Sawbones: A Marital Tour of Misguided Medicine - Physician Burnout

Episode Date: June 29, 2021

Workplace burnout is commonplace in the 21st century, but it’s a fairly recent idea. It’s especially insidious among physicians, who are taught that any fatigue is a sign of weakness. Dr. Sydnee shares her personal experience with exhaustion and what might be done to address this problem in the United States.Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talk is about books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We were sawed through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth. Wow, it's amazing. Hello everybody and welcome to Saabon's, Mayor of the Tour of Miscite and Medicine. I'm your co-host Justin McAroy. And I'm Sydney McAroy. What a pleasure it is to be back with you again. Oh, thank you Justin. It's been some busy weeks.

You know, last week we weren't here, and honestly folks, we just needed a break. You know, it's a stressful gig podcasting. Probably one of the most stressful that there is. And it's really important that you take the time that you need for yourself as a podcaster. I really believe that. And taking that time is so important and undervalued.

Now, Justin, I agree with you. And that's true for everyone, not just yeah. That's why that's hard casters, I suppose. But people who are wonder why Roman Mars hired that second Roman Mars to do 99% invisible. So the first Roman Mars or row prime, as he's known, could spend more time with his family. And that is why. I mean, it's just a very stressful gig. I don't, while I agree with you and everything you're saying, except for everything. Except for, I don't think that Roman Mars

hired a second Roman Mars. I don't think that that's accurate, but I honestly haven't researched it, so I'm not gonna say definitively. I try not to, you know, I try to stay in my lane, but we didn't do an episode. I would say not so much because podcasting had become overwhelming. I think my other like my side gig, I guess, at this point.

Side gig? Is it my side gig? That's a weird way of putting it, but sure. Yeah, I'll allow it. Well, it's very, I don't know if everyone knows this. I assume everyone does, but maybe this is like a doctor thing. A lot of doctors have side gigs these days. A lot of, and that's what they call them.

I'm like, I do medicine, but my side gig is... Etsy. Etsy or like I sell... MLM. I'm an MLM. I'm an MLM. I got, I fell into an MLM. There are a lot of doctors with side gigs,

who are, I don't know if they're trying to offer amp, some of them are. Some of them are trying to find a way to offer amp for medicine. Not all of them, obviously, they're just trying to make a little extra dough, payback those student loans. But I guess in my case is medicine my side gig. I guess.

I don't know. It doesn't feel that way because I identify, and this is all playing into what we're going to talk about. in my case is medicine my side gig. I guess. I don't know. It doesn't feel that way because I identify, and this is all playing into what we're going to talk about, identify so strongly as a doctor, not just as like my job, but it's like who you are, who I am. Right. And I wouldn't say that I identify with the title podcaster in that same. Well, that's only because it feels terrible to say, and I've never said it to anyone with

a straight face. You know what I've got? You know what I've never said it to anyone with a stray face. You know what I've got? You know what I've recently been doing and tried to get away with. I'm an entertainer. I'm an entertainer. I'm an entertainer. That's what I put on like forms and stuff.

That is what you put on. I don't know. I make boner ghosts jokes, boner ghosts jokes and horses and stuff. That's what I have to tell people when they're like, what is your husband do? Actually, if you and if you're in medicine, you might know this. The question they're like, what is your husband do? Actually, if you, and if you're in medicine, you might know this.

The question I get is not what is your husband do. The question I get is, is your husband a doctor as well? That is always the way the question is phrased. I am an honorary doctor. And then I say, no, he's an entertainer. He's a clown. He's a clown for money. Thank you for asking.

I'm very ashamed of my clown husband. He's not a asking. I'm very ashamed of my clown husband. He's not a doctor. I'm not ashamed of my clown husband. I love my clown husband. There's a bumper sticker. I'm not ashamed of my clown husband. So I was, it was a lot and I couldn't get it, I just couldn't get it done.

