Podcasts Health Lunch and Learn with Dr. Berry LLP124: 21st Century Physician Burnourt with Dr. Nicole Washington

LLP124: 21st Century Physician Burnourt with Dr. Nicole Washington

Published: Sept. 4, 2019, 10 a.m.

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Let\'s Talk about Physician Burnout...

On this week\'s episode of the Lunch and Learn with Dr. Berry I sat down with Dr. Nicole Washington (For the Second Time - check out episode 62 to talk about a very serious topic of Physician Burnout. It is one that affects physicians at all levels of training and no one is immune.

If you think this is some new topic, Dr. Nicole wants you to think hard about saying that is your final answer. We talk about the history of burnout, common symptoms associated with physician burn out and why our medical system may be to blame.

This was an amazing conversation as we got to talk about what physicians need to do TODAY, if they want to prevent becoming the next victim of burnout.

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Download Episode 124 Transcript

Episode 124 Transcript...

Introduction

Dr. Berry:
And welcome to another episode of the Lunch and Learn with Dr. Berry. I\'m your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com as well as a CEO of Pierre Medical Consulting. Helping you empower yourself for better health with the number one podcast for patient advocacy, education and empowerment. This week we bring you a repeat guest with Dr. Nicole Washington who is Board Certified Psychiatrist who focuses and specializes in a treatment of high performing individuals and helps provide face to face services in the state of Oklahoma. But she also does some psychiatric services at Georgia, Louisiana, South Carolina, Texas, Virginia, Tennessee. So she\'s pretty much where you need to go and where you need to find her. And I bring her on the podcast this week to talk about a very important topic and I want to especially the listenership to understand that a lot of times we talk about the mental health and focused on the mental health and that focusing on the patient.
But now we have to focus on, well the person who\'s actually giving the advice, the physician. And unless you\'ve been under a rock, you\'ve probably heard the term Physician Burnout. Whether you read it, where you saw it in a blog, where you listened to it on a podcast and we\'re going to be doing a nice little dive into the psyche of physician burnout. Why it happens, where it happens, when it happens, and how you can actually deal with it. So again, this is an amazing episode. I was glad that she, I must\'ve did something right because she came back for another go around for another talking with us. Again, if you don\'t remember, she was actually on Episode 62 of us. Can you know the link drberrypierre.com/LLP062 if you want to check out that episode. So check that episode out.
But after you do checking this episode out about physician burnout, and this is going to be the first of a series of episodes with different physicians and colleagues just talking about what physician burnout means to them and their personal experiences. So like always, if you have not, and this may be your first time. But if you have not subscribed to a podcast, make sure you subscribe to the podcast whether it be Apple podcast, Google podcast, Spotify, iHeartRadio, Overcast. We\'re pretty much there where every podcast outlets are. Go ahead and subscribe to the podcast. Leave me a review wherever you can as well too. Just let us know how we\'re doing. Let Dr. Nicole know how she\'s doing well on this amazing episode. I know you guys are in for a treat. So like always, you guys have a great and blessed day. And again, I\'m going to see you on the next amazing episode here on the Lunch and Learn with Dr. Berry.

Episode

Dr. Berry:
Alright, Lunch and Learn community. Just heard another amazing introduction on a guess who one is kind of funny because not only is she a repeat guest but she was on episode 62 which she is a repeat guest 62 episodes later. So ladies and gentlemen, take the time to give a warm welcome back to Nicole for again blessing our podcast audience with a very significant topic that especially if you do a googling or you just watch TV. It\'s getting so much more I guess fanfare these days. Again, Dr. Nicole thank you for joining us on the Lunch and Learn with Dr. Berry.

Dr. Nicole Washington:
Thank you for having me.

Dr. Berry:
So we had your bio. We read your bio out. I got a lot of people where my listeners who like to skip the bio, go right to the main episode. So even if someone did read your bio, what is something that they may not be able to know about you that just happens to not be in your bio? Tell us something about yourself.

Dr. Nicole Washington:
I am an advocate for mainly people who just don\'t consume services on a regular basis. So whether we\'re talking about people with severe mental illness like schizophrenia. We\\u2019re talking about people of color who have all kinds of barriers about accessing services or even professionals. Because I think a lot of people think that because you are a doctor or a lawyer or whatever you are, that you\'ve achieved that space. So what do you have to be stressed about? What do you have in need? What could possibly be going on with you that could be interfering with your mental health? You\'re making good money. You got a good family. You live in a nice house. People have a hard time with that.

