October 30, 2020 • 32 mins
Dr. Peter Yellowlees, chief wellness officer of UC Davis, joins Dr. Verret for a discussion about the programs he has implemented and participated in to maintain physician mental health. The top three focusses on the top three things physicians can do if we are feeling depressed.
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Announcer (00:00):
Ask Me MD, medical school for the real world with
(00:03):
the MD Dr. D.J. Verret.
Commercial (00:06):
Greetings and welcome to another edition of
Ask Me MD, medical school forthe real world. I'm Dr. D.J.
Verret. And today we continueanother edition of our physician
mental wellness series bytalking with Dr. Peter
Yellowlees, the chief wellnessOfficer of UC Davis Health,
about the programs he'sinstituted to maintain physician
(00:27):
mental health. We'll talk withPeter right after this.
Commercial inserted hereWelcome back to Ask Me MD,
medical school for the realworld. I'm Dr. D.J. Verret. And
(01:57):
today we have the great pleasureof being joined by Dr. Peter
Yellowlees, psychiatrist andchief wellness officer at UC
Davis. We're going to be talkingabout physician well being Dr.
Yellowlees. Thanks for joiningus.
Peter Yellowlees, MD (02:12):
And we'll thank you very much for having
me, D.J..
Commercial (02:14):
I, I was very impressed with the work that
you're doing out there, which iswhy I reached out but for those
of our listeners who aren'tfamiliar, could you tell us a
little bit about yourself andyour background?
Peter Yellowlees, MD (02:27):
Oh, I mean, I'm a sort of fairly
fairly, pretty pathetic person.
I was born and brought up inBritain and went to medical
school in London at UniversityCollege London. I then moved to
Australia and spent 20 years inAustralia where I've trained in
psychiatry, and did a PhD, andgot used to treating cancer
physicians. And I've always hadphysicians referred to me as
(02:50):
patients. And then I gotrecruited by the University of
California, back in about 2004.
And I've been on faculty thereDavis ever since. And continue
treating physicians as patientswere my psychiatric pap. But for
the last 10 years or so I'vebeen chair of our well being
(03:12):
Committee, which is a Jaycomandated committee that all
health systems have to have thatis to support and help
physicians with possibleimpairment from either
psychiatric or substance relatedproblems. And then finally, I
guess, the health system set upa position of Chief wellness
officer about two years ago, forand I was appointed to that. And
(03:36):
in that role, which is ahalftime role. My main
responsibility is actuallytrying to change the culture of
our health system to change theway we work organizationally.
And to make life easier and moreefficient and more acceptable
for physicians. As part of that,I clearly also work across with
(04:01):
other disciplines. So there's alot of work with with the nurses
in particular, but also with allof our staff. So it's really
interesting. It's all aboutactually keeping our our health
workers healthy. And obviouslyin COVID. That's been difficult
at times. But I think it's arole that increasing numbers of
(04:22):
health systems around thecountry are taking up. Because
in reality, if you don't lookafter your health workers, they
can't look after your patients.
Commercial (04:29):
And I know that as part of that role as well.
You've started some work withthe local medical society in joy
medicine program. Can you tellus a little bit about what that
program entails?
Peter Yellowlees, MD (04:42):
Sure. So this is the Sierra Sacramento
Valley Medical Society and youknow, most areas have their own
local medical society. As hasabout 6000 members here in
Northern California across sixcounties. And this is a program
run by the SSVMS. I just happento be involved in it among the
(05:02):
the sort of committee thatmanages the program, but really,
it's a program run by the svms.
And I'd encourage anybodylistening to go to SSVMS.org.
And put in joy of medicine. Andyou'll get all of the details of
the program. And so essentially,what is a program about it has a
range of different facets to it.
(05:23):
And there are regular talks,and, and an annual educational
summit, which in fact, thismonth, or this year has been run
across a month. So instead ofhaving a full day of education,
it's been two hours a week, forfour weeks during September. And
I think it's gone very well. Weorganize for essentially a
(05:48):
series of support services forphysicians who may be suffering
from burnout or otherdifficulties. So the ssms
actually pays for free coachingfor up to six sessions per
physician. And we've had wellover 100 of our local physicians
take out this option of going tosee a coach. We've also set up a
system whereby any physicianfrom our region can urgently be
(06:11):
seen by one of our psychiatristshere at UC Davis. So we have
essentially a quick route forphysicians to get psychiatric
care if they if they need that.
And obviously, as you will know,it's sometimes very difficult to
get in to see a psychiatrist. Wedo a lot of educational things.
So we regularly run podcasts.
(06:32):
I've been one of thefacilitators of us for the last
few months. And we have a lot ofresources about physician well
being, we organize a series ofmeetups, which, prior to COVID,
with physical meetups inpeople's homes, and in COVID,
they've been obviously virtual.
And then we also about 18 monthsago did a survey of all of our
(06:55):
members looking at not just theprevalence of stress and
burnout, but also what othertypes of services and whatever
types of assistance with thelocal doctors want from a
medical society, and from fourbig health systems that all work
in our area. So it's a veryactive, busy program. And it's
(07:17):
something that I think all localmedical scientists should really
think about as, as a real valueto physicians, particularly
physicians in private practice,who can get very isolated at
times.
Commercial (07:33):
That is a fascinating program. And I
totally agree, I in our area,probably 50 plus percent of the
physicians are in privatepractice, in that isolation is
very real for them, I can I canspeak to it personally. It gets
difficult when you're not inthat large group setting to make
(07:54):
those connections and startfeeling isolated and and just
kind of get down in the dumpssometimes. I think that's true.
And I think,
Peter Yellowlees, MD (08:02):
you know, one of the one of the more
popular elements of ours hasbeen the meetups that have been
arranged. And it's not andagain, obviously, people in
private practice find thathelpful. But, you know, I work
for a major university system.
And yet I don't get to meetcolleagues who work for maybe
for Kaiser or for solder or forsome of the other health systems
(08:24):
in our area. And so it actuallygives us the opportunity of
interacting with colleagues inother systems that we simply
wouldn't normally have.