I couldn't get it all done. Well, I can't, and we can't, it's funny. You can't talk about any of it. And very little, honestly, with me, because of all the different hippo stuff, but it's been a stressful one, I could tell. A stressful couple of weeks. So I started thinking, I should do a podcast

about physician burnout, because we talk about that a lot, and I just want to get out in front of this. I put this all together before the Vox article about physician mental health and wellness just came out. That's very that to me whenever I see something like that start to happen we're like a lot of different sources are coming to the same idea at the same time like I think that you are often at the cusp of some actual actual change or recognition or whatever, because people are trying to talk more about it. I hope so, because I wanted to get into, like,

where did this term come from and where did the idea? I mean, I think we all know about the idea of burnout in general, but like, as it applies to physicians, it's very buzzy. And I think it was reaching sort of a fever pitch right before the pandemic, but it all got put on hold because pandemic. And we needed all of our healthcare providers to be well because they had to do this work. So I think we all just simultaneously decided they're fine. And put this concern on the back burner, but now that things are starting hopefully to,

at least we can see the end. We know how this should play out. We're starting to see a light, knock on wood. Then I think this idea is resurfacing like, hey, by the way, we were all super burnt out and not in a good place before this started. And can you imagine how a lot of us are feeling now? I think it's the conversation. So the concept of workplace burnout is generally a pretty new concept.

Like this is not, I mean, historically, yes, everybody needs to work and play. I mean, that's not, you know, that's a, it would be weird to say, no, everybody always enjoyed toiling away for hours and hours with no, with no fun. But no, like everybody's always needed to find a balance, but the idea of like specifically burnout, and especially for, for physicians or, you know, a lot of the work was on with physicians, but healthcare providers in general, you could, you could save for a lot of this. The word sort of describes what it is, right? Burnout. Burnout. Yeah, you lose energy.

You have no more power. You cease to function. You can't do your jobs. Whatever your roles are in society, whatever your things are in life, be a happy human. You can't do any of it. It's your burnout. The term itself, the way we use it now, you know, in common use. Probably dates back to 1974, a psychologist named Dr. Herbert Freudenberger, who came to the US, he immigrated here from Germany in 1933 to escape the Nazis. And he worked his way through school and college. He was a hard worker. He always had to, I think he was, I think experienced homelessness for a while. He worked really hard to get through school and college.

And then finally, while he was studying, he ran into Maslow, Dr. Maslow, who created, you've probably heard of... hierarchy of needs. Exactly, a psychologist. And from him was directed into the study of psychology, was very interested in that. And wanted to, kind of, was a protege of his wanted to

follow in those footsteps and he became a leader in his field in one of the first people to really address and work with addiction as a disease. So he began this work and he decided, you know, this was also is we're moving into like the 70s we're getting into the free clinic movement the idea that the revolutionary idea that the revolutionary idea that everybody should have access to healthcare, which we've always wanted, but I think we all know it's not true, but he started working at these free clinics so that he could have more hands-on, one-on-one experience with people who have addiction, who have substance use disorders, and volunteer there and work with them directly

and sort of grow that body of knowledge, our understanding. And this is where he kind of started coming up with this idea, this concept of the word burnout. There was an interview with his daughter where she said that his explanation for it is that sometimes he would see people who had long term addiction who just seemed to sort of like fade away, sort of be vacant from themselves, from their person.

And he would watch them stand against a wall holding lit cigarette and not moving and not smoking it until the thing just burn out in their hand. Burn out. And this was sort of the inspiration for this word. And the reason that he probably recognized it so readily is that Dr. Freud and Burger would go on to experience burnout and talk about it quite intensely. He was working all day in his hospital job and all night in his free clinic volunteering work or vice versa all day in the volunteering all night at the hospital. So he was pulling long hard days. He was exhausted. He was unhappy and a day came where there was a family vacation and he could not get out of bed. That is the way it is described. He literally could not lift his body out of bed. And the way he described it was that I don't know how to be readily joyful. Now you can tell that he wasn't at Disney

because Disney has several services for parents who can't get out of bed. Get Mickey's magical lift and for $69.99 Mickey will come to your room and put you in a sedan carried by four chips Of chip and Dale fame and just carry you about there's no need to get out of bed Which chip and Dale what which chip and Dale there's four chip and Dale. There's four chips. Okay. It's like the chip and Dale Not Dale is not it Dale is above this work. He's not gonna carry a tired parent in a sedan chip though No, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, Yeah, they can all. Yeah. I'm more of a dail. Is he bringing gadgets? Be honest that I'm more of a dail. No. I think I'm more of a dail. He does wear her Hawaiian shirts.

