The Worthy Physician Podcast

Season 2 Ep. 3: Interview with Dr. Robyn Tiger, MD

April 13, 2022 Dr. Sapna Shah-Haque MD Season 2 Episode 3
The Worthy Physician Podcast
Season 2 Ep. 3: Interview with Dr. Robyn Tiger, MD
Show Notes Transcript

Dr. Robyn Tiger, MD is a radiologist who shares her story about burnout and how she saved her own life.  She had several symptoms that were being treated with Western medicine, but could not be solved.  Burnout can take the shape of physical symptoms. She shares her personal story and insight that is not taught in medical school or residency.  Furthermore, she is now helping physicians.



Hi, welcome to the worthy physician podcast. I am your host, Dr. Sapna Shah-Haque, a board certified internal medicine physician. Keep life simple. You are human. You are worthy. Remember what matters to you Our goal is to help physicians remember this and to make it a reality through addressing various components of physician burnout via podcast. This is meant to be used as a tool to help guide physicians. It does not take place of professional medical help opinions reflected in this are my own.

Dr. Shah-Haque

  01:00 - 01:12

Okay, so I'm sitting here talking with Dr. Tiger. Now, can you please tell me, tell me about yourself, introduce yourself to me and to the listeners, please.

Dr. Tiger

  01:13 - 02:17

Yeah. Hi. Well, thank you so much for having me. I'm a really big fan of your podcast and I'm really, really honored to be here, to talk about a topic that is really, really deep in my heart. And who am I Well, I'm the physician. Yes. That, yeah, that, when did that start Well, I was in third grade and, Mrs. Miller, my third grade teacher, Mrs. Miller, if you're listening, this is, this is for you. She wheeled out this life-size skeleton. And it was at that time that I learned that skeletons were not just Halloween decorations or costumes that we wear, but they actually were inside our bodies. Right. And I just found that super fascinating as an eight year old. And so that was actually the moment where I knew I wanted to be a doctor. Right. I thought there could be nothing more amazing than learning about the human body and, and taking care of others.

Dr. Tiger

  02:17 - 03:41

So that was the beginning and fast forward. I had a very traditional path of going to college and medical school. I did a year of internal medicine, four years of radiology residency, a year of fellowship in body imaging. And then I went into private practice in radiology and initially everything seemed okay. I mean, I had an amazing husband who I still have in two incredible kids who were very young at the time one, and then one on the way, soon after that. And, again, you know, I thought, wow, this is an incredible privilege. And there's nothing more amazing than being a physician, right. It's such an incredible honor and responsibility. Yeah. Yeah. But I have to tell you that over time I started to become aware that I didn't even recognize myself anymore. And it started with several symptoms that, you know, they didn't all come on at once, but at one point they were all present at once and they started with things like migraine headaches with intractable vomiting, like just forceful, horrible vomiting.

Dr. Tiger

  03:41 - 04:35

They're like, I couldn't even function. Like we had to postpone the kids Disney trip because I, I could barely get up off the floor. You know, this one year you're making a deal with the devil. You feel that horrible, right Never, never, never had this in my life. I had this vertigo that was so incredible that somebody would just quickly call my name, Dr. Tiger to my head, or, I mean the supermarket, Hey Robin. And the whole room would just spin around, you know, this really bad tinnitus where I couldn't sleep. It was just so loud. This ringing in my ears and this horrible reflux with horrible burning chest pain, my gums were bleeding in my gums, are bleeding all over the inside of my mouth. And I had really bad pain in my body. I would just wake up and the best way to describe it would be like the tin man from the wizard of Oz where you just can't move, not move.

Dr. Tiger

  04:35 - 05:37

My joints just felt stuck. My muscles all hurt. And I had a really, really scary symptom that developed, which were these intermittent. Parasthesias where there will be times where I would lose sensation. And I tingling in my hands, my feet and the left side of my back. And, you know, I could be cutting up vegetables. All of a sudden, I can't feel the knife in my hands. I would be doing a breast biopsy. And all of a sudden, I can't feel a gun in my hand, you know, the biopsy gun. And I just be standing there. My tech will kind of be looking at me like, what the heck is she doing And I would just have to wait for that lack of sensation to pass. And then, you know, I can continue with the procedure. And so these were the physical symptoms that I was dealing with, that led to many, payments with several medical specialists from Paris, from like a periodontist to gastro neurologist, to neurologist.

