Episode 15: Burnout in Medicine

Milena Garcia: Welcome back everybody. Thank you for joining us this week. My guest is Dr. Lori Helgoe. She's a clinical psychologist and Associate Professor of behavioral sciences here at Ross University in addition to being an educator.

Dr. Helgoe is an internationally acclaimed author and public speaker with the special interest in their relationships between personality and culture, she's written books about narcissism and introversion, and she's been interviewed and quoted internationally and she finds the time to paint. Dr. Helgoe thank you for joining us. We appreciate it. Please let's take a moment to have you introduce yourself to our audience.

Laurie Helgoe: Thank you so much. Milena! I am happy to be here to talk about burnout and in fact that when I reflect back on the start of my journey that got me to Ross, I wouldn't have known it at the time, and it took me several years, maybe decades. But I practice as a psychologist for a good part of my career and was working in a busy clinic when I actually went through my own psychoanalysis as a part of my training as well as my own mental health maintenance and I was in a session and I found myself saying I don't like my life right now.

 Wow, that's the problem. I'm still paying off student loans and I don't like what I'm doing. And it wasn't that I didn't love the field of psychology, because I did and I do, but it was because my career had become rather one dimensional, and I found that I needed an outlet for both learning and teaching as well as practicing and Ross University has really given me that outlet. So I'm able to do both the consultations with students about their clinical skills and bring my psychology background to that. But I also get to think and teach and consider ideas and that part, that creative part of what I do is very important to me.

 

What is Burnout in Medicine? 

Milena Garcia: And it's a pleasure to have you with us. We appreciate you taking your time and to bring attention to this very urgent topic of burnout in medicine. Doctor Helgoe what is burnout in medicine, and why is it important to take notice?

Laurie Helgoe: Well, one of the definitions of burnout that I find compelling, perhaps a little depressing, but it is, I think, very attention, giving is that it is a kind of erosion of the soul. And in fact, in my own experience, I can attest to this, it is kind of becoming one dimensional. We become just what we do. So there's three facets of burnout we look at: one is emotional exhaustion.: You are putting yourself out. You're giving, you're giving, your giving. And at some point, you're not getting replenished. There's nothing left. And it's different from physical exhaustion. You may have that as well, but it is more this sense of not being able to restore yourself, restore your energy, your drive, your passion for what you do.

So emotional exhaustion is one facet. Then there's also deeper realization, and this is very sad because none of us feel good when we see ourselves experiencing this, but this is kind of the yeah go ahead and tell me your sad story. I don't care. It is the scene, a body and not a human for for doctors, it is a cynicism and, you know, a sense of, you know, when we find ourselves depersonalizing we more likely need to vent about patients or colleagues and we are really detached from it is what it is that we're really here to do. And then the third facet of burnout is a sense of a lack of accomplishment and along with that comes a loss of meaning. It's kind of the, what's the use, what am I doing here. I don't care. Or I can't do any good. So there may be, and it's very easy in the medical profession and in medical studies. To get to that point where you feel overwhelmed. Do you feel very small in relation to what you have to know or what you need to, and that can become overwhelming. So we look at those three dimensions as signs of burnout.

Milena Garcia: And when do you see the signs start showing?

Laurie Helgoe: Unfortunately, we see it pretty early in medical education students who come into medical school. They aren't really that much different in terms of mental health and students going into other graduate professions, but the process of being in medical school threatens to degrade mental health. So we see depression, two to five times more prevalent among medical school students said among their same age peers. We see increased levels of anxiety and certainly the burnout can definitely happen in medical school. So all those symptoms can become apparent even before you become a doctor.

How to Combat Burnout in Medicine?

Milena Garcia: And what are we doing here at Ross University to reverse the trend?

Laurie Helgoe: So that's what excites me because I, and I think that's part of what became the ultimate fit for me is that I have studied self care throughout my career, I've been my own patient, in a sense, in that regard. And I think the medical profession is very, very good at having a service orientation and outward focus and these students are amazing in their commitment to service and into making the world a better place. What often can be missing unfortunately is pointing that back at themselves and looking at what they need. So at Ross, we have a number of resources, one is our wellness and counseling center.

