, you know, that's the thing that will none of us will ever forget, you know, how things stopped. But then also how things went crazy from that point on, um, and for healthcare workers and for health care physicians. It's been relentless. And now that things are starting to kind of ease a little bit, it isn't happening for healthcare workers and for health care providers. And they've really experienced significant and unprecedented burnout because of COVID-19. Can you talk to us about burnout, and its causes pre COVID and mid COVID. And then a little bit later, we're going to talk about what that might look like in the future.

Sure. One thing that I think is important to realise is that burnout amongst doctors and other health professionals was very high before this pandemic ever came. Every year, there is a publication called Medscape, that does a survey of several 1000s of doctors of all different specialties in the United States, asking questions about burnout. And so they publish every year a breakdown of each medical specialty, and how many members of that particular specialty claimed to be burned out than these are practising physicians. And so the average rates of burnout, pre COVID, were somewhere around 40%. So 40%, of practising physicians average it depended on the specialty. But somewhere, I would say, between 35 and 40%, claimed to be burned out at the time, this was pre COVID. Now, when I say burnout, there is a specific definition in the literature that talks about burnout. As far as physicians are concerned, that has three components. The first component is emotional exhaustion. So physical exhaustion, I think, is something we're used to, as physicians are all our training everything, but the emotional exhaustion, the sense of, of just kind of being completely spent, and we just have nothing left in her tanks. So emotional exhaustion. The second component is this sense of dissociation, or disconnection from our patients. And we all all of us, almost all doctors, regardless of the specialty, have some sense of wanting in relationship with patients that's, you know, they want they care about patients, and they want to help people. And so the third, the second component is dissociation where you're just kind of like going through the motions, and you really don't have that connection of knowing who your patient who's sitting in front of you, right? And then the third component is that loss of this sense of purpose or meaning, the loss of the why the loss of like, why am I here, I'm not having any impact at all on people. I'm just kind of part of the system. So those are the three components that sense of emotional exhaustion, dissociation from your patients. And the third thing is a loss of sense of meaning or purpose in what you do. So you can imagine If close if about 40% of physicians were already that way, and then COVID comes and then the first thing that happens with COVID is that we are very well trained probably, as educators. Also you could you say this, that, to be self sacrificing, you, you put your patients first, I don't know how many hospitals have a, you know, their motto or their tagline is, patients first or put patients first patient care comes first. And so that is part of medical culture in the United States is to always put the other person first. And as a matter of fact, that fits into a lot of religious traditions that we were raised in. So when we put the patient first all the time, then there's a great deal of self sacrifice, this great deal of like, suck it up and deal because people really need you, they're suffering. And I will tell you for a crisis, like a pandemic, or if somebody is in trouble, that's actually a good response to an emergency to a crisis. And in the beginning of the pandemic, all medical providers, especially nurses, I would say, right there in the front lines, everybody was ready to go. And it was almost like even those that claim to be burned out were like we are needed. And this is what we know how to do. And we can help we know a way that we can help. So there was initially this surge of like camaraderie, this kind of like in the trenches kind of boot camp mentality of Come on, let's get together we can do this we can, we can beat this pandemic. And so people joined together. But then as time went on, especially as patients started dying, and because of of isolation rules, and everything was structions, for visitation, families could not be there to accompany their loved ones. So then that became the job of nurses, especially nurses, chaplains, social workers, and physicians, as well as respiratory therapists, and radio and all these other people, lab technicians, custodial staff, all these people who work in the hospital, were called on to be comforting, sick and dying patients because their loved ones were not allowed to be with them. This took a tremendous toll on the medical community. And as much as we wanted to raise everyone up as heroes and healthcare heroes and all of that, which is wonderful, that just kind of fed the flames of us wanting to kind of do more and more and more without any breaks. And now what we're seeing is as the pandemic had it surges and then it's kind of like comes down and, and many people in healthcare, we're like, oh, man, maybe we can at least get back to some type of normal and then boom, another surge comes and, and it just was kind of like, you know, some boxer getting beaten down, trying to stand up getting beaten down again. So that made the measurements of burnout in these annual surveys go up to 55 to 60%. of physicians, and then that was followed by the great resignation of nurses, something like 21% of the of the nursing workforce, left, resign, quit, and many physicians held on and are still holding on but at a great price to their mental health. And so now we are dealing with the mental health fallout of everyone in healthcare, not taking care of themselves, systems not being not being equipped to be able to, to give people breaks to be able to just give people breathers days off time to recuperate, trying to coordinate things. So now, this is what we're dealing with. We've moved beyond burnout for many people, and now we're in mental illness. And that's where that's that's unfortunately, where we are right now with healthcare professionals.

