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The word “resiliency” has been lauded, applauded, and buzzed about in talks about physician burnout. When I hear it, I tune out. My stomach churns. I feel sick. Why?

Because physicians are resilient. We are, in fact, the walking, talking, breathing personification of the word. We cannot manage to get through medical school, residency, and boards, without being resilient.”

Dympna Weil is an obstetrician-gynecologist.

She shares her story and discusses her KevinMD article, “Less resiliency may heal burnout.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/follow. Today on the show, we welcome back Dympna Weil. She is an obstetrician-gynecologist. Her latest KevinMD article is titled “Less resiliency may heal burnout.” Dympna, welcome to the show.

Dympna Weil: Thank you so much for having me, Kevin. It’s a joy to be with you.

Kevin Pho: Now, for those who didn’t get a chance to listen to our first episode together, just briefly share your story and journey to where you are today.

Dympna Weil: Sure. So I am an OB/GYN, and I am based in New York. I am currently not practicing because of some medical conditions that started in the fall of 2020, about six months into the pandemic. That was a very pivotal moment for me, and humbling, as the physician became the patient. And that was the moment where we have to reckon with what we do about our own identity as a physician. I had to really reckon with what it is that I do when I’m not wearing my white coat, and who I am. I had to learn how to manage my emotions about my worth and my value when I wasn’t able to see patients.

And I started coaching, actually, for myself, and then pursued life coaching training with Martha Beck, and it was a pivot in what I was able to do with some of the skills, the many skills that I had learned through life as well as through my physician training, and I realized a lot of them were so similar. So many of the things that I enjoyed about being with my patients, listening to their stories and helping them navigate the different parts of their lives, were so many of the things that I was now doing in my coaching practice. So it was a pivot that I never saw coming, and one that was quite humbling, but they were gifts in a different sort of way. The stillness that I was kind of forced into became quite a gift in my life, and it’s brought me to now.

Kevin Pho: So a lot of physicians, unfortunately, have to transition out of that physician identity for whatever reason. In your case, there was that transition from a physician to a patient. Now that you’ve made that journey, to the other clinicians who may be listening, what would you say are some tips and advice you could give those physicians who have to make that transition, not by their own choice?

Dympna Weil: I think there are two things. One, you’re still a physician. Yes, you’re a patient, but you’re still a physician. The identity part really messed with my mind a little bit: “I’m not a doctor anymore if I’m not wearing the white coat, and what use am I?” And that’s actually not really true. That’s where the mindset work and the thought work were really helpful, because when I questioned that thought, “I’m not a doctor, and what use am I?”, that’s actually not true.

And the second part of that is when I allowed myself to see that not only am I a doctor, but I am a human. I have human needs, and I can allow myself to be a human with human needs and allow myself to be cared for. That was a really hard thing to accept. But when I started to let other people in and accept care from others, things really started to change for me. That was a tricky space, but support really was key.

And I think the last time we spoke, it was about the topic of infertility, but I think it all kind of bridges, because the themes are so similar with us as physicians. We are very stoic, we do a lot of things our way, and we do tend to keep things close to the vest, and we don’t overshare. A lot of that is that we have built that up by not sharing with our patients, but we also just don’t share a lot with others. It’s hard to break down those walls when we need to. And this was one of those times when I needed to, and it was difficult to do. But once I did it, it made it a lot easier to manage what I was going through.

Kevin Pho: All right, let’s talk about your latest KevinMD article, and it’s about the topic of resiliency. It’s titled “Less resiliency may heal burnout.” Whenever we talk about clinician burnout, and I’m sure that everyone listening knows the numbers by now, over 50 percent of clinicians experience symptoms of burnout. A lot of health systems address that by offering these resiliency training courses, and you argue that we need another path. So for those who didn’t get a chance to read your article, just walk my audience through it and share the story. Why did you decide to write it?

Dympna Weil: Sure. Well, I decided to write it because when I was most recently in practice as a hospitalist, there was a real need to address this. We were OB hospitalists in a very large organization, and we were kind of like ships passing in the night. We needed a way to connect, and my organization was really very responsive to having some sort of way to address physician wellness. They were very, very supportive. So I had approached our leadership about beginning some type of wellness committee to look at what we could be doing differently, how we could improve things, and increase connections. I really threw myself into this work with the support of our CMO and our organization.

And one of the things that struck me was this focus on personal resilience. There was addressing the culture of wellness and efficiency of practice, but personal resilience kept popping up. And not from my company, but in all of the articles that I was reading, and even from the AMA STEPS Forward. It was one of the things that kept coming up. Every time I read it, or every time it was put forth in a talk or a TED Talk or something that I would come across, it just kind of ate at my soul, because we’re such resilient people, and to assert that physicians somehow needed more resilience just didn’t sit well with me. That always just kind of stuck with me as something that didn’t make a whole lot of sense, that we needed to be more resilient, because it put the blame on us for something that really was not our doing.

Kevin Pho: So tell us exactly how the medical system or the academic medical center portrays these solutions to you. Did they say that you just have to be more resilient? Was it through the courses or classes that they offer? How did they tell you that, in effect, physicians need to be more resilient?

Dympna Weil: I think centers, hospitals, and systems, and I think everyone, are so well-meaning, right? They want to give us tools. But to say, “Have a wellness program,” or “Let’s do this course,” or to institute a new way of addressing it, “You’re going to have to do this new program,” or “We’re going to do this required, check-the-box sort of approach to it,” feels like another task to people. And that’s one of the things that I came up against with colleagues: “We want to try and understand this, but I don’t want it to be another onerous task, and I don’t want it to feel that way.”