Yes, he has to say, okay. Anyway, so I'm a dail in the streets and the Monterey Jack and the sheets. So I like to do myself. I'm just gouged it all the way. So he began to, and I really like this about Dr. Frouinberger. I feel like when I read this about him that I would, I understood it on a deep level. He began to talk into a tape recorder

about his feelings and then play it back so that he could sort of psychoanalyze him, like to be his own psychologist. The worst way is it doing it. I mean, honestly, that's the only tool you have is being able to... He was a very good psychologist. Analyze your own thoughts. The worst way is doing it. I mean, honestly, that's the only tool you have is being able to analyze your own thoughts. Yeah. And so he would talk as if he was the patient and then listen back to his own thoughts.

And I, that resonates with me on a deep level. So he realized that he was experiencing burnout, that the same, this idea that you can't be happy, you can't experience joy, you just can't anymore, he, it was experiencing it. So, he wrote a book called Burn Out, The High Cost of High Achievement, and by 1981, this book was a big deal. Like, he went on Oprah and Donahue and all the shows

to discuss it, and a lot of people were talking about, it was very buzzzy, this book, this idea of burnout. And especially in someone like himself who was a high achiever, who worked nonstop was recognized as being brilliant and capable and all of this stuff. And eventually he would find joy for himself. I'm not really clear.

It's not really like, he didn't put a case study out there. So I don't know exactly how he found a way to deal with what he thought of as like this response to extreme stress. But it wasn't like a treatment for everybody. It wasn't like there was one protocol that was developed that everybody could. It was just, this is a thing that exists. He found a way to live with it and work with it and find joy again, find happiness again.

But this book really put the idea out there and in the 80s it really took off. That is really where you see like the idea of burnout. This is the birth of this concept. And I think it makes sense because you think of the 80s not just in medicine, but in the whole, especially in the US, the 80s were when everybody was scrambling for more, you know better There was this disproportionate amount of time that everyone was spending

Trying to climb that ladder and achieve some sort of ultimate career Success, I don't know. They all had those popped collars and those convertibles. It's a very self-interested decade, which I think if your religion, if your faith system is self-based, how do you say, like, I have done enough today, I have achieved enough today, I've gone high enough in my career, you know, I've achieved enough. When your religion is you, I think it's very hard to see past that. And it was also a time where in the name of gender equality, and again, I'm not saying this is gender equality, but at the time, the concept of gender equality was, hey, you can do this to ladies,

you can have it all. Do all the other stuff you're doing. But you can also work your butt off trying to fight your way up the career hierarchy. And work twice as hard as your male colleagues to achieve the same successes. Exactly. And so everybody was intensely trying to have it all and do it all.

But at the same time, came in the idea of work life balance that came into the picture So but okay, but no, no, don't don't forget you got a family you got to relax Yeah, you got to have you got to work hard play hard right? Yeah, and so that's why we as an American society We've really value this. That's why we have institutionalized two weeks off vacation time per year. We really value yeah like like this work life balance of 50 weeks to two weeks at a full time salary position. Sorry for wage based employees.

Yeah. Well, I would say that two week vacation is only if you're able to be one of the lucky ones who gets one of the prestige jobs that gives you two weeks pay vacation because not I'll do. So anyway, the impetus was really put on the American worker to listen. You've got to find a way to troubleshoot all this, okay? You can have it all, you can do it all, you can be it all.

And if you're not, there's something wrong with you and you need to find a way to fix that for yourself. Whatever that looks like. And since it was the 80s, I guess, I mean, I think a lot of it was partying drugs. Okay, which just invented. Something plastic, a lot of plastic things, I think that was part of the 80s too.

Anyway, and some bright colors. But that's... You guys have seen Americans, like, go, you get it. You get it, it of the 80s too. Anyway, and some bright colors. But that- You guys have seen Americans like, you get it. You get it. It was the 80s, you know? We can burn it. The problem is you.

But the solution is you. So there's the good news. Just troubleshoot you and you'll be able to survive in this system and it's great. Now, initially, this was not really aimed at doctors, even though it came from a psychologist and working in a free clinic And so you would think that like

application to medicine would be Obvious a lot of this was originally thought to apply to everybody else like well doctors don't seem to say they have this problem They don't talk about it. They don't complain. They never ask for help. So they must not need it, right? And it really, that is, I should say, baked into the job. You are trained not to complain, not to ask for help. You are praised for your ability to withhold pleasure from yourself and not even just pleasure like, you brag about how long you've gone without peeing in a shift.

