Ask Me MD: Medical School for the real world

Peter Yellowlees, MD - Mental Health Series - Addressing Physician Stress

October 30, 2020 D.J. Verret, MD, FACS Season 1 Episode 18
Ask Me MD: Medical School for the real world
Peter Yellowlees, MD - Mental Health Series - Addressing Physician Stress
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Ask Me MD: Medical School for the real world
Peter Yellowlees, MD - Mental Health Series - Addressing Physician Stress
Oct 30, 2020 Season 1 Episode 18
D.J. Verret, MD, FACS

Dr. Peter Yellowlees, chief wellness officer of UC Davis, joins Dr. Verret for a discussion about the programs he has implemented and participated in to maintain physician mental health. The top three focusses on the top three things physicians can do if we are feeling depressed.


If you have questions or ideas for a show, send us an email at [email protected]. Hear the latest podcast at http://askmemdpodcast.com or through your favorite podcast directory.  

Show Notes Transcript

Dr. Peter Yellowlees, chief wellness officer of UC Davis, joins Dr. Verret for a discussion about the programs he has implemented and participated in to maintain physician mental health. The top three focusses on the top three things physicians can do if we are feeling depressed.


If you have questions or ideas for a show, send us an email at [email protected]. Hear the latest podcast at http://askmemdpodcast.com or through your favorite podcast directory.  

Announcer:

Ask Me MD, medical school for the real world with the MD Dr. D.J. Verret.

Commercial:

Greetings and welcome to another edition of Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret. And today we continue another edition of our physician mental wellness series by talking with Dr. Peter Yellowlees, the chief wellness Officer of UC Davis Health, about the programs he's instituted to maintain physician mental health. We'll talk with Peter right after this. Commercial inserted here Welcome back to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret. And today we have the great pleasure of being joined by Dr. Peter Yellowlees, psychiatrist and chief wellness officer at UC Davis. We're going to be talking about physician well being Dr. Yellowlees. Thanks for joining us.

Peter Yellowlees, MD:

And we'll thank you very much for having me, D.J..

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I, I was very impressed with the work that you're doing out there, which is why I reached out but for those of our listeners who aren't familiar, could you tell us a little bit about yourself and your background?

Peter Yellowlees, MD:

Oh, I mean, I'm a sort of fairly fairly, pretty pathetic person. I was born and brought up in Britain and went to medical school in London at University College London. I then moved to Australia and spent 20 years in Australia where I've trained in psychiatry, and did a PhD, and got used to treating cancer physicians. And I've always had physicians referred to me as patients. And then I got recruited by the University of California, back in about 2004. And I've been on faculty there Davis ever since. And continue treating physicians as patients were my psychiatric pap. But for the last 10 years or so I've been chair of our well being Committee, which is a Jayco mandated committee that all health systems have to have that is to support and help physicians with possible impairment from either psychiatric or substance related problems. And then finally, I guess, the health system set up a position of Chief wellness officer about two years ago, for and I was appointed to that. And in that role, which is a halftime role. My main responsibility is actually trying to change the culture of our health system to change the way we work organizationally. And to make life easier and more efficient and more acceptable for physicians. As part of that, I clearly also work across with other disciplines. So there's a lot of work with with the nurses in particular, but also with all of our staff. So it's really interesting. It's all about actually keeping our our health workers healthy. And obviously in COVID. That's been difficult at times. But I think it's a role that increasing numbers of health systems around the country are taking up. Because in reality, if you don't look after your health workers, they can't look after your patients.

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And I know that as part of that role as well. You've started some work with the local medical society in joy medicine program. Can you tell us a little bit about what that program entails?

Peter Yellowlees, MD:

