Depression vs. burnout: A physician goes through both [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“I have been depressed.

I have been burned out.

I have been both.

I have been neither.

How do you know if you are depressed vs. burned out when your chief complaint is, “I feel like crap?” It’s time to call a consult. I don’t mean curbsiding your colleagues to fill your medications off the record without evaluation. I mean, ask for real help, from someone who can objectively help you define your diagnosis and the best path forward. If you “feel like crap” and think you may be depressed or burned out, please reach out to a trusted physician, therapist, or coach. You are not alone, and there is hope and help waiting for you.”

Kara Pepper is an internal medicine physician and can be reached at her self-titled site, Physician Life Coach: Kara Pepper, MD.

She shares her story and discusses her KevinMD article, “Call a consult: depression vs. burnout.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

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 Kara Pepper. She’s an internal medicine physician, and she wrote the KevinMD article “Call a consult: depression vs. burnout.” Kara, welcome to the show.

Kara Pepper: Hi, 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?

Kara Pepper: Yeah. When I was a kid, I wanted to be a professional ballet dancer, so I left home in eighth grade, moved to communist Russia, and trained. Ultimately, after years of dancing, I kept breaking things and had to do a fallback plan of going to med school. So I went through this journey of med school feeling like I tricked people into letting me in, and I spent many years thinking that I was an impostor in a sea of super smart people. So I worked hard, dealt with my perfectionism, and finally found my way to internal medicine.

Years into my career, I ended up really burned out and almost left medicine because of all that fatigue and burnout and feeling like what I was doing was overwhelming. I thought I was going to move home to Florida and open a yoga studio, but thank God I took a sabbatical, addressed my own burnout, and asked for help in a meaningful way for the first time in my life.

Kevin Pho: Wonderful, and we’ll certainly get into that journey in a little bit, but tell me a little bit about your practice.

Kara Pepper: Yeah, I’m outpatient internal medicine, so primary care. I see everything 18 and older, and I have a special focus in eating disorder care for my patients.

Kevin Pho: And you mentioned you had a background in ballet training. Has that helped or hurt you as a physician now?

Kara Pepper: You know, dancers and doctors are the same people: perfectionists, lifelong learners, wanting to get better and better at your job every day. So now I pay it forward. I’m the primary care physician for Atlanta Ballet, so it’s been a really cool full circle.

Kevin Pho: All right. So let’s go into your KevinMD article, “Call a consult: depression vs. burnout.” Now, for those who haven’t read your article, can you walk the audience through it and share the story of why you decided to write it?

Kara Pepper: Yeah, I don’t think it’s a surprise that a lot of people are struggling with burnout in this season of medicine, but particularly post-COVID. So, from my own personal experience, having dealt with both depression and burnout, a lot of people come to me as a physician coach saying, “I just don’t feel good. What is this?” And frankly, it’s easier to say that we’re burned out than depressed. So really distinguishing between the two is not only important for treatment, but also important just to realize where you are and what you need. So the article comes from that place of a really personal story and really wanting to help physicians find their best life.

Kevin Pho: Excellent. Share a little bit about your own personal journey. What are some of the things that you did to overcome that?

Kara Pepper: Yeah, well, you know, we’re not really trained to ask for help in health care. We’re supposed to have all the answers and be really independent and be able to help other people. So asking for help was not something I was certainly trained to do. So when I became so burned out that I really could not show up to work anymore, I was forced to ask for help. I had tentatively done that for years leading up to that, but not in a meaningful way. So I really had to take the advice from my therapist, and I found coaching at that point in time. I was able to actually set goals and address my own brain and the narrative I had around practicing medicine, and make it a really healthy one for the first time ever.

Kevin Pho: What about physician practices today? What are some of the specific aspects that lead physicians to burnout or even exacerbate depression and mental illness?

Kara Pepper: Yeah, I mean, if you look at just the data, the overwhelming thing that people talk about is the EMR, paperwork, and dealing with bureaucracies, insurance companies, and health care companies. But I think part of it is that we go in with this altruistic, wanting-to-help-people feeling, and there’s a lot that takes us away from the bedside, and that dissociation really, really takes an impact. And then we’ve got issues like second victim syndrome, particularly in this era of COVID, where people are witnessing trauma and not having a place to process that. All of this compounds into not having the time or space or cultural awareness to want to ask for help and take it.

Kevin Pho: So some people say that when physicians ask for help, that places the burden on the physician himself or herself. Now, a lot of people also say that we need more structural change around the physician. We need physicians to be helped, to help alleviate the burdens of the EMR, and some help in alleviating the stresses of practice. Now, how do you comment on that? And how can we change some of the more structural influences that cause physicians to burn out?

Kara Pepper: Absolutely. I mean, it’s not if people are going to struggle, it’s when. We know that 80 percent of physicians struggle with second victim syndrome, emotional trauma from unanticipated events. We know that half of physicians are burned out at any given time, and the numbers are increasing after COVID. So, waiting for the physician to say, “Hey, here’s the white flag. I need to ask for help.” Institutions need to assume that this is going to be an issue in the culture of their organization, and there are structured, evidence-based guidelines in place that you can implement to say, “Hey, we have this resource to catch you when you fall.”