Dr. Tiger

  05:37 - 06:43

And so on. I had lots of imaging studies, which were negative. I took lots of pills because each doctor treated my symptom with a pill and I wasn't getting better. And I was exhausted. I wasn't digesting my food. I just didn't know which way was up. And I was so scared. And the thoughts started to come. The, I don't really know if I could spend another day doing this. I don't really know if I want to be here any more, which was incredibly scary. And I have to tell you that at this point I had two of three physician colleagues had died from suicide at this point in my, in my career. And so I was at the bottom and there was no way out, but up, I had two choices either to continue on this path, which I knew was incredibly scary. And I saw myself going in the direction of my physician colleagues who had died from suicide, or I could try and figure it out myself.

Dr. Shah-Haque

  06:44 - 06:49

Oh, wow. And how far into your career were you at this point in time

Dr. Tiger

  06:50 - 07:33

So at this point in time, let's see probably about 10 to 12 years into practice. In retrospect, I started to notice the symptoms, the, which began with the migraines back in residency, when I would have to leave one dark room and radiology to another and just put myself into a dark, quiet space and just try and, you know, gather myself until the pain would pass. But, it was, you know, accumulate a cumulative decade or so I would say of the symptoms that over time, when I look back one after the next I'm just piling on until they were all there at the same time.

Dr. Shah-Haque

  07:34 - 07:34

Oh wow.

Dr. Tiger

  07:36 - 07:57

And I went to a mental health care professional, and you know, that professional was really wonderful human, but I still wasn't getting better. So the medications weren't helping, the imaging studies were negative. The mental health care, you know, professional sessions are not helping. And Western medicine at this point was just not what I needed, even though it was all that I knew.

Dr. Shah-Haque

  07:59 - 08:00

Can you expand on that?

Dr. Tiger

  08:02 - 09:23

Well, we know it's doctors that we try and figure out what's going on with patients. So every doctor I went to saw me as a symptom. So I was on, you know, H two blockers and, you know, I was on, I was getting antibiotics, injected into my gums and I was on medications for my migraines and medications, where, where to go. And, you know, I was just on so many pills and nothing was helping, right. My body hurts so bad and yet all the imaging studies were negative. So everything that I knew, everything I'd studied, everything that my colleagues had studied up until this point, wasn't, wasn't figuring out what was going on with me. Nobody could diagnose what was going on with me. And of course I was terrified. I had a debilitating neurologic disease due to the prior stages. Gabapentin was on board, nothing was working. Oh, wow. So, you know, I decided that I needed to try and figure it out because I didn't want to end up like my colleagues. And again, this amazing husband has two incredible kids. And on the outside, everything looked perfect. Right. I'm also married to a doctor. We had a beautiful home. I mean, you name it. It looked like fairytale land, you know, but on the inside completely discordant as to how I was feeling.

Dr. Tiger

  09:25 - 09:27

And so, yeah.

Dr. Shah-Haque

  09:28 - 09:33

How did you, how did you figure out and what did, I mean, how did you figure out what was going on

Dr. Tiger

  09:35 - 10:11

So what happened next was I decided to just kind of start to look outside the box of traditional medicine and I was already exercising a lot and I was already on a plant-based diet. I mean, just eating really well when I could eat. I was, you know, my fitness level was really, really good. So, you know, those things were not things I needed to change. and I kept seeing things out there and the news and on TV and in magazines and so on about yoga meditation. And I'd have to tell you that I did a lot of eye-rolling

Dr. Tiger

  10:13 - 11:04

Because I'm a gym rat. I was training for races all the time. I just thought that was for those people over there who want to wear all kinds of weird spandex and twist their bodies up into upside down poses and sit uncomfortably for long periods of time and listen to weird music and say exactly. But that's what I thought, because that's what everybody thought, right Those people are really weird. Why would I ever consider doing any of that But I was seriously at the bottom, right I was at the bottom and nobody was talking about any of this stuff. Then this was like 15 years ago or something. And I, I heard about a yoga meditation, 1 0 1, 5 week series at a studio near my home, about five minutes away. And I kept seeing it. I kept seeing it, you know, you need to see things.

