When physicians get sick: We are just as human as the patients we treat [PODCAST]

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“My experience with recent knee surgery that left me significantly disabled for over a month brought this to my attention yet again. I was completely dependent on others for basic self-care since I was unable to get in and out of the tub/shower without help. I was only able to walk with significant pain on crutches and was completely incapable of navigating stairs. Driving was out of the question. I experienced acutely the loss of independence that my older patients feel about having to surrender their driving license. I was unable to cook, clean, and interact with family since I was fairly bed-bound and sedentary until I regained my mobility.

I learned several important lessons from this experience.”

Rizwana Khan is a pulmonary and critical care physician.

She shares her story and discusses her KevinMD article, “When physicians get sick: We are just as human as the patients we treat.”

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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 Rizwana Khan. She is a pulmonary and critical care physician, and she wrote the KevinMD article “When physicians get sick: We are just as human as the patients we treat.” Rizwana, welcome to the show.

Rizwana Khan: Hi, Kevin, thanks for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Rizwana Khan: Yeah. So, Kevin, I am a pulm critical care physician based out of Washington State. I’ve been practicing in a community setting for the last 10-plus years. I started my training in the Midwest, moved to California for fellowship, and I’m here. Like most mid-career physicians, I did experience what I thought was burnout, but after a lot of self-reflection, I realized that my passion for medicine was still alive. I still love taking care of patients. So it really wasn’t burnout per se; it was more of a moral injury. And that’s sort of when I started writing about my journey, sort of as a means to be a voice for change, and here I am today.

Kevin Pho: And for those who don’t know the difference, what is the difference between burnout and moral injury?

Rizwana Khan: So burnout is a little bit different from moral injury. It’s a very nuanced difference. Burnout sort of puts the burden on the victim, where physicians are felt to be not resilient, not strong enough, and hence they’re not able to handle the pressures of their job. So it’s almost victim-shaming, per se. They’re asked to do things like meditate and go on wellness retreats. And we all need to manage stress, but I think burnout is not the right term for it, because I think physicians are very resilient.

Moral injury is more related to a code of ethics, a code of morals that we all have, and to not being able to perform up to the standards of those morals. For example, when we went into medicine, we went in because we wanted to take care of patients. We wanted to make a difference. And if we are not able to give the patients the care that they deserve, that’s when we suffer moral injury. We need to have the tools, we need to have the autonomy, and we need to have the ability to take care of patients the way they deserve and the way we think they need to be taken care of. And if there’s a disconnect, that’s where the moral injury comes into play, which is a little bit different than burnout.

Kevin Pho: Sure. So let’s get into your KevinMD article now, “When physicians get sick: We are just as human as the patients we treat.” Now, for those who haven’t read your article, can you walk my audience through it and share the story of why you decided to write it?

Rizwana Khan: So, Kevin, I had never had to apply for FMLA in my 10 years of being in practice, and I had to have a limb surgery, which meant that I needed to be off work for a period of time. When I started navigating the FMLA process, I was just floored by the amount of paperwork, the phone calls, and the back-and-forth that it required for me to be able to take the leave, to take care of myself and a genuine medical problem that I had. I had a mountain of paperwork that I had to fill out. It was the same repetitive forms over and over again, via different agencies.

But what concerned me the most was that my surgeon had to fill out the same paperwork, and in triplicate. He had to duplicate the same paperwork, the same questions, over and over again to get my leave approved. And I just felt that this was time that he could have spent in the office with patients. This was time that he could have spent performing surgery, doing his job as a physician. And it really bothered me. And not only was it the paperwork that we had to go through, but it was sort of the whole process, the application process, the number of phone calls that had to be made, just to get this leave approved.

And I think that the thing that bothered me the most, really, was that my surgery was a limb surgery. I was able to multitask; my mental faculties were intact. But I really had to think to myself that if I was in an ICU, for example, or if I’d had a brain hemorrhage, there was really no way that I could have dealt with this complicated system. I am a physician. I know the system. I am savvy about the health care system, and I had a really hard time navigating the system, and it really made me think about my patients who were not in the system. For them to have to go through this, it must have been really, really hard, and I just wanted to highlight that.

Kevin Pho: Now, having gone through the FMLA experience, what kind of advice can you share with other clinicians who may have to take extended periods of leave?

Rizwana Khan: FMLA? It’s a really, really hard thing to go through, because FMLA implies that you’re sick, that you’re not able to perform your job. And as physicians, our work is our identity, and it’s our life. So when physicians go on FMLA, I think it’s bigger than just not being able to go to work. It’s a loss of identity. It’s a loss of self. We are so in tune with taking care of patients that when we are on the other side of the fence, and we become the patients as opposed to the caregivers, it’s a tough pill to swallow.

So when I was going through the process, I learned a few things. I think first and foremost was just letting go of being the caregiver. It’s OK to be a patient, it’s OK to ask for help, and it’s OK to receive the help if needed. We are better as physicians, at our jobs, as caregivers, if we are well.

The second thing that I learned was the guilt that comes with not being able to do our job. We don’t want to be a burden on other physicians, on other clinicians. We don’t want other physicians to have to cover our shifts. We feel guilty about it. We delay getting the health care that we need because we don’t want to put that burden of our work on other physicians. And that’s not OK as well.

And obviously, FMLA is usually a long process. It’s not a short process; for some, it may be longer than for others, and we just have to be patient. We have to let our bodies heal. We have to let our minds heal.

And I think the last take-home point is the financial aspect of it. The loss of income definitely hits us pretty hard, and we need to be prepared for that. We need to know what we need in order to prepare financially for this if the need arises.

Kevin Pho: We’re talking to Rizwana Khan. She’s a pulmonary and critical care physician, and she wrote the KevinMD article “When physicians get sick: We are just as human as the patients we treat.” Now, your story sounds like it was quite the ordeal. What kind of support services did you have, or what kind of help did you have, as you were going through this?

Rizwana Khan: I was lucky. It was a limb surgery. I had great support from my family. I had a great physician. I had a really good ancillary staff at the hospital. But you’re right, there are a lot of patients out there who don’t have these support systems, family support, ancillary staff at the hospital. And that’s obviously something that does need to be taken into account if you’re going through FMLA.

Kevin Pho: Where can physicians research to find out more information about the process, and what kind of questions should they be asking? Because you’re right, a lot of physicians themselves don’t go through the FMLA process very often. Where can they turn for more resources?

Rizwana Khan: Right. So the first thing that I did, really, was to turn to my employee resource at the hospital, because it really depends on the health care system that you belong to, whether you’re a private physician or you’re an employed physician. Are you working for a large company? Are you working for a small company? Are you a contract worker? Are you an employee? So there are a lot of variables that come into play. So the first avenue, I think, would be the employee resource.

And then you just have to go online, and you have to do your own research in terms of the financial aspect of it. FMLA means that you don’t get paid. It’s leave without pay. So you need to figure out what your income source is going to be during that time. Do you have short-term disability? Does your state offer benefits? So there are a lot of resources out there, and it does take some legwork on our part to figure these things out.

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

Rizwana Khan: So the take-home message that I have as a pulm critical care physician is that we are in the middle of a pandemic. This is a once-in-a-century occurrence. We will get through this. There has been a vilification of science and public health. And I think that the only way forward, to get through this as quickly as possible with the least amount of casualties, really would be to follow good science and the advice of public health officials: mask, social distance, test, and isolate. I don’t think there is a way forward other than that.

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

Rizwana Khan: Thank you, Kevin.

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