Milena Garcia: Which in fact I'll do an episode on them specifically. So, good idea. Thank you.

Laurie Helgoe: Yes, that's great. And they are wonderful, and in fact have expanded what they provide beyond counseling to coaching services. So they really try to always be looking at the needs of our students. They do mindfulness workshops, testings, IT workshops. So they have a lot going on and they have been a staple of Ross, for sure. So I'm glad you're featuring them.

Milena Garcia: What a great idea. Yeah. So everybody check back. We're doing a whole episode entirely on the Counseling Center.

Laurie Helgoe: Fabulous. Something newer is something we're calling the Mind-Body Medicine Initiative. Mind-body medicine isn't our label, it comes from the Center for mind body medicine and I went through their training. I have colleagues who have been through that training or going through it and what we provide in second semester and we have just, we're just rolling this out for more and more students. It's in the pilot stages now. Its an eight week small group.

Two hours a week that just allows students to step away from school and study and talk with other students about what it is they're experiencing in the moment. Which is not, it seems like a simple things, but we often don't pause to ask us. So that's part of it. And that self awareness and that sense of sharing and community that develops from that. And then we also have an experiential component where we learn together and practice on mind body skills, so that may be contemplated meditation, it doesn't need to be the lotus. I can't do that.

Expressive meditation, mindful eating, use of writing.  So there's a number of skills, a different one taught every week and experienced and then between sessions we practice and we make discoveries about what works for us.

RUSM and the Mind-Body Initiative

Milena Garcia: Can you tell us a little bit more about the mind body initiative?

Laurie Helgoe: Yeah. So once the students have been through that program, another exciting component of that is that they then are eligible to become mind body ambassadors and so then they share with other students, their skills and a good example of that was not only with students, but with colleagues faculty and staff. On National Physician Suicide Awareness Day, the mind body ambassadors held an observance, where they we had a moment of silence to honor those who have we have lost but also they let us in some deep breathing and some shaking and dancing and I had a colleague, a dean, who said this was the most relaxed, he had ever felt in the middle of a workday.

And they were. It was just a very powerful session students and some faculty shared from their experiences and they think all of these things are part of changing the culture of medicine so that we're not just about being on the iPad and all knowing healers, but we are also huge humans who have stories to tell and have a need to be replenished and need connection.

Milena Garcia: And as you know, I was a participant in it as a staff member, to speed it into my body medicine that was available to us a couple months ago and really could see the results, even though I couldn't really explain how but I, you know, we all felt less alone. I think it was the usual feeling, so I know it it worked for me. What about for the students? How do we measure the benefits or are you measuring the impact it has on our students?

Laurie Helgoe: Yeah, I'm glad you asked that we are actually engaged in a study. The first phase is a pilot. So we're just using focus groups, talking to students who are in it, have been through it. Talking to colleagues, I went through the group as a part of my training. I've been in a couple groups. And yeah, so we're trying to really look very closely at what the benefits are of this and we have some theories about that. There's some evidence. But one thing that's really exciting is that we will be conducting the first randomized control trial of mind body medicine in a medical education setting. And so we that that should be a big contribution to the conversation right now because medical schools all over are adopting these kinds of groups to help the students

But I can say, just in terms of what we're observing, what students have talked about, students have talked about self awareness as being one benefit. And one thing that is unique about these groups. And I think it's speak to what you shared Molina, is that ability to tell your story, to share whatever it is going on. Nobody's interrupting you, and nobody's fixing you. People are just bearing witness to what you say, and when they share, they talk about their own experience. And what we find is that, oh my gosh, you just said. Exactly what I'm experiencing and when people make those connections. It is life changing because especially with medical students there tends to be a lot of posturing, like, yeah, yeah. Piece of cake. Every either we have we have two strings, we have like the posturing, like, you know, there's that cultural competition or we have the other extreme, which is that bragging about how burnt out I am and how overworked I am and what a martyr, and neither of those tells the whole story. And this is a forum where we really get kind of underneath the surface of those, those kind of positions that people tend to take

How to Avoid Burnout in Medicine

Milena Garcia: I felt it personally. I feel like you're talking to me about me. And it works. I don't know how, I don't have the scientific background to justify and explain like you have, but I tell you, it worked. We always think that prevention is better than remediation right? Is there a way to avoid this? How do we become burnout proof? Is there a way to avoid it, and how do we help our students become burnout proof?

