May 9, 2024 • 51 mins
Delve into the complexities, challenges, and joys of a fulfilling medical career with Dr. Rajani Katta in this insightful podcast episode. As an experienced dermatologist and mentor, Dr. Katta brings a unique perspective to maintaining career health in the medical field.
Dr. Katta emphasizes the importance of annual career check-ups and the ongoing self-evaluation of one’s professional growth and fulfillment. She explores the pressing issue of burnout among physicians while also introducing the 'Doctor Thinking' approach to career wellness and discusses the concept of effort to benefit ratio. Special emphasis is laid on personal modifications and strategic planning to enhance efficiency and productivity - experiences from her dermatology practice serve as real-world examples.
The episode provides a critical examination of career dynamics in the medical field against the intricacies and pressures that come with the profession. Rich viewpoints on career longevity, task meaningfulness, and work-life balance lay the foundation for preventing physician burnout.
The importance of cultivating positive relationships and maintaining adequate energy levels is also underlined, drawing references from the renowned Harvard Happiness Study. From dealing with rudeness at work to managing emotional exhaustion, Dr. Katta thoroughly reviews and addresses the issues physicians face in their career journey.
The episode closes with a deep dive into the topic of physician burnout. Dr. Katta introduces the NASA Physician Task Load, a useful tool to structure how demanding a medical professional's workday is. She emphasizes the importance of doctors' self-care and the essential role of social support and strong relationships for mental well-being. This captivating episode not only offers a wealth of wisdom for medical professionals but serves as an important reminder of the necessity of maintaining mental health in demanding professions.
Claim CME for this episode at the www.texmed.org/education.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
Thank you for listening to TMA's Practice Well podcast. TMA,
helping you improve the health of all Texans.
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(01:06):
construed as establishing medical standards of care for the purposes of litigation,
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Music.
(01:38):
Hi, I'm Cheryl Khroviak. I manage the TMA Education Center and produce the TMA Practice Well Podcast.
My guest speaker today is Rajina Katta, MD.
Dr. Katta currently serves on the adjunct clinical faculty of both the Baylor
College of Medicine and the McGovern Medical School, University of Texas, Houston.
(02:01):
Dr. Katta is committed to taking complex medical information and translating
it into practical recommendations for patients. As a physician,
researcher, and author, she is focused on developing and sharing her expertise.
She is an award-winning educator and has authored several books and over 100
medical journal articles and book chapters on diet and dermatology,
(02:23):
allergic reactions of the skin, and medical education.
Today, Dr. Katta shares her insights and unique perspective to maintaining career
health in the medical field.
To get the full CME details and to claim credit for this episode,
click the link in the episode description.
And now, welcome Dr. Katta.
(02:44):
I wanted to start this talk with a key foundational principle,
and it's that as physicians, we deserve, you deserve a strong career,
and that means you going strong and your career going strong.
And I'm excited to be talking about this topic of a career checkup,
and I hope that this is not just me speaking, but I'm going to ask that you take,
(03:07):
I'm going to ask you some questions as we go through, and I hope you will write
down your own responses for you to look at later.
And just like we do a checkup for our patients, I think this is a great practice
for us to do on an annual basis.
And you can look back six months from now or a year from now and look at your
responses from today and start thinking about what changes you've made and what
(03:29):
changes maybe that you need to make.
And I'll give you some background. My name is Rajani Katta, and I am a practicing dermatologist.
I was a faculty member at the Baylor College of Medicine and for over 17 years.
And in that position, I have mentored many medical students and pre-medical students.
And one of the changes that I started noticing in more recent years is,
(03:52):
and depending on when you started your career,
when I started my career, the word burnout was not really in my sphere of awareness.
It's not something that I had heard about. It's not something that we talked
about in medical school.
But now as I'm mentoring pre-medical students, I had conversations with two of them recently.
One of them used this specific word that I thought was really surprising.
(04:14):
And she said, you know, I'm really bracing for burnout. And she's not even in medical school yet.
So I thought, wow, that's really concerning to me.
But as I'm seeing all these statistics, the question that always comes to my
mind is, okay, I know about burnout.
I know the struggles in academic dermatology and private practice dermatology.
(04:36):
So who are the one third of doctors who are not burned out.
And one of the areas that I'm really interested in that I have been working
on throughout my career is mentoring medical students, as I mentioned.
And I've written and spoken to that group quite a bit. And I have a podcast.
And one of the series that I'm starting on my podcast right now for medical
(04:56):
students is interviewing doctors in all different specialties so that medical
students can learn about what is it like to be an anesthesiologist,
to be an and obesity medicine doctors.
And the name of this particular series is called Energized at Work.
And what can we learn from the strategies and choices from physicians who have
(05:19):
been in their career for maybe 10 years?
One of my mentors in her career, I want to say 40 plus years,
still going strong. And I think it's really interesting because most of them
describe to me ups and downs and challenges that they've faced in certain areas
that have really struck them.
So if we talk about energized at work, one of the key points that I'm already learning is that,
(05:42):
There are physicians in every field and every specialties who are still thriving
and learning despite the challenges.
But one of the things that I think is really helpful is that all of them have
shared at certain points how they've evaluated the health of their career.
And I really like mental models. It really breaks down for me how to approach
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a different topic. I really like things to be very tangible.
And so when I think about the health of a career, I really think about doctor thinking.
Smoking and if you approach it as a doctor, if you approach the health of your
career as you would with a physician lens, so how do we look at the health of
our patient? Well, it's certainly not just what's your BMI.
We look at a lot of different factors. We look at a lot of different vital signs,
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review of systems, and the same thing with our career.
It's not just your paycheck or promotion or your publications.
So how do you evaluate your patient's health? Well, history and physical,
review of systems, and when we think about why is our patient experiencing poor
health, we can ask the same question about our career health.
And when I've looked at the literature on physician burnout,
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I've seen a lot of articles trying to point what is the cause.
So is it the electronic health record? Is it the fact that there have been a
lot less sleep because of a number of different factors?
Is it not just overwork? Is it that we're demoralized by our health system?
(07:10):
And the answer is yes, yes, yes.
But if we think about physicians, we really think about our patients' health holistically.
We think about integrating all of these different organ systems.
You can't just look at one organ system.
And similarly, health is not just the state of health and not health and burnout.
It's not just burnout, not burned out. It really is a spectrum.
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And I think you can see on one end of the spectrum, spectrum energized,
and then you're tired, and then you're maybe pre-burned out,
and then you're burned out.
And there's a lot of overlap between these different areas. And just like in
preventive medicine, when we think about modifiable risk factors and early detection,
and how important it is to treat pre-hypertension, and that's preventive medicine.
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And also with our patients, we talk about being on a health journey,
where we ask about their symptoms, we think about pain points,
and certainly we celebrate every victory.
So I'm going to ask you right now, and feel free to take a little notation for
yourself, but I am going to ask you to put a number on this.
Are you energized at work on a scale of one to 10?
And I'd like to see where you are today and have you compare yourself to a year
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from now to just think about that. Are you energized at work?
And when we think about the strong, healthy career, that's the goal.
You want to be you don't want failure to thrive.
You want your well child exam. You want that strong, healthy, energized child.
And I think we can break it down into three main organ systems that I'm going to talk about today.
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Like I mentioned, that's my my mental model.
And I think before we talk about energized at work, it is important to think
about and talk about burnout.
And this is the ICD-11 World Health Organization definition,
where it's resulting from chronic workplace stress that hasn't been successfully managed.
And they characterize three dimensions.
(08:59):
And I'm going to start with the first dimension, which is reduced professional
professional efficacy.
So if we think about how to make that tangible, to me, that's the organ system of vision.
And I break it down into short-distance and long-distance vision.
And if you think about short-distance vision, that's your day-to-day,
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that's really your task management.
And if you think about that spectrum of tasks are manageable versus overwhelmed.
So I'm going to ask you this question. Can you complete your daily tasks at
work without feeling overwhelmed on a scale of one to 10? Where are you on that
manageable to overwhelmed?
And then let's talk a little bit about statement that really annoys me.
(09:44):
So I like to talk about things that well-meaning advice that people give you
or just common phrases that are out there in the lexicon. And one of the ones
that people like to say is, love your job and you'll never work a day in your life.
And when I talk to my friends whose children, my friends and I are having children
who are now entering college or about to graduate from college,
(10:05):
and what they say is, I just want her to find a job that she loves.
I just want her to find something that she's passionate about.
And so she gets to experience that.
And the reason that this annoys me is because I'm a dermatologist and I would
never say that I love my job, which surprises some of the young people that
I talk to, especially medical students who are trying to go into dermatology.
(10:27):
And the reason I say that is because I love my work, but I don't always love my job.
And I love the work of connecting with patients one-on-one.
I'm a specialist in allergic contact dermatitis, and I love the work of connecting
to patients one-on-one, the mystery involved in what is the cause of this chronic dermatitis.
(10:49):
And I really love talking to them and helping them overcome the obstacles to
avoiding these allergens.
But I don't always love my job. I don't love pre-authorizations.
I don't love documentation or coding or any of that.
And so I think when we talk about task management, I think one of the keys is
to think about, are you pushing this giant clunky block up a mountain or are
(11:14):
you rolling a ball down a hill? And that's...
What I mean by that is, what are the pain points in your job?
So I talk to a lot of physician colleagues, and when I hear some of their pain
points, things like patient access, just getting patients in,
or if you look at the literature,
mislabeled specimens, but certainly some of the most common ones are too many
(11:35):
patient portal messages and the
amount of time that it takes for prior authorization and documentation.
Those are all serious pain points.
But I think it comes back to this idea for me of how have other people been
able to fix these pain points.
So one of the articles that I just wrote was about practice efficiency in dermatology.
And I reviewed the literature on this.