Commercial (08:35):
I'd like to talk a little bit about just about
physician burnout, in suicides,mental health, and kind of maybe
some things that you've seenthat have worked to help
physicians stay mentallyhealthy. You know, physicians,
obviously, statistics showsuffer suicide at a rate
probably double the generalpopulation. But is that
(08:58):
something that is ispredestined? Or is that
something that evolves over timewith the job?
Peter Yellowlees, MD (09:05):
I think it's certainly not predestined.
I mean, we know from lots ofstudies that when we'll enter
medical school, that wereactually psychologically
healthier than equivalentgraduate students entering PhD
programs, for instance. So weknow and we know that it's very
difficult to get into medicalschool, you've got to be able to
(09:25):
jump a lot of hoops and be veryresilient to do that. So we know
that inherently physicians areactually highly resilient people
we have to be to get through thesystem. We we were working, but
we do work in a really horriblesystem. I think it's really we
need to be very clear aboutthat. The the organization of
healthcare is pretty chaotic,across the whole of this country
(09:48):
and in many other countries.
And, and I think professionally,we have some real deficits in
our professional culture. One ofwhich is you know, The denial of
our own needs in the Hippocraticoath, for instance, there is no
mention of the needs of aphysician to look after
themselves to be able to lookafter other people. And so we we
(10:08):
tend to get trained in a culturethat, that says that 100 hours
work a week is fantastic, thatwe can really do well, without
sleep, that if we're reallytired, then maybe, you know,
some, some glass or two of wineis the best treatment, you know,
or beer or whiskey or whatever.
(10:33):
And that we should treatourselves for our own problems
rather than having a primarycare physician. And so we tend
not to get good treatment, whenwe have either potential
problems with a mental healthproblems or physical problems.
And, and we, we tend to denialor only deny our own needs nice.
(10:56):
So I think there's a huge reasonto change the culture of
medicine. So first of all, itbecomes much more reasonable to
get help when you need it, forwhatever reason. Secondly, that
we need to be able to actuallytalk to our colleagues when we
see our colleagues becomingunwell. And take them aside
(11:16):
carefully and quietly, and havea chat with them and suggest
that they get help. You know, ifyou're like me, DJ, you've
probably seen colleagues in thepast who you knew were having
difficult times, but who youwere too embarrassed to talk to
about. And so we need to beprepared to help ourselves and
help our colleagues. And then weneed to have at good access to
(11:40):
care in a way that is notstigmatizing. And, and
relatively easy to organize. Andso all of these things need to
be we need to change a lot ofthings about our whole
profession, and about the way weare organized and the way we
work. It's really I mean, soundsridiculously simple. But, you
(12:00):
know, if we don't do this, thisis going to be more and more
suicides.
Commercial (12:04):
You mentioned looking out for our fellow
physicians, and and I have seenother physicians who I know are
stressed. What do you see is thebest way, though of approaching
them in a way that becomesconstructive and doesn't end up
pushing them further away?
Peter Yellowlees, MD (12:23):
I think that's a really great question.
And actually, that's somethingwe're training our residents to
do at the moment. And in fact,the double AMC and a number of
other groups are actually takingthat particular issue on as a
specific sort of learningobjective for the younger
physicians. So So the bestapproach, quite honestly, is to
(12:47):
just try and take your colleagueor your friend, somewhere that's
fairly neutral, I've done thison several occasions during my
career, I actually tend to tryand just go out to a local
coffee shop, and just say tosomebody, hey, look, you know,
we haven't caught up for awhile, you know, I'm just a bit
concerned about your How about,now we're gonna have a bit of a
chat about it. And they, andthen just suggest that you go,
(13:09):
you know, outside of the normalwork environment, go somewhere
neutral, go somewhere where ifthey get embarrassed or start
getting distressed, you know,it's actually a safer place for
them. And, and then just try andlisten to people just learn to
listen, as physicians, we tendto want to fix problems too
(13:30):
quickly, sometimes. And in thesesituations is much better, just
to give the person theopportunity of talking about
what the issues are. And listen,sometimes listening is all you
need to do. Obviously, if youthen know off resources to help,
that's great. But the firststage is just acknowledging that
was a problem and listening.
Commercial (13:52):
Obviously, it's one thing to identify a friend who
may have an issue, but it'sanother to kind of come to that
self realization. There's a lotof discussion in physician
boards, message boards, I seeabout people feeling burned out
and wanting to leave medicine.
Are there specific things thatyou've noticed in the practice
of medicine? I know you've saidthere's systemic issues there,
(14:14):
their personal care issues, butis there something specific that
you've noticed that reallypushes physicians towards that
feeling of burnout?
Peter Yellowlees, MD (14:25):
Yeah, I think we, we need to start
acknowledging that actuallybeing a physician can be quite
traumatic. And that we get sortof exposed to a lot of painful,
difficult and distressingincidents. And unfortunately,
(14:45):
we're trying to just deny this.
We're trying to sort of, youknow, take a stiff upper lip and
carry on working and, and youknow, if we can, we have a
distressing time with onepatient, we somehow got to pull
ourselves together and becompletely on top of everything.
So The next patient. So I thinkwe've got to start thinking
about the whole sort of World oftrauma, and the incidents that
(15:06):
affect us, and how can we bestlearn to cope with those in a
way that is helpful for us andallows and keeps us fit, rather
than just, you know, denying thewhole problem. So for instance,
one of the programs that we'redoing at UC Davis at the moment,
is training a lot of physiciansand nurses and other staff in
(15:28):
the, in essentially the processof what we call psychological
first day, which is really thecapacity to listen well to
someone, and to then assist themand organize resources and
referrals, if necessary, butacknowledging that there are
traumas and there are difficultincidents that we all have, and
(15:51):
giving people a chance torecover from those. It's very, I
mean, it's actually soundsridiculously simple. But it's
not something we tend to do asphysicians, we somehow feel
we've got to be the heroes allthe time.