And, you know, I, I was thinking about the fact that and maybe sometimes the perspective that the that the healthcare physicians and workers don't often see is you know, the being on the other side of the bed or the other side of the table or the other side of the chair, the patient coming in, and often actually, because of going back to what you were saying earlier, that persona, that you know, you feel you have to kind of present or you know as official addition, that a lot of times people will come in, and they'll be intimidated by their doctor and forget that you're human beings as well with, you know, life and stories and, you know, things that, you know, I, myself as a patient, you know, should go be able to go in and sit down with my doctor and say, How are you doing? You know, and I know that there are these other sort of strict things that have been happening, you know, trending, I guess, over the past 15 years, 1015 years, is that time and that you know, that you're allotted in the office, you know, patients are very aware of it, doctors are very aware of it, you know, because administration administrators, you know, will say, you know, you can only spend whatever, some amount of time with each patient and that kind of thing. And I think it's important to think about the fact that as a patient, going in I, you know, I should be able to look at my doctor, as somebody with a life and, you know, children and family and Little League and things like that they happen on the side, and just take a minute or two from my side and say, How are you doing, you know, as part of that important relationship that you were talking about earlier? And, and I think that, you know, again, there's all those a lot of those administrative factors that happen and things that that happen, you know, sometimes it is hard for us on both sides to control. But, you know, what is the impact of vet physician burnout, for patient care for the actual taking that time with that patient care? What's What's that impact? What would you say about that?

You know, many of the physicians that claim to be burned out, historically, I will also say that many of them, not all of them, but will also say that this does not in any way impact patient care, that even though I feel like I'm emotionally exhausted, I am dissociated from my patients. And I have no sense of meaning or purpose, I can still deliver perfect medical care. Well, I don't think that that's true. And I think I know, because right now, in my life, I spend more time on the other side of the table on the other side of the desk, either accompanying my family members and friends, as a patient advocate, or my own health, feeling, I get a little older now and I have met various medical problems. And I can tell you right away, as I sit in an exam room, and the doctor walks in, and, and she looks at me, and an even just begins to engage with me and already knows that I'm a doctor. I can tell very quickly, whether or not this is somebody who is burned out, somebody who's struggling, or anything else, because I can tell how distracted they are, how much that they're focused on the computer in the medical record, how have some very telltale sign is when a medical provider criticises another member of their team. Oh, my gosh, I'm so sorry, I'm late. But we have this new medical assistant, and she just is not on the ball and doesn't know what's going on those people at the front desk. You know, they're the things like that when you hear that as a patient. I think the provider thinks that they're trying to reassure you that it's not their fault. But really what's happening is kind of like, Ooh, boy, you just threw your coworker under the bus there, you know. And so that's what I feel I see those things. And so what you said before, this idea of asking your medical provider, how are you doing? I think, you know, I hate to put the responsibility on patients because you're coming in, you're suffering, you're in distress, everything. Right? I tell this story all the time, about my wife, who suffers from pretty severe migraines and was seeing a neurologist and a Headache Clinic. And I knew her provider personally, because we worked together. And my wife had a great relationship with this doctor and, and she came home after a visit with her and when she was in tears, and she said, Oh, my gosh, you know, you know, Dr. Jones, was just berating me because I was taking my medicine wrong. And she said, It's my fault that my migraines were getting worse and, and I had taken too many of my medications and, and all this and she's never done that before. And I felt terrible. It's like, oh my gosh, and I knew right away, something's going on with her. Right. So I said, let me go on the next visit with you and I sat next to her. And as soon as Dr. Jones walked into the room, and my wife next to me was going shaking, ready for something to happen. And as soon as she walked in, she sat down, she said hello to me and said hello to my wife. And I said, How are you doing? Things are kind of difficult these days, I know there's a lot going on in our institution, because work for the same place. I'm wondering how you're holding up. And she just, everything came out about everything that was going on? How, you know, they were moving their clinic, all these running just on and on. And I just listened to it. Oh, my gosh, I know, it's, you know, so I just listened for a little while. Well, that was the best visit my wife ever had, because someone was there and cared about their provider and knew a little bit about what they were going through. So I do think that that is a valid question to ask is just like you would any friend, you know, like, how are you doing? This pandemic has been hard on all of us, I bet it's hard on you too, how are you holding up. So that's something that's really important. And I think that something to realise about burnout.