You brag about how long it's been since you've eaten something. You brag about how many cups of black coffee you drank last night to get through the night of call you were on. You brag about how little care you're taking of yourself. And so the idea that you would ever like, admit like, hey, I'm not, you know, I need help. Well, no, of course you would. Of course. And so initially like the idea of burnout was being applied to all other sorts of workers.

Physicians were kind of behind in that. Like, oh, no, we don't, we don't experience that. Because if you did admit it, and this gets into, and I'll talk about it a little more at the end, the Vox article that just came out. If you did admit it, and this gets into, and I'll talk about it a little more at the end, the Vox article that just came out. If you did admit it, you could lose respect. You could be passed over for promotions. Patients won't trust you anymore. They won't have faith in you.

And then there's, like, if you would have him forbid, admit to actually having some sort of mental illness, I mean, you could lose your job. So, you know, for all those reasons, burnout comes into the American consciousness and it takes a while for doctors to be part of that. And I want to tell you about how it came to be among doctors. But before I do that, let's go to the billing department. Let's go. So you guys are finally ready to admit to your human like the rest of us, huh? So yes.

And it in helper, in what Freud and Burger called helper professions, this is always a risk, right? If you're in one of the jobs where like helping people is sort of the thing, that is the thing that you do. There's always this risk, but it was really the transformation of the American medical system into what it is today, this sort of bloated faceless money-making system that has nothing to do with the people taking care

or the people getting care, right? Like that transformation is what pushes us with the people taking care or the people getting care, right? Like that transformation is what pushes us into where we are now. Do, okay, I have a quick, a chicken and egg question for you before we get, and maybe this would be more appropriate later in which case, let me know. Do you think that the state of the American healthcare system is causing this physician burnout issue

or do you think that the prioritization of this like all work, no complaining, by a bear down and grin and bear whatever you get? Do you think that that attitude, which is so prevalent in most positions, in some ways, enabled this system to become something that like does not care about the people, individual people within it. I think it's tough to know which one was the bigger driver because I think they're both responsible for it. I mean, physicians are uniquely susceptible.

I shouldn't say uniquely, but we are definitely among those who are uniquely susceptible to this sort of situation because we do a lot of us tend to be type A, high achieving, like we have perfectionist driven to succeed to the point of self-detriment. I mean, I think that that is definitely, but why is that part of medicine? And why is that the kind of doctor you want? Because even that question, I mean, I have gotten to that, like why does that make someone a better physician? I don't know that it necessarily does.

So I think it's all, like I think this system created people who go into medicine, who fit that sort of archetypepe and maybe that's not even the best suited for medicine. It's maybe the best suited for the medical system that we've created because it is so damaging. But if we're talking about that just go to the root of it, the idea of a healer is that the best person to be a healer. I don't know anymore. I mean, I think it's all gotten so lost in there. And I say that as somebody who I would, who probably is, I mean, I know I'm a perfectionist. I know I am incredibly demanding on myself and put myself last in the hierarchy of like

who gets care. So I am one of those people and I don't know that I am the best suited for that. But to go back to where we were in this story, the reason that like it became more well-known among physicians is a professor of psychology at UC Berkeley, Dr. Christina Maslack, who had been responsible for it. Do you remember the Stanford prison experiment? Yes. She ended it. Oh, good. Well, she encouraged one of the investigators that she ended up marrying later. She told them like this sucks, you need to stop. This is a bad idea.

So she, that is in history, that this is who this is. She was interested in the response of an individual to chronic stress in a workplace environment. And she began surveying healthcare workers. What she found was, and at this point, there was, she actually interviewed somebody in another job that I would say stressful poverty law.

And they referred to it as, well, we just call it burnout. And she said, yeah, that's what it is. It's burnout. And all these healthcare workers also have burnout. So she published articles outlining the three principles of burnout and recognizing their existence in lots of different professions, including in healthcare. And it's a combo of emotional exhaustion, depersonalization, and a lack of a feeling of accomplishment.