Laurie Helgoe: Right. So I think that there's not a way to avoid any of the symptoms of burnout. There are probably some mindfulness gurus out there who really can stay in this centered place all the time. But I think more realistically, we get thrown about a bit. But I think what makes us burnout proof is self awareness, it is being able to notice the signs to be. It's a part of emotional intelligence to be able to tune into whether it is your feeling that certainly then can translate to your ability to pick up on the feelings of a patient. For example, if you know how to respond to yourself, that's the starting point. So it is really I think that self awareness to that. Oh yeah, I see that I'm becoming cynical, I see that you know I'm complaining all the time about everybody in my life. I see that the joy is gone. Okay, time to pause and think, see what needs shifting

So I think that's a big one. I think the ability and that mindfulness is a buzzword now, but I think it is really about being able to actually see what's happening in the moment and to distance ourselves a little bit from the noise of what goes on in our heads.

Milena Garcia: And it's nice that medicine is finally taking notice of this urgent need. Do you have any tips on how to manage the stress of medical school?

Laurie Helgoe: Yeah. And what is behind me- so I do painting and I didn't intend this as an object lesson but it kind of is because when I'm painting, it is a form of mindfulness, because I don't see what's around me, and when I paint, I have to actually look at what’s on it. What's in that photograph. And it's often not what I think it's gonna be, you know? Faces have all kinds of colors in them and lines that you don't necessarily notice because you're looking at the whole thing. And so I think that the incoming curious about all there is, that is out there. There's a ton of resources, little tips, little ways of doing mini-Mindfulness exercises throughout the day, becoming curious about that. Just as you are also curious about medicine is going to set you on a lifelong adventure with self care.

The other thing, and it's related again to  my painting or reminds me of my paintings,  is not to let go of your nonmedical interests. I mean, there is a danger and it happened to me when I was in this busy clinic. I was exercising one muscle. And that is a real risk, but one thing and the learning experts will tell you this, when your heads are always in your books, your head starts to get muddled. You lose perspective and you actually become less efficient as a learner. So beyond that, there's evidence that suggests that engagement in humanities is related to less burnout, which is fascinating.

So this excuse that I don't have time to paint, if you're interested in theater, if you're interested-- I have student hip hop dancers and students have interest in fashion. It's one of the first questions I asked them, What are your nonmedical interests? One student was telling me how she and her husband go boxing, go to a boxing gym. They go and they love punching.

Milena Garcia: This is their therapy or marriage counseling. Is that what? You know, for some of us it’s baking. For others, it's boxing.

Laurie Helgoe: And another thing that can very much engage the senses and help you tune into the process.

Milena Garcia: Great. These are all great tips. Thank you so much for sharing with us. Really appreciate you taking your time. What about any last two recommendations or advice for a future Rossies?

Laurie Helgoe: Really, I think the students that I see thrive are the ones that stay joyful. They maintain that fascination with medicine. And so sometimes it's work to do that when you're memorizing, you know, all the muscles. You're, you're trying to understand something very abstract. That's hard. Really to to relate to as but but i think it is when you have that beginner's mind and again, seek joy through other means. I mean, getting connected is very important. With that, too. They're in medicine. Now in around the country in the US.

There's something called meaning in medicine groups. And the reason for that is that as long as you continue to connect with the meaning of what you're doing, that again is a prevention of burnout. And so I think that there are clubs. There are ways to connect with students through study groups. There are ways to stay involved in athletics, again in the arts, whatever it is, but that helps you feel alive. I don't just expect somebody to do it for you. Attend to that, right? Attend to be alive.

Milena Garcia: These are all great suggestions. Thank you so much for joining us. I appreciate you taking your time once again and for everybody listening. Thank you for joining us. We appreciate you, appreciate your time and we will see you next week.

Laurie Helgoe: All right, thank you so much. I've been. I've really enjoyed this.