One physician’s story about losing her way and in the process, finding a path for many healers…
We’ve all gone through that feeling at some time or another when nothing tastes sweet, life seems to lose its meaning and every day is a battle. Burnout can be debilitating to anyone but is particularly serious for a physician. Doctors are supposed to heal others – how can they, when they need healing themselves?
Meet Dr. Neha Sangwan, a young physician based in San Francisco, CA. She has been on the precipice and seen just how traumatic burnout can be. In fact, Neha Sangwan was her own first patient!
Sangwan, who addresses this problem through her newly formed health strategy company, Intuitive Intelligence Inc., has treated over 250 physicians and nurses at one of the biggest HMOs in San Francisco and taught scores of workshops.
“The mantra of survival that proved beneficial in residency, ‘Eat when you can, sleep when you can, pee when you can,’ slowly erodes at us once we’re in practice,” she says. “We’re schooled in a culture that values placing our patients before ourselves. We are rewarded culturally by becoming superheroes in crisis, rather than for care and balance in our own lives.”
Ask her how she got into medicine, and she says frankly, “Because I had immigrant parents who came here in 1965 and ever since I was little asked me whether I’d be an engineer or a doctor. I thought there were only two options!”
Sangwan, who studied at the University of Buffalo Medical School in New York and did her residency at Temple University in Philadelphia, moved to San Francisco to work with a large HMO, and rose to become a partner. Since she was single with no family or children, she often took 36 hour shifts, missing out on food and sleep. Within three years of this frenetic lifestyle, she was burnt out.
“I was irritable, tired and worn out, short with people. I didn’t have very much patience. I was even short with my patients – I would cut them off as they were speaking – I just wanted to get through and get it done.”
The symptoms of burnout followed quickly – procrastination, apathy, cynicism and the blame game. Finally it all came to boiling point. She recalls, “I came in one day and I kept checking the same lab tests over and over again and I realized I wasn’t able to function on a level that would get me through18 patients. It was noon and I had seen only 2 patients – I kept double checking the same tests over and over.”
She felt that the solutions that traditional healthcare offered – anti-depressants, therapy and rest time – were not the answers she was seeking. She says, “The truth is what I needed was to know myself better, know my boundaries and be able to seek them, and not have to take responsibility for a system which probably needed more staff than we had.”
She realized that she had become a doctor to fulfill her parents’ expectations and that had carried over to her work where she was trying to please the system and please people, and had forgotten about herself.
“It was a huge lesson for me,” she says. “It was the beginning of understanding myself better and understanding how I got there. I had to own that I was saying yes when I really meant no. I think this plays a lot into the way physicians make decisions. We are typically people who come into this profession much better at taking care of others than we are at caring for ourselves. So there is no self care in health care.”
As she points out, physicians are rewarded for doing relentless 36 hour shifts and wear these punishing hours almost as a badge of honor, going without sleep, without meals. She says, “We are the very ones who understand that what that does to your cortisone level, your adrenalin levels, your work sleep cycles – all the things we care for other people about – we completely disregard in ourselves.”
Young physicians, especially, pick up a candy bar or a bag of chips for lunch at a vending machine, or grab a shuteye when they can. Externally they are handling sick people and emergencies, but try to manage their own stress with a soda or caffeine. She says, “We don’t fuel ourselves properly so our internal physiology is going crazy and we learn to numb out the signals from our body, running on that numbness until we crash.”
Sangwan had to ask herself hard questions – was medicine her calling and why was she so angry at the system?
She even took a trip to Bhutan to put things into perspective. She decided to make it her mission to help other physicians to find ways to avoid burnout. She took many workshops at the Center for Mind-Body Medicine, with Dr. Mark Hyman, a leader in nutrition and the healing power of food, and with Dr. Jim Gordon, the international leader in stress management. She says, “They helped school me on my place in the system and how I needed to take care of myself before I could take care of other people.”
She started work at the HMO once again but brought in a new idea – bringing self care to health care. She says, “When I came back I decided to put together a program for the staff because I saw there were so many people in my position – and there’s only help for burnout only at the end stage. It’s a badge of honor – until you can’t do it any more and then there’s a bit of judgment and pity.”
Sangwan got an innovation grant and created her own program for employee wellness and in the last four years has had 250 healthcare professionals go through the program. She has also trained six other physicians, as well as nurses and healthcare professionals to become teachers and has developed a program for leaders to recognize and address stress.
In the beginning, there was resistance to the workshops from physicians, almost as if it was a punishment for not performing one’s job well. But as word got around, it became almost trendy to attend Dr. Sangwan’s mind body stress class, with a wait list of people clamoring to get in!