Commercial (16:10):
Is there a way to know, as physicians, we kind of
look at administrators as thethe penny counters of the
organizations? Is, is there beena quantification put on? Or is
there some framework, we couldquantify the dollars and cents
of physician of the importanceof physician mental health to
(16:30):
larger organizations?
Peter Yellowlees, MD (16:33):
And yes, there absolutely is. In fact,
there's been some very nice workdone by Stanford and by some of
his colleagues at Mayo, where heused to be looking at leadership
in particular, and the costs ofburnout. And we know that in the
US, the the average burnt outphysician costs, the health
(16:58):
system, they work for about$6,000 per year. And if you
assume that somewhere between30, and 40% of your physicians
are showing some signs ofburnout, that becomes a very
considerable cost. And it'ssomething that health systems
are now very aware of, andincreasingly become aware of. So
I think that that brings you onto, again, the culture of health
(17:20):
systems. And then over the last15 2030 years, they've clearly
been excessively driven from afinancial perspective. And my
view is that the main single, Iguess, talent that CEOs of the
future will have is empathy, andthe ability to actually look at
(17:41):
how do people feel about theirwork? How are they coping? How
are they managing? How can weimprove this situation? And how
can we therefore, essentiallyget more out of them, but but in
a more effective way. And Ithink we have to really look at
our leaders and and startthinking about leaders as
(18:02):
needing to have a very differentmindset from a lot of the
leaders of the last two or threedecades.
Commercial (18:10):
It's interesting, you bring up the word empathy,
I'm actually listening to a bookby Alan Alda. And all the had
created a communicationsInstitute at Stony Brook
University that aims to improvecommunications between
scientists and people they'retalking to, in particular
doctors and their patients. Andone of the big things that they
(18:33):
talk about is exercises toimprove empathy of physicians
and communicating with their,with their patients. And you
bring it up that improvingempathy of the CEOs with their
doctors, it seems that there'sprobably more empathy to be have
on on had on every level.
Peter Yellowlees, MD (18:50):
I think that's true. And you're
absolutely right. I mean,there's a ton of evidence to
show that if you are a moreempathic person, that you
communicate better with yourpatients, your patients actually
do better, they like you better.
And ultimately, you're able tobe a better physician.
Commercial (19:08):
When we talked a little bit earlier about
independent physicians feelingmore isolated, the need for kind
of systemic system changes. Whatwhat steps though, could be
taken by independent physiciansto either recognize or hopefully
prevent burnout. Is there. Isthere something that you've seen
(19:29):
that has worked on on the moreindependent level?
Peter Yellowlees, MD (19:34):
Yes, um, I mean, I'm like you have been in
private practice in the past inmy career, and I really get how
lonely and isolating that canbe. I mean, I think the key most
important thing is to keep wellconnected with some colleagues
and to ensure that you havepeople who you can talk to about
(19:55):
difficult patients difficultproblems, that you have some
collegial process going. Andfriendships, you know, with that
are useful both professionallyand personally. And you actually
need to make the time to that.
And, and that's got to be partof your work plan. So you know,
(20:15):
you shouldn't be bookingpatients in 1012 hours a day,
556 days a week or longer, youneed to give yourself some
breaks and, and see a membershipin a local medical society, or
going out to dinner with groupsof colleagues or meeting people
at the gym, or going on runstogether or cycling together in
(20:39):
groups of colleagues or playinggolf, you need to see those as
being really important self helpapproaches to life, it's not
just a matter of taking a bit oftime away from patients is
actually giving you positivetime for yourself. I think one
of the dangers of privatepractice is that the financial
side, you know, becomesoverwhelming for many people.
(21:02):
And they somehow feel that ifthey take a few hours off, they,
they that's quantified at acertain dollar level. But in
reality, they should be thinkingthat if they don't take that
time off, then they're not goingto be investing in themselves to
the same extent. So I thinkwe've got to start taking that
sort of self investment mindset.
(21:24):
For for people in thatenvironment.
Commercial (21:28):
You mentioned that you were moderating a podcast
for the Medical Society in thejoy of medicine program. It's
it's, it's fascinating, theyhave some great stories. Are
there any in particular thatyou've heard, or even maybe from
your experience of physicians,who seem to have been burned
(21:48):
out, but reinvented themselvesthat you think would be
educational for some of ourlisteners.
Peter Yellowlees, MD (21:56):
And I was done. I mean, this, this was
probably about 20, to 25.
Examples of physicians beingbeing interviewed on that
particular podcast, several ofthem certainly have been burned
out, the thing that hasimpressed me most, quite
honestly, has been theextraordinary range of
backgrounds that they've had.
(22:19):
You know, there's a couple ofphysicians I've interviewed who
come from one from Russia thatare very well, who had just
overcome an quite amazing numberof barriers in her life, to be
able to become a physician inthe United States and to be very
successful at her job. And it'squite extraordinary and humbling
(22:44):
to see what some physiciansactually do. To be able to get
to what is still a very valuedand important role. within our
society, it's not an easy thingto succeed as a physician. And
so so I've that's what surprisedme most, really trying to
(23:05):
identify those stories and findpeople who've got this sort of
unusual background, and who'vereally overcome incredible
barriers.
Commercial (23:15):
Have you seen in interviewing the physicians,
have you seen a common threadthat led them to the burnout
that you weren't expecting fromyour previous experience?
Peter Yellowlees, MD (23:29):
Well, I think first of all, there's two
groups of physicians, we shouldthink about here, physicians
that are generally featured onthe podcast are not typically
physicians who have been burntout their their physicians
who've been doing actually verywell, and have come from, you
know, maybe an unusualbackground or, or who've learned
successfully how to manage theirstrengths. I mean, when I see
(23:52):
physicians as patients, it's nota different ballpark. And, and
typically, you know, what youfind is that, that they have got
into a cycle whereby they aregetting stressed, they've got
problems, whether it's personalproblems at home, or, or
problems at work, perhapsproblems with an EMR or, or some
(24:16):
other very specific issue. Andthey have got into the cycle
whereby they just think if onlyI worked a bit harder, I'd solve
this problem. And if youremember back in medical school,
that's what we were all taught,we were just taught, you know,
if you worked hard enough, you'dget good scores in the steps.