Sure. So this is the Sierra Sacramento Valley Medical Society and you know, most areas have their own local medical society. As has about 6000 members here in Northern California across six counties. And this is a program run by the SSVMS. I just happen to be involved in it among the the sort of committee that manages the program, but really, it's a program run by the svms. And I'd encourage anybody listening to go to SSVMS.org. And put in joy of medicine. And you'll get all of the details of the program. And so essentially, what is a program about it has a range of different facets to it. And there are regular talks, and, and an annual educational summit, which in fact, this month, or this year has been run across a month. So instead of having a full day of education, it's been two hours a week, for four weeks during September. And I think it's gone very well. We organize for essentially a series of support services for physicians who may be suffering from burnout or other difficulties. So the ssms actually pays for free coaching for up to six sessions per physician. And we've had well over 100 of our local physicians take out this option of going to see a coach. We've also set up a system whereby any physician from our region can urgently be seen by one of our psychiatrists here at UC Davis. So we have essentially a quick route for physicians to get psychiatric care if they if they need that. And obviously, as you will know, it's sometimes very difficult to get in to see a psychiatrist. We do a lot of educational things. So we regularly run podcasts. I've been one of the facilitators of us for the last few months. And we have a lot of resources about physician well being, we organize a series of meetups, which, prior to COVID, with physical meetups in people's homes, and in COVID, they've been obviously virtual. And then we also about 18 months ago did a survey of all of our members looking at not just the prevalence of stress and burnout, but also what other types of services and whatever types of assistance with the local doctors want from a medical society, and from four big health systems that all work in our area. So it's a very active, busy program. And it's something that I think all local medical scientists should really think about as, as a real value to physicians, particularly physicians in private practice, who can get very isolated at times.

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That is a fascinating program. And I totally agree, I in our area, probably 50 plus percent of the physicians are in private practice, in that isolation is very real for them, I can I can speak to it personally. It gets difficult when you're not in that large group setting to make those connections and start feeling isolated and and just kind of get down in the dumps sometimes. I think that's true. And I think,

Peter Yellowlees, MD:

you know, one of the one of the more popular elements of ours has been the meetups that have been arranged. And it's not and again, obviously, people in private practice find that helpful. But, you know, I work for a major university system. And yet I don't get to meet colleagues who work for maybe for Kaiser or for solder or for some of the other health systems in our area. And so it actually gives us the opportunity of interacting with colleagues in other systems that we simply wouldn't normally have.

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I'd like to talk a little bit about just about physician burnout, in suicides, mental health, and kind of maybe some things that you've seen that have worked to help physicians stay mentally healthy. You know, physicians, obviously, statistics show suffer suicide at a rate probably double the general population. But is that something that is is predestined? Or is that something that evolves over time with the job?

Peter Yellowlees, MD:

I think it's certainly not predestined. I mean, we know from lots of studies that when we'll enter medical school, that were actually psychologically healthier than equivalent graduate students entering PhD programs, for instance. So we know and we know that it's very difficult to get into medical school, you've got to be able to jump a lot of hoops and be very resilient to do that. So we know that inherently physicians are actually highly resilient people we have to be to get through the system. We we were working, but we do work in a really horrible system. I think it's really we need to be very clear about that. The the organization of healthcare is pretty chaotic, across the whole of this country and in many other countries. And, and I think professionally, we have some real deficits in our professional culture. One of which is you know, The denial of our own needs in the Hippocratic oath, for instance, there is no mention of the needs of a physician to look after themselves to be able to look after other people. And so we we tend to get trained in a culture that, that says that 100 hours work a week is fantastic, that we can really do well, without sleep, that if we're really tired, then maybe, you know, some, some glass or two of wine is the best treatment, you know, or beer or whiskey or whatever. And that we should treat ourselves for our own problems rather than having a primary care physician. And so we tend not to get good treatment, when we have either potential problems with a mental health problems or physical problems. And, and we, we tend to denial or only deny our own needs nice. So I think there's a huge reason to change the culture of medicine. So first of all, it becomes much more reasonable to get help when you need it, for whatever reason. Secondly, that we need to be able to actually talk to our colleagues when we see our colleagues becoming unwell. And take them aside carefully and quietly, and have a chat with them and suggest that they get help. You know, if you're like me, DJ, you've probably seen colleagues in the past who you knew were having difficult times, but who you were too embarrassed to talk to about. And so we need to be prepared to help ourselves and help our colleagues. And then we need to have at good access to care in a way that is not stigmatizing. And, and relatively easy to organize. And so all of these things need to be we need to change a lot of things about our whole profession, and about the way we are organized and the way we work. It's really I mean, sounds ridiculously simple. But, you know, if we don't do this, this is going to be more and more suicides.

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You mentioned looking out for our fellow physicians, and and I have seen other physicians who I know are stressed. What do you see is the best way, though of approaching them in a way that becomes constructive and doesn't end up pushing them further away?

