Medicine’s culture forces us to ignore our health [PODCAST]

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“Physicians are steeped in a noxious culture that seems to be averse to creating healthy physicians. We ignore mountains of evidence that show exercise, sleep, and healthy eating is beneficial for cognitive function, learning, and performance — all aspects that physicians should optimize. But the current medical training system pushes physicians, residents, and students to the brink of their physical, emotional, and mental capabilities and leaves little room for much else other than work. The culture of medicine forces us to ignore our health. I’ve done it too, but it’s time to focus more on our health, not just patients’.”

Vybhav Jetty is a cardiology fellow.

He shares his story and discusses his KevinMD article, “The culture of medicine forces us to ignore our health.”

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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. Today on the show, we have Vybhav Jetty. He’s a cardiology fellow, and he wrote the KevinMD article “The culture of medicine forces us to ignore our health.” Vybhav, welcome to the show.

Vybhav Jetty: Thank you so much, Dr. Pho. Yeah, I’m Vybhav Jetty, a cardiology fellow based out in Boston, working at St. Elizabeth’s Hospital, doing my second year of cardiology training. I did most of my medical training otherwise in Cincinnati, Ohio, and I’m just happy to be out here in Boston.

Kevin Pho: Wonderful. And how has the pandemic affected you and your cardiology training?

Vybhav Jetty: So the cardiology training per se has actually been a little bit better. We actually didn’t see a whole lot of really bad MIs while the pandemic was going on. Our census was actually pretty light. That being said, when they would show up, they were in pretty bad shape. I think a lot of people were avoiding coming to the hospital for some of their chest pain because of the pandemic, and therefore we saw some late complications of MIs. So that was really kind of interesting, and it was kind of reinforced by one of the JACC articles that came out recently saying that a lot of patients were just not showing up to the hospital.

Kevin Pho: Sure. So we’re now in the third week of August, and just recently we’re talking about some of the cardiac manifestations of COVID, specifically myocarditis. Can you talk about some of the cardiac ramifications of COVID-19, and what are some signs and symptoms that we in primary care should look out for?

Vybhav Jetty: So the main thing to look out for is chest pain, obviously, and fevers. Coronavirus, obviously, is going to present kind of like the parvovirus B19 as well as the adenovirus manifestations of myocarditis. The main thing: One of the studies I recently heard about is coming out of Ohio State. They’re doing MRIs on their athletes in order to assess for ejection fraction, as well as the other manifestations of myocarditis in the setting of coronavirus. There, I think they’re actually benching a number of their athletes because of this.

But the main thing, I think, from that standpoint is to give athletes and the patients who have a low ejection fraction just rest, and just wait for the virus to go through its usual ramifications, and just treat symptomatically. I don’t think you would necessarily need to go straight to a cath or to stress testing unless you have a high suspicion for coronary artery disease.

Kevin Pho: Sure. And can you comment on the role of anticoagulation?

Vybhav Jetty: So that was actually up for debate in our hospital quite a lot. We haven’t been using anticoagulation. We were not using thrombolytics at all for these patients. That may be more of our hospital policy. I think it may be beneficial in some patients, but I don’t think you need to necessarily do it for everybody.

Kevin Pho: So let’s get into your KevinMD article, “The culture of medicine forces us to ignore our health.” Now, for those who haven’t read your article, can you walk my audience through it and perhaps share the story of why you decided to write it?

Vybhav Jetty: Yeah. So the article was something that I’ve been thinking about basically since I entered medical school, and probably even college: just the fact that everything is getting so competitive these days, and there are so many people applying for so few spots, that it really puts a lot of pressure on the applicants to be the very best applicant that they can be. That in and of itself, I don’t think, is necessarily a bad thing. But because everything is so competitive, we end up doing a lot of things that we probably wouldn’t do otherwise, like taking on all these leadership roles and taking extra classes in order to get a couple of points higher on the MCAT, things like that.

So with all of those competing interests, we lose a lot of our desire to take care of ourselves, because we don’t have time. And it’s not the main focus, and it’s not going to help us get in, or at least look better on our applications for medical school or residency or fellowship. So because of that, going through all these application cycles, I see a lot of my colleagues and friends not really taking care of themselves, being super stressed out. They haven’t had really bad manifestations of this because they’re young, but as we get older, I think that’ll catch up with them.