Dr. Berry:
Trying to coping with that reality. What was so funny, especially when you say that, I see that happen more often, especially the cases of suicide, right? Especially witnesses like a celebrity suicide, death and everyone\'s almost like, oh my God, I can\'t believe that happened. How did it happen? Why did, it\'s like, it\'s almost a shock because people feel once you\'ve meet a certain level of credibility or statute and for some reason those same things that happen to you when you\'re not at that status can happen to someone else.

Dr. Nicole Washington:
Yeah. And it happen that you make or where you live or any of those things.

Dr. Berry:
So I want to talk today about a very important topic. I teased it in the introduction, about Physician Burnout. And it\'s a phrase now, which interestingly enough, it almost has its own like ICD-10 code now. Because it has gotten such fanfare. But of course being on the front lines, as a physician, as a practicing physician, I really wanted to delve into these, especially these next few episodes on our series, just what is it? Who is experiencing it? Where did it come from? You being in the introduction, which again, I\'m so thankful for. I would definitely like to start from there. Let\\u2019s talk about physician burnout. And just in general, what is it? What is that term we\'re hearing all of a sudden now?

Dr. Nicole Washington:
So the term burnout, even though it seems like it\'s become very sexy here in the last year. So it is a term that\'s actually been around since the early to mid-seventies. There was a book called Burnout: The High Cost of High Achievement that was written in 1974. From that book is where this term burnout came from. Herbert Freudenberger was the author\'s name. So he defined burnout as the extinction of motivation or incentive. Especially where one\'s devotion to a cause or relationship fails to produce the desired results. (Okay. Alright). I must say that again, extinction of motivation or incentive, especially where one\'s devotion to a cause or relationship fails to produce the desired results. And that is burnout. So you were once very motivated. You had a lot of incentive to do to be devoted to your field. You got a medical school. You had all the motivation and incentive in the world. You wanna help everybody. And you start to lose that motivation and you start to lose that incentive and then because you failed to get the results that you want.

Dr. Berry:
Oh, that\\u2019s deep. Remember Lunch and Learn community anytime a guest mentioned a book or anything, we\'ll make sure it is in the show notes so you can read that as well. When we talk about, especially in a sense from the physician standpoint, what does that even look like? A physician who\'s unfortunately losing their sense of self, I guess?

Dr. Nicole Washington:
When you start to experience burnout, it comes in different ways. So there\'s physical symptoms of burnout. You may have headaches or GI issues, muscle aches. You may notice tension, neck, shoulders. Sometimes people are emotionally exhausted. So you listen to everybody\'s stuff all day. Everybody needs you. Everybody\\u2019s pulling on you when you\'re burnt out. You just don\'t handle that as well. So you\'re emotionally drained and when you\'re emotionally drained, it takes away from your personal life. So it\'s then not just your day to day. It interferes with your ability to be empathic with your patients. If you\'re emotionally drained from people pulling on you and then it also affects you when you get home because you can\'t be a good friend, wife, husband, mother. When you just are drained, you can\'t take anything.

Dr. Berry:
That\'s very interesting point because I think a lot of times, especially when we talk about the physician burnout, I think a lot of times people think that it only, it starts when you clock in and it stops when you clock out. So as I loved that you had touched on it, that even outside of your work space, people are affected or your world just gets affected from what you\'re experiencing within the workspace.

Dr. Nicole Washington:
Yeah that\'s true. And then also with burnout, you can feel disconnected from your job. So you ended up having just this increasing sense of frustration and cynicism. So you just find yourself getting frustrated with patients about stuff or staff and making negative comments. You dread even getting up and going into work in the morning. Some people just go through the motions. They feel numb. And they have a hard time connecting with their patients in that way. That we did, which is for most of us the reason that we went into medicine because we liked that connection with people in that being able to help people and when you\'re burned out from your job, it\'s hard for you to remember why you loved it so much.

Dr. Berry:
Wow. That is a powerful words. especially in in the sense of a physician who tends to deal with, and I know you work with a lot of high level professionals, so in the case of a physician who tends to deal with that scenario where people are asking, asking, asking. I don\'t want to say taking, but again there\'s saying like, hey, let me give you my emotional burden. Sometimes let me give you the physical burden and please help me get this off of me. When you have a physician who that\'s really their job to deal with that, when do these issues start festering up? Is this something that 10 years down the line, 22 years down the line? When should physician actually should start being concerned about something like this?

