How physicians can play the hand they’re dealt [PODCAST]

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“Anyone can win at poker when dealt a royal flush. But what can you do when the cards you are dealt don’t appear winning at all? My answer: Make the best of what you have.

Recently I learned of a colleague who sustained a broken back in an accident. He continues to work, wearing a brace and not taking pain medication. I know from watching his videos that he routinely handles the most complicated eye surgeries. Such cases are challenging to any seasoned ophthalmologist, without physical constraints and constant pain. This internationally renowned eye surgeon dubbed his constant pain ‘background noise.’ How on earth has he maintained a positive attitude despite such a major setback?”

Paul Pender is an ophthalmologist and can be reached at his self-titled site, Dr. Paul Pender. He is the author of Rebuilding Trust in Healthcare: A Doctor’s Prescription for a Post-Pandemic America.

He shares his story and discusses his KevinMD article, “Playing the hand you are dealt.”

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

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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 we welcome back on the show Paul Pender. He is an ophthalmologist and now a health care consultant. He wrote the KevinMD article “Playing the hand you are dealt.” Paul, always great to have you back on the show.

Paul Pender: Hey, Kevin, thanks for having me once again.

Kevin Pho: So for those who didn’t get a chance to listen to our previous episodes, let’s briefly again share your story and journey to where you are today.

Paul Pender: Well, it started when I took a Harvard writers course for health professionals, and your platform came up as a very important one. So I submitted some articles, and you were kind enough to publish them. Next thing I know, I have a CEO of a health care company who wants me to advise his company on physician-related issues and how we can create a better model. So it was really through your platform that he even knew of me, and I’ve been working with him now for a little over two years, and it’s been a very interesting run.

Kevin Pho: Now, you’ve contributed so many articles on KevinMD, so thank you so much for that. The theme of your articles just seems to be issues dealing with the practice side of medicine. Now, why is that? Why is it important to really share stories about some of the difficulties physicians face regarding the practice side of medicine?

Paul Pender: Well, we’re clinicians here, and we’re facing those issues every day. I’ve since retired, but I stayed close to the people who are facing these issues, and they really come down to feeling valued as a professional and why burnout is occurring among a lot of our peers. Those who are taking care of patients want to feel like they can work to the best of their abilities with the least amount of friction. And so some of my articles have been: It’s never too late to change gears, to consider other alternatives and other positions besides just clinical care.

Kevin Pho: Now, when you talk to your colleagues who are still practicing, one of the things you mentioned was issues about feeling valued. What exactly do you mean by that, and what exactly are you hearing from your colleagues?

Paul Pender: I think if you’re feeling valued, you will have less tendency to burn out, because you have a connection through your professional identity to your patients, you have respect from the institutions that you work in, and your colleagues are considering your work important. If you are a specialist or a primary care doctor, it doesn’t matter. It’s really feeling like there’s still a connection to this altruistic profession that we have. And so I think when that connection is broken, either because of stress, the number of hours that you’re having to put in, or the amount of documentation that you have to go through, it all starts to pile on. And I think you’re feeling less valued when too much of the work you’re doing is what I consider minutiae.

So I hear from my colleagues that that really needs to be addressed. And I think we’re reading more and more about the surveys that show that across all specialties, this whole business about needing to feel like the work you’re doing is important, and not just cranking out widgets, is what helps define us as professionals.

Kevin Pho: And from an ophthalmology standpoint, I assume that you still stay in contact with a lot of your ophthalmology contacts. What are examples of some of the minutiae that they may face?

Paul Pender: Well, I had the opportunity of reviewing some episodes, not just from ophthalmologists but across the board. What prompted this particular article that you’re quoting now, “Playing the hand you are dealt,” you know, I figured that anyone can win at poker if dealt a royal flush, but what can you do when your hand isn’t a winning hand? You try to make the best of what you have. And so recently I learned of a colleague who had suffered a broken back in an accident, and he continued to work, wearing a brace and without taking pain medication. And I knew from watching his videos that this is someone who handles the most complicated cases.

So the reason why I was impressed was, how could he continue to maintain a positive attitude in light of these limitations? Here’s someone who considers his pain background noise, and I thought, “Really? So how does he manage to do this?” Well, his remarks provide some insight. He’s grateful for the fact that he can still perform these measures and that he can still work within this skill set despite these limitations. And so for my colleague, it was mind over matter. Our minds can overcome many kinds of bodily assaults, and this is one that I think he sees as temporary: that he can ultimately heal, that he’ll continue to work hard and go through therapy, and do whatever he has to do to be able to play his hand the best way he can.