So basically, I get home drained, I don't care about what I do there, and I never help anyone anyway. And that's the feeling that you eventually get from from the jobs that you do. And she would go on to create the there's an inventory that you can use a burnout inventory where you basically. You can find the the PDF of it if you're interested in what it is free online but I think you actually have to pay to get it like scored. To figure out and that you probably if you're in any of the sorts of jobs that might experience burnout at higher rates, you may have done this before, because an employer can hand it out to other employees and do it and see,

are you all burnt out? And ask you a bunch of questions about how happy you are with your job and do you ever feel like you do a good job and do you ever just feel like I don't care anymore? Like, I feel disconnected from the work I do and the people I care for and all that stuff. And again, it implies to a lot of different fields, but we're focusing on medicine. With the complete transformation of the American medical system throughout the 90s and the

early 2000s, you begin to see more and more healthcare providers talking about burnout, experiencing burnout, admitting to, hey, all that stuff you're talking about, that's me. Like I feel that now, and I'm feeling it so intensely that I can't hide it anymore, and so I'm saying it. So all that was great, right? Recognition. There's a problem.

That's the first step. We've found a problem. But in terms of what we do for that problem, I think that's where things have really gone off the rails because in many workplaces, what the treatment for this, the form that is taken is what are called wellness initiatives. So your wellness initiatives at your workplace

could look a lot of different ways, right? On TikTok, they like to joke about this a lot. Oh. That you ask for like better wages or like paid vacation or like, you know, parental leave and things like that. And they give you a pizza party. I mean, I'm not a doctor, but like a pizza party does sound pretty good. That sounds like a joke, but like a pizza party. Does somebody good?

That sounds like a joke, but it's really what it feels like. So there's not a pizza party. Well, I mean, I haven't, I mean, I don't know why you're giving me a pizza party. I've never had a pizza party, but like they do give you like, here's a gift certificate to a fancy restaurant. I mean, I've gotten that.

But like, we'll do your laundry or we'll give you gift cards for meals or spas or massages or something like that, right? Like, we'll do something. We'll go to the basket of snacks out. During, I thought this was, and this was very kind, but I thought this was a good, during the pandemic, a lot of the medical students started volunteering to like run errands for the physicians to help them out since they were so stressed and overwhelmed.

Which probably did help during the pandemic. But this is the kind of thing that we're usually offered. The classic example is how can we make this workplace better? You provide, the healthcare workers provide a list of like, we need more people in this job. We need to hire more of this kind of person, we need more of these services, the weekends, we're so strapped, we need more support on the weekends, we need more social workers, whatever, right? Like we ask for all these different things that would make the facility run better and

what we're given is like a better physicians lounge. You know, I mean, you get coffee refills more, like that kind of thing. And then again, this focus on work-life balance. Like, well, the problem is, you're just not prioritizing your off time the way you prioritize your work time. So just when you go out, when you leave, you just really need to turn off.

And, you know, and like, be at home, which, as anyone who's in healthcare right now is screaming, but what about all the notes in the electronic health record that I still haven't finished that I have to do? What about the fact that I've got 30 different patients to call back because I hadn't had time to call them all day, and they're all waiting to hear from me. I've got to call all these people. What about the fact that people get sick on the evenings and weekends, and you can't

turn all that off. But again, it's still the impetus is on you. Drink more water then. Well, exercise more then. We'll spend more time with your kids and family then. Like, you know, oh, it also takes a me time and get plenty of sleep. And they like, they lecture you on these things and they tell you to do all these things and then they give you a coupon to a restaurant

and say like, are you well? Are you better? Did we fix you? And it takes the focus off of the problem. And I think that is where we are finally getting to today. And I think that Vox article sort of spoke to it indirectly. But I think that this is where we are headed. All of this takes the focus off of the system as the problem and puts it on the person who is suffering

under the system to deal with that suffering better. Can I stop you for a second? I've been kind of before you go further. I've been a little more quiet this episode listening to you because I found it personally sort of disturbing. To what extent were you the way you are before you got into this system and how much of it has you don't do this on a day-to-day basis in this particular system. You're a doctor every day, but you're not in this system every day. You have weeks where you do it, weeks where you don't, but like, how much of the way you are, do you feel like as a result of being in the system?