Dr. Nicole Washington:
In med school, before med school. (Wow, way before). Yes it should happen in medical school. You should learn how to handle it because there are some of us who have really high stress jobs but then always lead to burnout. So it may be, for some people it is a reflection of how well they manage the stress that they\'re under. So if we learn how to set good boundaries with our careers. If we learn how to do great self-care and I mean real self-care, not like a spa day once a month. Because that\'s great. I mean, who doesn\'t love a good spot day? But real self-care. Consistent care about making sure that you\'re nurturing everything that you need to function well. So if we can teach that early, I think we do a better job of handling just the everyday stress that comes with our careers because of stress.

Dr. Berry:
Especially if you\'re a medical student having to learn to deal with, I guess what you\'re saying is the reality. The reality that yes, you\'re going to be in a stressful job. Yes, people are going to push and pull at you, but you have to be ready for it. Is there things that work better than others when you\'re first in that beginning process of trying to say like, okay, yeah, I think I do need to deal with something that\'s eventually going to come about?

Dr. Nicole Washington:
One of the problems that interferes with us in medicine, and I can\'t speak to other industries, but medicine for sure, we have a little bit of a disconnect. I guess we have a lot of a disconnect between what we are taught to teach other people to do for themselves and what we are allowed to do for ourselves.

Dr. Berry:
Oh, I like this. I like the direction we\'re going right now.

Dr. Nicole Washington:
I think it\'s our field that needs a revamp of how we look at our role and how we look at what we do. I mean, I can recall interviewing for residents, after residency, for jobs. And I interviewed with the CEO of a facility and he was going, you can make this much and then if work this many weekends you can make this much extra. And then if you take extra call you can make this much extra. And I said, if I don\'t have to work weekends, I can probably be okay with not making that extra money. I feel like that\'s not, I\'m good financially. That is enough money. I don\'t need to keep chasing. I\'d prefer to spend time with my family. And he said, well, I just don\'t know. These young doctors, kind of joking, but kind of not. You younger doctors, the old doctors would work 60, 80 hours a week plus, and they work every weekend. And I said, yeah. And they were all irritable and burnt out and their families hated them. The kids didn\'t like it. A lot of problems came with that. So I think the expectation has always been that you give 100%, the medicine and then you just figure it out where the rest of your life fits in.

Dr. Berry:
Wow. What I love about that because it\'s such a, I mean I\'m a program director so I work with residents and I\'ll sometimes hear other attendings, these young doctors just they don\'t want to work as hard anymore. I understand especially if you\'re not in Madison, right? Our regulated work week hours is making sure that my residents don\'t go over 80 hours and I\'m pretty sure some of y\'all like 80 hours? So yes, they can go over 70 and be okay. That\'s how we typically look at it when you\'re in a residency. Again, I don\'t know these other industries. But in, I want to say the real world, it shouldn\'t be that way. So I definitely agree that medicine has definitely skewed our way of thinking. And unfortunately the teachers, the one who were supposed to be passing down good skills, good knowledge. Because they\'re still relying on that old ways, they do downplay the efforts of newer and younger physicians. Because newer, young physicians aren\'t about that life. They don\'t want to have to work a hundred plus hours just to please somebody.

Dr. Nicole Washington:
And I think that\'s great for them. I mean I think that\'s fantastic. Thinking about even I used to work in an academic setting and how difficult for a medical student to say, I know this is my third year in psychiatry rotation Dr. Washington, but my sister\'s getting married in Arizona, can I go to my sister\'s wedding? And I would say, absolutely go to your sister\'s wedding because I think that kind of thing is important and part of self-care is nurturing relationships outside of your career and being available for your family. But I also have heard other attendings and other departments say, oh they want us to go to their best friend\'s wedding. And I thought, well why not? I would want to go to my best friend\'s wedding.

Dr. Berry:
Right. If you weren\'t in this field, it would seem common sense. Of course you want to attend that wedding. But in our field is like, huh. They don\'t want to stay for 12 hours taking notes.

Dr. Nicole Washington:
Because to ask if they could go to a family reunion. Yes. They have the audacity to ask if they could go to a family reunion. They should go to their family reunion. So those are the kinds of things. And even simple stuff like how many doctors do you know who make regular annual exam appointments or take care of their own things because they have the patient\'s scheduled and it\'s an inconvenience and they have to fit. It\'s just so much that goes into Madison that you end up totally losing and putting everybody else before your own basic needs.