The classes are popular with everyone from surgeons to nursing staff, and run with ten participants for two and a half hours a week, for eight weeks, teaching them to connect with themselves in order to face the incredibly hectic days ahead. Stress management, communication and nutrition are the major points used to teach the physicians that burnout is not fluff – it’s real.
Sangwan is affiliated with the Center for Mind-Body Medicine in Washington DC, which has 60 faculty members around the country who come together several times a year for workshops. Her own company addresses preventing burnout not only in physicians but also in people in corporations.
She herself has come to terms with her own role in medicine. As she told her parents, she is still a physician but in a different way from the traditional role they had envisaged for her. “I told them that I was going to be a doctor of the doctors – teaching them about their own self care. I really feel it’s important to educate physicians and have them take ownership and accountability for their health. It’s almost like if you’re not in a hospital bed, you’re not really sick. We want to look up codes in a book or see an abnormality in a cat scan to believe that it’s really there.”
There are many paths to a satisfying career and Sangwan encourages physicians to seek the one which suits them best. Dr. Emily Thomas, a physician who attended her classes because she was burnt out with the routine of a big hospital, found that opening her own medispa with its slower and calmer space was the answer for her. Now she runs her own successful business with several doctors and nurses working for her. The idea is to take inventory before burnout occurs.
“The stress will always change shape for living means stress,” says Sangwan who is enjoying her new profession. “If it doesn’t then it means people are sitting in their comfort zone. Any time you begin to feel stress, the good news is that you’re outside your comfort zone and you’re learning and you’re growing – and the downside is it’s a little uncomfortable. I think burning out changed my life – it jumpstarted me on a whole new career path, a whole new angle to my career that has been the most fulfilling that I’ve ever known. It was really my wakeup call.”
She adds, “My gift is that I can reach those physicians, who then impact so many thousands of people, much before they burn out. People ask me don’t you see patients any more? And I say to them, ‘These are my patients – they are actually the most important patients of the healthcare system.’”
In burnout, besides the physical damage, there is mental stress too: relationships sour and it takes a huge toll on families.
There’s no substitute for a happy, well-rested, present doctor because then the healing of patients can actually take place. These doctors are more present for their families, they are physically active and their eating patterns change even at home. They almost always eat breakfast while before they used to run out the door. They don’t need to pop pills for insomnia or headache and are more evenly energetic throughout the day. Self awareness and communication helps physicians to understand themselves better and thus value themselves more.
For more information, visit www.intuitiveintelligenceinc.com
Is the Golden Age of Physicians Over?
One physician who realizes the toll burnout takes on physicians is Dr. Pankaj Vij, an internist with a large multi-specialty group. “Burnout is hugely serious – I have a lot of people in my family who are physicians and many of my colleagues are also saying they frustrated and skeptical about the whole system. It’s really hard work and no amount of money can justify what doctors do, day in and day out, whether here or in India.”
Vij, who did his medical studies at AIMS in Delhi, came to the US in 1993 for his residency at William Beaumont Hospital in Detroit. He has practiced medicine in different settings from a solo practice to a two-doctor medical office, and both were a source of pressure since they entailed dealing with insurance carriers, lawyers, payment collection and obtaining loans for office expenses.
He turned to working at a large HMO where he was freed from administration but did not have much autonomy. He says, “Actually seeing patients and helping people is the fun part – it’s dealing with everything else that makes it difficult. The health industry is the most regulated in America – it takes more time to do all the documentation after seeing a patient than it takes to see the patient!”
The resulting frustration often leads to burnout, and Vij went through it too. He attended Neha Sangwan’s classes on communication as well as several mind-body workshops. He says, “We can all benefit from clear communications in life, and it’s helped me, not only with patients but also with my own family, because I’m now more centered and focused.”
Vij also attended special training for providers at the Center for Mind-Body Medicine and says, “I chose to work with my patients using mind body techniques of yoga and meditation to induce relaxation and reduce stress, and return the body to a more natural state.”
As he points out, people think of the medicine as a glamorous, high paying profession and it’s the ambition of every Indian parent to have their children be physicians. Yet he thinks that one could make much more money in other professions, without the hassles. “So if you become a doctor, it’s not for the money – it’s for something else. Whatever you’re doing is to help another human being – you’re touching another person’s life and making it better.”
If doctors don’t heed burnout and drive themselves too hard, it will be detrimental to the profession. “People who are in the profession don’t look as if they are having such a good time,” says Dr. Pankaj Vij. “Ten years down the line, you will see fewer new people entering the field – there will be a shortage. The golden age of being a physician in America might be over, but by learning to look within and to communicate better, one can still find immense satisfaction. Mind-body medicine is an exhilarating voyage of self discovery that can heal the healer along with the patient.”