Yeah, and we have personal intimate relationships like with, you know, the people that are closest to us, in our families and in our lives, you know, our friends and our confidence and our partners and, you know, husbands and wives and all of that, you know, and, you know, we should have more of that type of intimate relationship with somebody that we're sharing some of the most intimate medical issues and things that we have, with our, with our care provider. And, and it shouldn't be just one sided, you know, I mean, I'm not saying that, that they should be able to share, you know, sort of those intimate things with them, but just in that whole give and take in the fact that, you know, I want to care about my health care providers as much as, as I want them to care about me. And so again, it's that the importance of that balance, and give and take, and I think, you know, if anything is sort of that one takeaway today that we talk about is, is maybe that people, that listeners will say, you know, I'm going to be very specific in the future about making sure that that I do that every time I have a doctor's appointment, or a dentist appointment, or an eye appointment, or those types of thing is to just make sure that they realise that as a patient, you know, I care for them as much as they, I want them to care for me. So that's, that's an important takeaway that I mentally even taking today and going to do that this afternoon.

So that's, like I say, being intentional about it and. And I think, as a patient, you know, now as I go in, as I check in the front desk, if someone is pleasant to me and asked me how I'm doing everything, I always thank them, I always say thank you so much for your kind, compassionate care, it means a lot to me, I know it's hard to do that. So thank you so much. And every step of the way, if I if I hear that, you know, like, just as I recognise burnout, and I recognise people that are frustrated with the system that they are kind of forced into to playing. At the same time, when they're able to rise above that, or provide that kind of care, I always acknowledge it, because that's, that's really the key for me, self compassion, and recognising that the same compassionate care we give to patients is exactly what we need to give to ourselves. And if we're able to do that, which is really, really hard to do, for helpers and self sacrifices, really difficult to give self compassion. So we're so used to using our self critic, and that self critic telling us what we're doing wrong and how to correct it and how to get it right. And how to get it perfect, instead of being part of common humanity, and the people that are coming to, to us for help, is that we're less than perfect, and we need compassion, we can give it to ourselves, we don't have to have patient we shouldn't go around asking patients to take care of us having a comment, having a kind word or something to say in appreciation is great. But we ourselves need to take care of ourselves. And to be able to provide that self compassion, just like the systems that we work under need to create methods and interventions that promote that type of well being within healthcare providers, trying to give them the support that they need, trying to listen to them about what works and what doesn't work, and actually integrate what you're hearing back as healthcare administrators into the policies and procedures of how clinics and hospitals are run.

