Healing the Healers: Overcoming Physician Burnout
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Kara Wada, MD: Welcome back everyone to this episode of the Becoming Immune Confident Podcast. My name is Dr. Kara Wada. I'm a board certified pediatric and adult allergy immunology, lifestyle medicine physician and autoimmune patient. Today, I am so incredibly thrilled to welcome today Dr. Diana Londoño, the founder of the Physician Coach Support.com, where doctors can get peer support over Zoom 24/7. She is a certified life coach and one of the few female Latinx urologists in the country. She has experienced burnout twice herself, and because of that, she writes and speaks passionately about wellness and humanity and medicine on social media and on television. She says, if Physician Coach Support.com can pull just one doctor from the brink of burnout, it is all worth it.
Thank you so much for joining me, Dr. Diana, and I am so excited to chat today.
Diana Londoño, MD: Thank you so much for having me and just sharing your platform to really bring awareness of some of the issues that physicians are having, and so I'm just grateful to be here. Thank you so much.
Prevalence and Impact of physician burnout
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Kara Wada, MD: Yeah. Can you share a little bit more about your story?
Diana Londoño, MD: Absolutely. For those that don't know, physician burnout is quite extensive and almost two thirds of all physicians are in burnout. And what does that mean? It really means that we have unmanaged chronic stress, which then leads to burnout and it can manifest in many ways. And the ways that they can manifest is physicians may feel angry, they may be apathetic, they may be depersonalizing their patients, meaning that is not Mrs. Jones with an autoimmune disease, but it's just a disease, we don't even put a face or a story behind it. And we may be angry, we may have a lack of compassion, we may feel depressed or anxious, and many are suicidal. And up to 400 physicians per year commit suicide.
It really plagues a lot of our colleagues and that is one of the reasons that perhaps as patients, we see a physician and we may feel we don't get the care that we would expect that the physician doesn't look at you in the eyes, they are not listening adequately, they are not having compassion or empathy and they're just trying to just get through the motions or they're angry or reacted to the patient. And it's not because we are evil people, it's not because we only care about money or greedy, it's just because we cannot give all those great qualities you want in a physician when we are in chronic amount of stress. And many of us maybe contemplating how to end our lives that day.
So that's the reason it's not, it is multifactorial, it's not just the system. It's not just the self problem. It's, there's many many layers. It's a complex issue. And I also think that, it's not only obviously affecting physicians and that has many ripple effects to the people and the patients we touch, but in overall society has chronic stress. We especially see the effects of this with autoimmune diseases worsened by stress, aggravated by stress, but in many specialties. And even myself as a urologist, stress is a big part of symptoms that I see with things like overactive blood or frequency and urgency to pee or pelvic pain. All that is stress related.
So if you don't address the source or the root of the problem then we're just putting band aids and just treating symptoms, which is very western medicine in a way. We treat symptoms but we don't treat the root cause of what's causing a lot of these things.
Kara Wada, MD: What I will just commonly say to patients is we are all trying to function within this very broken system. So what are some of the things that you. As we think about the different aspects that play into this complex problem, what are some of the system issues that will come up when you talk with other physicians or maybe yourself that played into your burnout?
Role of chronic stress in causing burnout
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Diana Londoño, MD: For me personally, I mean my burnout, it really gets this chronic amount of stress really comes from worry, from stress, from fear. So some people say, "Oh I don't stress', but they worry. So it's the same thing. So basically you're activating that nervous system that, yeah, sympathetic that fight or flight, and again, it can get there anyway.
For me, it was really fear and it was from COVID, like severe fear that was really almost paralyzing, even though it was not the front lines per se. But I was very afraid. I also internalized a lot of people's fear that was not mine. And my nervous system was in complete overdrive.
What I experienced was: I had insomnia. I couldn't sleep. I was grinding my teeth, I destroyed my teeth. I had an abscess from destroying my teeth. I had to have root canals. I had to even Google what that means cause I didn't know how, what that was. I developed asthma at age 42. From chronic inflammation, and that's what stress, hormones, cortisol does. It's just an inflammatory state. I had debilitating chest pain. I developed joint pain and my rheumatoid factor, which is from autoimmune disease, elevated and I don't have autoimmune disease. I don't have, asthma.