Because a lot of times you do feel like you haven't done anything and you do feel like you haven't achieved stuff and you haven't done anything worthwhile and that you don't need help and et cetera, et cetera. How much of it do you feel like is a holdover from being in the system and how much of it's just inbuilt? I think that my drive to always achieve more and do more I think is part of me because that predates

medicine. I think that's just part of who I am. And probably part of why I chose medicine is because I was led to believe that's where people like me belong, right? Like I had lots of messages that like, oh, you should be a doctor because you do that stuff and blood doesn't make you pass out. But I think like the fact that I never feel like I have done anything, no matter how much

I do, I have to feel. I mean, I think it's a result of the same. I feel like there was a time in my life where I knew I had achieved things like where I could accept praise and feel good and I mean it's been so long I don't remember that anymore. I don't mean this in a self-pitting way. But yeah I have to imagine it's the system because no matter how much you do in the system that you haven't done enough and there's always someone you didn't help.

No matter how hard you work. I mean, and you know, it's funny. I say you're not in the system anymore, but I only mean that in the sense that you're not going to the hospital every day because you are still in this system. It's bigger. It's bigger than the hospital.

It is because if, and I think maybe this is why they first started noticing this concept in the quote unquote helper professions is that if you are in doing work that for instance a lot of the work I do these days is volunteer it's unpaid work to try to help people that I would argue society has not ever tried to help or at least has stopped short of ever actually doing anything for and has left behind and has abandoned. You learn pretty quickly that there is never going to be enough support or resources or people doing that work to really make big, giant fundamental change. And it becomes, you know, I mean,

you feel like you can't win. And for someone like myself, who goes at everything with the intention of winning and being the best and being at the top of my, whatever I can achieve at this, you learn pretty quickly that you can't. It's impossible. And I know I'm not alone in this.

There are a lot of people who do this kind of good, hard work for people that society left behind that they feel the same way. I'm sure. I know they do. I talk to them. But I think that's where we're going at this point is the concept of resilience, it comes into this a lot,

into these conversations that you need healthcare providers specifically to be resilient. And if you really think about what that means, what we're saying is this job will traumatize you. It's like a natural disaster, and we need you to be able to come back from it and work again. Why? Like, why is it constructed that way then? and we need you to be able to come back from it and work again. Why?

Like, why is it constructed that way then? Because it's not just the things you might encounter providing healthcare, the things that are just part of the work, right? Like sometimes people are sick and it's sad and sometimes you lose patience and it's sad. I mean everything else, all the other parts of it that aren't, you know, that there can be trauma for medical work, there shouldn't be trauma from the American medical system.

And I think, I think that's why like the conversation, especially right before COVID, was getting pretty dire. The word that I tend to use now instead of burnout, or the two words I should say, is moral injury. That is what I feel like myself and many, many, many other people have sustained at the hands of this inherently immoral system, where I went into it with the earnest intention of helping others. I want to learn these skills so that I might be able to keep someone from dying and give them a better quality of life and help them, you know,

achieve whatever their goals are by keeping them well or advising them so that they can stay well. Those kinds of things. But the system is not built to do that, right? Because the system, a lot of people will say that the American medical system is broken. And I always push back against that because it's not. It's not broken. It's working exactly the way it was built to work. But it's evil. No, it is.

Well, it's because. It's immoral, it's immoral, system functioning properly. And when it comes to a business that is meant to make money, it's not about serving you the patient or me the physician. It's about making money for other people for a third party. It does that. In spades, it does that, right? It makes a told amounts of money for that third party that's always in the exam room

with you quietly that you don't recognize. It harms you the patient. It harms me, the provider, it harms me, the provider, and it puts us at odds with each other, constantly we're at odds with each other, because that's what they want it, because then it keeps both of us from turning and looking at the third party and saying,

why are you making so much money off of our suffering? Yeah, we don't talk about this enough, but we go really hard on alternative therapies and home, homeopathy and a lot of like, woo, woo, crap. And I think that that is, I mean, that's been part of society since the beginning, since it all of time, and that's not gonna go away anytime soon. But I think that a lot of it is a reaction,

is a direct reaction to how crummy the American medical system is large, right? I mean, it is. It's a part of it. It's part of the broken system. Mm-hmm. I mean, it feels absolutely terrible to look at someone and say, I know what therapy you need, but I also know your insurance won't cover it, and I have no way to get it to you.