So I think when institutions start addressing it and saying, “We need to be more resilient. Go do some yoga, or just learn to meditate,” it had that sort of feel, like we were doing something wrong, like we could be doing something differently or better and that would just fix it. And certainly, stress plays a role, and sometimes at the individual level, we may not be managing our stress, right? And that does feed into a little bit of the article. But it’s not as simple as saying we need to build up our resilience and bounce back from these things that we come across in medicine, right? Because we deal with really heavy stuff, but we’ve always dealt with heavy stuff.

Kevin Pho: Whenever you encounter the medical system’s solution being these yoga classes or relaxation techniques or resiliency training, what did you do next? How did you push back against that?

Dympna Weil: Well, it’s not so much pushing back, because I think those things are super important. For some people, they really resonate, and that’s wonderful, but for others, they don’t. My pushback is that wellness to one person is something different. Resilience is important for everyone, but it may look different. For some people, it’s going hiking. For others, it’s a yoga class. So to impose one thing and just say, “Be more resilient,” it’s not cookie-cutter, right? And the sort of thing that a health care system wants to do is just to institute a one-size-fits-all sort of approach, and it’s not necessarily that simple.

I think giving people tools to manage stress is critically important, and I think that is a really important approach. But I recognize that the word “resilience,” perhaps, has been so overused in some ways, and has that connotation to a lot of physicians now, that it almost has the opposite effect from the intended use of it. So I guess what I’m trying to say is I’ve gotten a lot of feedback from the article, like, “Yes, this is exactly how I feel when I get this handed down to me from some office in a building where they’re like, ‘You just need to be more resilient.’ You don’t understand. I am resilient, and I’m still burned out. I’m still struggling. You just don’t get it.”

I think it’s recognizing that, yes, stress reduction techniques are critically important, and every individual may have their own way of reducing stress, and we want to encourage those healthful ways of reducing stress and support them in that. But it’s not a one-size-fits-all approach.

Kevin Pho: A lot of health care executives and administrators listen to this podcast. So from your perspective, how should they frame burnout if they can’t frame it from a resiliency standpoint? What would be your recommended approach to burnout?

Dympna Weil: Well, I think, as for the resiliency part of it, it’s recognizing that you’re dealing with people who are enormously resilient but don’t always allow themselves the opportunity to feel what they need to feel. And it’s supporting them the way that they need to be supported, which is maybe unloading a little bit. To continue to have the resiliency that we’ve had all along, that has gotten us to where we are, we need to let go of some of the hardships and some of the pain that we still carry from taking care of all these patients, and from taking care of all of the immense loss that physicians, and even all of the health care workers, have been dealing with in the past two-plus years.

And that’s one of the things I wrote about. In order to maintain the resilience that people have had, we need to let go of the emotions and let go. It’s supporting in that way, and I think the mental health support area is really critical in terms of what is needed at this point: giving physicians the outlets they need to decompress, and just a safe space to feel what they need to feel, and not to feel like they have to soldier on when they really can’t. I think that’s what’s critical.

Kevin Pho: So in your ideal world, in your ideal hospital setting, what would be an example of what you’re talking about when you talk about a safe space refuge? What would be a concrete example of that?

Dympna Weil: Well, I think increasingly there are programs in place, whether it’s peer-to-peer coaching programs or peer-to-peer support groups, where they’re not required, but they are supported by the organizations. Sometimes they’re facilitated, and sometimes they’re then just continued by faculty or by in-house staff, where it is a place where the physicians can gather. Yeah, the loss of the physician lounge is a big deal. There are no longer safe spaces where the physicians can get together and just kind of decompress over what’s going on in their lives.

And I think it’s having those spaces, and that time protected, and allowing that community to have a space where there is a value placed on them, and on their time together, and their shared experience. It’s saying, “We understand that what you do is important and hard and difficult. We want to support you in sharing. We want to support you. We want to normalize the feelings that you’re having.” And I think that’s what I hear from clients in some of the physician coaching groups that I’ve been a part of and that I have worked with: It’s normalizing what you’re going through, because when you don’t have those places and that safe space to discuss with colleagues, you think you’re the only one that’s feeling that way. And you’re not.

And that’s the most important thing that an organization or an administrator can understand: facilitating that safe space where physicians can share. That’s everything in combating that sense of isolation. To know that you’re not the only one, I think, is everything, really.

Kevin Pho: We’re talking to Dympna Weil. She’s an obstetrician-gynecologist and a physician coach. Her latest KevinMD article is titled “Less resiliency may heal burnout.” Dympna, what are some of your take-home messages that you want to leave with the KevinMD audience?

Dympna Weil: Well, I think the most important one is that we have to allow ourselves the opportunity to be human. We are just the most resilient, or not the most, but among the most resilient people out there. We go back to work under suboptimal conditions because we just love what we do. We want to serve our communities, but we do that to our own detriment at times. And we have to remember that we need to care for ourselves.

And when we feel the emotions that we’re having, and when we listen, when we know what other people are going through, and we share those emotions and we share those experiences, that’s really a very powerful opportunity for healing. But when we leave those emotions bottled up, that energy just builds up within us, and we don’t allow ourselves to heal. That’s where the burnout momentum just keeps building. And I think once we start to recognize that our human emotions need to be felt and need to be allowed, that’s really everything. It’s that allowance, allowing ourselves to be human.

Kevin Pho: Dympna, thank you so much for coming back on the show and sharing your time and insight.

Dympna Weil: Thank you so much for having me.