And, and so a lot of physiciansuse that as a mantra in life.
(24:40):
And if they, you know, almostany problem can be overcome if
they want to work a bit harderand do a few more hours. And so
that's what they do, and then itdoesn't work, and it fails and
then they get mad when theystart not sleeping and they're
not looking after themselves.
They give up the physicalfitness activities. The gym
anymore. And they graduallybecome anxious and depressed.
(25:03):
And so I see the symptoms ofburnout as being really almost
a, a marker for potentialdepression or anxiety. burnout
is not an illness per se. It'snot a psychiatric illness. It's
a it's essentially a stressresponse. And, but it's but
there's no question if you areburnt out, and then it it can
(25:26):
make you much more vulnerable todeveloping psychiatric
illnesses. And then, forinstance, getting referred to
someone like myself.
Commercial (25:38):
We're talking with Dr. Peter Yellowlees,
psychiatrist and chief wellnessofficer at UC Davis. You're
listening to Ask Me MD, medicalschool for the real world. We're
going to take a short break. Andwhen we come back, we're going
to talk the top three with Dr.
Yellowlees.
Commercial inserted hereWelcome back to Ask Me MD,
(26:23):
medical school for the realworld. I'm Dr. D.J. Verret. And
today we've been talking withDr. Peter Yellowlees,
psychiatrist and chief wellnessofficer at UC Davis. This
afternoon, we're going to askDr. Yellowlees, his top three
and Peter, the top three, I'mgoing to throw your way or what
are the top three things youwould suggest to physicians who
(26:45):
are feeling burned out?
Peter Yellowlees, MD (26:50):
So I think it's, first of all, acknowledge
the fact that you're feelingburnt out. And if necessary, do
some reading about it. Thinkabout the symptoms you've got
think about why was it you gotirritable with the with your MA
in clinic? No, earlier on in theday? Or? Why? Why are you
(27:10):
thinking of patients as numbersrather than people. So firstly,
you know, acknowledge that thatthis is not normal for you. And
this is not why you came intomedicine. And I think the second
thing is really, very simplething that we don't get our
patients to do enough, isactually write down what you do
(27:33):
during the week. And writeyourself that write out your
schedule, and look at yourschedule, in terms of the amount
of time you're working, theamount of time that you are
doing things you really enjoy,you know, being with your
partner, you know, the hobbies,interests, and keeping fit. And,
(27:56):
and then the amount of time thatyou're, you're sleeping, and,
and unrest. And, and you'll findthat physicians typically have a
lot of time at work, not notenough time of sleep, and
certainly not enough timeenjoying themselves. And, and
(28:16):
but actually try and be honestabout it. So so if you if you
get people to say, to do thisexercise, and also at the same
time save them. So what are yourreal passions in life? What do
you really like doing? And, andget them to quantify the amount
of time they actually do that.
So people will say, Well, I lovegoing to art galleries and
studying painting. And then youfollow up and say, Well, look,
(28:41):
how many times have you donethat? How many hours have you
spent on that in the last month,and and those people who are
burnt out will typically havedone very little of that. And
so, so look at what people likedoing it, and then actually how
much time they spend on it. Andfinally, look at other things
you're doing that are really nothelpful. Like, are you drinking
(29:06):
too much? Are you taking toomany substances? Are you taking,
you know, sleeping tablets, forinstance, that you really don't
need? Are you putting on a lotof weight? You know, are you are
you doing other whole otherthings that that you're actively
doing at the moment that they'rereally not good for you? And can
you change those? So so it'sreally, those, I guess those
(29:29):
three areas would be things thatI would suggest for any
physician to do, who's startingto feel feel burned out, and
then actually challenge yourselfto change and maybe change with
your wife or your husband or afriend or a colleague and do
things together. But it's oftenvery much easier to change when
(29:51):
you're when you're actuallydoing something with someone
else.
Commercial (29:57):
I love the suggestion of actually writing
things down, I think. And I hearit in a lot of different areas.
But I think if you write it downand you actually see it on
paper, you can no longerlegitimize it mentally, when
it's actually concrete and infront of you, you have to accept
that. That's actually what'sgoing on.
Peter Yellowlees, MD (30:19):
Right, exactly. I mean, a ton of people
say they really like sports.
Okay. So ask them, you know, howmany times have you actually
seen the local team in the lastmonth? How much time have you
spent on that? How much timehave you played yourself? And,
and you're right, I mean, seeingit written down objectively on
paper, it's actually hard tofind so many people.
Commercial (30:41):
Peter, thanks for joining us. That's some great
information. I think,unfortunately, several of our
listeners will probablyrecognize the symptoms that
you're seeing, but I'm hopingthat the information you've
given the ideas you've givenwill, will kind of help turn
them around as well.
Peter Yellowlees, MD (30:58):
And if I can just make one last quick
comment, because we've talked alittle bit about suicide if in
fact, anybody listening to this,you know, is suicidal, please
talk to somebody else. Please.
And if you know somebody who youthink is suicidal, talk to them.
Nobody ever gave anyone the ideaof suiciding. So it's an it's an
issue that you should bring out.
(31:19):
If you're concerned about it,don't hide it, and then get
people some help. If you need todo that.
Commercial (31:27):
I absolutely agree.
I don't think we should lose anyphysicians. And just to put it
out there, there is always theNational Suicide Prevention
Lifeline 1-800-273-8255 24 hoursa day, seven days a week,
definitely reach out. Peter,thanks for joining us. I really
appreciate the time and as Isaid, some really great
(31:48):
information.
Peter Yellowlees, MD (31:50):
And thank you very much, DJ and good for
you for doing this podcast.