Kevin Pho: So you referred to second victim syndrome. I’m actually not familiar with that. Can you explain to my audience what that is?

Kara Pepper: Yeah, absolutely. It was described about 20 years ago, but it’s the emotional trauma from unanticipated patient events. We all have that story of the first time a patient died unexpectedly and it really impacted you. I mean, for most of us, years later, you can still remember the granular details, the light that was out in the corner of the room, that type of thing. But this emotional impact that we carry, and peer-to-peer support and institutional planning for this, is really at the core of it. So helping each other through these crises, in a way that we uniquely understand, really helps us heal from this.

Kevin Pho: Now, burnout, as you mentioned, has reached almost 50 percent of physicians, and this was even before the pandemic. What are some unique ways that COVID-19 has exacerbated burnout among physicians?

Kara Pepper: Right. So, I mean, not only is the acuity of what we’re seeing in the hospital and the ICU setting so much higher, patients are sicker and dying. On the back end, there’s the guilt of “Am I going to get my family sick? Am I going to be able to send my kids to school? How am I going to balance all these needs?”

And in addition, physicians are taking pay cuts because they’re not taking the volume of patients that they were seeing before, in order to safely accommodate patients. So I think the problems that we were addressing before COVID have now just compounded and amplified through COVID. And because we are socially distanced, that isolation and the loneliness are making that even worse. So there are a lot of factors.

Kevin Pho: So we’re talking to Kara Pepper. She’s an internal medicine physician, and she wrote the KevinMD article “Call a consult: depression vs. burnout.” Now, let’s say you’re a practicing physician currently. What are some of the signs and symptoms he or she should look out for that may prompt them to get more help?

Kara Pepper: Yeah, absolutely. I joke that both of them, you know, feel like crap. They both equally are in this place of either overwhelm or darkness or just unhappiness that’s there, but the distinction is really important. Depression obviously is a mental illness that gets treated with medicine and psychotherapy, and burnout, by comparison, is an occupational hazard. So it’s structural support within your organization and addressing your narrative there.

So I wouldn’t prescribe a scribe to treat your depression, and I wouldn’t treat your overwhelm and your burnout with an SSRI. So the treatment is very different, and it’s important to make the distinction for that reason.

Kevin Pho: And what kind of resources are available to the majority of physicians today in case they want to seek more help?

Kara Pepper: Absolutely. So, I mean, there’s the standard traditional model of asking for help from your personal physician, whether it’s your PCP or your psychiatrist, and psychotherapy. There’s a whole army of physician coaches who are trained in this evidence-based cognitive behavioral therapy model, where we’re able to actually address physician needs. There are really interesting trials going on showing that it improves burnout, improves engagement, and improves resilience. So coaching is another way forward, which is how I integrate into this whole system. It’s really neat.

Kevin Pho: Now, I talked to a lot of physician coaches on this podcast, and I always ask them, “So, at what point does a doctor know when he or she should seek out a coach?”

Kara Pepper: Absolutely. So I think anyone who wants to feel better and improve their experience of life, either professionally or personally, that’s a reason to seek out coaching. This is not a new concept in corporate America. Executives have coaches all the time. So you don’t have to be in crisis in order to ask for coaching.

But within the realm of coaching, there are coaches who specialize in all kinds of things, whether it’s burnout or leadership or relationships. So sometimes people seek it out for very specific reasons.

So for me, I feel the best I’ve felt in my life, and I have a therapist, and I have a coach, because for me it’s just part of my wellness package. It’s what keeps me sane and keeps me curious about what’s going on in my own life experience.

Kevin Pho: If a physician wants to seek out a coach, what are some red flags to look out for, and what are some specific things that they should look for in order to find a coach that’s a good fit for them?

Kara Pepper: Absolutely. Part of it is exactly as you say, just fit. Is it someone you connect with? Is it someone you feel like you can be vulnerable with? Is it someone whose methodology you like? So, asking, “Tell me what it’s like to be your client. What is it like to work with you? What are the modalities that you use?” And seeing if that really is a fit. So many of us are doing work in the COVID environment to really reach out to our colleagues, and so there are plenty of free, accessible ways that you can interface with coaches and test the waters if you’ve never done it before.

Kevin Pho: And my final question, Kara: What is your take-home message that you want to leave with the KevinMD audience?

Kara Pepper: You are your most important patient. You are allowed to make decisions. You’re allowed to give yourself permission to try new things, to go off the beaten path, and to create a life that you really love, whether that’s in medicine or otherwise. So this is your one precious life, and giving yourself permission to do it in the best way for you is absolutely within your power.

Kevin Pho: And how can people find you?

Kara Pepper: You can find me on social media at KaraPepperMD or on my website, karapeppermd.com.

Kevin Pho: Kara, thank you so much for sharing your insight, and thanks again for being on the show.

Kara Pepper: Thanks. Thanks for having me.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes