Stress in medicine: lessons learned through my years as a surgeon [PODCAST]

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“Medical professionals face uniquely challenging pressures. Our work itself is extremely demanding, and always has high stakes for those we care for. External circumstances that impact our work carry uncertainties that add more stress. Constantly feeling targeted as the financial solutions to greater health system issues compounds our burden.

While some choose to talk about their struggles openly, many stay silent and suffer in solitude. There is reluctance to share for fear of being judged negatively in some way. This culture of silence is harmful, and it works against medical professionals’ wellness. It is time that we address our difficulties head-on.”

Nina Ahuja is an ophthalmologist and author of Stress in Medicine: Lessons Learned Through My Years as a Surgeon, from Med School to Residency, and Beyond.

She shares her story and discusses her KevinMD article, “The culture of silence works against medical professionals’ wellness.”

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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 Nina Ahuja. She is an ophthalmologist, and she’s author of the book, Stress in Medicine: Lessons Learned Through My Years as a Surgeon, from Med School to Residency, and Beyond. There was a post on KevinMD which was an excerpt from that book, and it’s titled “The culture of silence works against medical professionals’ wellness.” Nina, welcome to the show.

Nina Ahuja: Thanks, Kevin, for having me. I’m happy to be here.

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

Nina Ahuja: Absolutely. So I went to medical school in Hamilton, Ontario, Canada, at McMaster University, after graduating from my undergraduate degree at the University of Waterloo. After graduating from medical school, I did my residency at the University of Ottawa in ophthalmology, and then I returned to Hamilton and started my surgical practice in 2003. In 2005, we actually started a residency program in ophthalmology at the university, so I was very much involved in establishing and developing that program.

And through the years, I held numerous leadership positions at both the university and hospital, and through that gained a lot of exposure and experience in terms of physician leadership and what the various capacities are among our colleagues in those types of positions. I was motivated then to establish an organization I call Dachshund Leadership, which promotes leadership education for health care professionals, recognizing the fact that we really don’t get any formal education in our training at this point.

After that, in my academic leadership role, when COVID caused closures for elective procedures, which impacted me as an eye surgeon, I actually wrote a book called Stress in Medicine. So basically, I reflected back on my experiences in medical school, saw what was happening with the residents and medical students today, related, and thought, “You know what? This is the perfect time to put pen to paper,” where stress is hugely augmented right now given the pandemic. So that’s where I wrote the book, and here we are.

Kevin Pho: I love talking to physician leadership experts on my podcast, because I think leadership is one of the traits that’s missing in a lot of doctors, both in Canada and the United States. So if you were to give one actionable tip to my clinician audience in terms of improving their leadership skills, what would that one actionable tip be?

Nina Ahuja: I would say to actually pursue leadership courses. I think it’s really important for us as physicians to be aware of what the issues are from a health system level, which we don’t get formal training in, as you mentioned, and also the skills of being an emotionally intelligent leader.

I think that in order for us to really be able to have impact on a system level, we need to be able to engage with decision-makers within government and other decision-making tables in a way that we can speak to them in their language, so that they know we know the issues, we know what we’re talking about. And then having that experience in terms of communication style, to be really able to form a collaborative environment, so that we are really in the spirit of working together.

Kevin Pho: Now, that additional training, does that necessarily come in the form of an MBA? Can it be physician coaching? Could it be an online course? So what’s something that you recommend in terms of further training to improve their leadership?

Nina Ahuja: I think if you actually take courses from leadership programs that are unique to the health care system, that’s very valuable. I don’t think it necessarily has to be an MBA. As we know, where there are publicly funded systems, as we are in Canada, the approach is very different to private industry, which is what a lot of MBA circles around, unless you’re actually focusing in on the public sector.

So there are courses that are offered through various executive programs. I’m offering webinars through my website. There are different avenues. Actually, there are lots of organizations that offer physician leadership development courses. So I think just even starting there, and then learning from your own experiences, having coaches, having mentors, there’s value in place for all of those things.

