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Join us for an insightful podcast episode with guest Eliza Humphreys, a pediatrician and certified life coach, as we explore the challenges faced by young teens and their families in navigating mental health issues. Through a poignant story from her practice, Eliza sheds light on the unmet needs within the health care system and the increasing impact of mental health concerns on annual check-ups. Discover the prevalent ailments, such as anxiety, depression, and disordered eating, that affect young people today, especially in the wake of the pandemic. Eliza shares her personal journey and offers valuable insights into the importance of self-compassion and kindness in promoting mental well-being. Learn practical strategies for caregivers to model self-compassion and create a nurturing environment for children. Don’t miss this engaging conversation that explores the intersection of pediatric medicine, mental health, and personal growth.

Eliza Humphreys is a pediatrician and certified life coach.

She discusses her KevinMD article, “A pediatrician’s view on critical self-talk among patients and doctors.”

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Transcript

Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Eliza Humphreys. She’s a pediatrician and certified life coach. Her KevinMD article is titled “A pediatrician’s view on critical self-talk among patients and doctors.” Eliza, welcome to the show.

Eliza Humphreys: Thanks, Kevin. Thanks for having me.

Kevin Pho: We’ll get into your article in a little bit. First off, briefly share your story and journey to where you are today.

Eliza Humphreys: Sure. I am originally from California and completed my medical training there at UCSF as a general pediatrician. I did a second residency in general preventive medicine and public health and practiced for a bit, did a few various things, and then moved east. I’ve been practicing pediatrics in Beverly for over 10 years now, which is north of Boston. And more recently, I was certified as a trauma-informed coach and also took on a role as a trained physician peer supporter, which is a volunteer role here in the state through one of our public health organizations.

Kevin Pho: So tell us about what you do as a physician peer supporter.

Eliza Humphreys: A physician peer supporter, through something called the Betsy Lehman Center, PACE is a statewide group of peers who are available for any provider. These are doctors, nurses, respiratory therapists, etc., who are offered this service after a traumatic event or an adverse event, or who, for whatever reason, are feeling the need to have some outside personal support.

The advantage of having a statewide system over a hospital system is that sometimes there is a perceived stigma in accessing resources at one’s place of employment, or one might know personally the person doing the peer support. So this model offers a little bit more anonymity for those who are seeking the services, and it’s, of course, free and not meant to replace actual mental health resources if those are in need. But it is kind of a triage, referral, and support service.

Kevin Pho: So without, of course, giving out too many details, tell us what kind of things you are hearing through the support.

Eliza Humphreys: So oftentimes there may be one event that is perceived as challenging or problematic for a provider. That could be something went wrong, or one had a perceived sense of being reprimanded in the workplace. So there may be some cases where someone is reaching out to debrief that event but doesn’t feel like they have the capacity to do that at the place of employment. Other times it really is for more life circumstances, so anything from divorce, financial constraints, or an ill family member. Those are all reasons that people actually seek our services.

Kevin Pho: All right, let’s talk about your KevinMD article titled “A pediatrician’s view on critical self-talk among patients and doctors.” Now, you start this article off with a case study or story, so start there. Tell us the story.

Eliza Humphreys: Sure. I mean, the scenario depicted in the article is an amalgamation of a frequent complaint we see as general pediatricians these days, and perhaps your audience who is in the role of being a primary care doctor will resonate. People are coming in with complaints of anxiety and depression, or general isolation and loneliness. Sometimes this comes across as complaints that are somatized, so general fatigue, sleeplessness, and lack of energy and motivation.

And of course, we saw a lot of teens and young people with anxiety and depression prior to the pandemic. But as your audience, I’m sure, is really aware, the prevalence of these afflictions has just really increased. And I think not only are we seeing more burden of those issues, but they are occurring at a younger age, and the symptoms seem to be more severe.

Kevin Pho: So take us into your exam room. You have one of your patients who presents like that. What do you do next?

Eliza Humphreys: You know, that’s a good question. I think in the amount of time we have, it’s really challenging, Kevin, and that partly led to the article. I rely heavily on our very capable, trained, licensed mental health professionals. There has been a shortage of those, as you’ve heard and probably experienced, as has, I’m sure, your audience. But fortunately, in my state we have some very good services, and I would say some increasing capacity in that realm on behalf of our excellent Department of Public Health and other infrastructure, kind of trying to bolster that rapidly. But it has been challenging.

Of course, we try to make a connection. We are often trying to triage the most acute issue, safety, so assessing for any immediate threat to health, so suicidality and self-harm. And then we’re trying to connect the family and that patient to mental health resources.

I mean, interestingly, this article really was an attempt at trying to identify more primary prevention tools for care providers so that it doesn’t get to this secondary or tertiary, more acute phase. And so while the challenges of the last couple years have been unprecedented, I think I was trying in the article to provide some tools that may eventually, downstream, actually minimize this later effect of seeing patients in the exam room, such as the one I described in the article.

Kevin Pho: So talk more about that. What are some primary prevention tools that we have available to us?