And, and if you wouldn't mind to kind of expanding a little bit on that. You've brought up system and institution a couple of times there and what you were just saying but, you know, you just said you suggested like how they should handle that type of thing with their, you know, their providers and that type of thing, but how what is your opinion on how the healthcare is An institution here in the US and even from your experiences worldwide are addressing physician burnout now, and you know, do you feel that they're doing as best as they can? Or do you feel there's significant room for improvement as an as institutions and as systems.

I think as a result of the pandemic, there are many lessons that we've learned. We've learned how overall our system, our health care system in the United States, was ill prepared for something like this. And we have a healthcare system that is heavily weighted toward specialty care, hospitalisation, and high tech care, which is extremely expensive. We do not have enough frontline care, we have not invested in the infrastructure of good integrated primary care, a place that people can have a medical home where they feel like they know where to go to, for help, where to go to for support, that primary care provider and the team surrounding that primary care provider. So I think that that's one lesson learned, and hopefully, to be integrated. Now, the way our healthcare system is reimbursed financially, is that, that high tech care of that tertiary care in hospitals and procedures, and all of those things, is very highly reimbursed, primary care is not. So that shows us as a health care system, that financially we value more of the specialty or care in high tech care, therefore, the industry will push that. So they'll push all of their resources toward that in primary care. Financially, the incentive is to try to see as many patients as possible and select those patients that you can send on to the more expensive care, because that's where the income comes. So this is a thing that we need to like flip flop completely, and really invest more in that medical home primary care model, in that team care, that team care where it's not just the medical provider, that in the electronic health record of the computer in front of her or him Are they that they have this sense of everything coming to them. So they have to do all the administrative tasks, all the answering of calls and inquiries, patient portal information, refills, all of these different things. Instead, that should be offloaded into a medical team that is able to kind of help that provider, pay attention to the patient in front of them, and be able to provide compassionate care, and then have other people that are going to be able to handle all of the emails, all of the lab results, all of the patient phone calls, all of those other administrative tasks. And when you work integrated Lee like that, I think that we can move toward a system that that is a lot more user friendly for patients and a lot more tolerable and actually enjoyable for providers. So I think that that's really important, as far as some of the movements that have come out of the pandemic, too, is this whole idea of virtual care, remote care. And that's something that I think is with us and will be with us for quite some time. But the other things that hopefully will come out and I think some institutions have realised this, I think mostly because nurses have started to walk. Doctors are really going to be next and they're going to walk. If they're Condi this, this, the AMA did a very extensive survey of all health providers after the pandemic or during the pandemic and near the end. Everybody thinks it's after the pandemic, but you never know. But for all health providers from front desk, staff, everybody all the way through the two most important factors for people feeling that they have satisfaction and fulfilment in their work. Number one, was this sense of being valued by leadership that you Dr. Garland, you are an integral important part of who we are. We value you tremendously. So we want to listen to what you have to say and what your experience has taught you about how we can improve With our system of health care, number two, besides that sense of being valued, is this sense of, we're all in this together, we have a common mission. And that we, as frontline providers have the exact same goal and mission as the CEO, the CMO, chief medical officer, and all of those medical directors that are that are underneath the administrators, if we really feel in our hearts, that we're all on the same team, and that we're being valued as a member of that team, then oh, my gosh, we'll go into battle with anybody. And I think that that's really the key, if you want to kind of now everything else kind of flows from that. So if I really value you, as a doctor, I'm going to make sure that you have enough time off, I'm going to make sure that you have enough support, because you're a valued member of our team, I'm going to make sure that you know exactly those things that are expected of you and clear up anything that is confusing to you, I'm going to make sure that you have somebody else who's working with you that's maybe more experienced, who's whose role is to make sure that your well being is taken care of. And that that person is a mentor for you, actually emotionally, psychologically, spiritually, not just professionally, so that you can be sustained in your work. And I all of these different things are things that flow from those two major important factors being valued and having a common mission. Yeah.

And do you feel I just sort of got got this feeling from what you were saying that that, hopefully fingers crossed would be kind of what the new normal looks like in the field of medicine going forward? Is there anything that you want to add to that?