Peter Yellowlees, MD:

I think that's a really great question. And actually, that's something we're training our residents to do at the moment. And in fact, the double AMC and a number of other groups are actually taking that particular issue on as a specific sort of learning objective for the younger physicians. So So the best approach, quite honestly, is to just try and take your colleague or your friend, somewhere that's fairly neutral, I've done this on several occasions during my career, I actually tend to try and just go out to a local coffee shop, and just say to somebody, hey, look, you know, we haven't caught up for a while, you know, I'm just a bit concerned about your How about, now we're gonna have a bit of a chat about it. And they, and then just suggest that you go, you know, outside of the normal work environment, go somewhere neutral, go somewhere where if they get embarrassed or start getting distressed, you know, it's actually a safer place for them. And, and then just try and listen to people just learn to listen, as physicians, we tend to want to fix problems too quickly, sometimes. And in these situations is much better, just to give the person the opportunity of talking about what the issues are. And listen, sometimes listening is all you need to do. Obviously, if you then know off resources to help, that's great. But the first stage is just acknowledging that was a problem and listening.

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Obviously, it's one thing to identify a friend who may have an issue, but it's another to kind of come to that self realization. There's a lot of discussion in physician boards, message boards, I see about people feeling burned out and wanting to leave medicine. Are there specific things that you've noticed in the practice of medicine? I know you've said there's systemic issues there, their personal care issues, but is there something specific that you've noticed that really pushes physicians towards that feeling of burnout?

Peter Yellowlees, MD:

Yeah, I think we, we need to start acknowledging that actually being a physician can be quite traumatic. And that we get sort of exposed to a lot of painful, difficult and distressing incidents. And unfortunately, we're trying to just deny this. We're trying to sort of, you know, take a stiff upper lip and carry on working and, and you know, if we can, we have a distressing time with one patient, we somehow got to pull ourselves together and be completely on top of everything. So The next patient. So I think we've got to start thinking about the whole sort of World of trauma, and the incidents that affect us, and how can we best learn to cope with those in a way that is helpful for us and allows and keeps us fit, rather than just, you know, denying the whole problem. So for instance, one of the programs that we're doing at UC Davis at the moment, is training a lot of physicians and nurses and other staff in the, in essentially the process of what we call psychological first day, which is really the capacity to listen well to someone, and to then assist them and organize resources and referrals, if necessary, but acknowledging that there are traumas and there are difficult incidents that we all have, and giving people a chance to recover from those. It's very, I mean, it's actually sounds ridiculously simple. But it's not something we tend to do as physicians, we somehow feel we've got to be the heroes all the time.

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Is there a way to know, as physicians, we kind of look at administrators as the the penny counters of the organizations? Is, is there been a quantification put on? Or is there some framework, we could quantify the dollars and cents of physician of the importance of physician mental health to larger organizations?

Peter Yellowlees, MD:

And yes, there absolutely is. In fact, there's been some very nice work done by Stanford and by some of his colleagues at Mayo, where he used to be looking at leadership in particular, and the costs of burnout. And we know that in the US, the the average burnt out physician costs, the health system, they work for about $6,000 per year. And if you assume that somewhere between 30, and 40% of your physicians are showing some signs of burnout, that becomes a very considerable cost. And it's something that health systems are now very aware of, and increasingly become aware of. So I think that that brings you on to, again, the culture of health systems. And then over the last 15 2030 years, they've clearly been excessively driven from a financial perspective. And my view is that the main single, I guess, talent that CEOs of the future will have is empathy, and the ability to actually look at how do people feel about their work? How are they coping? How are they managing? How can we improve this situation? And how can we therefore, essentially get more out of them, but but in a more effective way. And I think we have to really look at our leaders and and start thinking about leaders as needing to have a very different mindset from a lot of the leaders of the last two or three decades.

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It's interesting, you bring up the word empathy, I'm actually listening to a book by Alan Alda. And all the had created a communications Institute at Stony Brook University that aims to improve communications between scientists and people they're talking to, in particular doctors and their patients. And one of the big things that they talk about is exercises to improve empathy of physicians and communicating with their, with their patients. And you bring it up that improving empathy of the CEOs with their doctors, it seems that there's probably more empathy to be have on on had on every level.