Eliza Humphreys: Yeah, and these are not new. So I have dug deep and gone down a rabbit hole of the research in neuroscience, which is fascinating, and really, it’s amazing how far the research has come just in the last few years. But my tips were very basic and brief. They’re very applicable, and I think it’s important that really small changes can actually have a big impact. So I did go through a few of them, which I’ll briefly touch upon if you like.

The first was just to have an awareness of the voice of our inner critic. So by inner critic, I mean the hypercritical, self-judgmental voice that is inside everyone’s head. Some researchers call this kind of your inner chatter. Ethan Kross is one of the researchers in this area.

And with the inner critic, paradoxically, I think my initial assumption, and perhaps that of those unfamiliar with the research in this area, is that the inner critic is there for a good reason. It’s meant to prompt hard work, be an accountable force for deadlines or for striving, kind of our inner drill sergeant. But the research actually shows that this hypercritical, negative voice in our brains does not actually serve us well or result in increased productivity, for example. It’s actually counterproductive. And so the first kind of tool or pearl that I had outlined was just being aware of the inner critic voice and the fact that, paradoxically, it’s not helpful.

Another kind of tip for the audience that I had written about was modeling certain behaviors. So, for instance, there’s a whole vocabulary on affect labeling and just learning about talking about feelings, which can be taught at a very young age, which we often overlook. Sometimes when kids are learning about emotions, or if you haven’t expressly been taught, we’re reduced to just saying we feel mad, glad, or sad. But there’s a whole literature on affect labeling and how impactful that can be. So for a parent of a young child to actually narrate their emotional state can be very helpful in terms of that child learning the language of emotions, which in turn can be really impactful on overall well-being.

For instance, instead of saying, “I’m really angry,” one might pivot to say, “I am feeling really angry,” which offers a little bit of depersonalization and more space to process that emotion. Carried with that is the knowledge that emotions are temporary, so we’re not consumed. We don’t totally personify that emotion. Those emotions come and go, just like the weather pattern might. So these are kind of frameworks for children to understand very easily, some of those learning tips.

There are a few others. Breathing, obviously, receives a lot of airtime in terms of how important it can be to regulate pulse and blood pressure. And I think the key with breathing is that there are a few tips. One of them I got from Rachel Turow, who’s another researcher, is just adding a kind name while you’re breathing. So instead of just “in” and “out,” it’s like saying, “Inhale, friend. Exhale, friend.” And again, this offers a little bit more distance between the person and the action. Her point is that it’s very difficult to be mean to oneself if you’re calling yourself a friend. So it serves two purposes. One, you’re actually breathing more slowly as you do that, usually, and you’re also kind of negating that negative thought loop that might be berating yourself, by calling yourself a friend.

Kevin Pho: What would be an example where you can use these techniques today? Is there a story that you could tell, either from the physician side or the patient side?

Eliza Humphreys: So I think of when the patient or a parent is asking my advice about a toddler who may have, kind of euphemistically speaking, big feelings. They might say, “So-and-so has a lot of big feelings these days.” I will often ask a question: “Have you heard of self-compassion? Do you know what self-compassion is?”

In an older child who comes in with obvious symptoms of anxiety and depression, I will ask the same question, and I will ask them, “Is it possible you’re augmenting, or amplifying, I should say, your distress by being mean to yourself, judging yourself, or having these feelings?” And often, by asking the question, it opens up a conversation, which may lead to a different avenue of resources than we had initially planned.

But I find a lot of what I’m doing is just teaching about awareness of the automaticity of these thought loops and negative self-talk. So I think that also is a very frequent scenario, where I’m just presenting the reflection that this may be going on. “Have you noticed this yourself, or have you had an insight about this?”

Kevin Pho: One of the interesting points in your article was the second impact of the youth mental health crisis on physicians. So talk to us more about that.

Eliza Humphreys: Right. I think among my colleagues, and I don’t want to speak for everyone, but I know it’s just been really hard to see so much distress and suffering in these young teens, and it does take a toll on us as physicians and care providers, just because at the end of the day, there are many days it feels like there’s not much at our fingertips. There’s not much in the tool kit, in a way, to offer. And so that really was one of the reasons I was kind of led down this path of learning more about it.

But we’ve had some terrible times with patients in holding patterns, awaiting an inpatient bed for weeks at a time in the ER, and I can only imagine how our ER colleagues are dealing with it. But the second impact, I mean, certainly not to deflect from the suffering of the patient, but we do want to remain vibrant in our practice. We don’t want everyone to leave clinical medicine. So I think these tools are very relevant for those of us providing the care, as well as for those families of the patients needing the care.

I have found this research and the learning to be very helpful on a personal level as well. I would also share with you, Kevin, that I’m a parent of two young boys, and so trying to import these lessons to my children and also practicing them personally has been helpful, both personally and professionally, I would say.

Kevin Pho: We’re talking to Eliza Humphreys. She’s a pediatrician and certified life coach. Her KevinMD article is titled “A pediatrician’s view on critical self-talk among patients and doctors.” Eliza, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Eliza Humphreys: Thanks. I think I would share with your audience that small changes can matter, and being kind to ourselves matters.

Kevin Pho: Eliza, thank you so much for sharing your time and insight. Thanks again for being on the show.

Eliza Humphreys: Thank you, Kevin.