Dr. Berry:
Do you find the physicians who tend to err on that side where they\'re really gung-ho when it comes to medicine, they really do a lot of work in that field tend to have these same types of traits where the burnout comes a little bit earlier?

Dr. Nicole Washington:
I think a lot of it is just based on who you are and just your priorities and how you manage stress. I know doctors who work tons of hours, but they do so well at setting boundaries when they\'re not at work. And they exercise regularly and they take care of themselves. And they seem to do pretty well. But there are those of us who are not doing as great a job of managing our stress well and setting limits and boundaries. So I think a lot of it is personal characteristics that play a part.

Dr. Berry:
Especially with burnout, especially with our system of medicine. And we touched a little bit on it, how it is almost status quo to overwork yourself. And you almost seem like your outlay when you don\'t want to. What is it about just our system in and of itself that I guess takes away the fire that a pre, we\'ll even go down to our pre-medical student, right? That pre-medical students who all they could think about as one of the save lives. You know the personal statements, right? Take care of people, take care of people, take care of people. And then sometimes they\'re not even getting out of school before they\'re starting to say, I don\'t know. I don\'t know if this is what I really want to do. What is it about our system just in general that continues to fester that?

Dr. Nicole Washington:
Yeah, it seems like we do a really good job of just beating people down in general. We just crush everybody\'s spirits up front. I mean it\'s hard. I definitely know people and med student, being in academics and medical students who by the end of med school didn\'t even know if they wanted to even practice. And I have seen, a handful of students not go on to residencies because they said this four years of medical school took me down. I don\'t think my mental health, I don\'t think I can handle this as a career. This environment is so cut throat. So we talk about burnout on one end because just the job itself, just always having people lean on you and just the pressure of everybody\'s looking at you and then you have the Internet and anybody can make comments about you on the Internet.

You can\'t defend them because you know. There\'s all these things that just come with, even if the job is going well, but then you add in the negative cultural stuff and it just takes them down. I look at it a little bit like I\'m not making light of anybody who is abused and going through an abusive situation. But I think if I have a person standing in front of me who is dealing with significant abuse, whether it be verbal, physical, whatever. And then in my treatment with them, I only focus on them and coping skills and let me give you an anti-depressant and let\'s work on your coping skills. Well, yeah, that person needs good coping skills. We all do. But I need to be focused on this some toxic environment that they\'re in that is abusive to them.

Not telling the lady who\'s abused. Well, we just need to work on your coping skills if you just had better coping skills. How about you do a spa day once a month? How about you make sure you turn your emails off at night? That\'s not going to change the fact that that environment is so toxic and some of our work environments are toxic. Not every environment in medicine is, but some of our work environments are so toxic and almost abusive to the people that work in them that talking about the regular burnout stuff, about self-care and all that, it\'s a moot point. Because I can go to spa days every day, but it\'s not going to change the fact, in this toxic work environment.

Dr. Berry:
I love that. Especially because I\'m hearing it. And I\'m thinking about, as a program director, I, being in the graduate medical education side, even now when I tell you that the burnout has gotten so, such a, and I don\'t wanna say popular, but because more people are talking about it, what\'s been happening now is this push on wellness. And I think it\'s so funny the push on wellness like, oh, we got to make them well. We gotta make sure doing real well. We gotta make sure you\'re getting sleep because it seems like no one really wants to talk about what, hey, your system is causing this, right? So, yeah, you can have a thousand different wellness efforts, but if you, if you don\'t have a thousand fixes to your system, especially. And again, I can talk candidly because I\'m in GME, right?

If you don\'t have a thousand fixes to your system from that aspect of itself, it doesn\'t matter how many wellness retreats they go to. It doesn\'t matter how much sleep you give up. It doesn\'t matter how much hours they work because they\'re not happy. I guess that\'s really the crux of it. So I love that aspect because sometimes I think that\'s, and again, it\'s easy, I think when you\'re not in the zone, right? Quote unquote you\'re not in the club, right? When you\'re not in the club, it may be easy to focus on. I\'m like, oh well, you know, they\'re just not coping well. Right. Oh, they got so much money, what they worried about? And I love how you talk about like, no, no, we gotta look at this system itself.