Kevin Pho: All right, so let’s transition now into your book and excerpt. The excerpt is titled “The culture of silence works against medical professionals’ wellness,” and that’s an excerpt from your book titled Stress in Medicine: Lessons Learned Through My Years as a Surgeon, from Med School to Residency, and Beyond. Now, for those who didn’t read that excerpt, can you just walk my audience through it and share the story of why you decided to share that particular one?

Nina Ahuja: Sure. So that story is basically an overall summary of the journey through medicine that I experienced. For myself, having gone to an undergraduate degree or program that was primarily rooted in didactic teaching, I went into a problem-based environment, which was very new at the time, and it was new to me. And so I struggled a lot with transitioning into that learning style and really had some difficult times transitioning to that. I eventually made it through.

But given the fact that we’re in a very competitive culture and environment, it was very uncomfortable for me to talk about the challenges that I faced, and with that, I struggled a lot. I had a lot of support through family, of course, and some trusted friends, but I was hesitant to talk about it. We’re used to being high achievers. We’re surrounded by people of high caliber.

And so my goal in this excerpt was really to relay the sense of safety that we should have with one another, where we all struggle, we all have challenges. We have the benefit of understanding what stress is about, what mental illness is about, from both the objective experience through our education and also subjectively, when we do have challenges with stress. The idea is, it’s OK to talk about these things, and we need to develop that sense of comfort that it doesn’t take away from who we are, how capable we are, and how skilled we are.

So that was really a message to move away from the stigma, to feel comfortable talking about it, and to encourage one another to talk about it, especially now with the pandemic, when we’re really, really in heightened states of anxiety and stress for multiple reasons, not just the usual ones we typically face.

Kevin Pho: Now, can you share a story or an example of one of those challenges that you faced, whether it’s in medical education, training, or through your professional years, and what specific things you did to overcome that particular challenge?

Nina Ahuja: So the big one that I really do talk about is the adjustment to the learning style when I was in medical school. It was one of those things where, having that desire to do things perfectly and to do things very well, I really had a tough time setting endpoints for my learning, where it was about setting objectives and collating that curriculum myself, really. When we would do that individually, we would then go back to our groups. We had a group learning style, and we would talk about the cases and the issues and the facts of the case. But for myself, when I was doing my research, I really wasn’t able to stop, and was losing the forest for the trees, so to speak.

So with that, I really was able to reach out. I did reach out to a mentor at that time, and he worked with me to basically help me establish what those endpoints needed to be. I learned to organize and prioritize what needed to be looked at for the benefit of the patient without getting lost in the details, and really was able to also learn to manage my time and evaluate for myself: How am I going to measure my success? Is it going to be that I know the minutia of everything that may not be relevant for what I need to do for a patient? Or is it going to be that I know I’ve worked my best, I’ve put in the hours, I’ve put in the effort, and I can have confidence in what I’ve learned, because I really do know what I learned?

So those were different things that I learned to look at, and ultimately, over the years, I have repeated this with patients. In fact, you can apply these concepts to patients, residents, and medical students when I’m working with them, and I have actually put it together in that five-phase framework that I present in the book.

Kevin Pho: I’m sure other students or your colleagues were going through similar issues that you described. Now, what kind of support within that medical system did you have to help you through that, or did you have to seek mentors or people outside of that medical education system to help with these issues?

Nina Ahuja: In the program that I was in, I was fortunate that we did have good relationships with those physicians and leaders who were leading our tutorial groups, actually, so that if you wanted to, you felt good enough and close enough that you could approach them for some mentorship and some coaching. So that was beneficial.

Also, I had strong support from my parents and my brother. I had really strong family support, which I’ve been blessed to have through my entire life. I also had some good friends that were going through some similar challenges, so because we were sort of in the same boat, we could talk about it with one another. So I did have that around.

A lot of programs do have support systems that students can reach out to. They have wellness programs as well, which may not necessarily be academic coaching per se, but more in the realm of how to deal with the stress. So that was there at that time. It wasn’t known to me so much at that time. I’m now more familiar with it given my academic roles, but those programs are definitely available. And then some of the national organizations that advocate for physicians, and for residents and medical students, actually do have programs as well that people can turn to for that kind of support.