Peter Yellowlees, MD:

I think that's true. And you're absolutely right. I mean, there's a ton of evidence to show that if you are a more empathic person, that you communicate better with your patients, your patients actually do better, they like you better. And ultimately, you're able to be a better physician.

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When we talked a little bit earlier about independent physicians feeling more isolated, the need for kind of systemic system changes. What what steps though, could be taken by independent physicians to either recognize or hopefully prevent burnout. Is there. Is there something that you've seen that has worked on on the more independent level?

Peter Yellowlees, MD:

Yes, um, I mean, I'm like you have been in private practice in the past in my career, and I really get how lonely and isolating that can be. I mean, I think the key most important thing is to keep well connected with some colleagues and to ensure that you have people who you can talk to about difficult patients difficult problems, that you have some collegial process going. And friendships, you know, with that are useful both professionally and personally. And you actually need to make the time to that. And, and that's got to be part of your work plan. So you know, you shouldn't be booking patients in 1012 hours a day, 556 days a week or longer, you need to give yourself some breaks and, and see a membership in a local medical society, or going out to dinner with groups of colleagues or meeting people at the gym, or going on runs together or cycling together in groups of colleagues or playing golf, you need to see those as being really important self help approaches to life, it's not just a matter of taking a bit of time away from patients is actually giving you positive time for yourself. I think one of the dangers of private practice is that the financial side, you know, becomes overwhelming for many people. And they somehow feel that if they take a few hours off, they, they that's quantified at a certain dollar level. But in reality, they should be thinking that if they don't take that time off, then they're not going to be investing in themselves to the same extent. So I think we've got to start taking that sort of self investment mindset. For for people in that environment.

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You mentioned that you were moderating a podcast for the Medical Society in the joy of medicine program. It's it's, it's fascinating, they have some great stories. Are there any in particular that you've heard, or even maybe from your experience of physicians, who seem to have been burned out, but reinvented themselves that you think would be educational for some of our listeners.

Peter Yellowlees, MD:

And I was done. I mean, this, this was probably about 20, to 25. Examples of physicians being being interviewed on that particular podcast, several of them certainly have been burned out, the thing that has impressed me most, quite honestly, has been the extraordinary range of backgrounds that they've had. You know, there's a couple of physicians I've interviewed who come from one from Russia that are very well, who had just overcome an quite amazing number of barriers in her life, to be able to become a physician in the United States and to be very successful at her job. And it's quite extraordinary and humbling to see what some physicians actually do. To be able to get to what is still a very valued and important role. within our society, it's not an easy thing to succeed as a physician. And so so I've that's what surprised me most, really trying to identify those stories and find people who've got this sort of unusual background, and who've really overcome incredible barriers.

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Have you seen in interviewing the physicians, have you seen a common thread that led them to the burnout that you weren't expecting from your previous experience?

Peter Yellowlees, MD:

Well, I think first of all, there's two groups of physicians, we should think about here, physicians that are generally featured on the podcast are not typically physicians who have been burnt out their their physicians who've been doing actually very well, and have come from, you know, maybe an unusual background or, or who've learned successfully how to manage their strengths. I mean, when I see physicians as patients, it's not a different ballpark. And, and typically, you know, what you find is that, that they have got into a cycle whereby they are getting stressed, they've got problems, whether it's personal problems at home, or, or problems at work, perhaps problems with an EMR or, or some other very specific issue. And they have got into the cycle whereby they just think if only I worked a bit harder, I'd solve this problem. And if you remember back in medical school, that's what we were all taught, we were just taught, you know, if you worked hard enough, you'd get good scores in the steps. And, and so a lot of physicians use that as a mantra in life. And if they, you know, almost any problem can be overcome if they want to work a bit harder and do a few more hours. And so that's what they do, and then it doesn't work, and it fails and then they get mad when they start not sleeping and they're not looking after themselves. They give up the physical fitness activities. The gym anymore. And they gradually become anxious and depressed. And so I see the symptoms of burnout as being really almost a, a marker for potential depression or anxiety. burnout is not an illness per se. It's not a psychiatric illness. It's a it's essentially a stress response. And, but it's but there's no question if you are burnt out, and then it it can make you much more vulnerable to developing psychiatric illnesses. And then, for instance, getting referred to someone like myself.

