MedPEP

Hi. I’m Dr. Marie Curious from MedPEP, the Medical Professionals Empowerment Program. We’re releasing this one-minute reminder to let you know that MedPEP physician listeners are eligible to receive as many as 20 FREE AMA PRA Category 1 Credits™ for listening to MedPEP.  Just go to www.medpep.org/cme and follow the link to the MMS site. You don’t need to listen to the podcasts again (although you can if you want to). After you register (it’s free), you’ll be asked to write a few sentences reflecting on the content of each podcast. It’s easy, and your truth is the right answer! Each podcast episode, combined with your reflective statement, counts for an entire hour of CME. 

If you’re wondering about me, I’m doing much better. As a direct result of what I learned from my MedPEP journey, I’ve become more engaged in my healthcare organization. I feel better about my role in my medical practice, and, by diversifying what I do, I’ve enhanced my personal wellbeing and professional satisfaction. Try it, you’ll like it. Bye now! 

This is the 20th and final episode of the first season of MedPEP. Along with the first and eighth episodes, this is one of three episodes in which Marie and Les engage in a two-way conversation without a guest expert. Their two-way exchanges, relative to the more didactic three-way conversations, are particularly personal and heartfelt. In this final episode, they review Marie’s MedPEP journey, which commenced with a focus on the “self” and ended with a broader focus that encompassed teamwork, conflict management, and career development. Marie reveals that the abrupt departure of a valued colleague and mentor from her practice is what prompted her to participate in the MedPEP project. It was professional burnout that led her colleague to leave the clinic, and Marie decided to become proactive so as to avoid succumbing to the same stresses and strains that befell her friend and colleague. In this final episode, Marie and Les take stock of her struggles, her learning, and the mentorship and coaching she received from the MedPEP experts and, most importantly, from her MedPEP guide, Dr. Schwab. In the first MedPEP session she spoke rather poignantly about NOT wanting her children to become physicians. Now, in the last session, she explores with Les the possibility of having her children join her on home visits. She has gone from having a beleaguered and overwhelmed attitude to being more of a “can-do problem solver.” Both she and Les attribute this shift to what they learned on the MedPEP journey, and she expresses a great deal of gratitude to him for his skill, compassion, and support. Their positive connection exemplifies what often happens when a struggling physician is coached by a trained colleague, and the series ends on a hopeful and positive note, with them agreeing to stay in touch.

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At the beginning of this episode, Marie acknowledges to Les that she is continuing to mull over Dr. Green’s paradoxical suggestion (episode 18) that one way to overcome a sense of powerlessness is to embrace it. In today’s discussion with Dr. Liebschutz, they consider the possibility that some physicians may be able to overcome their sense of being overwhelmed and downtrodden by actually taking on more. Dr. Liebschutz, an accomplished physician leader at the University of Pittsburgh Medical Center, proposes to Marie that she may be able to overcome the frustration of being a “cog-in-the-wheel” generalist by “leaning in” and embracing a subspecialty area, a teaching role, or committee work that might open up the path to medical leadership. When Marie conveys her skepticism to Dr. Liebschutz, they then consider the possibility that Marie might leverage her value to her clinic by pushing for a temporary sabbatical or by reducing her work effort. They also discuss practical ways for getting more help at home. It is clear throughout this podcast that Marie is paying close attention to Dr. Liebschutz’s every word. Dr. Liebschutz comes across to Marie as a wise and experienced veteran physician, wife, and mother who has crafted a meaningful career by overcoming many of the same obstacles that are daunting to Marie. By the end of the conversation, Marie comes across as energized and inspired, ostensibly ready to put into practice many of the tips and strategies offered by MedPEP’s experts. All three physicians seem to share the view that going forward, Marie is going to chart the course of her career.

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None of the individuals in a position to control the content of this CME activity, and/or their spouse/partner, have any relevant financial relationships with commercial interests to disclose.

Every practicing physician has had the experience of feeling powerless in the face of patient expectations that come across as overblown or unrealistic. Addiction psychiatrist Mark Green, MD, shares with Drs. Curious and Schwab that an effective strategy for managing such expectations is for the health professional to join with the patient by acknowledging their shared experience of powerlessness. In this episode, Dr. Green reflects on the work he has done helping primary care physicians manage challenging patients with chronic pain and so-called “drug-seeking behavior.” He observes that sometimes physicians who are rushed for time and feel compelled to “do something” may inadvertently end up hurting their patients, rather than helping. Sadly, this problematic dynamic may be one of the root causes of the opioid epidemic. Although patients may expect physicians to alleviate their pain and meet other expectations, it is the professional’s job to help them differentiate between unrealistic hopes and achievable goals. By taking time to listen to patients and gain a deeper understanding of the causes of their distress, it is sometimes possible to accomplish more by doing less (fewer unnecessary tests, less medication). Empathically engaging with patients, understanding their helplessness, and sharing in patients’ powerlessness all may reduce their suffering, loneliness, and desperation. Although Dr. Green acknowledges that taking the time to forge these kinds of connections to patients may be draining to the professional, he describes it as potentially fulfilling and even invigorating. In fact, he believes that burnout ensues when physicians and other professionals find themselves in practice situations that deprive them of the opportunity to connect with and listen to their patients. Dr. Green recommends acknowledging one’s powerlessness as an act of self-compassion. His counterintuitive perspective provides Marie and Les with much food for thought.

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None of the individuals in a position to control the content of this CME activity, and/or their spouse/partner, have any relevant financial relationships with commercial interests to disclose.

Dr. Steve Adelman, founder of MedPEP and the former medical director of the physician health program in Massachusetts, has a frank discussion with Marie and Les about physicians’ use of addictive substances like alcohol and marijuana. In this era of stress, burnout, and medical “battle fatigue,” doctors may be especially susceptible to numbing themselves with substances that have the potential to impede their performance. Steve’s perspective is that physicians are safety-sensitive professionals who are responsible for the health of the public. Consequently, they have an ethical obligation to stay above reproach by avoiding problematic use of psychoactive substances. Physicians with a history of problematic substance use should abstain; others should consider practices like “clean margin drinking,” a minimalistic approach that is fleshed out with specifics. Marie acknowledges that sometimes physicians cross the line in the name of celebration or stress relief. Steve points out that physicians are at risk because they have easy access to controlled substances and may also resist seeking professional help despite needing it. Marie and Steve discuss a specific case involving a patient whose therapist appeared impaired during a psychotherapy session. A guiding principle is that the safety of the public should never be compromised. Les asks Steve to comment on the use of marijuana by physicians. Steve focuses on the downside, advising licensed health professionals to avoid marijuana altogether. He links this MedPEP episode to earlier podcasts by suggesting that health professionals should avoid misusing substances; instead, we should focus on improving our self-care with diet, exercise, meditation, and better work/life balance, all of which may counter personal and professional burnout, and preserve our careers.

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None of the individuals in a position to control the content of this CME activity, and/or their spouse/partner, have any relevant financial relationships with commercial interests to disclose.

Dr. Marie Curious and MedPEP host Dr. Schwab have a rich and engaging conversation on the doctor-patient relationship with primary care physician and writer Dr. Danielle Ofri. The discussion contains numerous clinical pearls, some of which are drawn from Dr. Ofri’s experiences learning to play the cello as an adult. She reflects on her own frustrations with electronic medical records in a way that steers Marie in the direction of valuing and savoring the time she spends with patients, attentively listening to their stories, while judiciously and productively managing the visit length. Dr. Ofri urges physicians to utilize the first few minutes of each outpatient visit for “full frontal listening.” This helps to win the patient’s trust while providing hard data that reveals the patient’s most pressing health concerns. She links this technique of active, empathic listening to two of the holy grails valued by health care business leaders: patient satisfaction and patient safety. Dr. Ofri encourages physicians to adopt a mindset of continuous learning, growth, and professional development, and views this stance as an antidote to personal and professional burnout. And finally, Dr. Ofri advises that “if you really want to feel rejuvenated about medicine, make a house call to one of your frail patients. It makes you feel good about what you are doing.” Drs. Curious and Schwab concur with the importance of reconnecting to the essence of clinical medicine: the doctor-patient relationship. 

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None of the individuals in a position to control the content of this CME activity, and/or their spouse/partner, have any relevant financial relationships with commercial interests to disclose.

Dr. Jeffrey Auerbach is a psychologist, coach, and author who has coached health care executives, physicians, and physician leaders for more than 20 years. This episode focuses on the complexities of emotional intelligence (EI). Jeff explains to Marie and Les that there are four broad domains of EI: (1) knowing yourself, (2) managing yourself, (3) understanding other people, and (4) being able to effectively and sensitively manage relationships with others. Specific competencies within each of these four domains are enumerated. Dr. Auerbach makes the case that by developing EI skills and competencies, physicians become better equipped to perform at their peak in today’s demanding and stressful medical environment. By knowing, managing, and regulating themselves, some physicians will be able to avoid becoming overwhelmed and emotionally overloaded by potentially destabilizing interactions that come up in the course of everyday medical practice. The discussion drills down on the topic of burned-out physicians who experience anxiety and dread about going to work. Although it may be helpful to be aware of these feelings, dwelling on them excessively on a Monday morning may be counterproductive. The role of emotionally intelligent leadership and its positive impact on teams and organizations is also touched upon. Research findings indicate that physicians who are led by emotionally intelligent leaders are less likely to experience burnout. Drs. Auerbach, Curious, and Schwab also discuss the role of EI in preventing conflict. Negativity in the health care environment may arise when emotionally unaware individuals blurt things out impulsively in a way that incites others. Consequently, EI may be viewed as a core competency for all members of teams, groups, and organizations. 