Well, that's my hopeful side, I would say, I would say that there is a tendency in medical culture and also in the healthcare industry, to kind of fall back to what is familiar. And so one of the dangers is that we've all suffered this trauma of the pandemic. And we have this choice now, this choice, as an entire health care system, to go through and suffer the post traumatic stress and the mental health Fallout, or actually change and experience, post traumatic growth, and fulfilment and change. So my fear is that the new normal that the old normal doesn't look so bad now, after this. And so as medical providers who tend to be a little afraid of rocking the boat, and a little afraid of trying to discover if the grass is greener on the other side, and it may not be, may just default back to saying, well, at least it's not as bad as when we were in the pandemic, we're back to our 40% burnout. Well, I don't accept that, I think that we need to learn from this, from top to bottom. Now, it's harder for us, as individual providers to change the healthcare system of the United States of America. However, some of us are called to do that, and we need to do it. But many of us can make a change in our little medical team, our little office that we, with whom we interact with all of our colleagues every day. So I think for individual providers and individual, mid level managers within healthcare, we can work together, try to understand each other, listen to each other stories about what we experienced during the pandemic, and try to work together creatively to make changes, at least within the people that we work with every day to improve our own well being and therefore the well being of our patients.

Yeah. Yeah. And again, I'm seeing the parallels, like you know, a lot of times when, when, you know, when I give lectures to an initial teacher education to student teachers, and, and that type of thing, um, you know, I'm hearing the same things that you know, and I'm saying the same things to teachers as well. You know, your responsibility, your overall responsibility is not to the huge big picture, your your responsibility is to start in the classroom with your students, and then in your schools in a smaller atmosphere. And yes, there are some that will stand up and advocate and you know, want to push for them, you know, institutions and the administration's and, you know, the systems and things like that, that's great to have those that that, you know, are able and have the ability to do that. But in general, for the vast majority, it is most important to start small. And, and, you know, let that ripple its way up from there. Um, and the other thing that you had said that I absolutely love, and I just wanted to put it out there again, was you referred to post traumatic growth. And that is the first time I've heard that. And I absolutely actually love that terminology that that that, you know, what it does for me sort of metaphorically in my head, you know, what, post traumatic growth, you know, you know, you think about rather than continually being victimised by something, you know, you can be victorious over something. And that's what that that term that you just use post traumatic growth does, you know, does for me is to help me think about how can you be victorious over adversity and triumph over adversity? And, you know, deal with something that way? I love that. So, a great, a great term that I hope catches on.