Efficiency is one of the six domains of quality of care.
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And it's one that doesn't get a lot of press. A lot of press is on efficacy and safety.
But efficiency of practice is considered one of the three main pillars of professional
fulfillment, one of the six domains of patient care.
And so if we think about how we learned about treatments and residency,
well, okay, what treatments have you personally tried?
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What's worked? What hasn't worked? What are those adverse effects?
And the particular area that I worked on for years is documentation,
because it took a lot of work to document.
And I was continuously sculpting my processes. And I think there's a lot of
interesting literature in the quality improvement science.
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And one of the key factors of quality improvement science is this model of plan,
do, study, act, where you identify a pain point, and then you study it,
and then you act, and then you modify it again.
But I prefer, instead of the plan, do, study, act model, I prefer the doctor thinking model.
And for me, the doctor thinking model is that I'm a skin doctor.
(13:08):
But I'm also a work doctor, so I'm looking at what's not working well in my workday.
So where does it hurt and why does it hurt and how can we help?
So here's the model for doctor thinking, symptoms, diagnosis,
treatment, modification.
And one of the most effective for me with task management has been what I call
the effort to benefit ratio.
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So we know about the risk benefit ratio in medicine.
And one of the things that really inspired me early on in my career to come
up with this effort to benefit ratio was that I,
in my first year as a faculty member, was asked to give a board review talk
to a group of dermatology residents, to our dermatology residents.
And I spent so much time on this talk. And it was great.
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I spent a lot of hours. It was a great talk. And I gave this talk to 10 residents.
And as they filed out, one of them stopped and said, thank you.
That was really helpful.
And then everybody left and then it was done. And I realized I had put in a lot of effort.
For a task that did not have much in the way of a tangible benefit.
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At that point in my career, I was looking for career advancement.
And so that started to change the way I thought about the tasks academically.
And so I call it the effort to benefit ratio, or it's the E to B.
And so nowadays, sometimes I'll think about, okay, do I really need to document
all this? What's the E to B on this?
Or instead of giving a board review talk, what I started to do was give talks
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on areas where I was also writing.
And so I was able to develop talks that I could then utilize more often.
So the effort was there, but I was able to increase the benefit side of that.
And I know in medicine, obviously, we all have to be perfectionists so much
of the time, but I consider myself a part-time perfectionist.
There are definitely tasks that require full perfectionism, but there's others
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where I'm going to do the E to B on that.
And I'll say with the E to B, one of the biggest benefits for myself and for
a lot of my colleagues has become a power user of the electronic medical record.
And for our residents, that's one of the first things I recommend as you're
going out into practice, whatever
your EMR is, I tell them you have to learn how to be a power user.
(15:23):
If you have not heard of Dr. Dyke Drummond, he writes several articles,
but I love his approach to the EMR. And this is open access.
It's a five-part EMR strategy. And I do have all of these references on my website.
My website for medical students is The Successful Match, but backslash references,
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and you'll find these references there.
So when we talk about the five-part EMR strategy, what I tell the graduating
residents is that you're not a medical student anymore.
And when you think about your medical record, there are, from Dr.
Dyke Drummond, there are three reasons to write a chart note,
billing, medical, legal, and continuity.
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And if there's anything in your note that is not meeting those three purposes, then it's too long.
Or if you are overwriting, I think right now that's definitely a problem that
we see in in our early residents as they start to think about how to write a
note that is efficient, yet still very effective, that's not a medical student note.
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And I think about all of these small changes that make a big impact.
And to me, it's like Tylenol, where it's over the counter. But if you've ever
had that horrible headache, it's really amazing all the impact.
So I like to talk to my friends. And I was talking to one of my friends about
she was definitely burned out. And one of the things that she arranged to do
was she ended her workday one hour early.
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She was a big revenue producer for her dermatology practice.
And it actually wasn't a big deal for her to get buy-in from the practice to
say, okay, I'm going to end my workday one hour early.
It was really interesting to me how she didn't think that she had the agency
to be able to do that, even though she was such a big producer.
And she said that one change changed everything for her. that just ending one
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day early brought her back from the brink of burnout.
And I thought it was really interesting how many small changes that I hear from
my colleagues are making that kind of big impact for them.
For me, I'll tell you one of the things that was very difficult for me that
was a big pain point was that I ran the Allergic Contact Dermatitis Clinic at Baylor.
And I, at that point in time, was the only one in Houston doing that.
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And so I became a victim of my own success in the sense that I had a lot of
patients coming in for testing.
But then we ended up with a four month waiting list.
And, you know, two years of working on that four month waiting list,
I was making no progress at all. It was always a four month waiting list.
And it was a big pain point because
I really felt for patients who really needed to get in for testing.
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And also I was getting a lot of emails and phone calls from my colleagues and
friends trying to get their patients in. And then also patient reviews,
I would hear things like, you know, the doctor was great, but it was completely
unacceptable that I had to wait that long to see her.
And one of the things that I ended up doing was I had a lot of patient handouts.
So sometimes I couldn't test patients.
(18:17):
And so what I did was I started to create a series of before the patch test handouts.
So before a patient would see me for testing, if I couldn't do testing,
I had a series of recommendations that I would make for them.
Okay, you have eyelid dermatitis. This is what I want you to do for the next
eight weeks to see if this is going to help.
And so what I did was I put all of those handouts up on my website.
(18:39):
And well, I created a website and then I put all those handouts up on that website
and I shared those with all of my colleagues.
And now if a patient called, my assistant would say, well, her next appointment
is in four months, but she has a handout that she wants you to start following.
And it's on the website, and it can take up to eight weeks for these recommendations to take effect.
So all of a sudden, I was able to reduce my wait time from four months to two months.
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And the number of calls and emails and complaints that I got just dropped dramatically.
And I started sharing this with, and this is open access, anybody with contact
dermatitis is welcome to go to my website and use these handouts.
And now there are over 300,000 views every year of these handouts,
and my colleagues across the country are using them.
But it all started with identifying that pain point of that patient access.
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And it's been remarkable to
me when we did this review article on practice efficiency and dermatology,
some of the quality improvement projects that had been documented in the literature
are really interesting and fascinating how one group had a problem with all
of the skin biopsies that they were doing that they had mislabeled specimens.
And so they instituted a little change where now they were able to put in a
(19:47):
biopsy request and it automatically printed out a label.
And to me, that sounds like something, wow, that sounds like that's a great
idea, but it had not occurred to them until they really identified that pain point.
So I think the idea here is to really be conscious of you deserve a smooth clinic
day and why is it not smooth and what can you do about it?
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So how much I love my work hasn't changed, but how much I like my job with those
small incremental changes really has made a big difference.
So I also, when I think about vision, we talk about short-distance vision as task management.
Long-distance vision is about career strategy. And this is where are you making
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progress in your career?
So are you progressing up a slope or are you running on a treadmill?
And I'm going to ask you a question. Are you making progress on your professional goals?
And on a scale of 1 to 10. And I'll also ask you another question as well.
Well, what goals did you set for yourself last year?
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And are you on track for achieving these?
And if you're not sure what goals you set for yourself, I'll share with you
some of the goals from the physicians that I've interviewed,
where the goals range from every patient, every single patient that walks into
my office is receiving high quality care,
or in dermatology, some of the new treatments that are coming out, biologic treatments,
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or some of the new procedures that are out there.
I also have a colleague who runs a giant dermatology practice who's really interested
in streamlining clinical processes and others who are educating online,
clinical research and more.
When you think about those goals, what goals did you set for yourself last year?
And when I talk about mental models, this to me has been one of the most important
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mental models for myself, where if you think about your career,
are you climbing a ladder? That's been in the traditional mental model.
But I think nowadays, I don't think most of the people I know are really climbing
a ladder, really think it's a career mountain range where they are climbing and exploring,
especially as physicians, incredibly interested in lifelong learning,
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really excited and energized by lifelong learning.
So I think it's a series of mountains that we're climbing. And if you use that
as your mental model, you can start to see that it's a little little bit different.
So I think of it as a career hike.
And I think of all the different trails that are out there that my colleagues are pursuing.
For my early career residents who are going out there, I emphasize this point over and over again.
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The first trail you take, you should start to be a coding sensei because we
know that revenue generation is incredibly important for most employers.
So for the early career doctors, I talk about really becoming experts at coding.
But as we explore further into our careers, I think it's really interesting, some of the new trails.
One of the doctors that I had interviewed, who was a family practice physician,
(22:44):
had decided to become an obesity medicine physician.
And you could just see how much that lit her up, going back to school and learning
about that and starting to implement this in her practice.
For me, I started writing books years ago for the medical students,
as I mentioned, and that's been a really exciting trail. And I think when you
talk about career strategy, we talk a lot about goal setting.
(23:06):
And I all do credit to my husband. I remember one year, this was early in my
career where I hadn't been so deep into thinking about these topics.
And it was the start of a new year. And he turned to me and he said,
so I wanted to ask you, what are your professional goals for this year?
And how can I support you in that? And I thought, wow, I usually don't think
(23:29):
about that in such a concrete, conscious way.
And now I do. I do think about the year ahead. What are the goals that I've
set for myself for the year ahead?
But one thing I sent back to him was, let's also do a year in review.
And this has actually been even more important than thinking about the year
ahead. I find that the year in review has been.
(23:51):
Even more valuable. And by that, what I mean is that I actually ask him and
we do my career and we do his career and we talk about them separately.
And we really try to celebrate all of the wins and successes and the progress that we've made.
And it's really interesting when he shares with me what he's seen about my career.
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It's interesting to me. There are a number of things that I had just completely
forgotten that once you achieve a milestone, you kind of just move on.
And it's been interesting to hear about him because he shares cases with me sometimes.
He's a hospitalist at Baylor at the VA.
And sometimes he'll share cases with me. And sometimes I'll share that back
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with him at the end of the year about how this was this amazing diagnosis that he and his team had made.
And he's just completely forgotten about it. For him, it was just another day
at work. And hearing me talk about it, it reminds him, oh, wow,
you know, we did save that patient's life.
And if that patient hadn't been at the VA hospital on that exact day with this
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team, maybe the patient wouldn't have made it.
So I think the year in review is incredibly important.
So before you set goals, you need to celebrate how far you've come and you need
to make your accomplishments tangible. So I talk about efficiency.
One of the things that my assistants all know, I'm a huge dictator. No, I'm into dictation.
I'm not a dictator. I'm into dictation.
(25:18):
And I promise you, my assistants would not tell you I'm a dictator,
but I'm a huge, huge into dictation. So I dictate everything.
And then oftentimes they will help me proofread and fix it up.
One of the things about documentation is I like to use, in certain settings,
a flipped scribe model where I don't have people scribe for me.
Instead, I do dictation.
(25:38):
And then the scribe fixes up my dictation. So the scribe is the one that...
Described as my assistant, she proofreads it and then sends it back to me.
And so I can dictate super quickly.
So one of the things I like to do is I like to dictate my year in review,
make it really tangible.
I have a folder on my email where I save all of that.
(26:00):
And on occasionally, I'll go back and look at that, especially when I'm not
reaching my goals as quickly as I want to.
It's really nice to see that tangible list of accomplishments.
So I'll ask you right now, in the last year, what are two areas of professional
progress or achievement that you've experienced?
I'll also ask you, what are two things that you're proud of over the last year in your personal life?
(26:24):
And that might be health or family or community.
I think it's good to actually write these down and remind yourself.
When you look at the literature on job satisfaction, Dr.
Teresa Amabile, and one of the things her research has found is that on the
days when people are feeling the happiest, the proudest, the most motivated,
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the single most prominent event in those days is making progress in meaningful work.
And so that's from her book, The Progress Principle. And that has been borne
out by the literature on job satisfaction, that sense of progress and really being aware of that.
So as physicians, of course, when you're thinking about career strategy,
(27:07):
the shifting sands of the terrain, things are really shifting quickly.
And so if you think about career strategy and success and career advancement.
The question that I tell my early career dermatologists is, if you leave this
position, are you going to leave it better than when you arrived?
And when we talk about shifting sands, the rise of private equity,
(27:30):
we watch the competitiveness of medical specialties very closely for the medical students.
And one of the things that's been really shocking is how quickly private equity
has taken over emergency medicine.
And this year in emergency medicine, there were over 550 residency slots that went unfilled.
Medical students are not interested in emergency medicine right now because
(27:50):
of this rise of private equity.
So I think as you are developing your career strategy, you really have to think
about those shifting sands and how are you going to become indispensable.
And you should be indispensable, but of course, they should never be indispensable
to you, meaning you have to have reserves of time, energy, money, so that you are not.
(28:12):
Relying wholly on this one job if it went away.
So when we talk about trails to explore, how can you add value?
I am going to mention the risk benefit ratio of different career trails.
I had a friend, I'm going to change the details, but my friend wanted to increase
his income from $200,000 to $300,000.
(28:33):
And so what he did was just went crazy that year to really increase that revenue.
And he did it. He achieved that goal that he had set for himself.
But in the process, he really impacted his health and he gained 50 pounds that
several years later has not budged.
It's really important to think about the risk-benefit ratio of any of these career trails.
(28:57):
And of course, we have to think about our tools. And I mentioned reserves of time, energy, money.
This was a book that I read, Rich Dad, Poor Dad, when I, I think I read it my
first years in attending.
And one of the quotes that I share with all of my students is that a surgeon
is one broken thumb away from disaster.
So early career, I never forgot that line.
(29:21):
And it really, of course, helped when we had to close practice for two months
in COVID because I did have one of my friends who's a dermatologist who unfortunately,
because of some issues in life, had lost her emergency reserve fund.
And two months without income was disaster for her to not have two months of income.
(29:41):
So this is the line when you think about reserves. It's one of the biggest things
that's helped me take some of the chances in my career that I have is because I have those reserves.
When I talk about your team, we all know none of us succeeds on our own.
So I really, I love hiking.
I don't mountain climb, but I also love documentaries about mountain climbers.
(30:03):
And then I saw this documentary and I now recommended this documentary to everybody.
It's called 14 Peaks. It was on Netflix.
Nothing is impossible. And he called it Project Impossible. I love,
love, love this documentary.
It has beautiful cinematography. So he was climbing not just Mount Everest,
but 14 peaks in one season. in.
And one of the things that really struck me on this was that he is from Nepal.
(30:27):
And right from the beginning, he gives all credit to his team of mountain climbers.
And throughout this movie, he's talking about teamwork.
And I made my children watch this movie and just about how you really give credit to your team.
And not just that you need a team to get to where you're going,
but also that you give credit to that team.
(30:48):
And I just think about how my success as a private but practice physician is
my front desk staff, my nursing staff, so many people that go into making us successful.
So that's one thing that we all need to pay attention, of course, in career.
And then if we think about the career checkup, those three organ systems that
(31:09):
we really need to be paying attention to, and I like to say that there are three
vital organ systems that are the backbone of a healthy career.
Of course, heart is so critical.
When you look at the second domain of physician burnout, it's increased mental
distance from one's job or feelings of negativism or cynicism related to one's job.
(31:30):
And I think we all have friends and colleagues who are burned out.
I remember one of my first experiences was when one of my friends was going
through a surgery residency and I remember looking at him and saying to him,
you have really changed.
You are not the same person that you used to be.
He really radiated that negative energy and that cynicism and that negativism.
(31:51):
And this is something that I think most people don't, it's hard to evaluate that from ourselves.
But I think if you ask the people around you to share what they think,
there's a lot of valuable insight.
So does your, so here's the question I'm going to ask you, does your job allow
you to honor your mission?
And if you would write down two patients that you helped in the last week.
(32:14):
So when you think about quality of patient care, and here's the spectrum of
high quality care consistent with our values or care that is not consistent with our values.
And in talking to one of my friends who's in a dermatology practice that was
bought out by private equity, she is trying to get out of there as quickly as
possible because that private equity ownership,
(32:35):
I'm not saying every private equity owner, this particular practice,
the private equity ownership is not allowing her to provide high quality patient care.
And she will be the first to tell you that, which is why she's leaving,
because it's very hard for her to practice in that setting.
So are you consistently providing high quality patient care?
(32:55):
And the literature has shown, this is a great article where it was a project
that was sponsored by the AMA and the Rand Institute wanted to characterize
factors that influenced physician professional satisfaction.
And what they found was that when physicians perceived themselves as providing
high-quality care or their practices were able to deliver that kind of care,
(33:19):
they reported better professional satisfaction.
So in this article, when they summarized, this was one of the best predictors
of professional satisfaction was that high-quality patient care.
Another one that was huge was greater physician autonomy and greater controller
of the pace and the content of clinical work.
(33:42):
Now, when I have residents who ask me advice about the jobs that they're considering,
one of the things I really emphasize is for me, having that clinical autonomy was huge.
It kept me in a job for 17 years because I had that autonomy.
So those are the factors associated with the
professional satisfaction. And then if you're in academics or if you're a non-clinical
(34:05):
physician, the question that I would ask is, does your job allow you to do the
work that you find most meaningful?
And if you look at the literature where they talk about career fit and burnout
among academic faculty, what they found was that in this group,
there were different facets of their work, the academic faculty that they found most meaningful.
(34:25):
Some of it, it was patient care. some of it was research or education.
But the bottom line was that time spent on that meaningful activity was the
largest predictor of burnout.
So do you have enough time to do the work that you found most meaningful?
And here they found that it was 20%. So that was kind of the cutoff.
(34:46):
Those spending less than 20% of their time or approximately one day per week
on the activity that they found most meaningful, if you didn't have that 20%
time, then you had a higher rate you to burnout.
So it's really paying close attention to the kind of work that you find most
meaningful. And does your job allow you to do that?
And when people talk about work-life balance, I also think work-life alignment
(35:10):
is one of the terms that I like, where you think about alignment of your work and your values.
So does your work allow you to live your values?
And as As you look at different values, which values do you find most meaningful?
And does your work allow you to live these values?
(35:33):
I have to say continuous learning is one that's very, very meaningful to me.
And so I love that I'm able to do that. But I remember as an intern,
it was very, very, I don't remember reading much as an intern. It was just doing.
So that was a question on a scale of one to 10. does your work allow you to live your values?
(35:54):
And similarly, your life should also allow you to live your values.
Your work should allow you to live your values and your life should allow you
to build your values. Work-life alignment.
And when we're talking about values, this got a lot of media attention about
the 85-year Harvard study.
So this is a great study. It's all over the media if you just Google Harvard study.
(36:14):
And what they did was they followed a group of young men.
And they started in 1938 following this group.
And later they added their wives to this study. But basically,
it's called the Harvard Happiness Study.
So decades-long study to find out what makes us happy in life.
And so they had these participants and they followed them. The bottom line that
(36:38):
it's relationships, love is happiness, full stop.
So positive relationships Keep us happier, healthier and help us live longer.
Out of this long, long study, that was the strongest finding that positive relationships were the key.
And then when we think about the healthy career, three organ systems,
the final piece of this is energized energy.
(37:02):
So if you think about physician burnout, that third domain is feelings of energy
depletion or exhaustion.
And at the risk of, well,
this is one of the mental models that I like to think about,
that if you are a physician and if you are a mother or a sister or a daughter
or a spouse or a friend or a volunteer or an active community member or politically
(37:26):
engaged community member,
that requires a lot of energy.
Energy and I think about I think about how we
all have energy within us and how that energy has
to go outwards to help sustain to help
fuel the people in our closest circle our immediate family and then outside
of that the people with whom we work with our friends and then you still have
to have energy in order to be able to impact your community in the wider world
(37:49):
and that's a lot of energy that you need to be sustaining and fueling in order
to be able to be that source for so many different people.
And when I think about productivity and just getting through the day,
it's energy management first, time management second.
What I mean by that, when I think about energy, it's brain, body, and emotional energy.
(38:12):
So I'm going to start with the physician task load.
So when we were writing our article about practice efficiency,
this was a tool that I had never heard of before.
It's really pretty simple, but it's been validated in many different studies.
So it's called the NASA Physician Task Load.
And they studied the task load score and the risk of burnout.
(38:36):
So this is a modification of the NASA Task Load Index.
And it's four domains. It's mental, physical, time demands, and effort demands.
So let me ask you, and you can write this number down if you want,
because I'm going to have you add up these four numbers.
Reflect on a day that you performed clinical work during the last one to two
weeks. Think about that day, and it should be representative of your typical workday.
(38:59):
So question number one is, how mentally demanding was that workday? On a score of 0 to 100.
So 100 means that it was incredibly mentally demanding. That's question one.
Question two, how physically demanding was that workday?
Score or zero to 100. Question three is how hurried or rushed was the pace of your workday?
(39:26):
And then question four was, how hard did you have to work to accomplish your
level of performance during the workday?
And so now that you have those four numbers, go ahead and quickly add them up.
Once you add those up, you have a score. And in that study, what they found
(39:46):
was that if you had a score of, let's say, 227, no symptoms of burnout.
But once you started to get in
the 280s, that's when physicians started to have one symptom of burnout.
And as you went higher, your risk of burnout increased. And when I think about
(40:06):
my own journey through my career,
I do remember days when I had so many emails and phone calls from physician
colleagues trying to get their patients in and how that really increased that
emotional energy of the day.
And how once I solved that problem, that score, if I had been tracking it,
(40:31):
would have just dropped, would have just plummeted.
I also solved my documentation problem.
I had gone through multiple rounds of trying to figure out documentation.
Now, actually, a lot of what I do for my patient history, it's no longer required.
Aspects of that patient history are required for my chart,
but they're not required for coding or billing reasons.
(40:53):
And so now what I do is most of my patient history, I just take notes as we're
talking, I handwrite it, and then it's scanned into the EMR.
And that one change has really helped the mental demands of my workday.
So it's interesting if you can start to think, how can you reduce that load
of each of these four, or really be conscious about it.
So if you look at that four elements, what the authors wrote is that this suggests
(41:20):
areas of particular focus in which you can improve the practice environment
and start to make changes.
And of course, some of this is out of your control. Of course,
there's individual level interventions, there's organizational level interventions,
and there's system-wide interventions.
And people are working on each of those. But if you think about the individual
interventions to think about.
(41:41):
So when you think about brain, so I mentioned it's brain energy,
body energy, and emotional energy.
So for me, the scale here is alert to fuzzy when I think about brain energy.
And there's a field of study called cognitive ergonomics.
And as people are looking into the EMR, just about how you can adjust the EMR
(42:02):
to stop putting such a cognitive load on our physicians.
So this is where it can really start to make a difference in terms of that brain energy.
Body energy is energized to exhausted. Okay, is burnout due to sleep deprivation?
And what we know is that it's not one single factor, but that all of these factors
(42:24):
play a role in different ways.
And they definitely have found significant associations between physician sleep and burnout.
Sleep-related impairment had significant correlations with burnout and professional fulfillment.
So here's the question I'm going to ask you right now. Do you follow your own advice?
The advice that you give to your patients related to sleep, exercise,
(42:46):
diet, especially stress management strategies, I will ask you right now,
do you follow your own advice on a scale of 1 to 10? Because nobody's perfect.
And this was the Harvard study of adult development. The doctor who currently
runs it is Robert Waldinger.
And if you look him up, he's definitely been on a lot of podcasts and has a TED Talk.
(43:06):
But the best predictor of longevity and well-being is social support.
So I mentioned sleep, exercise, diet, and stress management.
And of course, we have to put social support there. I love the revised Declaration of Geneva.
So instead of the Hippocratic Oath, now some organizations are starting to use
this modern day physician's pledge.
(43:27):
And I really like it. And one of the points that is highlighted in this revised
declaration is that I will attend to my own health, well-being,
and abilities in order to provide care of the highest standard.
I like that. I gave this talk, and one of my residents texted me afterwards.
She's good on brain energy, body energy, warning, warning, but emotional energy,
(43:48):
SOS. And I think emotional energy, especially after the pandemic and talking
to my friends and colleagues, has really been a challenge in certain settings.
God bless my emergency room colleagues who have had to deal with so many challenges
in the emergency room and then my friends in the ICU.
And I think really in so many different settings. So I think the scale here
(44:12):
is positive energy to negative energy or cynicism.
And the question I would ask you here is, OK, well, how do we treat a headache?
I know how I would treat a headache, right? You take two ibuprofen.
The question I would ask you is, how do you treat a bad day at work?
So if you know you're having a bad day at work or if you know you're going to
have a bad day at work, what would be your treatment for that?
(44:33):
And the reason I'm talking about emotional energy as part of this and how bad
things have gotten out there is since Dr.
Christine Porath, she's written for Harvard Business Reviews.
She's a researcher on rudeness and incivility, and she's run a study every year for years.
So how often are frontline workers treated rudely at work? In 2005,
(44:53):
it was a little less than half.
But now when she's talked to people globally in multiple industries,
you're getting close to 80% are being treated rudely at work.
And this rudeness has a lot of overlap with verbal abuse.
It really spans a range of behaviors. And what this says to me is that all of
us are going to encounter rude, uncivil, maybe even abusive behavior from the
(45:17):
people that we are trying to serve.
And this was an article that was not about rudeness. This was actually about
mistreatment and discrimination by patients, families and visitors and how that
related to burnout. out.
And what they found, 6,500 physicians, mistreatment and discriminatory behaviors
were common within the previous year.
(45:38):
And the groups that are most at risk were female and racial and ethnic minority physicians.
And that experiencing this kind of behavior from the people that we are trying
to serve has been associated with higher burnout rates.
So I think it's likely that most of us, many of us are going to experience this kind of behavior.
And so if you are one of my colleagues who went into work one day working for
(46:02):
a really large hospital system, and then we're told we are cutting your salary by 10% as of today,
and we are doing this to thousands of our doctors, it's not just you.
So if you had a bad day like that, or if your patient yelled at you,
what's the treatment you recommend for yourself? And the associated question
is, what's the risk benefit ratio of that treatment?
(46:24):
And, you know, when I talk to my friends, we all have different treatments for
a bad day. Promise you no judgment.
I like to call them stress cookies, personally, like that's the term I use is stress cookies.
There's also other treatments for a bad day. I have to say that I have had experiences
where somebody has yelled at me in the office, a patient has yelled at me,
(46:45):
and I'm a big believer of taking the stairs.
I find that two minutes of running up and down the stairs is incredibly helpful
for releasing cortisol.
And whether it's stopping at the
YMC after work, a lot of my friends have different techniques for that.
And we wrote an article about positive psychology interventions.
There's been a lot of research into mindfulness and other practices like that,
(47:07):
gratitude intervention.
Personally, Personally, I love gratitude prayers to start my day and to end
my day. So there's definitely a lot of treatments for that bad day at work.
So the question I would ask you is, what are two coping strategies that you
are proud that you employed in the past six months?
And what are two coping strategies that you would like to use less of in the
(47:28):
next six months, considering the risk-benefit ratio of that coping strategy?
And I'll also ask you one other question, is how do you down-regulate?
So I didn't think of this ever when I was first starting out in practice.
And I only recognized it later that a patient would be yelling at me,
and I could feel my heart rate increasing and my respiratory rate increasing.
(47:50):
And I started to consciously think about that. how do you downregulate?
So how do you decrease cortisol levels? And how do you decrease sympathetic arousal?
And how do you activate the parasympathetic nervous system? And it really is pretty amazing.
Dr. Andrew Weil in Integrative Medicine talks about the breathing practices,
the prolonged breathing practices.
And lots of studies have shown that it really does activate the parasympathetic nervous system.
(48:14):
And now I can really drop my heart rate and my breathing rate pretty quickly
with these kind of simple breathing exercises.
I think it's really interesting when you look at the pathophysiology of
it. So how do you downregulate?
And I'm just going to mention one thing about when I've seen this with friends
or colleagues, I call these early warning signs of career cancer,
(48:34):
where you can start to see somebody kicking the dog.
So for example, if you are in the hospital and you see that doctor just railing
into that nurse, really overreacting to that, I think about that as kicking the dog.
And what that refers to, The dog is an analogy for the people who are important and loyal to us.
I've heard of people taking it out on their spouses or, God forbid,
(48:57):
their children or their friends.
And that is a sign of career cancer.
So how do we counsel our patients when we talk about health?
And here we are talking about healthy career, and it's the same concept,
good daily choices, positive reinforcement of all of our healthy habits.
And I really think celebrating any health goals that you achieve is really important. And then also.
(49:20):
Really think about symptoms. What are these early warning signs?
And this is what I consider screening to actually sit down once a year with
your friend, your colleague, your advisor, your spouse to do this conscious
evaluation of your career health and your career choices.
And then, of course, if you start to see anything, initiate treatment and schedule follow-up.
(49:42):
So I think we all deserve a strong, healthy career.
And so we also deserve our own career checkup that is completed with the same
level of attention and commitment that we provide to our patients.
And I'm just going to ask you, are you making progress?
Are you honoring your mission? Are you staying fueled? So I will end there. And thank you so much.
(50:06):
Thank you, Dr. Katta. To our listeners, we hope you found this episode valuable
and take away techniques that you're able to incorporate into your day-to-day practice.
To claim CME for this episode, just click the link in the episode description
and follow the instructions provided.
Remember to like and follow TMA Practice Well to receive every episode.
(50:28):
Until next time, stay well.
TMA has a long, proud history of promoting patient rights, advocating for physicians,
and providing real solutions for your practice.
We can accomplish so much when we unite in one Call the TMA Knowledge Center
at 1-800-880-7955 or visit textmed.org to find out how you can join or renew your membership today.
(50:52):
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(01:06):
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(01:38):
Hi, I'm Cheryl Khroviak. I manage the TMA Education Center and produce the TMA Practice Well Podcast.
My guest speaker today is Rajina Katta, MD.
Dr. Katta currently serves on the adjunct clinical faculty of both the Baylor
College of Medicine and the McGovern Medical School, University of Texas, Houston.
(02:01):
Dr. Katta is committed to taking complex medical information and translating
it into practical recommendations for patients. As a physician,
researcher, and author, she is focused on developing and sharing her expertise.
She is an award-winning educator and has authored several books and over 100
medical journal articles and book chapters on diet and dermatology,
(02:23):
allergic reactions of the skin, and medical education.
Today, Dr. Katta shares her insights and unique perspective to maintaining career
health in the medical field.
To get the full CME details and to claim credit for this episode,
click the link in the episode description.
And now, welcome Dr. Katta.
(02:44):
I wanted to start this talk with a key foundational principle,
and it's that as physicians, we deserve, you deserve a strong career,
and that means you going strong and your career going strong.
And I'm excited to be talking about this topic of a career checkup,
and I hope that this is not just me speaking, but I'm going to ask that you take,
(03:07):
I'm going to ask you some questions as we go through, and I hope you will write
down your own responses for you to look at later.
And just like we do a checkup for our patients, I think this is a great practice
for us to do on an annual basis.
And you can look back six months from now or a year from now and look at your
responses from today and start thinking about what changes you've made and what
(03:29):
changes maybe that you need to make.
And I'll give you some background. My name is Rajani Katta, and I am a practicing dermatologist.
I was a faculty member at the Baylor College of Medicine and for over 17 years.
And in that position, I have mentored many medical students and pre-medical students.
And one of the changes that I started noticing in more recent years is,
(03:52):
and depending on when you started your career,
when I started my career, the word burnout was not really in my sphere of awareness.
It's not something that I had heard about. It's not something that we talked
about in medical school.
But now as I'm mentoring pre-medical students, I had conversations with two of them recently.
One of them used this specific word that I thought was really surprising.
(04:14):
And she said, you know, I'm really bracing for burnout. And she's not even in medical school yet.
So I thought, wow, that's really concerning to me.
But as I'm seeing all these statistics, the question that always comes to my
mind is, okay, I know about burnout.
I know the struggles in academic dermatology and private practice dermatology.
(04:36):
So who are the one third of doctors who are not burned out.
And one of the areas that I'm really interested in that I have been working
on throughout my career is mentoring medical students, as I mentioned.
And I've written and spoken to that group quite a bit. And I have a podcast.
And one of the series that I'm starting on my podcast right now for medical
(04:56):
students is interviewing doctors in all different specialties so that medical
students can learn about what is it like to be an anesthesiologist,
to be an and obesity medicine doctors.
And the name of this particular series is called Energized at Work.
And what can we learn from the strategies and choices from physicians who have
(05:19):
been in their career for maybe 10 years?
One of my mentors in her career, I want to say 40 plus years,
still going strong. And I think it's really interesting because most of them
describe to me ups and downs and challenges that they've faced in certain areas
that have really struck them.
So if we talk about energized at work, one of the key points that I'm already learning is that,
(05:42):
There are physicians in every field and every specialties who are still thriving
and learning despite the challenges.
But one of the things that I think is really helpful is that all of them have
shared at certain points how they've evaluated the health of their career.
And I really like mental models. It really breaks down for me how to approach
(06:03):
a different topic. I really like things to be very tangible.
And so when I think about the health of a career, I really think about doctor thinking.
Smoking and if you approach it as a doctor, if you approach the health of your
career as you would with a physician lens, so how do we look at the health of
our patient? Well, it's certainly not just what's your BMI.
We look at a lot of different factors. We look at a lot of different vital signs,
(06:25):
review of systems, and the same thing with our career.
It's not just your paycheck or promotion or your publications.
So how do you evaluate your patient's health? Well, history and physical,
review of systems, and when we think about why is our patient experiencing poor
health, we can ask the same question about our career health.
And when I've looked at the literature on physician burnout,
(06:49):
I've seen a lot of articles trying to point what is the cause.
So is it the electronic health record? Is it the fact that there have been a
lot less sleep because of a number of different factors?
Is it not just overwork? Is it that we're demoralized by our health system?
(07:10):
And the answer is yes, yes, yes.
But if we think about physicians, we really think about our patients' health holistically.
We think about integrating all of these different organ systems.
You can't just look at one organ system.
And similarly, health is not just the state of health and not health and burnout.
It's not just burnout, not burned out. It really is a spectrum.
(07:32):
And I think you can see on one end of the spectrum, spectrum energized,
and then you're tired, and then you're maybe pre-burned out,
and then you're burned out.
And there's a lot of overlap between these different areas. And just like in
preventive medicine, when we think about modifiable risk factors and early detection,
and how important it is to treat pre-hypertension, and that's preventive medicine.
(07:52):
And also with our patients, we talk about being on a health journey,
where we ask about their symptoms, we think about pain points,
and certainly we celebrate every victory.
So I'm going to ask you right now, and feel free to take a little notation for
yourself, but I am going to ask you to put a number on this.
Are you energized at work on a scale of one to 10?
And I'd like to see where you are today and have you compare yourself to a year
(08:17):
from now to just think about that. Are you energized at work?
And when we think about the strong, healthy career, that's the goal.
You want to be you don't want failure to thrive.
You want your well child exam. You want that strong, healthy, energized child.
And I think we can break it down into three main organ systems that I'm going to talk about today.
(08:38):
Like I mentioned, that's my my mental model.
And I think before we talk about energized at work, it is important to think
about and talk about burnout.
And this is the ICD-11 World Health Organization definition,
where it's resulting from chronic workplace stress that hasn't been successfully managed.
And they characterize three dimensions.
(08:59):
And I'm going to start with the first dimension, which is reduced professional
professional efficacy.
So if we think about how to make that tangible, to me, that's the organ system of vision.
And I break it down into short-distance and long-distance vision.
And if you think about short-distance vision, that's your day-to-day,
(09:20):
that's really your task management.
And if you think about that spectrum of tasks are manageable versus overwhelmed.
So I'm going to ask you this question. Can you complete your daily tasks at
work without feeling overwhelmed on a scale of one to 10? Where are you on that
manageable to overwhelmed?
And then let's talk a little bit about statement that really annoys me.
(09:44):
So I like to talk about things that well-meaning advice that people give you
or just common phrases that are out there in the lexicon. And one of the ones
that people like to say is, love your job and you'll never work a day in your life.
And when I talk to my friends whose children, my friends and I are having children
who are now entering college or about to graduate from college,
(10:05):
and what they say is, I just want her to find a job that she loves.
I just want her to find something that she's passionate about.
And so she gets to experience that.
And the reason that this annoys me is because I'm a dermatologist and I would
never say that I love my job, which surprises some of the young people that
I talk to, especially medical students who are trying to go into dermatology.
(10:27):
And the reason I say that is because I love my work, but I don't always love my job.
And I love the work of connecting with patients one-on-one.
I'm a specialist in allergic contact dermatitis, and I love the work of connecting
to patients one-on-one, the mystery involved in what is the cause of this chronic dermatitis.
(10:49):
And I really love talking to them and helping them overcome the obstacles to
avoiding these allergens.
But I don't always love my job. I don't love pre-authorizations.
I don't love documentation or coding or any of that.
And so I think when we talk about task management, I think one of the keys is
to think about, are you pushing this giant clunky block up a mountain or are
(11:14):
you rolling a ball down a hill? And that's...
What I mean by that is, what are the pain points in your job?
So I talk to a lot of physician colleagues, and when I hear some of their pain
points, things like patient access, just getting patients in,
or if you look at the literature,
mislabeled specimens, but certainly some of the most common ones are too many
(11:35):
patient portal messages and the
amount of time that it takes for prior authorization and documentation.
Those are all serious pain points.
But I think it comes back to this idea for me of how have other people been
able to fix these pain points.
So one of the articles that I just wrote was about practice efficiency in dermatology.
And I reviewed the literature on this.
Efficiency is one of the six domains of quality of care.
(12:00):
And it's one that doesn't get a lot of press. A lot of press is on efficacy and safety.
But efficiency of practice is considered one of the three main pillars of professional
fulfillment, one of the six domains of patient care.
And so if we think about how we learned about treatments and residency,
well, okay, what treatments have you personally tried?
(12:22):
What's worked? What hasn't worked? What are those adverse effects?
And the particular area that I worked on for years is documentation,
because it took a lot of work to document.
And I was continuously sculpting my processes. And I think there's a lot of
interesting literature in the quality improvement science.
(12:44):
And one of the key factors of quality improvement science is this model of plan,
do, study, act, where you identify a pain point, and then you study it,
and then you act, and then you modify it again.
But I prefer, instead of the plan, do, study, act model, I prefer the doctor thinking model.
And for me, the doctor thinking model is that I'm a skin doctor.
(13:08):
But I'm also a work doctor, so I'm looking at what's not working well in my workday.
So where does it hurt and why does it hurt and how can we help?