Commercial (31:54):
We've been talking with Dr. Peter Yellowlees,
psychiatrist and chief wellnessofficer at UC Davis about
physician well being you'relistening to Ask Me MD, medica
school for the real world. I'Dr. D.J. Verret. And until n
xt time, make it an awesome we
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Commercial (00:06):
Greetings and welcome to another edition of
Ask Me MD, medical school forthe real world. I'm Dr. D.J.
Verret. And today we continueanother edition of our physician
mental wellness series bytalking with Dr. Peter
Yellowlees, the chief wellnessOfficer of UC Davis Health,
about the programs he'sinstituted to maintain physician
(00:27):
mental health. We'll talk withPeter right after this.
Commercial inserted hereWelcome back to Ask Me MD,
medical school for the realworld. I'm Dr. D.J. Verret. And
(01:57):
today we have the great pleasureof being joined by Dr. Peter
Yellowlees, psychiatrist andchief wellness officer at UC
Davis. We're going to be talkingabout physician well being Dr.
Yellowlees. Thanks for joiningus.
Peter Yellowlees, MD (02:12):
And we'll thank you very much for having
me, D.J..
Commercial (02:14):
I, I was very impressed with the work that
you're doing out there, which iswhy I reached out but for those
of our listeners who aren'tfamiliar, could you tell us a
little bit about yourself andyour background?
Peter Yellowlees, MD (02:27):
Oh, I mean, I'm a sort of fairly
fairly, pretty pathetic person.
I was born and brought up inBritain and went to medical
school in London at UniversityCollege London. I then moved to
Australia and spent 20 years inAustralia where I've trained in
psychiatry, and did a PhD, andgot used to treating cancer
physicians. And I've always hadphysicians referred to me as
(02:50):
patients. And then I gotrecruited by the University of
California, back in about 2004.
And I've been on faculty thereDavis ever since. And continue
treating physicians as patientswere my psychiatric pap. But for
the last 10 years or so I'vebeen chair of our well being
(03:12):
Committee, which is a Jaycomandated committee that all
health systems have to have thatis to support and help
physicians with possibleimpairment from either
psychiatric or substance relatedproblems. And then finally, I
guess, the health system set upa position of Chief wellness
officer about two years ago, forand I was appointed to that. And
(03:36):
in that role, which is ahalftime role. My main
responsibility is actuallytrying to change the culture of
our health system to change theway we work organizationally.
And to make life easier and moreefficient and more acceptable
for physicians. As part of that,I clearly also work across with
(04:01):
other disciplines. So there's alot of work with with the nurses
in particular, but also with allof our staff. So it's really
interesting. It's all aboutactually keeping our our health
workers healthy. And obviouslyin COVID. That's been difficult
at times. But I think it's arole that increasing numbers of
(04:22):
health systems around thecountry are taking up. Because
in reality, if you don't lookafter your health workers, they
can't look after your patients.
Commercial (04:29):
And I know that as part of that role as well.
You've started some work withthe local medical society in joy
medicine program. Can you tellus a little bit about what that
program entails?
Peter Yellowlees, MD (04:42):
Sure. So this is the Sierra Sacramento
Valley Medical Society and youknow, most areas have their own
local medical society. As hasabout 6000 members here in
Northern California across sixcounties. And this is a program
run by the SSVMS. I just happento be involved in it among the
(05:02):
the sort of committee thatmanages the program, but really,
it's a program run by the svms.
And I'd encourage anybodylistening to go to SSVMS.org.
And put in joy of medicine. Andyou'll get all of the details of
the program. And so essentially,what is a program about it has a
range of different facets to it.
(05:23):
And there are regular talks,and, and an annual educational
summit, which in fact, thismonth, or this year has been run
across a month. So instead ofhaving a full day of education,
it's been two hours a week, forfour weeks during September. And
I think it's gone very well. Weorganize for essentially a
(05:48):
series of support services forphysicians who may be suffering
from burnout or otherdifficulties. So the ssms
actually pays for free coachingfor up to six sessions per
physician. And we've had wellover 100 of our local physicians
take out this option of going tosee a coach. We've also set up a
system whereby any physicianfrom our region can urgently be
(06:11):
seen by one of our psychiatristshere at UC Davis. So we have
essentially a quick route forphysicians to get psychiatric
care if they if they need that.
And obviously, as you will know,it's sometimes very difficult to
get in to see a psychiatrist. Wedo a lot of educational things.
So we regularly run podcasts.
(06:32):
I've been one of thefacilitators of us for the last
few months. And we have a lot ofresources about physician well
being, we organize a series ofmeetups, which, prior to COVID,
with physical meetups inpeople's homes, and in COVID,
they've been obviously virtual.
And then we also about 18 monthsago did a survey of all of our
(06:55):
members looking at not just theprevalence of stress and
burnout, but also what othertypes of services and whatever
types of assistance with thelocal doctors want from a
medical society, and from fourbig health systems that all work
in our area. So it's a veryactive, busy program. And it's
(07:17):
something that I think all localmedical scientists should really
think about as, as a real valueto physicians, particularly
physicians in private practice,who can get very isolated at
times.
Commercial (07:33):
That is a fascinating program. And I
totally agree, I in our area,probably 50 plus percent of the
physicians are in privatepractice, in that isolation is
very real for them, I can I canspeak to it personally. It gets
difficult when you're not inthat large group setting to make
(07:54):
those connections and startfeeling isolated and and just
kind of get down in the dumpssometimes. I think that's true.
And I think,
Peter Yellowlees, MD (08:02):
you know, one of the one of the more
popular elements of ours hasbeen the meetups that have been
arranged. And it's not andagain, obviously, people in
private practice find thathelpful. But, you know, I work
for a major university system.
And yet I don't get to meetcolleagues who work for maybe
for Kaiser or for solder or forsome of the other health systems
(08:24):
in our area. And so it actuallygives us the opportunity of
interacting with colleagues inother systems that we simply
wouldn't normally have.
Commercial (08:35):
I'd like to talk a little bit about just about
physician burnout, in suicides,mental health, and kind of maybe
some things that you've seenthat have worked to help
physicians stay mentallyhealthy. You know, physicians,
obviously, statistics showsuffer suicide at a rate
probably double the generalpopulation. But is that
(08:58):
something that is ispredestined? Or is that
something that evolves over timewith the job?