Kevin Pho: Now that you’ve been a practicing physician for a while now, and you still maintain connections in the academic field, what would you say currently are some of the biggest challenges that students and residents face today during their medical education journey?

Nina Ahuja: I think right now, what’s really become obvious to me in my role as academic division head for ophthalmology is the disruption in curriculum because of the pandemic. That has brought about a huge amount of anxiety, and understandably so. It raises questions for people: Will they have the skills and have the confidence in their competence in the various medical and surgical skills that they’re expected to have by the time that they graduate from their residency programs?

Similarly, applications for residency for medical students, that’s been impacted. Fellowship applications for residents, that’s been impacted. Getting jobs, that’s also a significant issue right now, where the students, whether you’re in medical school, residency, or in fellowship, you don’t have that opportunity to go to different communities, into different programs, to really engage and get a sense of what those programs are like. So there are a lot of stresses that way. Also, examinations are being conducted virtually now. We’ve also got interviews for matching; residency matching is all virtual. So there are lots of things that are being layered on top of the service that needs to be delivered, in a context now where there are safety issues as well.

COVID, as we know, the pandemic, is a major concern. The virus is highly contagious and infectious, and so our residents and medical students are often at the front lines dealing with patients first, before we engage as staff. And so that becomes another element of stress that gets added. And then also dealing with family when you go home, or having to have all those precautions when you re-enter your home and work and workspace, and going back and forth. So there’s lots going on right now.

Kevin Pho: We’re talking to Nina Ahuja. She’s an ophthalmologist, and she’s the author of the book, Stress in Medicine: Lessons Learned Through My Years as a Surgeon, from Med School to Residency, and Beyond. Nina, for those medical students, residents, and even early physicians who are going through this difficult time, especially during the pandemic, or even without the pandemic, going through the medical education journey is a difficult journey. What are some of your top tips and advice that you could share with them to make their journey a little bit smoother?

Nina Ahuja: I think the biggest tip that I can offer is an approach to looking at your stress and your feelings when you’re feeling overwhelmed. In my book, I present a five-phase framework, which I call ADMIT. Each letter stands for something; it is an acronym. A stands for adapting to new ways, D stands for doing the work, M is measuring success, I is introspection, and T is transformation.

So the idea is that when you’re feeling particularly challenged, if you can identify which one of those five phases of experience seems to be the primary challenge at that point, you can try to work through that and create small goals and objectives for that particular thing, to try to get through that aspect. And then you can try to pull back and look at the other phases in that framework to see what else is being impacted here that could be impacting my initial issues.

So for example, if the workload is an issue, that’s in the doing aspect. So with that, you can reflect, organize, and prioritize what needs to be done. There may be some elements of that where you need to delegate work, and that might be a concept that you’re not used to, because we’re so used to wanting to do everything ourselves. So then that leads to the adapting to new ways idea, where we need to be able to accept or adapt to the idea that it’s OK to delegate. And then you can work through that part of the framework to say, what can help you accept that new idea more?

And so by being able to organize things in a fashion like that, my hope is that you can make that feeling of overwhelm seem less overwhelming, and in fact more manageable, in a way that helps you think about things and transform, so that the next time you hit that challenge, you’ve already got those new skills in place and that new outlook in place to make it easier.

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

Nina Ahuja: I’d love to just share with the audience that, again, we all do have challenges. We all struggle in one way or another. It looks different for each of us, in different aspects of our lives, and it’s OK, and very important, to acknowledge that we don’t have to be perfect in everything that we do. We do try our best, and what happens happens. And we need to be comfortable with the fact that what we’re doing is coming from a place of true intention, and that needs to be good enough for us. It’s very hard for us as perfectionists and high achievers, but I do think it’s important to really take that message away.

Kevin Pho: Nina, thank you so much for sharing your time and expertise, and thanks again for being on the show.

Nina Ahuja: Thank you very much.

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