So not every ophthalmologist, not every doctor, is going to face such difficulties physically or emotionally, but I do think that having a positive attitude can really help. And in light of all the stuff that’s been said about burnout, what we realize is that you have to separate the thought from the thinker, and you have to be able to say, “OK, I’m still in control of what I choose.” Now, we do know that the world is full of suffering, and some of it is not chosen. But those of us who go through medicine, those of us who have been subjected to the rigors of academic and clinical training, realized that it has made us tougher. And as it was Nietzsche, I think, who said, “What doesn’t kill us makes us stronger.”

So I think we’re finding that now there’s a recognition on the part of institutions that doctors are having to come to grips with a lot of different challenges, and one of them, I thought, was just the whole business about medical records. One of these wellness counselors that I watched on one of these podcasts talked about when you go to your IT person and find out that they’re doing most of their medical records updates at night, you know that those are the people who are already starting to feel burned out. So I think this is an issue that’s pervasive, but I think that we have to sort of say there comes a point where you have to be the one in charge of your own destiny, and you have to take on the responsibility of making some choices.

Kevin Pho: So you told the story in your KevinMD article titled “Playing the hand you are dealt.” When you were talking to your colleague and he was sharing the story about his injury and how that didn’t prevent him from continuing to perform complicated procedures, what was your initial reaction when you saw your colleague do that despite the obstacles?

Paul Pender: I was impressed. I think it reminds me of the book by Angela Duckworth, Grit. And I think that grit isn’t genetically determined. It’s something that we all have. We have to bring it out. Sometimes it’s passion with direction. And I just felt like here’s someone who is remarkable, and I admire his determination. It may not seem that unusual when you look across the board and see the kinds of challenges people are facing in medicine right now, but his might be a temporary challenge that he hopes he’ll be able to get through. But I think even if you find that there are challenges that look to you like they may be of a more permanent nature, then you have to start thinking and examining your options.

Kevin Pho: Now, physicians, as you know, are probably the most resilient people who are out there. They have to complete rigorous training, go through multiple board exams, take call, and do a lot of things a lot of professions don’t. At what point is that resilience enough? Is there a point where physicians should say, “No, I can’t do it anymore. This is too much”? Because if they don’t, wouldn’t more and more just become burnt out?

Paul Pender: Yeah, I think that part of what is happening is that there’s a recognition that this is pervasive and that sometimes it’s OK to ask for help or to talk to people about this. Those who keep it all internalized may wind up having too much of a burden to bear. And so I think part of it is mindset, but a lot of it can be, “What else can I do about my situation, and are my peers facing the same kinds of challenges?”

So I actually kept some of these quotes, because I thought, “I’ve got to be prepared for Kevin.” One of them was from Henry Ford: “Whether you think you can or think you can’t, you’re right.” So part of it is attitude, and that has to do with, “OK, I may have reached my breaking point, and I need to talk to somebody about it.” And there are certainly professionals who are there to help.

And I think one of the pieces that I got in my news feed recently was that HHS is coming up with grants that are going to go out especially toward rural communities and communities that have had health disparities, to be able to reach out to professionals who may be feeling the challenges from COVID and other things even more. So it’s reaching a point where physicians don’t have to feel like they’re alone, that these are challenges that are going to come up. Our profession is a very strong one, but I think they also need to see that there are changes in the future that are going to make a difference for their daily care of patients.

Kevin Pho: We’re talking to Paul Pender. He is an ophthalmologist who wrote the KevinMD article “Playing the hand you are dealt.” Paul, can you share a story or a case study? It could be in ophthalmology or outside the field, where a physician encountering an obstacle should play the hand that he or she is dealt, with a real-world example that can apply some of your ideas in action.

Paul Pender: I’ll give you a very personal example. I wore a knee brace for two years because of bone-on-bone from an athletic injury, and eventually decided to have a total knee replacement. Following the surgery, I had a flexion contracture, so I needed another procedure under general to straighten my leg. And I thought I’d taken enough time off from work, but I found I was still having pain and would have to actually bring my ice cuff with me, and between patients, elevate my leg and ice my knee down. If I had to do it over again, I probably would have had the work done sooner and not put it off.

And the other thing is that I realized that my insurance at the time covered a certain span of physical therapy, but it kind of disappeared after a certain period, and I needed it for another four or five months. So I think that the best thing that physicians can do is catch something early, and I didn’t do it for myself.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Paul Pender: OK, so once again, I’m kind of looking at my notes, and I also want to share with your followers that this burnout may be pervasive, but you still have control to make choices. Acknowledging the challenges is the first step to gain perspective as to what options exist. If these challenges are temporary, you may choose to ride it out. If you determine these challenges to be permanent, you may choose a different path. Either way, you are in charge of your own destiny.

Kevin Pho: Paul, thank you so much for sharing again your time and insight, and thanks again for coming back on the show.

Paul Pender: Thank you for having me.

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