Now I can run with without issues, but when I was in chronic stress, I was so prolonged. That's what my body was doing. I. And our body is very wise. It has a lot of wisdom and it gives us signals, it gives us symptoms, it gives us pain. And these are really signals to say, pay attention. Pay attention to what's going on. And we just ignore it. We say, oh, whatever. Or, we want all these scans to prove to us that there's something, and you're not gonna find anything on the scan, cuz it's not an organ problem at this point where you say, oh, there's a mass or something. This is stress. You don't see it on any test.
But I didn't change anything except what I pay attention to, how I start my day, what I focus on, and really schedule time every single day. To activate that other nervous system part that parasympathetic that rest and adjust and like that is essential, and I do that every day. Multiple times a day, and also scheduled night and in morning to really, stop that stress cycle and be in a place that is calm and it feels joy and I can have compassion and I can have excitement and I'm not, feeling empathetic or just totally burned out that I don't care.
So I think that happens to patients. That happens to physicians. Again, why it's so important as physicians is we touch a lot of lives every single day. And when you're rude to a patient and they're rude to the front desk and then they're rude to their family and it just has a ripple effect. And the reality is too, that we make mistakes when we're in chronic stress, we make mistakes, and that's because we are on fight or flight.
We're now waiting to rest and digest and compute the problems and think about all the reasons that we're seeing things. And that matters when you make mistakes and that matters when you're not compassionate. It's really important to address as physicians and for physicians to really pay attention and say,
" We matter. Our time is important to take care of ourselves. We have to learn boundaries. We have to learn to say no or say yes to things that are important for us" and that's like the first step to have some awareness, have courage and take actions, take steps to do something different, to take care of ourselves.
Effects of burnout on physicians' well-being and patient care
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Kara Wada, MD: Yeah. I wanna go back to a point and just reiterate, you were talking about how when you're in fight or flight, you really have a narrowed focus on what you were thinking about, especially in your clinical decision making. And I know one thing that I recall from my experiences with burnout is I am referred a lot of patients who are challenging, in that they're on their diagnostic odyssey trying to sort out what their symptoms are caused by. Whether it be an evolving autoimmune condition, an allergy, what have you, and those situations, I know when I was in burnout, I was not getting curious. I wasn't staying engaged, I wasn't really listening. I was looking to check boxes and how quick can I get my day done? And. I'll say that in part has really been where I've seen such a dramatic change, and I think those are the situations that your clinical judgment in that moment or that half hour visit or what have you, that you have with the patient really has the potential to change the trajectory of that patient's outcome and their treatment over the long term.
Diana Londoño, MD: Absolutely. And I really do think that so much comes from the history. It really does. It really tell you what is wrong, and we also have to honor what people tell you and what they experience. A lot of it comes from ego that, "Oh, I know better". But it's not if I patient tells me "This is what I'm experiencing", then I need to listen and be like, "Okay, what are you telling me?"
Because their wisdom is their body and we don't wanna say," I know more than you".
I do have clinical experience, but we have to value what patients tell us. But again, if we're in burnout we don't listen. We just are trying to get like those kind of clue words that sort of get to the diagnosis and tick it off.
So it's so important what you said and absolutely. You lose that curiosity because when you're in that burnout like curve, that curiosity, that relaxed state, that joyfulness, it's gone. It's just you're not in that place. And when you're calm, happy and joyful, which you're not in burnout, you're not in stress mode. You know you have that space. To have compassion, to have curiosity. And it's if you're like in Bora-bora, like you're like in nothing fazes you, you're just like, "Oh, okay". But when you're in the middle of LA traffic or something, it's like you're in a different place.
And that's what it means to be in burnout every single day where you're like reactive, you're angry, you're just like in a short fuse. And yeah you, like I said, you make mistakes and you don't have that space to really listen, like you said.
Kara Wada, MD: Yeah. You were mentioning that you have some practices that you've incorporated into your daily routine.
How does that look for someone who's maybe wanting to start tapping into that parasympathetic response?
Purpose, spirituality, and self-care in overcoming burnout
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Diana Londoño, MD: Yeah, absolutely. And I actually prescribed this to many patients as well. So it's not like I just give them, here's your medication. I really say, "okay, this is what you're gonna do, and my burnout story really then became into coaching. And coaching is very important. Coaching is like an awareness. And it really gives you an awareness of your thoughts and your feelings leading to like actions and results. And that's important, but I really think there's much more than that. And you can have awareness, but if you don't go deeper into a couple of things, one is spirituality, and I'm not talking about religion, I'm saying spirituality. And that's really also tapping into the purpose.
What is your purpose in this world and having purpose it is really what gets you outta burnout. Get having something to look forward every day that you're excited about, whether it's your podcast, whether it's saving chickens, like whatever it is in your life. That purpose really gets you outta burnout.
So having a purpose, realizing like, what am I here for? How can I use my gifts? How can I contribute to the world is really important. And also really not only spirituality, but just really thinking about again, how to activate that parasympathetic and for me starts with gratitude and there's like neuroscience behind it. It's not just fluffy stuff. Gratitude changes the neurochemistry, the hormones that are released in your brain and your body. And you're feel in a different state just by practicing and thinking about gratitude. So for me, before I go to bed, I write down in my little journal what I'm grateful for the day.
When went well, what I'm grateful for. And when I wake up, I do the same. And I also do meditation and there's many forms of meditation. You don't have to close your eyes and be quiet, it's not like the thoughts stop, like thoughts continue to happen, but it's really about quieting in your mind. And there's many ways to do meditation.
Meditation can be a prayer, that is one form of meditation. So if it's not secular, it could be, like in religious, if that's something that helps you. But you could also have like a mantra. And you just repeat that and it helps to anchor your billion thoughts that you have every day and it just quiets down like all the noise in your head.
So by having a mantra, something you repeat, whether it's secular or religious, it really helps you. So if it's something that you know, religion works well for you to say a prayer, do that. If it's not religious, just close your eyes and breathe. But I definitely do that. For me, I mean I also do yoga, but again, you don't have to do yoga.
It's just something that I do, I used to run a lot. And running is one type of meditation as well, cuz you're moving and breathing. So if running works for you, do that. If biking works for you, do that. But I think that's really important to incorporate that in your day and for me, like 30 minutes in the morning are essential because I quiet down my mind.
I just breathe and it stars your parasympathetic. And you can do that throughout the day.
Breathing, conscious, breathing, activate your parasympathetic. So when you just take like three deep breaths, I mean that immediately will start that parasympathetic. And you can do that at any time of the day, maybe before a stressful situation, maybe before going to the doctor if you're nervous. That's gonna bring down your blood pressure, it's gonna bring down your breathing, and that's helpful.
I do that and I definitely try to, like I said, exercise. That's very helpful. It has been shown to be just as effective as antidepressants. And I'm not saying antidepressants don't have a role, if you can do it without medication, I think that's fantastic.
And exercise is a great way to feel better to decrease and release stress, so I do that.
And I also like to dance, so I usually, like I'm dancing somewhere or on Instagram or something fun just to release like all the stress that builds up.
I also like to do, baths, like warm baths, and I put salt in there and lavender and I just lay there for 20 minutes twice a week to just get rid of all the energy that we pick up, especially if you're an empathetic person.
So to me, those are helpful things I add to my routine. Especially also sleeping really important. Sleeping is key. You have to sleep well in enough hours. That's really important so you're not angry and reactive and eating well that bit, it's all like doing a lot of things.
And they may change, maybe for few months, this works well, and then it try something different. So it's just not one size fits all. And again, it's not about yoga, but yoga's helpful. But if you like Qigong, if you like Tai chi, do Tai Chi. If you like hiking, do hiking. You have to do something.
So you just have to find the things that you like, you enjoy, drawing, painting, I mean something that you enjoy. It's really important.