So here's the model for doctor thinking, symptoms, diagnosis,
treatment, modification.
And one of the most effective for me with task management has been what I call
the effort to benefit ratio.
(13:29):
So we know about the risk benefit ratio in medicine.
And one of the things that really inspired me early on in my career to come
up with this effort to benefit ratio was that I,
in my first year as a faculty member, was asked to give a board review talk
to a group of dermatology residents, to our dermatology residents.
And I spent so much time on this talk. And it was great.
(13:53):
I spent a lot of hours. It was a great talk. And I gave this talk to 10 residents.
And as they filed out, one of them stopped and said, thank you.
That was really helpful.
And then everybody left and then it was done. And I realized I had put in a lot of effort.
For a task that did not have much in the way of a tangible benefit.
(14:14):
At that point in my career, I was looking for career advancement.
And so that started to change the way I thought about the tasks academically.
And so I call it the effort to benefit ratio, or it's the E to B.
And so nowadays, sometimes I'll think about, okay, do I really need to document
all this? What's the E to B on this?
Or instead of giving a board review talk, what I started to do was give talks
(14:39):
on areas where I was also writing.
And so I was able to develop talks that I could then utilize more often.
So the effort was there, but I was able to increase the benefit side of that.
And I know in medicine, obviously, we all have to be perfectionists so much
of the time, but I consider myself a part-time perfectionist.
There are definitely tasks that require full perfectionism, but there's others
(15:02):
where I'm going to do the E to B on that.
And I'll say with the E to B, one of the biggest benefits for myself and for
a lot of my colleagues has become a power user of the electronic medical record.
And for our residents, that's one of the first things I recommend as you're
going out into practice, whatever
your EMR is, I tell them you have to learn how to be a power user.
(15:23):
If you have not heard of Dr. Dyke Drummond, he writes several articles,
but I love his approach to the EMR. And this is open access.
It's a five-part EMR strategy. And I do have all of these references on my website.
My website for medical students is The Successful Match, but backslash references,
(15:44):
and you'll find these references there.
So when we talk about the five-part EMR strategy, what I tell the graduating
residents is that you're not a medical student anymore.
And when you think about your medical record, there are, from Dr.
Dyke Drummond, there are three reasons to write a chart note,
billing, medical, legal, and continuity.
(16:06):
And if there's anything in your note that is not meeting those three purposes, then it's too long.
Or if you are overwriting, I think right now that's definitely a problem that
we see in in our early residents as they start to think about how to write a
note that is efficient, yet still very effective, that's not a medical student note.
(16:27):
And I think about all of these small changes that make a big impact.
And to me, it's like Tylenol, where it's over the counter. But if you've ever
had that horrible headache, it's really amazing all the impact.
So I like to talk to my friends. And I was talking to one of my friends about
she was definitely burned out. And one of the things that she arranged to do
was she ended her workday one hour early.
(16:51):
She was a big revenue producer for her dermatology practice.
And it actually wasn't a big deal for her to get buy-in from the practice to
say, okay, I'm going to end my workday one hour early.
It was really interesting to me how she didn't think that she had the agency
to be able to do that, even though she was such a big producer.
And she said that one change changed everything for her. that just ending one
(17:12):
day early brought her back from the brink of burnout.
And I thought it was really interesting how many small changes that I hear from
my colleagues are making that kind of big impact for them.
For me, I'll tell you one of the things that was very difficult for me that
was a big pain point was that I ran the Allergic Contact Dermatitis Clinic at Baylor.
And I, at that point in time, was the only one in Houston doing that.
(17:36):
And so I became a victim of my own success in the sense that I had a lot of
patients coming in for testing.
But then we ended up with a four month waiting list.
And, you know, two years of working on that four month waiting list,
I was making no progress at all. It was always a four month waiting list.
And it was a big pain point because
I really felt for patients who really needed to get in for testing.
(17:57):
And also I was getting a lot of emails and phone calls from my colleagues and
friends trying to get their patients in. And then also patient reviews,
I would hear things like, you know, the doctor was great, but it was completely
unacceptable that I had to wait that long to see her.
And one of the things that I ended up doing was I had a lot of patient handouts.
So sometimes I couldn't test patients.
(18:17):
And so what I did was I started to create a series of before the patch test handouts.
So before a patient would see me for testing, if I couldn't do testing,
I had a series of recommendations that I would make for them.
Okay, you have eyelid dermatitis. This is what I want you to do for the next
eight weeks to see if this is going to help.
And so what I did was I put all of those handouts up on my website.
(18:39):
And well, I created a website and then I put all those handouts up on that website
and I shared those with all of my colleagues.
And now if a patient called, my assistant would say, well, her next appointment
is in four months, but she has a handout that she wants you to start following.
And it's on the website, and it can take up to eight weeks for these recommendations to take effect.
So all of a sudden, I was able to reduce my wait time from four months to two months.
(19:02):
And the number of calls and emails and complaints that I got just dropped dramatically.
And I started sharing this with, and this is open access, anybody with contact
dermatitis is welcome to go to my website and use these handouts.
And now there are over 300,000 views every year of these handouts,
and my colleagues across the country are using them.
But it all started with identifying that pain point of that patient access.
(19:26):
And it's been remarkable to
me when we did this review article on practice efficiency and dermatology,
some of the quality improvement projects that had been documented in the literature
are really interesting and fascinating how one group had a problem with all
of the skin biopsies that they were doing that they had mislabeled specimens.
And so they instituted a little change where now they were able to put in a
(19:47):
biopsy request and it automatically printed out a label.
And to me, that sounds like something, wow, that sounds like that's a great
idea, but it had not occurred to them until they really identified that pain point.
So I think the idea here is to really be conscious of you deserve a smooth clinic
day and why is it not smooth and what can you do about it?
(20:08):
So how much I love my work hasn't changed, but how much I like my job with those
small incremental changes really has made a big difference.
So I also, when I think about vision, we talk about short-distance vision as task management.
Long-distance vision is about career strategy. And this is where are you making
(20:29):
progress in your career?
So are you progressing up a slope or are you running on a treadmill?
And I'm going to ask you a question. Are you making progress on your professional goals?
And on a scale of 1 to 10. And I'll also ask you another question as well.
Well, what goals did you set for yourself last year?
(20:49):
And are you on track for achieving these?
And if you're not sure what goals you set for yourself, I'll share with you
some of the goals from the physicians that I've interviewed,
where the goals range from every patient, every single patient that walks into
my office is receiving high quality care,
or in dermatology, some of the new treatments that are coming out, biologic treatments,
(21:12):
or some of the new procedures that are out there.
I also have a colleague who runs a giant dermatology practice who's really interested
in streamlining clinical processes and others who are educating online,
clinical research and more.
When you think about those goals, what goals did you set for yourself last year?
And when I talk about mental models, this to me has been one of the most important
(21:36):
mental models for myself, where if you think about your career,
are you climbing a ladder? That's been in the traditional mental model.
But I think nowadays, I don't think most of the people I know are really climbing
a ladder, really think it's a career mountain range where they are climbing and exploring,
especially as physicians, incredibly interested in lifelong learning,
(21:58):
really excited and energized by lifelong learning.
So I think it's a series of mountains that we're climbing. And if you use that
as your mental model, you can start to see that it's a little little bit different.
So I think of it as a career hike.
And I think of all the different trails that are out there that my colleagues are pursuing.
For my early career residents who are going out there, I emphasize this point over and over again.
(22:21):
The first trail you take, you should start to be a coding sensei because we
know that revenue generation is incredibly important for most employers.
So for the early career doctors, I talk about really becoming experts at coding.
But as we explore further into our careers, I think it's really interesting, some of the new trails.
One of the doctors that I had interviewed, who was a family practice physician,
(22:44):
had decided to become an obesity medicine physician.
And you could just see how much that lit her up, going back to school and learning
about that and starting to implement this in her practice.
For me, I started writing books years ago for the medical students,
as I mentioned, and that's been a really exciting trail. And I think when you
talk about career strategy, we talk a lot about goal setting.
(23:06):
And I all do credit to my husband. I remember one year, this was early in my
career where I hadn't been so deep into thinking about these topics.
And it was the start of a new year. And he turned to me and he said,
so I wanted to ask you, what are your professional goals for this year?
And how can I support you in that? And I thought, wow, I usually don't think
(23:29):
about that in such a concrete, conscious way.
And now I do. I do think about the year ahead. What are the goals that I've
set for myself for the year ahead?
But one thing I sent back to him was, let's also do a year in review.
And this has actually been even more important than thinking about the year
ahead. I find that the year in review has been.
(23:51):
Even more valuable. And by that, what I mean is that I actually ask him and
we do my career and we do his career and we talk about them separately.
And we really try to celebrate all of the wins and successes and the progress that we've made.
And it's really interesting when he shares with me what he's seen about my career.
(24:14):
It's interesting to me. There are a number of things that I had just completely
forgotten that once you achieve a milestone, you kind of just move on.
And it's been interesting to hear about him because he shares cases with me sometimes.
He's a hospitalist at Baylor at the VA.
And sometimes he'll share cases with me. And sometimes I'll share that back
(24:34):
with him at the end of the year about how this was this amazing diagnosis that he and his team had made.
And he's just completely forgotten about it. For him, it was just another day
at work. And hearing me talk about it, it reminds him, oh, wow,
you know, we did save that patient's life.
And if that patient hadn't been at the VA hospital on that exact day with this
(24:55):
team, maybe the patient wouldn't have made it.
So I think the year in review is incredibly important.
So before you set goals, you need to celebrate how far you've come and you need
to make your accomplishments tangible. So I talk about efficiency.
One of the things that my assistants all know, I'm a huge dictator. No, I'm into dictation.
I'm not a dictator. I'm into dictation.
