MedPEP PHS - Physician Health Services

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 MedPEP.org/CME.

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

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.

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.

Dr. Steve Adelman, founder of MedPEP and 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.

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.