Mandatory Me-time
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Kara Wada, MD: It's funny, as you were going through those, I was like, "Oh, these are a lot of the things that that I have lovingly referred to as mandatory me time". Over the last few months of "Okay, no, this is going on my calendar because I do need that Epsom salt bath".
At least once a week if I could, if I can squeeze in a second one, great. And more recently really reestablishing that meditation practice in the morning. It's when I look at the days when I feel like I've really gotten the juice out of my day, and had a good day, it's those days that I start with that five minutes of just grounding.
Diana Londoño, MD: Absolutely. Yeah. And it doesn't take a lot of time. You could do, the studies actually studies show 13 minutes. 13 minutes. That's like how long you wait in Starbucks. So 13 minutes is not a long time. You may have to definitely schedule this into your schedule to make sure you do it.
Whatever time you can add, you can do it twice a day. My meditation teacher was like, you should do it twice a day. I'm like but then I do yoga, so that's my meditation. So whatever works for you. But it has to be added. And I have little kids too, and I have this, it's like, they can wait. If mom's not happy, nobody's happy. So this stuff is really important. You have to do it for yourself, you have to.
Kara Wada, MD: Yeah. And similarly, my kiddos are seven and under and so on. For instance, like the Headspace app, they have Sesame Street meditations that we on occasion have done together, or at bedtime if they're having trouble sleeping, "Okay, let's turn on one of these bedtime meditations" and I'll do it together and it's not a hundred percent, but most often they will drift off to sleep. And then the hope is that I can actually not totally fall asleep in their bed too.
Diana Londoño, MD: Absolutely. And kids like love it. And, even the breathing, my little one who's five, she's a little rambunctious and she can get a little emotional and she's vocal and my husband will just literally grab her cheeks here and just say, "Let's breathe together" and she'll just calm down.
And that is actually a grounding breathing exercise when you put your hands here, like on your chin and your cheeks. That and breathing really restarts the parasympathetic you. You're pressing like the trigeminal and all of those nerves. So that really helps to lower the stress and it works for kids.
And again, my little one's little rambunctious and it works. And so it works for adults too. These are things that are just tools. They're skills, they're little things that we never learned, but they're just so important. And otherwise we start off our day looking at social media and emails and this, and starting all frustrated, and then it just escalates throughout the day.
But when we start calm, we start breathing, we start journaling or praying or whatever works for you. Like you said, it's a very different day when you start out with an intention.
Kara Wada, MD: Can you share a little bit more about the physician coach support and this program that you've started?
Physician Coach Support and its mission
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Diana Londoño, MD: Yeah, so I started it really at the end of sort of my burnout and when I was in burnout, I was trying to figure out how to crawl out of it.
And I learned about coaching and I decided I wanna become a coach. So I became a certified life coach and through the process of training for that, I thought like we're learning how to do this, which is like we have to coach people and practice our skills just like when we're medical students, we have to practice how to do procedures and so we have to practice and people need help because we're in burnout big time.
So maybe I can use these skills so we're learning and ask other coaches, see if they want to be a part of this because I had used a similar sister program, the physician support line which is a psychiatrist and it's a phone line and I used it myself and I found it very helpful. I don't even know what I talked about, but the fact that somebody who was a physician took time another day to be there just for me, who you don't know me, and they did that, really planted a seed of hope and of goodness in this world that there's good, no matter all the craziness that was going on , there's good and there's good people, and these are physicians that were getting hit the hardest because this is very challenging times for so many people. We had so much anxiety, so much depression, so much stress, and they really were taking care of a lot of people, including us physicians. No, they did that and I thought, " There's good, like what can I do? I'm not a psychiatrist, but can I do something?"
And decided to do that. So Physician Coach Support is a free and confidential platform. You go online, physiciancoachsupport.com, you look at your time zone, you look what's available for appointments, and you choose an appointment time and you get a email to your email with a link via Zoom, or you can talk to a physician who is a certified life coach, and you can talk about anything, any circumstance, any complication you have that you're worried about, you feel like an imposter, your kids are driving you nuts, you're having problems with your spouse, and you're irritated. You're contemplating leaving, whatever it is that you wanna discuss confidentially, we're there for you.