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None of the individuals in a position to control the content of this CME activity, and/or their spouse/partner, have any relevant financial relationships with commercial interests to disclose.

After learning about the causes of burnout, how to cope with it, and how to convey one’s concerns to the higher-ups in an organization, Marie meets Dr. Helen Riess, a practicing psychiatrist who directs the empathy research program at Massachusetts General Hospital. Helen believes that the rigors and pressures of medical education, training and practice deplete physicians of their natural ability to empathize and connect with patients. She describes how physicians can form meaningful empathic connections to patients during the limited time of an office visit. A quick gaze conveying that “I see you” acknowledges the patient. Actively including the patient in reviewing lab and imaging tests may improve the patient’s experience of the physician and the visit. Helen helps physicians to notice and decode patients’ facial expressions and body postures. When the patient feels understood, this improves the care experience for doctor and patient alike, enhancing the well-being of both parties. Helen coaches Marie to encourage dialogue through open-ended questions, and to artfully and tactfully close discussions in a timely manner without giving the impression of rushing. As these skills are mastered, a mutually satisfying connection may emerge, enhancing the personal and professional fulfillment of the caregiver in a way that may mitigate the stress and burnout that is rampant.  Cognitive reframing and self-regulation are additional skills that help a physician to avoid becoming overwhelmed by the emotions of shared experiences that patients bring to the exam room and office.   

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None of the individuals in a position to control the content of this CME activity, and/or their spouse/partner, have any relevant financial relationships with commercial interests to disclose.

The stresses and strains of medical practice burned out Dr. Diane Shannon to the point where she left clinical practice and reinvented herself as a medical writer. She shares her moving, cautionary tale with Marie Curious, explaining to her that medical practice was not what she had expected it to be. She found it to be so chaotic and stressful that it was taking a serious toll on her physical and emotional health. It also detracted from her capacity to sustain healthy relationships. Since leaving the practice of medicine, Diane’s research and writing have led her to the conclusion that her personal crisis had multiple causes: her inability to adequately handle pressure, stress and frustration at work; the lack of organizational support for her and other physicians; and, the bevy of system-wide regulations and requirements that have culminated in the dehumanization of the role of the physician. Diane believes that some leading edge organizations are instituting meaningful changes in processes, culture and leadership that are just beginning to move the needle on physician burnout. Diane gives Marie advice about having effective discussions with leaders and managers about the linkages between physician well-being, patient satisfaction, and organizational success.  She also shares some personal survival strategies with Marie, including informal peer-to-peer support groups.   

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None of the individuals in a position to control the content of this CME activity, and/or their spouse/partner, have any relevant financial relationships with commercial interests to disclose.

Marie meets with Dr. Paul DeChant, a former family medicine physician and CEO who now works as a health care management consultant. As a medical leader at the Sutter Gould Medical Foundation, Paul successfully led a system-wide transformation that enhanced clinician well-being and restored joy in caring for patients. Paul is the lead author of Preventing Physician Burnout which focuses on the use of Toyota Lean principles to improve the practice-level processes that have dehumanized the care experience for patients and doctors alike. In his conversation with Marie and Les, Paul focuses on removing the obstacles that come up in the course of everyday office practice. He emphasizes a process improvement approach that respects and embraces the opinions and insights of front-line office staff, stressing the importance of collaborative change initiatives. Paul underscores the importance of physician engagement. Without the buy-in of distressed physicians like Marie, turning around an oppressive practice situation may not be possible. Paul attempts to leverage his experience and track record to empower Marie, and others like her, in office-wide and system-wide transformation efforts.  He stresses the importance of communication between front-line physicians and the medical and corporate leadership, and Marie is somewhat skeptical that her voice will be heard. Dr. DeChant explains that the when physicians and other members of the team are able to implement and sustain meaningful changes at the level of the practice, not only do people feel better about the care they deliver; the practice may even increase its capacity to accommodate more patients at the same time.  

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None of the individuals in a position to control the content of this CME activity, and/or their spouse/partner, have any relevant financial relationships with commercial interests to disclose.