Peter Yellowlees, MD (09:05):
I think it's certainly not predestined.
I mean, we know from lots ofstudies that when we'll enter
medical school, that wereactually psychologically
healthier than equivalentgraduate students entering PhD
programs, for instance. So weknow and we know that it's very
difficult to get into medicalschool, you've got to be able to
(09:25):
jump a lot of hoops and be veryresilient to do that. So we know
that inherently physicians areactually highly resilient people
we have to be to get through thesystem. We we were working, but
we do work in a really horriblesystem. I think it's really we
need to be very clear aboutthat. The the organization of
healthcare is pretty chaotic,across the whole of this country
(09:48):
and in many other countries.
And, and I think professionally,we have some real deficits in
our professional culture. One ofwhich is you know, The denial of
our own needs in the Hippocraticoath, for instance, there is no
mention of the needs of aphysician to look after
themselves to be able to lookafter other people. And so we we
(10:08):
tend to get trained in a culturethat, that says that 100 hours
work a week is fantastic, thatwe can really do well, without
sleep, that if we're reallytired, then maybe, you know,
some, some glass or two of wineis the best treatment, you know,
or beer or whiskey or whatever.
(10:33):
And that we should treatourselves for our own problems
rather than having a primarycare physician. And so we tend
not to get good treatment, whenwe have either potential
problems with a mental healthproblems or physical problems.
And, and we, we tend to denialor only deny our own needs nice.
(10:56):
So I think there's a huge reasonto change the culture of
medicine. So first of all, itbecomes much more reasonable to
get help when you need it, forwhatever reason. Secondly, that
we need to be able to actuallytalk to our colleagues when we
see our colleagues becomingunwell. And take them aside
(11:16):
carefully and quietly, and havea chat with them and suggest
that they get help. You know, ifyou're like me, DJ, you've
probably seen colleagues in thepast who you knew were having
difficult times, but who youwere too embarrassed to talk to
about. And so we need to beprepared to help ourselves and
help our colleagues. And then weneed to have at good access to
(11:40):
care in a way that is notstigmatizing. And, and
relatively easy to organize. Andso all of these things need to
be we need to change a lot ofthings about our whole
profession, and about the way weare organized and the way we
work. It's really I mean, soundsridiculously simple. But, you
(12:00):
know, if we don't do this, thisis going to be more and more
suicides.
Commercial (12:04):
You mentioned looking out for our fellow
physicians, and and I have seenother physicians who I know are
stressed. What do you see is thebest way, though of approaching
them in a way that becomesconstructive and doesn't end up
pushing them further away?
Peter Yellowlees, MD (12:23):
I think that's a really great question.
And actually, that's somethingwe're training our residents to
do at the moment. And in fact,the double AMC and a number of
other groups are actually takingthat particular issue on as a
specific sort of learningobjective for the younger
physicians. So So the bestapproach, quite honestly, is to
(12:47):
just try and take your colleagueor your friend, somewhere that's
fairly neutral, I've done thison several occasions during my
career, I actually tend to tryand just go out to a local
coffee shop, and just say tosomebody, hey, look, you know,
we haven't caught up for awhile, you know, I'm just a bit
concerned about your How about,now we're gonna have a bit of a
chat about it. And they, andthen just suggest that you go,
(13:09):
you know, outside of the normalwork environment, go somewhere
neutral, go somewhere where ifthey get embarrassed or start
getting distressed, you know,it's actually a safer place for
them. And, and then just try andlisten to people just learn to
listen, as physicians, we tendto want to fix problems too
(13:30):
quickly, sometimes. And in thesesituations is much better, just
to give the person theopportunity of talking about
what the issues are. And listen,sometimes listening is all you
need to do. Obviously, if youthen know off resources to help,
that's great. But the firststage is just acknowledging that
was a problem and listening.
Commercial (13:52):
Obviously, it's one thing to identify a friend who
may have an issue, but it'sanother to kind of come to that
self realization. There's a lotof discussion in physician
boards, message boards, I seeabout people feeling burned out
and wanting to leave medicine.
Are there specific things thatyou've noticed in the practice
of medicine? I know you've saidthere's systemic issues there,
(14:14):
their personal care issues, butis there something specific that
you've noticed that reallypushes physicians towards that
feeling of burnout?
Peter Yellowlees, MD (14:25):
Yeah, I think we, we need to start
acknowledging that actuallybeing a physician can be quite
traumatic. And that we get sortof exposed to a lot of painful,
difficult and distressingincidents. And unfortunately,
(14:45):
we're trying to just deny this.
We're trying to sort of, youknow, take a stiff upper lip and
carry on working and, and youknow, if we can, we have a
distressing time with onepatient, we somehow got to pull
ourselves together and becompletely on top of everything.
So The next patient. So I thinkwe've got to start thinking
about the whole sort of World oftrauma, and the incidents that
(15:06):
affect us, and how can we bestlearn to cope with those in a
way that is helpful for us andallows and keeps us fit, rather
than just, you know, denying thewhole problem. So for instance,
one of the programs that we'redoing at UC Davis at the moment,
is training a lot of physiciansand nurses and other staff in
(15:28):
the, in essentially the processof what we call psychological
first day, which is really thecapacity to listen well to
someone, and to then assist themand organize resources and
referrals, if necessary, butacknowledging that there are
traumas and there are difficultincidents that we all have, and
(15:51):
giving people a chance torecover from those. It's very, I
mean, it's actually soundsridiculously simple. But it's
not something we tend to do asphysicians, we somehow feel
we've got to be the heroes allthe time.
Commercial (16:10):
Is there a way to know, as physicians, we kind of
look at administrators as thethe penny counters of the
organizations? Is, is there beena quantification put on? Or is
there some framework, we couldquantify the dollars and cents
of physician of the importanceof physician mental health to
(16:30):
larger organizations?