And I think that\'s something that really people don\'t really talk about when we talk about burnout. Because most of the burnout focuses on the physician. Why isn\'t the physician happy? Why isn\'t the physician deal, they got all the money, why can\'t they just cope how they need to cope. What did a quote unquote sad about? But I\'d love that aspect of it and I can only imagine it. Like I said, I\'m in GME. I used to be in private practice I guess in private practice stories as well too, they gonna see where that goes.

Dr. Nicole Washington:
Absolutely. My time in academics was very interesting because I do think that\'s where you make change. We make change with creating systems for our trainees so that when they get out and get into leadership systems, they will demand basically. I think a lot of our trainees, you know, millennials and people give millennials a hard time and all the millennials don\'t want to work, all that. I get it. I cannot ever blame somebody for saying I don\'t want to work 80 hours a week. I get it. I don\'t want to work 50 hours a week. How about that? If I don\'t want to work, I give you 40 that sounds good. I\'ll give you 40.

Dr. Berry:
Can I go back and forth? I\'ve thought 40 was the norm.

Dr. Nicole Washington:
I can\'t blame younger physicians for having those expectations. And I think the culture will shift hopefully as we have these younger physicians taking over leadership hopeful that we will see changes that really changed systems and not necessarily, like you say, I focus on physician wellness and 15 minutes once a month in a lounge.

Dr. Berry:
Say hi and then keep moving. What\'s usually, especially because when we were talking about medical students at first too with the burnout aspect, what are they learning? What are they learning that\'s already giving them that idea? Oh this is probably gonna be that rough. And I think it goes back to the expectations that they had. Could someone argue like, well, Dr. Nicole, maybe they should change the expectations.

Dr. Nicole Washington:
I do think that\'s part of it. I think when you go into any situation with unrealistic expectations, it can be difficult. But we also still very much having medicine, even at the medical school level. You have your gunners and you have this culture of kill or be killed. And there still may not be this collegiate relationship among the students because they\'re all vying for, I need to do better than you because I want this spot. And then you create, now we have students coming in who have the pressure of knowing that we\'re no longer at a place when you and I were in med school, when there were spots to scramble into and there were extra residency spots that went unfilled. And so we knew we can probably find a place somewhere. It may not be, you think, okay well might not be my number one or two, I could probably find spot somewhere. But these students have the additional pressure of am I even going to be able to find a residency spot? So you hear all of that, so there\'s that stress from day one and the culture at our medical schools is still very old school. It\'s still very kill or be killed and it\'s still very, very competitive.

Dr. Berry:
You touched on it because I didn\'t even think about that how competitive it was when you are, I didn\'t even think of, I forgot about how competitive you had to be a and I hate to say you had to be it, but you had to be when you are premed and you are in those undergrads and you studying to get, you studying those MCAT four questions because in your mind you felt like if I missed this one question, that person next to me may get the spot that I want. And you are right, I think a lot of us forget and I don\'t want to say forget cause maybe we\'re never encouraged to do so, but I think a lot of us never turn off like, oh hey by the way guys, we\'re here now.

We\\u2019re in the school so we probably don\'t need to fight because again I went to NSU com, they changed the name. But in NSU com and we had 200 plus in our class. But still, even with that 200 plus, there are some, like you said, there\'s some people who they kept in themselves, they stayed by themselves. They didn\'t want anything unnecessary do with the majority of population who might been more, collegial and just kinda like buddy-buddy and together because we were like, we felt like, hey, we were already here. We don\'t need to work hard, let\'s work together. So, and then I think that process starts right over again when it\'s time for getting on, getting residency interviews and getting residency spots and then that process, when you become a third year resident, you\'re doing it all. So yeah, we do that even in premed.

Dr. Nicole Washington:
Yeah. And has met so many students, the medical students are concerned about not having enough residency spots to fill into.

Dr. Berry:
Can we show our, we\'re building a new medical school everywhere you turn, but\\u2026

Dr. Nicole Washington:
And we\'re not creating new residency spots to match the number of students they were turning out. So somebody who\'s going to be left without a spot. So then that creates even more competition.

Dr. Berry:
Yeah, wow. I didn\'t even think about it. Oh yeah. Okay. So our system, the way it goes, it\'s going in a direction where the spotlight is now kinda highland and like, hey, something is wrong. If you had to focus on and we\'ve talked about different levels, if you had the focus on different levels of weights to correct, would you be more on the after their physician side and working in the medical system? Or would you be during the medical school aspect of it or even in the premed aspect to say like, hey, this is some of the reality. You\'re getting into, so please be prepared.