So I'm going to recommend something that is not as good, and I know it's not going to help you as much as it could, and money is the reason for all of this. I mean, and it's worse for the patient. I'm not saying it's worse for me. Of course, it's worse for the person who's suffering, but when you do that day in and day out, eventually, you know, it's and day out, eventually you know it's not just a feeling that you're never really helping. It's the knowledge. I'm not really helping because a lid as to how much I can do for people has been put on this and I just

have to struggle underneath it. And that is really, this idea was being talked about a lot. And then when COVID happened, it's the same always, like, well, but we really need you to be fine right now. We need you to be mentally healthy and we need you to not be burnt out. So we're just gonna pretend like you're not so that you can do all this work.

And then when this whole thing's over, maybe we'll talk about it again. And I think maybe that's why, especially with the increase in like physicians admitting to depression and other psychiatric diseases in the wake of COVID has maybe brought the spotlight back on it. Because that, and that's what that box article talks about. It's like physicians, I mean statistically, should at least be suffering mental illness at the same rate as the general public.

We believe that their rates of depression are higher. The rates of suicide are at least equal, but again, we believe they're higher just under reported. And the fact is that physicians are less likely to seek care because of fear of what that will do to their career. And if you lose the ability to be a doctor, it's so linked with for a lot of us, I'm not saying this is every single physician, but I know it's true for me. It is so linked with who I am as a person, not just my job, but like who I am inside that if I couldn't do it anymore, it would be

I mean, it would it would be devastating. And I think that many physicians feel the same way. And so, you know, there are all sorts of ways that like places have found to sort of skirt the idea that you're getting care while secretly giving you care, getting like secret therapy, that isn't therapy, that we'll call literally anything but therapy to try to help people create like support groups, that aren't support groups and call them something else

so that no one ever has to report that they received any care because they're so afraid. And it's not true. Let's take it back to Dr. Friedenberger, who you complimented for this, for this like, I'm gonna record my thoughts and then play them back. And. Oh, I'm not saying it's healthy.

No, but you know what he's doing. I understand that. You know what he's doing. He's doing therapy. Yes. On himself. To avoid though, actually getting therapy. Yes.

And I know a lot of, a lot of people in the healthcare system will do that because, and it's not true, like, part of it isn't based on reality. Like, and you can read that, I would recommend you read that box article if you're interested in this, but not in every state, do you have to report just because you like saw a therapist

or went on an antidepressant or something. That's not necessarily true in every state. There are states where it is very true. They can ask you all of those intrusive questions. When you sign to get privileges at a hospital, you give permission for them to go through your medical records in some cases. And so they can go through all of those and say,

oh, we don't want to hire you because you see a therapist. We don't want to hire you because you're on this medication. Or certainly for physicians who may have to seek inpatient psychiatric care, that is very stigmatized. And nobody's going to say we would never hire you. But the reality is there are going to be systems in which you won't be hired if you have sought that care. And part of it is perception. Part of it is the reality is there are going to be systems in which you won't be hired if you have sought that care and part of it is perception part of it is the reality. Um, like physicians believe it's much worse than it is part of it is no they do judge you on that. But either way we have to find a way to make it okay for doctors to ask for help all healthcare providers not just doctors we have to find a way to make it okay for them to receive that help. not just doctors. We have to find a way to make it okay for them to receive that help

so that they continue to do the job that they're doing because as it stands, it seems like the people who have the power to change this terrible system aren't doing it. I mean not currently anyway. But that, I mean, that is the way that we make it better. And all of it has to change. I mean, medical training has to change. Residency is all about how hard can you push yourself?

Yeah. I remember that. They've done some of these studies and they talk about them in the article about how many residents report like burnout or depression or any of these things. The numbers are astronomical because residency makes you question everything you ever wanted in life, and you know, think about quitting everything.

I mean, we called them the crying times. The every resident hits a point where they go into the crying times, which is when you start thinking like, I can never help anybody, I can never do anything good, I'm done with everything, and you start researching what can I do with this degree that I got that isn't being a doctor because it's so hard. And like, if you think about it, and I'm just realizing this, we called it the crying times, it was depression.