Dr. Tiger

  11:04 - 11:52

I think research shows you have to see things at least six times before we actually take action. And I probably saw more than six and, I, my next door neighbor was a nurse and I said to her, Hey, do you, do you want to come with me to this, this yoga thing And you know, she's, eye-rolling at me. Right. And, I said, look, you know, it could be, we get out of the house. Maybe it'll be okay. I don't know if it's terrible, we'll just leave and let's go, we'll go grab some dinner. It'll be fine. So either way, it's going to, it's going to be good win-win and she's like, all right. So she came with me and, you know, I walked into this studio incredibly uncomfortable and just had again with my whole entire huge basket of preconceived notions dragging along with me.

Dr. Tiger

  11:53 - 12:45

And, it ended up being a really, really wonderful, set up where it was a very informal kind of education, where there was a lot of science being described, questions, experienced, question, experience, back and forth. It wasn't what I had envisioned at all. And at the end of the first session, I felt this really, really unbelievable shift, not to tell you that my day was crazy before I got there. You know, it was typical day, like take care of the kids, work all day, really gazillion cases, do a bunch of procedures, get home, take care of the kids, you know, get the babysitter on board so I can get to this like seven, 7:30 PM class on time. I was exhausted. But at the end of the session, I wasn't tired. I wasn't tired. And I was clear and I was calm and I just, it was like, everything was stopped.

Dr. Tiger

  12:46 - 13:35

And I, I didn't know what to do with it. I mean, I'd never felt that way before, or at least I could never remember feeling that way and I was blown away. Okay. So I walked out of there kind of like looking around, am I really awake You know, my dreaming, what story And driving back just completely amazed. And my doctor brain, my left brain needed to unpack it all. And so I kept going to these classes and after the C series, I continued going to these classes and I was doing research and I started to dive into the physiology because I wanted to know what was going on. As my symptoms started to get better without the meds, without a mental health care professional on board, just with going to these classes, they started to get better. And so I saw what the heck's going on.

Dr. Tiger

  13:35 - 14:45

There's gotta be something physiologic, right Because my left brain was going to figure it out. And then I dove into the medical literature and found out that there was so many articles written on the benefits of what I was doing on yoga meditation. And that what my diagnosis was that every doctor missed, including me, was that I was suffering from a severe case of chronic stress. And that chronic stress was manifesting itself in my body, in all of these different symptoms that I described to you. And when I was able to learn, to start to balance that physiology, to really tap into the autonomic nervous system and to find that homeostasis between systems between the sympathetic and parasympathetic components, decrease the inflammation, decrease the cortisol levels, start to increase the good feeling hormones and so on the serotonin dopamine and the oxytocin, and really change that chemical imbalance. I started to feel better. And so that was the beginning of my realization of what was happening and how I could turn all of it around.

Dr. Shah-Haque

  14:47 - 14:56

That's awesome because that is definitely not something that we're taught medical school. At least I don't remember that lecture.

Dr. Tiger

  14:57 - 14:58

No, it doesn't.

Dr. Shah-Haque

  15:02 - 15:52

And that's, that's, that's too bad, you know, at the beginning of, of this, this is when I was still learning the audio part, sat down with, physio psychologist, Dr. Bean. And he went through that. And I really learned a lot just by sitting down and talking with him, you know, we're not running away from wild animals anymore, but the everyday stressors and the amount that has increased with technology, it's almost like sensory overload. And it's hard to get those cortisol levels down and it's hard to get those feel good hormones up. but there's a reason why things like Tai Chi and yoga has been around for centuries.

Dr. Tiger

  15:53 - 16:24

Yeah. Thousands and thousands of years. Yeah. And I'll tell you, it's not hard. Actually. What's hard is the not knowing. Right. What's hard is the fact that we were not educated, that we're missing this huge chunk of education from beginning medical school on that we learned so much anatomy and physiology, but no one tells us that we can actually work with what we've got so that we can feel better by herself. We just don't know how, because no one teaches it to us.