Dr. Nicole Washington:
I think I would hit the trainees, I would hit med students and residents. So I think for medical students, one of the things is, and I mean you could think back to your training. I know most med schools haven\'t changed. We don\'t do a lot of talking about the business of medicine and that side of medicine and we talk a lot about treating patients and we talk about, this is what you should do and this is what evidence says you should do and we need that foundation. I\'m not saying we don\'t, but then as a student you don\'t have a good feel for what is the business side of medicine. What is the reality of what I\'m about to jump into? What does it mean I want to do family medicine? What does that mean? What does that mean for me? Does that mean I\'m going to see patients there in 15 minutes and they going to have less as long as the arm and is that what that means? Am I going to constantly feel like I\'m not making a different, what is that going to look like for me? And I think we don\'t do a good job of pairings students with necessarily mentors who actually are out practicing in the fields they think they\'re interested in for them to really get a feel for, okay this is what it\'s really like. But somebody who\'s not going to scare you and say get out while you can. Somebody who\\u2019s gotta tell you the really bad things.

But these are the really good things and this is why I keep doing it and this is why I love it still. You need balanced people to give them realistic expectations and to learn a little bit about the business of medicine. For residents, I think the focus should be on just life and just living. What does your life look like? Because I think you\'re laying in residency a foundation of how I\'m going to practice for the rest of my career. So I think they should focus on not only making sure they get the knowledge they need and get the patients numbers and I get all that, but how do you live life? How do you nurture your personal life in addition to your career? Because you have to have balance and the people that don\'t have balance are in trouble. They need balance and to learn that as a resident because that\'s really hard after for three, four or five years, depending on your specialty. You literally cut off our relationships with people you love and care about and you don\'t talk to your best friends and your family and you don\'t hardly go to church and get all fat because don\'t work out.

These things that all of a sudden you\'re on a 10 day and it\'s like, okay, go figure it out. Go figure out how be a normal person again. (How to reconnect). Yeah, go reconnect with people you\'ve ignored for five years. No, it\'ll be fine. I mean you just have to I think help them and help them too with the expectations of what it\'s like to practice in the community. I trained in a program that we didn\'t have our own university system so we had to, we did all of our rotations mostly in community systems. And so we learned a lot about how that worked in reality but people I know who worked in closed systems, it was a false sense of what it\'s really like when you\'re out having to deal with managed care and having to deal with community based systems. And it just takes a lot of adjusting and getting used to and people think well this is not what I signed up for. This is not how I thought it would be because we don\'t train the residents a lot in the business part of medicine and how to function outside of resident.

Dr. Berry:
What I loved especially because we mentioned the business part of medicine. I\'ve seen people, I think I saw the meme the other day where they talked about just the growth of administrators versus the growth of physicians in healthcare, especially in regards to salaries. Because again, when we talk about physician, we don\'t think money is evil over here. We like money too. And they talked about just the amount of costs as that\'s going towards the administration aspect, the business of medicine. But then you see the growth of physicians, not even a sliver of the mountain and I 100% agree teaching the business at multiple different levels will go so much further. Because I think sometimes a lot of times of, I don\'t wanna say sometimes but I don\'t want to say a lot of times, but sometimes the financial remuneration that they were expecting isn\'t there because they\'re not seeing that many patients. So you alluded to the 15 minute and I was once, I always like talking about the 15 minute because a lot of times people think, well my physician doesn\'t care about me.

They try to get me in and out and I promise you is not that physician care about you, is just that they are in a system that unfortunately rewards seeing more people. And if I have to, if I need to maximize my hour that I\'m seeing, I\'m going to try to see at least four. So I say 15 minutes where I\'m really thinking 10 because I\'m hoping I can get it in and out your room in five minutes because I did outpatient medicine. Honestly we had full disclosure, we had a person who came to our office who timed everything we did in a day. So they would time how long it took a person to come to the front desk, sign in and when they sign in how long it took them to get to the back from my inmate to see him. And then how long it took from my MA to see him from an MA put them in a room. And when they may put it in the room, how long it took for me to go to there and then for me to get out of there and then for never go to the front office and then for me to finish the note.