And we still come up with euphemisms for it so that we don't have to admit that we experience psychiatric illness at the hands of this system. Do you feel like there are times in your life where you would have been well-served to seek out therapy that you, what did it? Yes. Oh, I know. Oh, 100%. Well, I mean, I think I talked about it when we talked about postpartum depression. I know, but I feel like we didn't focus enough on you saying like you were right Justin. I said, I don't know what you said. You better.

No, I definitely, I knew I needed, I knew, I mean, I had the clear thought, I need help with this postpartum depression. And I am afraid to seek it because I still want to be a doctor when I go, like eventually, you know, when this maternity leave ends, I would like to be a doctor again. And yeah, I mean, and I'd say there are a lot of people in healthcare who would say the same thing. And in that article, they talk about that, that, you know, that there are lots of people who, if they felt that they could access care, they would.

But everything has to change around it. It's not just the system and it's not just the doctors. Like, I will say the same thing. I have had, when I went on leave to have our children, the idea that a doctor would take time off to have a baby and care for that baby for some period of time. The resentment from my colleagues, from my staff, from my patients, from everybody was so huge. The expectation that I would come straight back and start doing my job again, because

that's what you do. And again, I don't think that's just doctors. I think that's capitalism. But yeah, right. I don't know. But that is where that is the origin of burnout. And this is where we are today. I'm hoping that in the wake of COVID, we can start having these conversations again because it would serve patients better if you had healthy doctors. And right now, I don't know how many of us are healthy. I'm not saying I'm not. But. What did I have to do though?

What did I have? You're not saying you're not what? I'm not saying I'm not healthy. You're not saying you're saying you're healthy? I'm saying I'm healthy. Okay. I'm saying I'm fine right now. You're saying you're fine right now.

I'm fine right now. Now, can we flash back to 20 minutes ago when you said you're incapable of feeling like you've done a good job for the day, but still you resolutely refuse to seek out any sort of therapy whatsoever. Explain that to me. I'm hoping back saying that for like a half hour,

and it's making me feel a little loopy. So if you could just kind of pretend I'm a saw-bounds listener, like address for me please because there's an obvious dichotite There's an obvious contradiction in your in your actions. Here is why I'm saying you are you are you are Still a part of the problem as you sit here in front of me today What I am saying is and I have said this to many my colleagues and I always feel really guilty about saying it The when I was working to many of my colleagues and I always feel really guilty about saying it. When I was working non-stop doing outpatient and inpatient medicine before I backed away

from that and I was working 60 hours a week probably and then trying to also be your wife and a mom and a podcaster I guess and a human, just a person on earth. I got to a point where I didn't understand why I was doing any of it anymore, right? Like, why is this, how is this possibly what I chose? Now that I am doing my inpatient job and I am doing my volunteer work, and I have so much more time to be at home with our family, to do our show and feel like I can put the time into it to do a good job with it. I am much happier. I am much more at peace. I'm not saying that you can get rid of trauma in a year or two. It takes longer to work through all of that. But I have been lucky that I can do that and I can have these other things in my life. A lot of my friends and colleagues cannot.

What I'm getting to is the student loans. The student loans that people are saddled with, sometimes hundreds and hundreds of thousands of dollars, they're stuck. And I know they're suffering. I do feel like some survivors guilt sometimes, because I feel like I have been able to distance myself just enough from it that I can still be a doctor and take care of people, but I don't have to be at the mercy of the system in the way that a lot of my colleagues still do.

And it makes me very sad, but I don't know. It's so big. It's also big. Thank you so much for listening to this episode of sawbones Thank you to the taxpayers for the use of their song medicines is the intro and outro program and thanks to you for listening Hey, we did a live show we could mention last week because we didn't have an episode we did a live show Virtual live show if you go to you can still watch it. It was live last week. You can still watch it bit.aui-ford-slash-m-b-m-b-a-m-virtual. And you can, I think for another, I don't know, 10 days as you listen to this, I can't say exactly. But you could listen to

it. So go check it out. It was about TikTok, a health trend, so it was fun. A little lighter than this particular one. Much lighter. Just a little bit. Thank you so much for listening until next time. I name it Justin McRoy. I'm Sydney McRoy. And as always, don't drill a hole in your head. Alright! Maximumfun.org

Comedy and Culture Artists don't? Audience supported