And we're not therapists, we're not your best friend, but we use our life coaching skills to just give you a different perspective. And I started it because again, I wanted to give back, I wanted to be of service. I wanted to help others. And I could have also done my own coaching practice, but I thought, it's either one or the other. And I really thought I wanted to do this for more people and just have a place that people can come to. So we have amazing volunteers that are there and support all our colleagues anytime. So seven days a week.
Kara Wada, MD: That's incredible. How long has physician coach support been around?
Diana Londoño, MD: It's been like a probably a year and a half since we launched. Every day we grow a little more, we get organizations to support us to share with their members. Kaiser Permanente, Southern California share with their members. I just met today with the Santa Clara Medical Association, who's also gonna share it. And other organizations and just colleagues that share it in social media. Any way that we can let people know that we exist so they can come and we're there for anybody, because we know it's challenging.
It may not be the whole solution to whatever you're dealing with, but I think the fact that you take one step, one step to make an appointment to say, I'm important enough to have an hour with somebody. That is huge. That is huge because it really is a step on, like saying, "I'm important".
It's a step to saying, " I need help" and we all need each other. We cannot do things alone. I can't do this without other coaches. I can't do this without all the people on social media that share it. Organizations that we're affiliates with, just people that really believe in what we do.
So what I learned is that you can't do it alone, even if you have a great idea. And we're just stronger together when we come together as physicians. And when we just start saying, "We're important. This is enough. We have to learn boundaries. We gotta take care of each other and take care of ourselves".
And that's why we're there because I really believe in again, service. I believe in hope. I believe in saying over and over and over, that you matter. And then hopefully by the 50th time, it's gonna click on somebody and say, "It's time for me to take care of me".
Kara Wada, MD: It's interesting to me because I've been immersed within this physician coaching community and in culture for probably 18 months to 2 years now, and as a result of that, I see it all the time on my newsfeed, but every time I have a new set of trainees come in, either residents or medical students or fellows, very few of them have ever heard, if any, have heard of coaching and the role of coaching. And so there we have so many lives yet to touch.
Diana Londoño, MD: Absolutely. And I really believe in abundance and I believe that there's plenty. I think sometimes in the coaching community, people feel like, "Oh, like I can't share this in my own coaching world because I'm a coach".
And to me, it's many people may just come to us and realize they wanna coach and they'll go to you for coaching, and that's what we want. There's a study from [unintelligible] said "How many people are interested have, how many have never heard of it? Of coaching? How many are interested?" And with 1 million physicians. Now that a hundred thousand left, you know about 400,000 have some interest and they could be helped perhaps. And coaching is not the only solution of course. They're like, maybe you need a therapist and you need like a mentor. You need like a best friend and you need like your whole village.
So it's not the only thing, but it's just hopefully one thing that could help you. I just feel like we should all help each other. And the more you succeed, if you're a coach, like the more we also succeed because we're in a better place and we can start standing for our selves realizing what we want, what we don't want, but really what we want, how to get there, how to be joyful, how to like love medicine again.
And that benefits all of us. I just really think we have to have an abundance mindset and not a scarcity mindset.
Kara Wada, MD: Yeah. In particular, I think, those folks that their health, their immune system their physiology doesn't read the textbook, they need healthy, non burned out physicians, more than anyone.
And I'm just I'm so excited to hear more about this, to share this resource with my team at Ohio State and just get the word out. Because really if we're thinking about global solutions, treating root causes of some of the issues that we're seeing in patient care, it really hurt people, and we need healthy, healthcare professionals to take care of us all.
Healing from trauma and cultivating an abundance mindset
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Diana Londoño, MD: Absolutely. And I mean it's deep because like you have to then get into like trauma and we all have trauma, if you look at the adverse childhood, advanced study. I mean there's a lot of us that have trauma and that's many times why as physicians we're kinda like frozen because we can't get out of the trauma loop and we don't even realize it's so unconscious.