Well, that that term emerged from that large ama survey study is that that was the conclusion that those are the two pathways that we have. And I love it. Also, I think. I think that as I work with individual physicians, individual physicians, other health care providers, nurse practitioners, of PDAs, and and nurses, everybody that's in the health care. I say this is your time, we're all suffering. Now, we need to grieve, we need to really take care of ourselves from the trauma that we experienced through the pandemic. And many of us I was just meeting with a group of physicians yesterday, via Zoom is a group that, that we've gotten together now for gosh, I think close to six years on a regular basis, before the pandemic and just sharing stories and supporting each other. And one member of that group is an ICU physician, who was in the intensive care unit and just got out of there, was there for two weeks taking care of patients. And he said, it's the first time since the or since early 2020, that for his two weeks, there was not one new COVID diagnosed patient in the ICU. There were some that were still lingering from before, but no one else that was newly diagnosed in the ICU, he says that is amazing. He also, like many of us, are just waiting to see if another variant emerges, or what the next pandemic is gonna be. So there is a sense of relief. But there's also this sense of dread of fear. So when I work with individual physicians, the first thing I say is that as we emerge from this, whatever next phase there is that this is your opportunity, that if you were afraid before, to really pursue what you love doing, this is your chance. No regrets when this is all over, right. This is your chance to first discover or rediscover your y rediscover that sense of why you're doing this to begin with. It may have changed over the years, but make sure that that y comes from you inside of you who you are. It's not something that's been implanted in you during your medical training, to say this is who I think you would be when I was in medical training. And I decided to be a general paediatrician, the paediatric neurologist came to me and said, You're going into general paediatrics What a waste of your talent. You should be going into a specialty. So when I hear that from different people than I, you know, as this young trainee, I'm wondering, oh my god, maybe I am doing the wrong thing. Because it is this person is really smart and I respect is telling me that this is what I should be doing. And if I grew up with teachers and parents and everyone else saying what I should be doing, then I lose that sense of who am I what do I really want to be? Right? So now's the time, now's the time to do some work. And some of it is some hard reflective work of really discovering who it is, what are my values? How do I bring my values into my life? Inside the job outside the job with my family, my friends in the hospital in the clinic? And then looking around and saying, Where am I now? How closely does that relate to who I am, and what my values are? And if there are certain things that do relate to that, and I really gained life out of that, how do I expand those things, and push that other junk out of the way, right. So go and talk to my supervisor, talk to whoever it is, and say, I've been doing some tough work. And I've discovered how I can be the best provider possible for you. And I need to do more of this. And I think this is the time that I that leadership will listen, because people are going to walk, they're leaving, and they need they need physicians, we need health care providers. If it can't be done where you are, there will be other places that will be looking for people that are passionate about what they do. So I think this is a great time for healthcare providers to start taking a look at what they really want, what really brings them joy and fulfilment, and pursue that.

So you were just saying there about self reflection and self, you know, motivation, and you know, self help, per se, you know, how healthcare providers and health care workers can, you know, really kind of look in and figure out about trying to find that passion, and exploring that passion and why they got involved. But now, again, I'm going to step back here and put it into my perspective as somebody who's not in the healthcare profession. But somebody who cares about education and empowerment of our communities, in our wider societies, on issues that healthcare providers and healthcare workers face. What do you suggest that somebody like me and other community members and patients and people, what can we do, you know, to help to encourage that to help encourage, you know, health care providers to maybe if they need to take a break, take a break, but don't walk away from something that that they passionately got involved in the first place? What can we do, as you know, as your community and your supporters?

Yeah, this is interesting, I would say, whenever I hear somebody ask, What can we do to help whether it has to do with the, you know, anything, especially many of the social issues that have have emerged during this pandemic, that you know, including structural racism, including, you know, global health and, and, and our healthcare system, just a myriad of issues? The first thing to do is to look inside, the first thing to do is to start with yourself, right? How am I as an individual, being compassionate toward myself, accepting of myself the way I am, and aware of how I can be present in the world as a result of being more self aware, and really claiming who I am. And being compassionate toward those things that I don't like about myself or when I screw up. And those things is what really will be able then for us to be present actually present to other people. Because if I am not being compassionate and accepting of myself, when I encounter somebody else that's in distress or having any issues at all, I will immediately start self reference referential activity and dialogue. He's like, Oh, boy, do you think you got a bad let me tell you what's wrong with me, you know? So being able to take care of ourselves first is really important. It's important across the board. And then being able to, like I said, In the beginning, being able to really appreciate and accept when you see health care providers and anyone one in health care, that is really doing a job that is connecting and compassionate. And toward you. I think that that's really important. Teachers every time I think, especially not only physicians, but especially paediatricians, I think paediatricians and teachers really share a lot in common. Just, you know, the way that if you look across the board at you know, physician compensation, paediatricians are always near the bottom of all medical specialties, right? Teachers are at the bottom childcare workers at the bottom. I don't know what it is about our society in our culture that undervalues children so much that anybody who works with children gets paid less than anybody who works with adults. I don't quite understand that. Other cultures are in Not like that. Anyway, I'm rambling now. But I think I think what you're saying is, is important for all of us. We all naturally desire community, we all naturally desire to be in relationship with one another. We've all been isolated during this pandemic. And to be honest with you, as an extrovert, I have a little social phobia as I emerge from my solitude, and yet, I am starving for it. And so I think, really having an attitude of community and being in relationship with one another, and that the sense that we're all in this together, will then be able to guide you in what to do next.