(25:18):
And I promise you, my assistants would not tell you I'm a dictator,
but I'm a huge, huge into dictation. So I dictate everything.
And then oftentimes they will help me proofread and fix it up.
One of the things about documentation is I like to use, in certain settings,
a flipped scribe model where I don't have people scribe for me.
Instead, I do dictation.
(25:38):
And then the scribe fixes up my dictation. So the scribe is the one that...
Described as my assistant, she proofreads it and then sends it back to me.
And so I can dictate super quickly.
So one of the things I like to do is I like to dictate my year in review,
make it really tangible.
I have a folder on my email where I save all of that.
(26:00):
And on occasionally, I'll go back and look at that, especially when I'm not
reaching my goals as quickly as I want to.
It's really nice to see that tangible list of accomplishments.
So I'll ask you right now, in the last year, what are two areas of professional
progress or achievement that you've experienced?
I'll also ask you, what are two things that you're proud of over the last year in your personal life?
(26:24):
And that might be health or family or community.
I think it's good to actually write these down and remind yourself.
When you look at the literature on job satisfaction, Dr.
Teresa Amabile, and one of the things her research has found is that on the
days when people are feeling the happiest, the proudest, the most motivated,
(26:45):
the single most prominent event in those days is making progress in meaningful work.
And so that's from her book, The Progress Principle. And that has been borne
out by the literature on job satisfaction, that sense of progress and really being aware of that.
So as physicians, of course, when you're thinking about career strategy,
(27:07):
the shifting sands of the terrain, things are really shifting quickly.
And so if you think about career strategy and success and career advancement.
The question that I tell my early career dermatologists is, if you leave this
position, are you going to leave it better than when you arrived?
And when we talk about shifting sands, the rise of private equity,
(27:30):
we watch the competitiveness of medical specialties very closely for the medical students.
And one of the things that's been really shocking is how quickly private equity
has taken over emergency medicine.
And this year in emergency medicine, there were over 550 residency slots that went unfilled.
Medical students are not interested in emergency medicine right now because
(27:50):
of this rise of private equity.
So I think as you are developing your career strategy, you really have to think
about those shifting sands and how are you going to become indispensable.
And you should be indispensable, but of course, they should never be indispensable
to you, meaning you have to have reserves of time, energy, money, so that you are not.
(28:12):
Relying wholly on this one job if it went away.
So when we talk about trails to explore, how can you add value?
I am going to mention the risk benefit ratio of different career trails.
I had a friend, I'm going to change the details, but my friend wanted to increase
his income from $200,000 to $300,000.
(28:33):
And so what he did was just went crazy that year to really increase that revenue.
And he did it. He achieved that goal that he had set for himself.
But in the process, he really impacted his health and he gained 50 pounds that
several years later has not budged.
It's really important to think about the risk-benefit ratio of any of these career trails.
(28:57):
And of course, we have to think about our tools. And I mentioned reserves of time, energy, money.
This was a book that I read, Rich Dad, Poor Dad, when I, I think I read it my
first years in attending.
And one of the quotes that I share with all of my students is that a surgeon
is one broken thumb away from disaster.
So early career, I never forgot that line.
(29:21):
And it really, of course, helped when we had to close practice for two months
in COVID because I did have one of my friends who's a dermatologist who unfortunately,
because of some issues in life, had lost her emergency reserve fund.
And two months without income was disaster for her to not have two months of income.
(29:41):
So this is the line when you think about reserves. It's one of the biggest things
that's helped me take some of the chances in my career that I have is because I have those reserves.
When I talk about your team, we all know none of us succeeds on our own.
So I really, I love hiking.
I don't mountain climb, but I also love documentaries about mountain climbers.
(30:03):
And then I saw this documentary and I now recommended this documentary to everybody.
It's called 14 Peaks. It was on Netflix.
Nothing is impossible. And he called it Project Impossible. I love,
love, love this documentary.
It has beautiful cinematography. So he was climbing not just Mount Everest,
but 14 peaks in one season. in.
And one of the things that really struck me on this was that he is from Nepal.
(30:27):
And right from the beginning, he gives all credit to his team of mountain climbers.
And throughout this movie, he's talking about teamwork.
And I made my children watch this movie and just about how you really give credit to your team.
And not just that you need a team to get to where you're going,
but also that you give credit to that team.
(30:48):
And I just think about how my success as a private but practice physician is
my front desk staff, my nursing staff, so many people that go into making us successful.
So that's one thing that we all need to pay attention, of course, in career.
And then if we think about the career checkup, those three organ systems that
(31:09):
we really need to be paying attention to, and I like to say that there are three
vital organ systems that are the backbone of a healthy career.
Of course, heart is so critical.
When you look at the second domain of physician burnout, it's increased mental
distance from one's job or feelings of negativism or cynicism related to one's job.
(31:30):
And I think we all have friends and colleagues who are burned out.
I remember one of my first experiences was when one of my friends was going
through a surgery residency and I remember looking at him and saying to him,
you have really changed.
You are not the same person that you used to be.
He really radiated that negative energy and that cynicism and that negativism.
(31:51):
And this is something that I think most people don't, it's hard to evaluate that from ourselves.
But I think if you ask the people around you to share what they think,
there's a lot of valuable insight.
So does your, so here's the question I'm going to ask you, does your job allow
you to honor your mission?
And if you would write down two patients that you helped in the last week.
(32:14):
So when you think about quality of patient care, and here's the spectrum of
high quality care consistent with our values or care that is not consistent with our values.
And in talking to one of my friends who's in a dermatology practice that was
bought out by private equity, she is trying to get out of there as quickly as
possible because that private equity ownership,
(32:35):
I'm not saying every private equity owner, this particular practice,
the private equity ownership is not allowing her to provide high quality patient care.
And she will be the first to tell you that, which is why she's leaving,
because it's very hard for her to practice in that setting.
So are you consistently providing high quality patient care?
(32:55):
And the literature has shown, this is a great article where it was a project
that was sponsored by the AMA and the Rand Institute wanted to characterize
factors that influenced physician professional satisfaction.
And what they found was that when physicians perceived themselves as providing
high-quality care or their practices were able to deliver that kind of care,
(33:19):
they reported better professional satisfaction.
So in this article, when they summarized, this was one of the best predictors
of professional satisfaction was that high-quality patient care.
Another one that was huge was greater physician autonomy and greater controller
of the pace and the content of clinical work.
(33:42):
Now, when I have residents who ask me advice about the jobs that they're considering,
one of the things I really emphasize is for me, having that clinical autonomy was huge.
It kept me in a job for 17 years because I had that autonomy.
So those are the factors associated with the
professional satisfaction. And then if you're in academics or if you're a non-clinical
(34:05):
physician, the question that I would ask is, does your job allow you to do the
work that you find most meaningful?
And if you look at the literature where they talk about career fit and burnout
among academic faculty, what they found was that in this group,
there were different facets of their work, the academic faculty that they found most meaningful.
(34:25):
Some of it, it was patient care. some of it was research or education.
But the bottom line was that time spent on that meaningful activity was the
largest predictor of burnout.
So do you have enough time to do the work that you found most meaningful?
And here they found that it was 20%. So that was kind of the cutoff.
(34:46):
Those spending less than 20% of their time or approximately one day per week
on the activity that they found most meaningful, if you didn't have that 20%
time, then you had a higher rate you to burnout.
So it's really paying close attention to the kind of work that you find most
meaningful. And does your job allow you to do that?
And when people talk about work-life balance, I also think work-life alignment
(35:10):
is one of the terms that I like, where you think about alignment of your work and your values.
So does your work allow you to live your values?
And as As you look at different values, which values do you find most meaningful?
And does your work allow you to live these values?
(35:33):
I have to say continuous learning is one that's very, very meaningful to me.
And so I love that I'm able to do that. But I remember as an intern,
it was very, very, I don't remember reading much as an intern. It was just doing.
So that was a question on a scale of one to 10. does your work allow you to live your values?
(35:54):
And similarly, your life should also allow you to live your values.
Your work should allow you to live your values and your life should allow you
to build your values. Work-life alignment.
And when we're talking about values, this got a lot of media attention about
the 85-year Harvard study.
So this is a great study. It's all over the media if you just Google Harvard study.
(36:14):
And what they did was they followed a group of young men.
And they started in 1938 following this group.
And later they added their wives to this study. But basically,
it's called the Harvard Happiness Study.
So decades-long study to find out what makes us happy in life.
And so they had these participants and they followed them. The bottom line that
(36:38):
it's relationships, love is happiness, full stop.
So positive relationships Keep us happier, healthier and help us live longer.
Out of this long, long study, that was the strongest finding that positive relationships were the key.
And then when we think about the healthy career, three organ systems,
the final piece of this is energized energy.
(37:02):
So if you think about physician burnout, that third domain is feelings of energy
depletion or exhaustion.
And at the risk of, well,
this is one of the mental models that I like to think about,
that if you are a physician and if you are a mother or a sister or a daughter
or a spouse or a friend or a volunteer or an active community member or politically
(37:26):
engaged community member,
that requires a lot of energy.
Energy and I think about I think about how we
all have energy within us and how that energy has
to go outwards to help sustain to help
fuel the people in our closest circle our immediate family and then outside
of that the people with whom we work with our friends and then you still have
to have energy in order to be able to impact your community in the wider world
(37:49):
and that's a lot of energy that you need to be sustaining and fueling in order
to be able to be that source for so many different people.
And when I think about productivity and just getting through the day,
it's energy management first, time management second.
What I mean by that, when I think about energy, it's brain, body, and emotional energy.
(38:12):
So I'm going to start with the physician task load.
So when we were writing our article about practice efficiency,
this was a tool that I had never heard of before.
It's really pretty simple, but it's been validated in many different studies.