And we are people pleasers. And why is that? Maybe something in childhood, like that's the only way you got attention or love, was people pleasing. So then you are that in medicine. But that's a problem because now you have no boundaries. Now you don't have to stand up when so many changes in medicine have happened in the last 15, 20 years that really have affected us or EMR is not helpful or there's so many issues that are happening and it feels like we're losing kinda like the battle of control. So we have to heal ourselves, figure out, not just like awareness with coaching, but like tapping into some higher source spirituality and really addressing our own traumas, trying to heal those.
So again, we can get out of that. Not even just fight or flight. We're like in a frozen state of trauma. We can't get out of it. And then we need to just speak up and again, start taking back our profession, start taking care of ourselves so we can again, have that positive impact on so many, that it really changes the care you give when you're burned out or when you're joyful.
impact of burnout on physician-patient interactions
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Kara Wada, MD: Yeah. I think that's the advice I give if people ask, "Oh, hey, what should I look for in a physician?" I'm like, "Look for someone who's happy in their job. They're gonna take, I think, overall have the bandwidth to take care of you".
Diana Londoño, MD: Yeah. One of my patients tell me like, "Oh the physician was like yelling at me". I'm like, "Oh my goodness. What's going on?"
Kara Wada, MD: They were burned out.
Diana Londoño, MD: Yeah, they were burned out and that's many times how people or physicians know they're burned out. It's like they're sent to anger management, because they're always angry, they're always yelling or they're cynical, like how many are like so cynical and just complain.
And it's like a sort of a little bit of a victim mindset. And people really get triggered when we talk about victim mindset. First, it's a growth mindset. But I really do see a lot of my colleagues are in this victim mindset that everything's happening to us and we have no control. And as admin and healthcare, I'm like, we are part of it. Like we can't change others. If you don't start the change yourself, like Andy said, be the change you wanna see in the world. It starts with you. You have to be loving. You can't be angry. You want everybody else to be loving and happy. You have to be loving, and you want this.
You are like, what are you doing? How are you showing up? We have to look at ourselves first and then start talking about everything else and really making the changes. But they really start with us. And then we start coming together, then we start helping each other, amplifying voices saying, "This is not right. This has to change". But we can't do it if we're frozen, if we're angry, if we're contemplating suicide. Nobody can do anything in those states. So we have to really. Again, have that awareness, but have that courage and really take steps. And like a baby step is okay, like that's the first step, and then you just keep going and you keep building like your tribe and your momentum to get out of the hole.
Or the molasses of burnout. It's really like molasses, but we gotta get out of it.
Connect with Dr. Diana Londoño & Physician Coach Support.com
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Kara Wada, MD: Thank you so much Dr. Diana. Of course. Where can people connect with you? We're gonna list all of your social links and everything.
Diana Londoño, MD: Yeah, so you can look in my website. It's dianalondonomd. com or like on any social media platform, just dianalondonomd.
And check out physiciancoachsupport.com. Again, pass some of my info too, but all the coaches there, all the volunteers are there. And just if you know a physician, if you are one that is having any issue. Again, it's confidential. Everyone signs a confidentiaity agreement, it's a legal document.
We don't disclose or share anything with anybody else, and we're just there to help you. And take that step, whether it's our platform or any that are on the resources to really take care of you. Whatever you have to do, just make one step and, maybe gratitude's the first step you take and try it out and see if you feel different.
I guarantee you, you'll feel different. I'll guarantee people around you will say something's different and there's nothing to lose, okay? Going from angry to a lot more angry. There's nothing to lose. So just start one little step and realize you can take care of you, you're worth it.
You matter, and it's really time to take care of you.
Kara Wada, MD: Thank you so much.
Diana Londoño, MD: Thank you. Thank you.
Kara Wada, MD: This is wonderful.
Diana Londoño, MD: Thank you so much for having me, for your platform and congratulations on your amazing platform and everything you're doing for patients and colleagues. I'm just so grateful.
Kara Wada, MD: Thank you so much for all that you're doing and I can't wait to talk again soon.
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