They time every single thing to the point where they even recommended switching, like how the room was set up because they\'re like Dr. Pierre if your chairs on the opposite side of the door and you got across your patient, I know it\'s crazy, right? If you had across your patient, they may ask you another question, that may take a couple of minutes. So you imagine that a couple of minutes times 50 patients, right? You could have seen 10 more. So I\'ll just like wow. So and when we talked about the business, there are people who really focus on a business aspect of medicine unfortunately at the demise of the physician and at the demise of the patient themselves.

Dr. Nicole Washington:
Absolutely. And I think the business and for the students and the residents, I think so many of us are made to feel guilty about being concerned about the money. And so they\'re labeled as not caring and we get labeled as being money hungry and all about the money. And they just want to turn more patients out so they make more money. They don\'t care about us. And that\'s not true. But I think in any of us, no matter what you do, you want to make what you can make and you want to be able to make for your industry what is a good living. And I think a lot of us are made to feel guilty in medicine. We shouldn\'t care about how much we make because we should just do it. And I think people have a false, so for students and residents I think is helpful to make that a little more normal or of conversation and understand that that\'s part of it. This is your career and that will play a huge part in your satisfaction in your career and your burnout. I mean that will play a huge part in all of that.

Dr. Berry:
I was reading some article that talked about how the businesses, the businesses at hand, hospitals, health administrations, because they know our love for the patient, right? Because when we talk about physician burnout, yes, the physician loses, but the patient ultimately loses as well. So when we talk about this, our love and care for wanting to take care of people, sometimes they use that against us and that\'s where this talk of all that doctor cares about his money comes from, it usually comes from people who are making money off the doctor. And they\'re like, well, you shouldn\'t be focused on that. And, and they know that because we love our patients, we care for our patients. We\'ll go the extra mile for our patients. We\\u2019ll spend extra time for our patients. We\'ll stay longer. We\'ll come in earlier. We\'ll do all these things that are unfortunately detrimental to us because of the goal of taking care of our own.

Dr. Nicole Washington:
We will not spend time with our families in the evening because we\'re charting from the day of the people we saw because we didn\'t have time to see all the people we needed to see, give them the care that we felt was really good care and chart at the same time.

Dr. Berry:
First of all, amazing episodes. Before I let you go though, is there any, especially for, let\'s say you\'ve got a physician right now who thinks like, hey, you know what? I think I may be burning out and I think I feel like I\'ve read enough articles, I listened to enough podcasts. I\'ve seen enough videos. I think I may be ready. What do you tell them? Especially because again, you tend to deal with so many more high level professionals. What do you tell them? What can you say at this point?

Dr. Nicole Washington:
So I always call it crispy. For my own self, when I say oh, I\'m feeling a little crisp. A feeling things are getting a little hard. I\'m hard and on the outside. I need to do something. So the first thing is just being okay with it. Recognizing that you\'re human and recognizing what your signs are and what you need to do. I think I recommend that people take their vacation regularly. I think that helps. I worked at a job once where I had 330 something hours of PTO racked up because I never took leave. Because it painful for me to take leave because I would either pay for it on the front end or back end. Because I was either going to have to see extra patients before I left or when I came back.

So I just didn\'t take leave. So 300 plus hours, that\'s insane. Somebody should\'ve said, girl, you better take leave and take care of yourself. So I would say make sure you force yourself to take your vacation regularly. Schedule time off, even if you don\'t go out of town and doing things fancy, just take some time to reset. So I recommend doing that for prevention and maintenance kind of stuff. But if you feel that you are getting there, I think you have to be very intentional about recognizing your burnout sides because mine may not be yours. I know mine are, my personal one is I get a little snippy with the people in my house and normally I\'m not. And so when I, the people in my house, my husband will say, hey, hey, hey now you know, I didn\'t do anything to you.

And I go, oh my God, you\'re right. That\'s how I know when I\'m getting to that point. And so when I am getting to that point, I take extra steps to do things during the day to pull back to give me chances to reach ours. I go outside and walk around. I make sure I take lunch away from the building. I do things, just little things to help me kind of decompress. I focus a lot more on my gratitude. Sometimes I get lax and I don\'t do my gratitude work like I shoot it. But at the end of it all, if that, if those little things don\'t work for you and go talk to somebody. Realizing that going to talk to somebody or doing therapy does not set you up for a lifetime of going to therapy.

Dr. Berry:
I think that\'s always people fear. If I got to see him one week, on my, I got to see him for the rest of my life.