Yeah. And you know, there's something about, I know that these words get thrown around about being a little bit gentler and a little bit kinder. But there's so much truth to that is to just step back for a second, and just be a little bit gentler and a little bit kinder in your interactions with other people in your day to day in your daily basis. Because, you know, people are going through things that you don't know anything about. And, you know, if you can just have a little bit of compassion and understanding and educate yourself and have that awareness and kind of think ahead of time, before you interact, you know, with with others, especially those who are bombarded on a daily basis, which would be our health care workers, our health care physicians, you know, our providers in, you know, in the system that, again, as I said, said at the beginning at the top of our discussion together, it's relentless for you all, and it hasn't ended. And as things ease up in some places, it's not using up in those hospitals, and in those doctor's offices, and in those clinics, it's still happening, you know, on just a constant basis. And I think we just need as community members to kind of step back and say, you know, how can I be supportive, and to think about, again, that tag that came out of this, we're all in this together, we're all in this together, we are all in this together. And we should be able to be supportive of each other, I'd hate to see doctors and nurses and medical staff, walking away and throwing in the towel and say, I'm never going back to this. Because that's a tragedy. That is an absolute tragedy, because you go into your practice, and you go into that field, because of being passionate about, you know, helping others and, you know, wanting to do better for others and to have somebody walk away, and disillusionment and burnout. Again, another word that I don't like, because when I think about burnout, I think about, you know, when people are spinning their tires, and Bill, they explode, you cannot fix unexploded tire, you can't, you can't fix it exploded balloon, but when you were talking about being displaced, you know, you can come back, you know, there's that you it's not, it's not gone for good. It's it's not, you know, an end to end all things. And so, you know, these are the things that sort of, you know, your story and your conversation today has really helped me to think about again, as a community member who wants to be supportive. how can listeners find out more about you and your work? And where can they find you online?

Yeah, so thanks so much for, for asking. I have a website. It's Jo Sherman. md.com, very simple, Joe Sherman md.com. And you can reach me directly through email. And that is Joe at Joe Sherman md.com. And on my website, you will see various programmes that I have available both for groups, medical teams, retreats for healthcare providers, as well as individual one on one coaching. And when I want one on one coaching can be for healthcare providers who find themselves in a position of burnout find themselves in this position of this new normal and in a career transition, perhaps or even considering that, or maybe someone who's just trying to discern what their lessons learned from, from the pandemic and how that's going to impact their future. So those are all kinds of reasons why people seek out individual coaching with me. And then for retreats, they're often continuing medical education retreats, that include a sense of Transformative Leadership, which usually means which does mean transformation within myself as an individual, through that self discovery and realising what it is that brings me life. Enjoy. And then trying to promote that within my institution so that those others who work with me or under me, can have that same type of transformation. So all of those programmes are described and available on our website.

Thank you for that. One more question. If there's one thing that you really would like the listeners today to take away from our discussion, you know, any words of encouragement, wisdom or advice, just one thing, what would that be?

I would say, start with yourself. That's the key.

Joe, thank you so much for spending this time. With with me and with our listeners today. You have just been, you know, a joy to talk to. Thank you so much for spending this time with me. I really appreciate it.

Thank you so much, Shelli for having me. I really enjoy talking to you. Thank you.

I hope that you've enjoyed this discussion on A Dash of SaLT, a space where you'll always find fresh and current discussions on society and learning today. Seasoned with just the right touch of experts in education and a dash of sociological imagination. Please be sure to like and share this episode. And don't forget to subscribe to A Dash of SaLT on PodBean so that you don't miss the next episode. Thanks so much and we'll chat again soon.