Dr. Shah-Haque

  16:25 - 16:29

And so you've said earlier that you had, you're a gym rat and

Dr. Tiger

  16:29 - 16:30

Yeah.

Dr. Shah-Haque

  16:30 - 16:41

That's awesome. And, you know, train for marathons. So what was it about yoga and the meditation that was different than the exercises you had been doing

Dr. Tiger

  16:43 - 17:34

Yeah. So physical fitness is predominantly physical fitness, right So I could be doing three sets of bicep curls. And as a busy mom and doctor, I'd be making my grocery list and thinking about all the stuff the kids have to do and what I need to put in their lunches. And who's got to be where, when right. And I can still strengthen my bicep muscle all the same, but when you are meditating or doing yoga or the pieces of a wedge, because I deconstruct all of this into bite sized pieces of information, because lots of us are super busy. So even if it's just a couple minutes, when you tap into certain tools that work with your own physiology and you are connecting your body and your mind through your breath and through intraception is paying attention on purpose of the inside of, you know, your first person experience, you are regulating your autonomic nervous system.

Dr. Tiger

  17:34 - 18:24

So when you are working out and you are exercising hard, you really predominately still in that sympathetic tone, right So that's why some people who are super stressed out and anxious and angry, do a really, really hard workout or a really intense yoga class, because there are many flavors or really intense something else. They get, they feel worse. Cause they're just feeding that fire. So really being able to say, this is really important. This is really important for my body physical fitness. I'm going to strengthen my body, strengthen my muscles, my bones in school, on work, on my balance and everything. But then there's this other piece of, well, how can I regulate my nervous system You know, that doesn't have to be this, you know, more is better. It's actually less is more. And when you learn to do both, because they're both so important for our health, then you have a more whole way of caring for yourself.

Dr. Tiger

  18:25 - 19:12

I was only in the one side of just, you know, working out, working out, working out, which I still do, but I'm not doing that solely anymore. You know And it still is part of my everyday routine, but it's not the only thing I'm doing and working out does not help you when you wake up anxious, when someone's screaming at you, when you worried about whatever, when you make a mistake, when a patient is sick, when you have to give bad news, when someone dies, you know, when someone cuts you off, when you're driving, you know, you know, whatever it is, you know, the political climate, you name it, life is stressful. But the thing is, are you equipped with a toolbox to deal with those stresses when they come up or you going to become incredibly reactive and say, and do things you wish you didn't, every time something happens. And so that's the difference

Dr. Shah-Haque

  19:13 - 19:26

Very well said very well said. So then after you started to incorporate yoga into and meditation into your routine, where did that put you in your professional life

Dr. Tiger

  19:28 - 20:14

Well, what happened after that is that I wanted to learn more because we're we're doctors and we are like information junkies. Right. And I, I'm always trying to learn 150% of everything, this fascinating to me. Right. That's what we do. And so I decided to go into yoga teacher training, never thinking I would ever teach another human, anything just because I wanted to learn more. And I figured how best to learn that, but putting myself into the school. And so I went into yoga, teacher's training and it was there that I learned about the field of yoga therapy. And so for the listeners who may not know yoga teacher training is a 200 hour base level of certification. But a yoga therapist is at least 1000 hours over a three-year period.

Dr. Shah-Haque

  20:15 - 20:15

Oh, wow.

Dr. Tiger

  20:16 - 20:34

Okay. Yeah. And what are yoga therapist What, what makes a yoga therapist different than yoga teacher is that you study more deeply the concepts of yoga and meditation for most disciplines. And then you can apply them to help individuals with many types of symptoms, illnesses, and diseases.

Dr. Tiger

  20:36 - 21:15

So I said, well, of course I want to learn that because that's like doctoring in a different way. Right Right. Being a radiologist, I was diagnosing cancer all the time. I was always hoping I could help my patients in a different way. They think that I saved their lives. They're giving me gifts. They think I'm the greatest thing next to God. And I go home crying, you know, because I knew what was going to happen next. After I say, you have cancer all day, you have cancer, your answer. And then I know the physical, the emotional, the psychological debilitation, which is going to happen after that. So I always thought, well, what else could I do to help these patients You know, when I was at the VA and I worked a lot with the vets, well, what else can I do to help them

Dr. Tiger

  21:15 - 22:04

You know, I want to give them medication all the time because I know that just knowing them, isn't going to help them with whatever they're experiencing. And so I always thought from beginning of medical school, that there was more the out there, but I didn't know what it was. And so I thought, wow, you know, with therapy, that's going to afford me the education to help patients in a different way to help individuals in a different way. So I went on to become a certified yoga therapist. I went on to study even deeper trauma and stress, which is really the umbrella under which so many of these other symptoms known as is a lie. I think it's like over 80 or 90% of patients report to their primary care physician with a symptom that's related to stress, right So it's really an epidemic. And now even more so with the pandemic upon us and meditation, right.

Dr. Tiger

  22:04 - 23:35

I really, I wanted to learn more about meditation and I didn't resonate with a lot of flavors. There are so many types, but the one flavor that I was experiencing when I was in my own training was called, I rest like the iPhone little I bake are, this is I rest. And it was created initially for Walter Reed army hospital. And it was created to help our military relieve their suffering from PTSD. And this was several decades ago and it was found to be so helpful in processing trauma and relieving suffering that it actually went even one step further to relieve chronic pain. And that's because so much of the chronic pain in our body is related to our thoughts and what we're thinking, causing all that tension and discomfort. So the department of defense declared this type of meditation, a tier one treatment for chronic pain back in 2010, like equivalent to taking pain pills, which is amazing. So I became sort of cutting that, which is another three years and then the mindset piece. Okay. So we understand how to work with our bodies now, but you know, adding that, working with your thoughts piece, and I became certified in life coaching, and that's really the collaborative, that's really the, the recipe or the ingredients in, in what I found to be incredibly helpful for myself. And then what I teach others.

Dr. Shah-Haque

  23:37 - 23:46

So now, as it's, you don't, so you don't do radiology anymore. Would that be safe to say

Dr. Tiger

  23:47 - 24:27

PR so no. So I stopped practicing radiology about 10 years ago. Okay. I really wanted to help others in a different way, and this was not opportunity for me to do that. I knew that I wouldn't be able to study and experience what I needed to, to help in the way that I wanted. So I needed to go full in and educate myself as I continued my own transformation. And as I continued my own transformation, my own studies in these disciplines, all of my symptoms completely disappeared all of them. Oh

Dr. Shah-Haque

  24:27 - 24:27

Wow.

Dr. Tiger

  24:28 - 25:16

So they started to get better when I started, you know, doing some of this work, but it wasn't until I actually dive deeper and learned even more that everything went away, even the parasthesias even the dark thoughts, everything. So that just even validated more that what I, what I needed to do was to learn. So I can be an instrument by which other people could help themselves as well, including doctors, which, you know, I was helping lots of our colleagues along the way. And it was just unbelievable what I was seeing, that the stats were getting worse and worse and worse and worse with burnout and depression and suicidal ideation and suicide and lack of joy and so on. And then the pandemic hit and everything skyrocketed.

Dr. Shah-Haque

  25:16 - 25:39

Yeah. Yeah. It really has. It's heartbreaking. It's heartbreaking to see that and where we, as physicians are expected to always put out a hundred percent, no matter if we have it in us or not. And we're almost shamed if we're wanting to take a step back.

Dr. Tiger

  25:41 - 26:13

Yeah. And what I like to say is stand up and take a step towards yourself. Right. Not even take a step back, but can you walk towards yourself You know, can you take a step toward yourself Meaning, can you care for yourself You're depleted, can you fill that cup back up And the answer is, yes. You just have to want to first, you have to recognize there's an issue. Then you have to want to learn how, and then it's completely easy. You just need the Dulce.

Dr. Shah-Haque

  26:14 - 26:54

Right. Right. And I really liked the way that you phrased that. Can you take a step toward yourself That's, that's really good word choice and very positive. So what do you, what do you do What is your structure like How do you, when you say that you help people and our physician colleagues, what does that look like because you've studied all these things. So what is it is exactly the doc Dr. Teicher does. And by the way, I find this fascinating and I wish, I wish that we were taught more of this in residency or medical school. I really do.

Dr. Tiger

  26:56 - 28:44

Yeah, me too. And so I'm trying to, you know, I've made it, my life's work now and my deep passion to fill that gap for as many medical professionals as possible. And the way that I do that is that I created stress free and D which is the umbrella under which all of my teachings lie. I have several CME accredited programs, RX centerpiece of physician's guide for self-care is the mothership. And that is where I've basically taken everything from my brain that I've been teaching and working with over the last decade and put it into an online self-paced format for that physiology piece, you know, short 15 minutes or less pieces, snacks of content, because doctors are super busy. And I combine that with live coaching group coaching weekly, and one-on-one private coaching where we get into the mindset work, you know, really understanding how to work with our thoughts and understanding how to achieve the goals in your life that you want to achieve whatever they are. And that is CME accredited through UNC may heck my local hospital and university, North Carolina. And for 25 credits, I work with colleagues one-on-one if they prefer complete private sessions with me, and I have a podcast, the stress free MD podcasts, where I teach these stress free snacks each week to educate as many as possible. And that's really turned into this international following, which has been so amazing. I was in Mexico a few months ago and someone came up to me and said, oh, I know you, I listened to your podcast. It was

Dr. Shah-Haque

  28:44 - 28:45

Awesome.

Dr. Tiger

  28:45 - 29:43

Yeah. So, you know, lots of different ways. I I've been presenting at retreats. I give talks, I present at conferences. I work with my local medical society. I'm doing coaching programs for them, and workshops and create workshops for hospitals locally. And so I'm really, you know, whether it's virtual or whether it's in person, whether it's a program, whether it's a podcast, you know, any, any, any way I can, someone says, can you create a retreat where you present here or you present there and like, I'm there. So that's really how I educate. And most recently the American college of lifestyle medicine has appointed me lead faculty for the stress management pillar in lifestyle medicine. Thank you. Thank you. So, yeah, I'm their subject matter expert on stress management now, and I'm starting to create the content for the next board review exam.

Dr. Shah-Haque

  29:45 - 29:52

Oh, wow. So that keeps you busy, but just hearing you talk about it and you really love what you do.

Dr. Tiger

  29:53 - 30:44

Yeah, I do. You know, I feel that, you know, the saying goes, make your mess, your message. And I, you know, people say, you know, do you miss practicing radiology And I say, well, there are definitely parts that I miss, but I feel almost like I needed to go through that so I could help other people. And, you know, up until the pandemic hit, I was pretty much just in person. And, and a lot of what I did was local. And I would frequently get asked questions. Like, I can't remember what you just taught me. Can you make a video Or, you know, I can never make it to anything you do because I'm on call or I've got stuff with my kids, or can you make a video And I was like, no, I don't know how to do that. Right. And when the pandemic hit, as you probably know, our stats were, you know, one and two physicians were burned out, right

Dr. Tiger

  30:44 - 31:27

Suicide rate was already twice the national average. And I just saw, in my mind, I envisioned this almost upward, steep, maybe completely perpendicular curve of, of suffering that was going to happen in 2020. I have this vision and I just buckled down and educated myself and created the content. And the way the doctors had been asking me for years, and, fast forward two years, we've got four out of five physicians burned out. That's 800,000 doctors in the U S out of the million. you know, w we have over 80 to 90% on the depression scale, that's Medscape status and just came out this

Dr. Shah-Haque

  31:27 - 31:28

Month.

Dr. Tiger

  31:29 - 31:43

So we are in a huge pool of suffering. And so anything that I can do, anything anybody asks me to do, I, I try and say yes to, to help alleviate that.