Peter Yellowlees, MD (16:33):
And yes, there absolutely is. In fact,
there's been some very nice workdone by Stanford and by some of
his colleagues at Mayo, where heused to be looking at leadership
in particular, and the costs ofburnout. And we know that in the
US, the the average burnt outphysician costs, the health
(16:58):
system, they work for about$6,000 per year. And if you
assume that somewhere between30, and 40% of your physicians
are showing some signs ofburnout, that becomes a very
considerable cost. And it'ssomething that health systems
are now very aware of, andincreasingly become aware of. So
I think that that brings you onto, again, the culture of health
(17:20):
systems. And then over the last15 2030 years, they've clearly
been excessively driven from afinancial perspective. And my
view is that the main single, Iguess, talent that CEOs of the
future will have is empathy, andthe ability to actually look at
(17:41):
how do people feel about theirwork? How are they coping? How
are they managing? How can weimprove this situation? And how
can we therefore, essentiallyget more out of them, but but in
a more effective way. And Ithink we have to really look at
our leaders and and startthinking about leaders as
(18:02):
needing to have a very differentmindset from a lot of the
leaders of the last two or threedecades.
Commercial (18:10):
It's interesting, you bring up the word empathy,
I'm actually listening to a bookby Alan Alda. And all the had
created a communicationsInstitute at Stony Brook
University that aims to improvecommunications between
scientists and people they'retalking to, in particular
doctors and their patients. Andone of the big things that they
(18:33):
talk about is exercises toimprove empathy of physicians
and communicating with their,with their patients. And you
bring it up that improvingempathy of the CEOs with their
doctors, it seems that there'sprobably more empathy to be have
on on had on every level.
Peter Yellowlees, MD (18:50):
I think that's true. And you're
absolutely right. I mean,there's a ton of evidence to
show that if you are a moreempathic person, that you
communicate better with yourpatients, your patients actually
do better, they like you better.
And ultimately, you're able tobe a better physician.
Commercial (19:08):
When we talked a little bit earlier about
independent physicians feelingmore isolated, the need for kind
of systemic system changes. Whatwhat steps though, could be
taken by independent physiciansto either recognize or hopefully
prevent burnout. Is there. Isthere something that you've seen
(19:29):
that has worked on on the moreindependent level?
Peter Yellowlees, MD (19:34):
Yes, um, I mean, I'm like you have been in
private practice in the past inmy career, and I really get how
lonely and isolating that canbe. I mean, I think the key most
important thing is to keep wellconnected with some colleagues
and to ensure that you havepeople who you can talk to about
(19:55):
difficult patients difficultproblems, that you have some
collegial process going. Andfriendships, you know, with that
are useful both professionallyand personally. And you actually
need to make the time to that.
And, and that's got to be partof your work plan. So you know,
(20:15):
you shouldn't be bookingpatients in 1012 hours a day,
556 days a week or longer, youneed to give yourself some
breaks and, and see a membershipin a local medical society, or
going out to dinner with groupsof colleagues or meeting people
at the gym, or going on runstogether or cycling together in
(20:39):
groups of colleagues or playinggolf, you need to see those as
being really important self helpapproaches to life, it's not
just a matter of taking a bit oftime away from patients is
actually giving you positivetime for yourself. I think one
of the dangers of privatepractice is that the financial
side, you know, becomesoverwhelming for many people.
(21:02):
And they somehow feel that ifthey take a few hours off, they,
they that's quantified at acertain dollar level. But in
reality, they should be thinkingthat if they don't take that
time off, then they're not goingto be investing in themselves to
the same extent. So I thinkwe've got to start taking that
sort of self investment mindset.
(21:24):
For for people in thatenvironment.
Commercial (21:28):
You mentioned that you were moderating a podcast
for the Medical Society in thejoy of medicine program. It's
it's, it's fascinating, theyhave some great stories. Are
there any in particular thatyou've heard, or even maybe from
your experience of physicians,who seem to have been burned
(21:48):
out, but reinvented themselvesthat you think would be
educational for some of ourlisteners.
Peter Yellowlees, MD (21:56):
And I was done. I mean, this, this was
probably about 20, to 25.
Examples of physicians beingbeing interviewed on that
particular podcast, several ofthem certainly have been burned
out, the thing that hasimpressed me most, quite
honestly, has been theextraordinary range of
backgrounds that they've had.
(22:19):
You know, there's a couple ofphysicians I've interviewed who
come from one from Russia thatare very well, who had just
overcome an quite amazing numberof barriers in her life, to be
able to become a physician inthe United States and to be very
successful at her job. And it'squite extraordinary and humbling
(22:44):
to see what some physiciansactually do. To be able to get
to what is still a very valuedand important role. within our
society, it's not an easy thingto succeed as a physician. And
so so I've that's what surprisedme most, really trying to
(23:05):
identify those stories and findpeople who've got this sort of
unusual background, and who'vereally overcome incredible
barriers.
Commercial (23:15):
Have you seen in interviewing the physicians,
have you seen a common threadthat led them to the burnout
that you weren't expecting fromyour previous experience?
Peter Yellowlees, MD (23:29):
Well, I think first of all, there's two
groups of physicians, we shouldthink about here, physicians
that are generally featured onthe podcast are not typically
physicians who have been burntout their their physicians
who've been doing actually verywell, and have come from, you
know, maybe an unusualbackground or, or who've learned
successfully how to manage theirstrengths. I mean, when I see
(23:52):
physicians as patients, it's nota different ballpark. And, and
typically, you know, what youfind is that, that they have got
into a cycle whereby they aregetting stressed, they've got
problems, whether it's personalproblems at home, or, or
problems at work, perhapsproblems with an EMR or, or some
(24:16):
other very specific issue. Andthey have got into the cycle
whereby they just think if onlyI worked a bit harder, I'd solve
this problem. And if youremember back in medical school,
that's what we were all taught,we were just taught, you know,
if you worked hard enough, you'dget good scores in the steps.
And, and so a lot of physiciansuse that as a mantra in life.