So it's called the NASA Physician Task Load.
And they studied the task load score and the risk of burnout.
(38:36):
So this is a modification of the NASA Task Load Index.
And it's four domains. It's mental, physical, time demands, and effort demands.
So let me ask you, and you can write this number down if you want,
because I'm going to have you add up these four numbers.
Reflect on a day that you performed clinical work during the last one to two
weeks. Think about that day, and it should be representative of your typical workday.
(38:59):
So question number one is, how mentally demanding was that workday? On a score of 0 to 100.
So 100 means that it was incredibly mentally demanding. That's question one.
Question two, how physically demanding was that workday?
Score or zero to 100. Question three is how hurried or rushed was the pace of your workday?
(39:26):
And then question four was, how hard did you have to work to accomplish your
level of performance during the workday?
And so now that you have those four numbers, go ahead and quickly add them up.
Once you add those up, you have a score. And in that study, what they found
(39:46):
was that if you had a score of, let's say, 227, no symptoms of burnout.
But once you started to get in
the 280s, that's when physicians started to have one symptom of burnout.
And as you went higher, your risk of burnout increased. And when I think about
(40:06):
my own journey through my career,
I do remember days when I had so many emails and phone calls from physician
colleagues trying to get their patients in and how that really increased that
emotional energy of the day.
And how once I solved that problem, that score, if I had been tracking it,
(40:31):
would have just dropped, would have just plummeted.
I also solved my documentation problem.
I had gone through multiple rounds of trying to figure out documentation.
Now, actually, a lot of what I do for my patient history, it's no longer required.
Aspects of that patient history are required for my chart,
but they're not required for coding or billing reasons.
(40:53):
And so now what I do is most of my patient history, I just take notes as we're
talking, I handwrite it, and then it's scanned into the EMR.
And that one change has really helped the mental demands of my workday.
So it's interesting if you can start to think, how can you reduce that load
of each of these four, or really be conscious about it.
So if you look at that four elements, what the authors wrote is that this suggests
(41:20):
areas of particular focus in which you can improve the practice environment
and start to make changes.
And of course, some of this is out of your control. Of course,
there's individual level interventions, there's organizational level interventions,
and there's system-wide interventions.
And people are working on each of those. But if you think about the individual
interventions to think about.
(41:41):
So when you think about brain, so I mentioned it's brain energy,
body energy, and emotional energy.
So for me, the scale here is alert to fuzzy when I think about brain energy.
And there's a field of study called cognitive ergonomics.
And as people are looking into the EMR, just about how you can adjust the EMR
(42:02):
to stop putting such a cognitive load on our physicians.
So this is where it can really start to make a difference in terms of that brain energy.
Body energy is energized to exhausted. Okay, is burnout due to sleep deprivation?
And what we know is that it's not one single factor, but that all of these factors
(42:24):
play a role in different ways.
And they definitely have found significant associations between physician sleep and burnout.
Sleep-related impairment had significant correlations with burnout and professional fulfillment.
So here's the question I'm going to ask you right now. Do you follow your own advice?
The advice that you give to your patients related to sleep, exercise,
(42:46):
diet, especially stress management strategies, I will ask you right now,
do you follow your own advice on a scale of 1 to 10? Because nobody's perfect.
And this was the Harvard study of adult development. The doctor who currently
runs it is Robert Waldinger.
And if you look him up, he's definitely been on a lot of podcasts and has a TED Talk.
(43:06):
But the best predictor of longevity and well-being is social support.
So I mentioned sleep, exercise, diet, and stress management.
And of course, we have to put social support there. I love the revised Declaration of Geneva.
So instead of the Hippocratic Oath, now some organizations are starting to use
this modern day physician's pledge.
(43:27):
And I really like it. And one of the points that is highlighted in this revised
declaration is that I will attend to my own health, well-being,
and abilities in order to provide care of the highest standard.
I like that. I gave this talk, and one of my residents texted me afterwards.
She's good on brain energy, body energy, warning, warning, but emotional energy,
(43:48):
SOS. And I think emotional energy, especially after the pandemic and talking
to my friends and colleagues, has really been a challenge in certain settings.
God bless my emergency room colleagues who have had to deal with so many challenges
in the emergency room and then my friends in the ICU.
And I think really in so many different settings. So I think the scale here
(44:12):
is positive energy to negative energy or cynicism.
And the question I would ask you here is, OK, well, how do we treat a headache?
I know how I would treat a headache, right? You take two ibuprofen.
The question I would ask you is, how do you treat a bad day at work?
So if you know you're having a bad day at work or if you know you're going to
have a bad day at work, what would be your treatment for that?
(44:33):
And the reason I'm talking about emotional energy as part of this and how bad
things have gotten out there is since Dr.
Christine Porath, she's written for Harvard Business Reviews.
She's a researcher on rudeness and incivility, and she's run a study every year for years.
So how often are frontline workers treated rudely at work? In 2005,
(44:53):
it was a little less than half.
But now when she's talked to people globally in multiple industries,
you're getting close to 80% are being treated rudely at work.
And this rudeness has a lot of overlap with verbal abuse.
It really spans a range of behaviors. And what this says to me is that all of
us are going to encounter rude, uncivil, maybe even abusive behavior from the
(45:17):
people that we are trying to serve.
And this was an article that was not about rudeness. This was actually about
mistreatment and discrimination by patients, families and visitors and how that
related to burnout. out.
And what they found, 6,500 physicians, mistreatment and discriminatory behaviors
were common within the previous year.
(45:38):
And the groups that are most at risk were female and racial and ethnic minority physicians.
And that experiencing this kind of behavior from the people that we are trying
to serve has been associated with higher burnout rates.
So I think it's likely that most of us, many of us are going to experience this kind of behavior.
And so if you are one of my colleagues who went into work one day working for
(46:02):
a really large hospital system, and then we're told we are cutting your salary by 10% as of today,
and we are doing this to thousands of our doctors, it's not just you.
So if you had a bad day like that, or if your patient yelled at you,
what's the treatment you recommend for yourself? And the associated question
is, what's the risk benefit ratio of that treatment?
(46:24):
And, you know, when I talk to my friends, we all have different treatments for
a bad day. Promise you no judgment.
I like to call them stress cookies, personally, like that's the term I use is stress cookies.
There's also other treatments for a bad day. I have to say that I have had experiences
where somebody has yelled at me in the office, a patient has yelled at me,
(46:45):
and I'm a big believer of taking the stairs.
I find that two minutes of running up and down the stairs is incredibly helpful
for releasing cortisol.
And whether it's stopping at the
YMC after work, a lot of my friends have different techniques for that.
And we wrote an article about positive psychology interventions.
There's been a lot of research into mindfulness and other practices like that,
(47:07):
gratitude intervention.
Personally, Personally, I love gratitude prayers to start my day and to end
my day. So there's definitely a lot of treatments for that bad day at work.
So the question I would ask you is, what are two coping strategies that you
are proud that you employed in the past six months?
And what are two coping strategies that you would like to use less of in the
(47:28):
next six months, considering the risk-benefit ratio of that coping strategy?
And I'll also ask you one other question, is how do you down-regulate?
So I didn't think of this ever when I was first starting out in practice.
And I only recognized it later that a patient would be yelling at me,
and I could feel my heart rate increasing and my respiratory rate increasing.
(47:50):
And I started to consciously think about that. how do you downregulate?
So how do you decrease cortisol levels? And how do you decrease sympathetic arousal?
And how do you activate the parasympathetic nervous system? And it really is pretty amazing.
Dr. Andrew Weil in Integrative Medicine talks about the breathing practices,
the prolonged breathing practices.
And lots of studies have shown that it really does activate the parasympathetic nervous system.
(48:14):
And now I can really drop my heart rate and my breathing rate pretty quickly
with these kind of simple breathing exercises.
I think it's really interesting when you look at the pathophysiology of
it. So how do you downregulate?
And I'm just going to mention one thing about when I've seen this with friends
or colleagues, I call these early warning signs of career cancer,
(48:34):
where you can start to see somebody kicking the dog.
So for example, if you are in the hospital and you see that doctor just railing
into that nurse, really overreacting to that, I think about that as kicking the dog.
And what that refers to, The dog is an analogy for the people who are important and loyal to us.
I've heard of people taking it out on their spouses or, God forbid,
(48:57):
their children or their friends.
And that is a sign of career cancer.
So how do we counsel our patients when we talk about health?
And here we are talking about healthy career, and it's the same concept,
good daily choices, positive reinforcement of all of our healthy habits.
And I really think celebrating any health goals that you achieve is really important. And then also.
(49:20):
Really think about symptoms. What are these early warning signs?
And this is what I consider screening to actually sit down once a year with
your friend, your colleague, your advisor, your spouse to do this conscious
evaluation of your career health and your career choices.
And then, of course, if you start to see anything, initiate treatment and schedule follow-up.
(49:42):
So I think we all deserve a strong, healthy career.
And so we also deserve our own career checkup that is completed with the same
level of attention and commitment that we provide to our patients.
And I'm just going to ask you, are you making progress?
Are you honoring your mission? Are you staying fueled? So I will end there. And thank you so much.
(50:06):
Thank you, Dr. Katta. To our listeners, we hope you found this episode valuable
and take away techniques that you're able to incorporate into your day-to-day practice.
To claim CME for this episode, just click the link in the episode description
and follow the instructions provided.
Remember to like and follow TMA Practice Well to receive every episode.
(50:28):
Until next time, stay well.
TMA has a long, proud history of promoting patient rights, advocating for physicians,
and providing real solutions for your practice.
We can accomplish so much when we unite in one Call the TMA Knowledge Center
at 1-800-880-7955 or visit textmed.org to find out how you can join or renew your membership today.
(50:52):
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