Commercial:

We're talking with Dr. Peter Yellowlees, psychiatrist and chief wellness officer at UC Davis. You're listening to Ask Me MD, medical school for the real world. We're going to take a short break. And when we come back, we're going to talk the top three with Dr. Yellowlees. Commercial inserted here Welcome back to Ask Me MD, medical school for the real world. I'm Dr. D.J. Verret. And today we've been talking with Dr. Peter Yellowlees, psychiatrist and chief wellness officer at UC Davis. This afternoon, we're going to ask Dr. Yellowlees, his top three and Peter, the top three, I'm going to throw your way or what are the top three things you would suggest to physicians who are feeling burned out?

Peter Yellowlees, MD:

So I think it's, first of all, acknowledge the fact that you're feeling burnt out. And if necessary, do some reading about it. Think about the symptoms you've got think about why was it you got irritable with the with your MA in clinic? No, earlier on in the day? Or? Why? Why are you thinking of patients as numbers rather than people. So firstly, you know, acknowledge that that this is not normal for you. And this is not why you came into medicine. And I think the second thing is really, very simple thing that we don't get our patients to do enough, is actually write down what you do during the week. And write yourself that write out your schedule, and look at your schedule, in terms of the amount of time you're working, the amount of time that you are doing things you really enjoy, you know, being with your partner, you know, the hobbies, interests, and keeping fit. And, and then the amount of time that you're, you're sleeping, and, and unrest. And, and you'll find that physicians typically have a lot of time at work, not not enough time of sleep, and certainly not enough time enjoying themselves. And, and but actually try and be honest about it. So so if you if you get people to say, to do this exercise, and also at the same time save them. So what are your real passions in life? What do you really like doing? And, and get them to quantify the amount of time they actually do that. So people will say, Well, I love going to art galleries and studying painting. And then you follow up and say, Well, look, how many times have you done that? How many hours have you spent on that in the last month, and and those people who are burnt out will typically have done very little of that. And so, so look at what people like doing it, and then actually how much time they spend on it. And finally, look at other things you're doing that are really not helpful. Like, are you drinking too much? Are you taking too many substances? Are you taking, you know, sleeping tablets, for instance, that you really don't need? Are you putting on a lot of weight? You know, are you are you doing other whole other things that that you're actively doing at the moment that they're really not good for you? And can you change those? So so it's really, those, I guess those three areas would be things that I would suggest for any physician to do, who's starting to feel feel burned out, and then actually challenge yourself to change and maybe change with your wife or your husband or a friend or a colleague and do things together. But it's often very much easier to change when you're when you're actually doing something with someone else.

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I love the suggestion of actually writing things down, I think. And I hear it in a lot of different areas. But I think if you write it down and you actually see it on paper, you can no longer legitimize it mentally, when it's actually concrete and in front of you, you have to accept that. That's actually what's going on.

Peter Yellowlees, MD:

Right, exactly. I mean, a ton of people say they really like sports. Okay. So ask them, you know, how many times have you actually seen the local team in the last month? How much time have you spent on that? How much time have you played yourself? And, and you're right, I mean, seeing it written down objectively on paper, it's actually hard to find so many people.

Commercial:

Peter, thanks for joining us. That's some great information. I think, unfortunately, several of our listeners will probably recognize the symptoms that you're seeing, but I'm hoping that the information you've given the ideas you've given will, will kind of help turn them around as well.

Peter Yellowlees, MD:

And if I can just make one last quick comment, because we've talked a little bit about suicide if in fact, anybody listening to this, you know, is suicidal, please talk to somebody else. Please. And if you know somebody who you think is suicidal, talk to them. Nobody ever gave anyone the idea of suiciding. So it's an it's an issue that you should bring out. If you're concerned about it, don't hide it, and then get people some help. If you need to do that.

Commercial:

I absolutely agree. I don't think we should lose any physicians. And just to put it out there, there is always the National Suicide Prevention Lifeline 1-800-273-8255 24 hours a day, seven days a week, definitely reach out. Peter, thanks for joining us. I really appreciate the time and as I said, some really great information.

Peter Yellowlees, MD:

And thank you very much, DJ and good for you for doing this podcast.

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We've been talking with Dr. Peter Yellowlees, psychiatrist and chief wellness officer at UC Davis about physician well being you're listening to Ask Me MD, medica school for the real world. I' Dr. D.J. Verret. And until n xt time, make it an awesome we

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