Dr. Shah-Haque

  31:44 - 32:14

I think that's, that's really awesome. And, I, I love your work. I look, I've listened to your podcast and I, I'm a, I'm a fan. I it's really important that we take care of ourselves and that we take care of each other. And, going back to the culture of medicine, it's, it's not something that is prioritized, but now it should be, it should be,

Dr. Tiger

  32:15 - 33:19

It should be. And there's a scary study out there that shows that they, they evaluated medical student. They evaluated college students that recently matriculated, right So the graduates of college, and they compare those who are going to medical school, and those who are not. And what they found was that the students that were entering medical school had less burnout, less depression, and a higher quality of life than those who are not going to medical school, which tells us that they're entering at a higher protoplasm, right. It's not that they're coming in damaged. They're actually coming in healthier. Yes, physically, emotionally, psychologically. And that's the process from that point on that's causing the burnout. And 50% of medical students are burned out, right 30% of depressed, 10% of suicidal ideation. I mean, this stuff is happening early on from day one of medical school, which is pretty scary,

Dr. Shah-Haque

  33:20 - 33:22

Scary, and sad because

Dr. Tiger

  33:22 - 33:23

Actually, yeah,

Dr. Shah-Haque

  33:24 - 33:60

I can't think of another profession except for maybe the military that would probably have very similar stats. They really break it down and then build you back up. And I've had some other podcast guests where we did dive in to that. You know, you really lose yourself in there. So with what you do in the stance that you just gave, what is some advice that you would potentially give to a medical student, a resident or a physician early on in their career

Dr. Tiger

  34:02 - 34:52

Yeah, I mean, continuing with those stats first is that there's research has showed in the first three months of internship that 20% of interns have suicidal ideation. So it doubles from medical student to intern and that as residents, the number one cause of death in male residents as suicide, and the number two cause of death and female residents is suicide after cancer. So most people don't talk about the steps prior to being an attending. We hear a lot of attending stats. Like, you know, four out of five doctors are burned out and 30% are this. And, you know, 90% are in depression scale. But what I want to bring awareness to is that what I already mentioned is this stuff is starting in medical school. Yes. Right. And it's continuing and worsening in internship and residency. And then we have attendings where we see the stats most commonly reported.

Dr. Tiger

  34:53 - 35:42

So to answer your question is I think the most important thing is that they need to be educated first awareness. You know, you chose this amazing field of service, right And you are going to be putting on your Cape for every patient. Or if it's not a patient, maybe it's, if you're a pathologist, then it's your slides or your radiologist, your films, or whatever it is. You're not having direct contact, but you're putting on your Cape. Right. But you need to put your own Cape on. And that's the thing that nobody tells you, you need to do. And that's the thing. Nobody tells you how to do so first I would just make this awareness that don't turn around and go the other way we need you. But what we also need you to do is to educate yourself and learn how to care for yourself. So you don't end up one of these negative statistics.

Dr. Shah-Haque

  35:46 - 35:60

No, I think that's very important. And if I'm not mistaken, the, AC GME almost requires residency programs to have something, regarding burnout. But I don't know all the details with that.

Dr. Tiger

  36:01 - 36:16

I'm not exactly sure what they're taking, but I do work with residents and they don't know anything that I'm teaching them. So whatever they're learning, isn't this, I'm not sure what they're learning. And I'm so glad they're learning something, but they're not learning the things that I'm sharing.

Dr. Shah-Haque

  36:16 - 36:17

Right.

Dr. Tiger

  36:17 - 36:21

So there still is this, this lack of, of knowledge.

Dr. Shah-Haque

  36:23 - 37:13

No, I would agree. you know, I think that, so I graduated from university of Kansas school of medicine, Wichita. I do think that they have done a good job, you know, trying to say, this is what burnout is. Take care of yourself, go to the gym, sleep when you can and eat well, you know, take, take advantage of what we have and that's great, but you go the extra step and say, Hey, this is, this is, this is what stress looks like. This is what it does to your body. And really giving people tools on how to calm that down and really be present. And I believe that there are more recent studies showing how meditation and yoga increase the plasticity of the brain and even rewires.