Dr. Nicole Washington:
Yeah. And that\'s not true. I mean you can do brief therapists with people. I\'ve seen physicians for very short periods of time. They had a bad outcome at work and they just needed to debrief through it is that we also don\'t do, which asks our burnout rate. You work with people. You lose patients, they die. You have to deal. Don\'t even get me started on people\'s secondary trauma associated with ER docs and child abuse pediatricians that are pediatricians and you just carry all that stuff. I mean that\'s a lot. Sometimes you just need to talk that stuff out with something and maybe that\'s once a month, maybe that\'s once every other month. Maybe that\'s just a standby on call. I had a bad case. I need to talk this out with you. But don\'t be afraid to link with a mental health person. It doesn\'t mean you have depression or bipolar and anxiety. It doesn\'t mean any of that. It just means you need a little help, which we all do from having.

Dr. Berry:
I agree. Before I let you go, I always like to spotlight our guests and make sure whatever they were doing, working on, the Lunch and Learn community can be privy too to try to help connect then. And like I said, we had you on episode 62. This podcast is definitely changed over the 62 episodes. We\'ve definitely grown already 62 episodes. So we\'re so appreciative that you came back and touched out. And is there anything going on with Dr. Nicole that we should be looking out for. Any things you\'re going on, courses, books, whatever. Please let us know.

Dr. Nicole Washington:
Yeah, I guess since I have been on the show last, I have jumped into the podcast world and my podcast is called The C-Suite Confidant. So it is all about a c-suite executives, doctors, lawyers, high performing folks and the stresses they deal with, whether it be occupational, personal, and listeners have the ability to go to my site, drnicolepsych.com. And you can go to the podcast and you can leave me a question. So if you have a work issue or there\'s something going on and you go, I want to know what the psychiatrist thinks about this that\'s going on. And you can leave a voice message on the website and I will respond to people\'s questions on the podcast.

Dr. Berry:
I love that. Okay. Alright. And remember links we\'ll definitely be in the show note because that\'s a very interesting thing. I actually, I need like hop on your podcast so we can talk about the life of an internist program director and the stress they got. Let\'s make that, I\'m putting it out on air right now so we can make that happen. (Absolutely). Especially sometimes you got to say it out loud, right? Beause when we talk about affirmation, right? You keep an affirmation inside so you don\'t try to disappoint yourself. But as long as you, if it\'s blurted out of there and now you got a whole bunch more people disappoint and you don\'t want to disappoint nobody. (Absolutely. Absolutely). And last question, how is what you\'re doing right now helping others, especially other physicians like really empower themselves to take better control of their health?

Dr. Nicole Washington:
I am all about us just taking our life back and taking our mental health into our own hands. I think we have just for so long worked really hard to pretend like we didn\'t have issues because how can we help people and have our own issues and that is super flawed thinking. But I just work through my practice, I work with physicians who are having untreated mental health disorders. I mean you mentioned physician suicide earlier, we think we lose about a physician a day in this country to suicide. But those are just the ones we know about. And those are just the ones that we lose. What about the ones of us who are out here suffering and depressed and anxious and every day they think, I wish I wouldn\'t wake up tomorrow. And those are the ones, because like you said earlier, it\'s not just about us, it\'s about the care we give to patients. And if you\'re impaired, you can\'t give the care to other people. It affects your patient care. So through my practice, I work with doctors in seven states now, South Carolina, Tennessee, Virginia, Louisiana, Texas, Georgia, Louisiana, Oklahoma. And I can work with them on addressing and a previously not dealt with mental health issues.

Dr. Berry:
Love it. What\'s the website again so people know how to find you? Where can they find you in any social media outlets

Dr. Nicole Washington:
I am on every social media platform at @drnicolepsych and at the website drnicolepsych.com and there\'s podcast, clinical services information there and so all you can find everything you need to know about what I have going on through that site.

Dr. Berry:
Dr. Nicole thank you for really enlightening the podcast audience to the topic that is very serious. Again, I know it\'s getting a lot of fanfare now but it\'s because it is extremely important and patients, especially those who are listening don\'t think that is just effecting. Because again, these physicians who are burning out, burnt out, still going to work. And they\'re still taking care of your mom, your dad, your grandpa, your grandma. So again, do not think that this is just a physician only problem. Please. Thank you for joining the podcast again.

Dr. Nicole Washington:
Thank you for having me.

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