(24:40):
And if they, you know, almostany problem can be overcome if
they want to work a bit harderand do a few more hours. And so
that's what they do, and then itdoesn't work, and it fails and
then they get mad when theystart not sleeping and they're
not looking after themselves.
They give up the physicalfitness activities. The gym
anymore. And they graduallybecome anxious and depressed.
(25:03):
And so I see the symptoms ofburnout as being really almost
a, a marker for potentialdepression or anxiety. burnout
is not an illness per se. It'snot a psychiatric illness. It's
a it's essentially a stressresponse. And, but it's but
there's no question if you areburnt out, and then it it can
(25:26):
make you much more vulnerable todeveloping psychiatric
illnesses. And then, forinstance, getting referred to
someone like myself.
Commercial (25:38):
We're talking with Dr. Peter Yellowlees,
psychiatrist and chief wellnessofficer at UC Davis. You're
listening to Ask Me MD, medicalschool for the real world. We're
going to take a short break. Andwhen we come back, we're going
to talk the top three with Dr.
Yellowlees.
Commercial inserted hereWelcome back to Ask Me MD,
(26:23):
medical school for the realworld. I'm Dr. D.J. Verret. And
today we've been talking withDr. Peter Yellowlees,
psychiatrist and chief wellnessofficer at UC Davis. This
afternoon, we're going to askDr. Yellowlees, his top three
and Peter, the top three, I'mgoing to throw your way or what
are the top three things youwould suggest to physicians who
(26:45):
are feeling burned out?
Peter Yellowlees, MD (26:50):
So I think it's, first of all, acknowledge
the fact that you're feelingburnt out. And if necessary, do
some reading about it. Thinkabout the symptoms you've got
think about why was it you gotirritable with the with your MA
in clinic? No, earlier on in theday? Or? Why? Why are you
(27:10):
thinking of patients as numbersrather than people. So firstly,
you know, acknowledge that thatthis is not normal for you. And
this is not why you came intomedicine. And I think the second
thing is really, very simplething that we don't get our
patients to do enough, isactually write down what you do
(27:33):
during the week. And writeyourself that write out your
schedule, and look at yourschedule, in terms of the amount
of time you're working, theamount of time that you are
doing things you really enjoy,you know, being with your
partner, you know, the hobbies,interests, and keeping fit. And,
(27:56):
and then the amount of time thatyou're, you're sleeping, and,
and unrest. And, and you'll findthat physicians typically have a
lot of time at work, not notenough time of sleep, and
certainly not enough timeenjoying themselves. And, and
(28:16):
but actually try and be honestabout it. So so if you if you
get people to say, to do thisexercise, and also at the same
time save them. So what are yourreal passions in life? What do
you really like doing? And, andget them to quantify the amount
of time they actually do that.
So people will say, Well, I lovegoing to art galleries and
studying painting. And then youfollow up and say, Well, look,
(28:41):
how many times have you donethat? How many hours have you
spent on that in the last month,and and those people who are
burnt out will typically havedone very little of that. And
so, so look at what people likedoing it, and then actually how
much time they spend on it. Andfinally, look at other things
you're doing that are really nothelpful. Like, are you drinking
(29:06):
too much? Are you taking toomany substances? Are you taking,
you know, sleeping tablets, forinstance, that you really don't
need? Are you putting on a lotof weight? You know, are you are
you doing other whole otherthings that that you're actively
doing at the moment that they'rereally not good for you? And can
you change those? So so it'sreally, those, I guess those
(29:29):
three areas would be things thatI would suggest for any
physician to do, who's startingto feel feel burned out, and
then actually challenge yourselfto change and maybe change with
your wife or your husband or afriend or a colleague and do
things together. But it's oftenvery much easier to change when
(29:51):
you're when you're actuallydoing something with someone
else.
Commercial (29:57):
I love the suggestion of actually writing
things down, I think. And I hearit in a lot of different areas.
But I think if you write it downand you actually see it on
paper, you can no longerlegitimize it mentally, when
it's actually concrete and infront of you, you have to accept
that. That's actually what'sgoing on.
Peter Yellowlees, MD (30:19):
Right, exactly. I mean, a ton of people
say they really like sports.
Okay. So ask them, you know, howmany times have you actually
seen the local team in the lastmonth? How much time have you
spent on that? How much timehave you played yourself? And,
and you're right, I mean, seeingit written down objectively on
paper, it's actually hard tofind so many people.
Commercial (30:41):
Peter, thanks for joining us. That's some great
information. I think,unfortunately, several of our
listeners will probablyrecognize the symptoms that
you're seeing, but I'm hopingthat the information you've
given the ideas you've givenwill, will kind of help turn
them around as well.
Peter Yellowlees, MD (30:58):
And if I can just make one last quick
comment, because we've talked alittle bit about suicide if in
fact, anybody listening to this,you know, is suicidal, please
talk to somebody else. Please.
And if you know somebody who youthink is suicidal, talk to them.
Nobody ever gave anyone the ideaof suiciding. So it's an it's an
issue that you should bring out.
(31:19):
If you're concerned about it,don't hide it, and then get
people some help. If you need todo that.
Commercial (31:27):
I absolutely agree.
I don't think we should lose anyphysicians. And just to put it
out there, there is always theNational Suicide Prevention
Lifeline 1-800-273-8255 24 hoursa day, seven days a week,
definitely reach out. Peter,thanks for joining us. I really
appreciate the time and as Isaid, some really great
(31:48):
information.
Peter Yellowlees, MD (31:50):
And thank you very much, DJ and good for
you for doing this podcast.
Commercial (31:54):
We've been talking with Dr. Peter Yellowlees,
psychiatrist and chief wellnessofficer at UC Davis about
physician well being you'relistening to Ask Me MD, medica
school for the real world. I'Dr. D.J. Verret. And until n
xt time, make it an awesome we
Announcer (32:11):
Thank you for joining us for another episode of Ask Me
MD, medical school for the reaworld with Dr. D.J. Verret. If
ou have a question or an idea foa show, send us an email
at questions at ask me Mpodcast.co
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