Dr. Tiger

  37:13 - 38:38

Absolutely. Yeah. It's amazing. So as a radiologist, I geek out on that stuff. So I remember like 10 years ago, or so being at a, at a lecture given by Harvard, mass general researchers who were showing before and after MRI exam images of functional images. And I was just what, I just couldn't believe it, you know, prefrontal cortex thickens, you know, that's the CEO of our brain that helps us with important decision-making and memories and processing of information. And that amygdala, that, that trauma center, right. That's responsible for our reactivity and all of our traumatic memory strengths in our hippocampus, which is responsible for new memories, right. And, and emotional regulation and learning gets thicker. And I just was so mind blown. Remember my husband's also radiologists. I remember leaving that very first lecture calling him really, really late at night because that's when it was never going to believe. I just saw Amazing, amazing. So you're absolutely right. And as doctors, we like tangible evidence. We like things we can see, we like things that are objective data, not just subjective. So that kind of thing is very helpful in when I talk to my own physician clients and to get them to buy in to learning these new things.

Dr. Shah-Haque

  38:38 - 39:06

Right. Right. No, I, I think that what you have shared is, is amazing. And, you know, I'm, I'm very happy that you were able to take care of yourself and then transition to help others because that's, that's really important. What final thoughts do you have that you would like to share, or almost like clinical pearls that you would like to share with the listeners

Dr. Tiger

  39:08 - 40:14

Well, first I would just say if you're feeling any of the things or all the things that I described earlier on in our chat today, that you're not alone and it's normal, and I don't want you to think that normal is okay, it's not okay. But what I want you to know is that you're not alone and it's normal because so many of us have felt this way or are feeling this way. Secondly, I'd like you to know that you have the innate ability to feel better whenever you want to. It's not your fault that you don't know how you were just never taught. So you just need the education. And thirdly, I'd like to say that, please reach out. You know, if you are in a place where you are having these dark thoughts, if you are in a place where, you know, you're not feeling like yourself, please reach out, you know, please reach out to mental health care professionals, if you need to.

Dr. Tiger

  40:14 - 40:56

And there's a hotline I want to let you know about that is run by physicians, helping other physicians who are having these thoughts. So it's not necessarily just go to a, you know, a mental healthcare professional, which certainly you could, but there is a wonderful service that there are physicians that are volunteering their time to help other physicians that need to talk about what's going on in their lives. And I just want to let you know about that and I can give, Sapna that phone number, or rather the phone number. Yes. And to put into the show notes. So that, that will be available to you as well. If you need to reach out.

Dr. Shah-Haque

  40:57 - 41:09

Yes. I would really like that as well. But, and for the listeners, if they really jived with what you're saying, because you have a lot of good information and not a pill for every symptom, right

Dr. Tiger

  41:09 - 41:10

No, I don't. I don't prescribe

Dr. Shah-Haque

  41:11 - 41:11

Exactly.

Dr. Tiger

  41:12 - 41:18

I don't prescribe any medications at all. I just prescribed learning how to take care of yourself from the inside out.

Dr. Shah-Haque

  41:19 - 41:27

And so how would, how would somebody get ahold of you How could somebody reach out to, through your website

Dr. Tiger

  41:28 - 42:23

Yeah. So my website is stress-free md.net and it's there you'll find, links to my podcasts, links about my program, RX inner peace links about private coaching. You can pop on a free call. I'm happy to talk with you. It's called a stress relief strategy calls so I can help understand what's going on and direct you in the right path. I have three, four, actually four. Now I decided one yesterday. I have four free five minute stress relief videos on my website. So you just have to go there and you can test out some of these tools that I'm talking about and experience them yourself. And yeah, I'd love to chat with you. So if there's any way I can support you, please reach out. And if you're a social media person, you can find me on LinkedIn. You can find me on Facebook, on Instagram, on Twitter, you name it. I'm there as well.

Dr. Shah-Haque

  42:24 - 42:32

Well, thank you so much, Dr. Tiger really appreciated your time and your, your information and your insight. So thank you very much.

Dr. Tiger

  42:33 - 42:42

Well, thank you for what you do. Thank you for inviting me here and for helping support other clinicians in the way that you do.

Dr. Shah-Haque

  42:42 - 42:59

Absolutely. Thank you for joining us today. This concludes the podcast. Subscribe, tell a friend, follow us at www.theworthyphysician.com. Remember, you are human, you are worthy.  Take care.