Kevin Pho: So I know that the physician burnout rate is 50 percent. Can you comment on how medical trainees not taking care of themselves can contribute to burnout as they move forward?

Vybhav Jetty: Oh, I think it absolutely contributes to burnout. We don’t have any balance in the training system that we have right now, and it’s not focused on. There are a few physicians here and there who try to focus on wellness and things like that, but I think that’s just kind of putting a Band-Aid on what the actual problem is. It’s the fact that it’s our culture that focuses on being the smartest, brightest, hardest-working. And that, unfortunately, comes at the cost of our health and drives a lot of burnout, because that’s all we’re doing, for the most part, 24/7, without any other real outlet to deal with the stresses that we deal with in the hospital.

Kevin Pho: Now, what kind of support systems do medical students and residents have if they need to talk to someone or they need any behavioral health support?

Vybhav Jetty: Yeah. So, being very topical with the COVID pandemic, our hospital had said that the psychiatry residents, like the seniors there, were able and willing to help out with any emotional support any of the staff may need. And that’s one thing that was done. In medical school, I’ll be honest, I didn’t really know about any, and it’s kind of the same in residency. I think it’s going to be very heterogeneous from program to program in terms of what’s actually available. I would assume maybe some of the better programs would have more resources. But for the most part, it’s kind of one of those things where you’re on your own in terms of taking care of your mental well-being.

Kevin Pho: Now, I have a lot of administrators who listen to this podcast, and you have their ear. What kind of suggestions do you have for them to improve the situation?

Vybhav Jetty: That’s a very difficult question. With administrators, I think, obviously, a lot of them tend to focus on the bottom line, and unfortunately, physician wellness, I don’t think, really will be represented there. The big thing, I think, is really asking the physicians what they need, or if they’re starting to feel more burnt out, and creating a space for them to really be open and honest about that. And I know, from my standpoint, I don’t even know if I would tell my administrators if I was burnt out, because there hasn’t really been very much trust there. So focusing on that administrator-to-physician relationship may be the first place to start.

Kevin Pho: Lessening the significance of testing, would that play a role? I know there’s tremendous pressure, for instance, on Step 1, and for a lot of first- and second-year medical students, that’s pretty much all they care about, 24/7. So can you comment on the role of testing, and perhaps the over-importance of testing, contributing to this?

Vybhav Jetty: I think so. I mean, we all know that the Step 1 score is the main thing that gets people into residencies and gets them into the programs that they want. Unfortunately, I didn’t do well on Step 1, and I suffered the consequences, unfortunately, and that caused a lot of depression in me, unfortunately. So it’s very, very much contributing.

Unfortunately, now that Step 1 is pass/fail, I think all of the emphasis is going to go on Step 2, and you can make an argument that that is more clinically oriented and less focused on the Krebs cycle and a bunch of nuances that don’t really manifest themselves in everyday clinical practice. But at the end of the day, the difficulty, I think, comes in the fact that program directors have no other real, relatively objective gauge of a candidate’s ability to perform in the medical setting. That being said, with Step 1 and Step 2, I’ve seen people who have amazing scores, and they’re completely unable to think critically at all in the hospital setting. So it’s a very poor gauge of a person’s ability to think clinically.

Kevin Pho: Sure. We’re talking to Vybhav Jetty. He’s a cardiology fellow, and he wrote the KevinMD article “The culture of medicine forces us to ignore our health.” Vybhav, you’re a cardiology fellow, so you’re a few years away from medical school. What kind of advice do you have for people just starting out their medical training?

Vybhav Jetty: I would just say, focus on your health. That, I think, is the most important thing. The grades, all the research, making good impressions, all that stuff comes into play. But I don’t really see the point, at least for me, logically, of putting all of this focus on taking care of other people’s health if you can’t take care of your own. And that certainly progresses when you’re an attending as well, because if you can’t take care of yourself, there’s no way that we can take care of patients.

Kevin Pho: Exactly. And my final question: Do you have a take-home message that you want to share with the KevinMD audience?

Vybhav Jetty: So it’s really just take care of yourself. I spent a lot of time in medical school in the gym, just because it was my own source of stress relief, and that, I think, has helped me deal with the stressors of working in the hospital, dealing with difficult patients, patient families, patients dying, that kind of thing. So really finding some sort of outlet is the most important thing, I think.

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

Vybhav Jetty: Thank you.

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