A Beacon, A Call to Self-care, and a Manifesto for the Restoration of Passion in Medicine.

What happens when the hospital corridors you once walked with passion turn into a maze of burnout? Dr. Maha Mohammad, a rheumatology fellow, joins us in this insightful conversation, shedding light on the rising rates of burnout among healthcare professionals. She takes us on a journey, exploring the challenges that our doctors, nurses, and healthcare providers face in their daily practice. Get ready for a critical dialogue about the takeover of hospitals by venture capitalists, and a system that seems to prioritize profit over care.

The journey of becoming a physician isn't easy, and neither is fighting burnout. We dig deep into the different paths one can take to don the white coat, along with the long hours and immense pressure that often follow. Dr. Mohammad shares invaluable advice on how to maintain a work-life balance during residency and fellowship, emphasizing the importance of sleep, diet, and exercise. It’s not all about work; we also address the need to set boundaries, avoid the trap of perfection, and focus on quality patient care. This episode is a beacon, a call to self-care, and a manifesto for the restoration of passion in medicine.

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Though I am a physician, this is not medical advice. This is only a tool that physicians can use to get ideas on how to deal with burnout and/or know they are not alone. If you are in need of medical assistance talk to your physician.


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Battle of the Boxes

21 Day Self Focus Journal

Transcript

Dr. Shah-Haque: 0:00

What is a piece of advice you wish you had as a resident, fellow or young attending? Today, you'll get that insight. Welcome to another episode of the Worthy Physician. I'm your host, dr Sapna Shah-Haque reigniting humanity and your passion for medicine.

Dr. Mohammad: 0:15

My name is Maha Mohammad I'm doing my rheumatology fellowship and I'm about to get done with my first year. I still have one more year to go and I'm looking forward to starting a new chapter soon.

Dr. Shah-Haque: 0:29

And your first year rheumatology fellow, and how are you liking it so far?

Dr. Mohammad: 0:35

Oh gosh, I love it. It's one of the very interesting shields of medicine. It's very much brain-cheasing. It's very much far away from direct stuff. You'll have to think about uncommon diagnoses, try to link the dots. We come usually after everybody has exhausted the list of differentials and we try to find out what's going on. It's a very interesting shield because it's mostly gray and you're kind of wearing your investigator's hat trying to find clues from patients, family members who might have noticed something. I just figured it's just very interesting and exciting.

Dr. Shah-Haque: 1:18

Yeah, Two areas of medicine that I've always thought out. Of internal medicine, some of the sub-specialties. I think you had some really good thoughts while you're brainstorming this podcast episode, so why don't you start out with your thoughts on burnout and being a resident?

Dr. Mohammad: 1:36

Yeah, absolutely so. I'll start with a very short story that happened about about years ago. I was in Boston, 18, and I was at a nephrology conference. A young MD who was walking into the conference very jovial, happy. The weather was amazing. Boston is a very captivating city.

Dr. Shah-Haque: 2:00

Yes, it is.

Dr. Mohammad: 2:01

Yeah, I was over the moon actually. So I met one of the providers during the break session and the provider was a middle-aged nephrologist who asked me a question that I will never forget. He said are you a physician? And I replied yes. He said you don't look like one, and I was so surprised and I asked why. He said you look very happy, and that was our conversation. Like that sparked a lot of curiosity in my mind as to try to know why did he say that? What's going on? Was I just over excited? Was he not having a good day?

Dr. Mohammad: 2:46

And after three years of residency and almost one year of fellowship, I can say that it's like medicine is a very interesting field. You'll get fulfilled, feeling gratitude. You're saving people's lives, trying to see what you can do to help them out, maintain a healthy lifestyle or even try to offer the best possible care, because you cannot actually like 100% cure people, but try to offer what you can to help them out. From an intellectual level, it's also a very stretching experience that teaches you not only about illnesses and not only how to manage diseases, but also about human nature and particularly yourself. Yeah. Therefore, I think we need to be intentional and know that medicine is associated with an occupational hazard, which is burnout, and statistics and research say that. Per the 2020 report from AMA, they say that 42% of physicians experience burnout and this is quite a huge percentage. Shifty percent were women, versus 41% to me, versus 36% were men, and this actually has done up in 2021. And I believe that pandemic has led to further burnout for sure, or the numbers got to for women and 41% for men. So that's quite scary. Actually, this topic is really dear to my heart because we would be lying or not seeing the truth if we say that it's all sunshine and rainbows and like the experience and on the wards and seeing those very sick patients does not leave a mark in us.

Dr. Mohammad: 4:41

I had some friends who experienced burnout, both in the states and outside the states, and I am a strong believer that it needs to be under spotlight, not only for combating burnout, but also for prevention of burnout, and this needs to be integral in our minds and in our training as well.

Dr. Mohammad: 5:04

What surprises me is that in the field of medicine, we have a huge portion that focuses on prevention, even if the percentage of the illness is really quite small, for example, like needle stick injuries. Right. What is the percentage of contracting HIV from a needle stick injury? And every time we use a needle for example during the procedures that I do in the clinic we're extra vigilant and careful as to not poke ourselves and not to kill fluid everywhere and try to just immediately go to the sharp box and just dispose that needle. And this is for a 0.3% of risk. How about when you talk about 51% and 41% of burnout and physicians who are supposed to be the gosh? I just get very much excited about this because we are supposed to be giving out our health and basically you cannot pour from an empty cup.

Dr. Shah-Haque: 6:10

And that's a good point. A system has to change, and the question is how, in the mid-levels, the physician assistants and the nurse practitioners have really figured that out? Number one, I think, because they have the representation through special interest groups. They really have solidified and they come together. Physicians are not very good at doing that at all. We have the AMA and the ACP American Medical Association and the American College of Physicians that try to go to bed for us, but I'm not sure how they can do better, honestly. But then you also have big pharma that drives a lot and people that have never practiced medicine that are legislating these laws. On top of that, you also have intracapitalists that are coming in and taking over hospitals, replacing physicians with nurse practitioners, and they don't even have the breadth of training that we do.

Dr. Shah-Haque: 7:01

I'm not putting down nurse practitioners. We utilize them in our office. They do a great job, right, absolutely. But it's a thing where we're putting money before people's health, and in that it drives up the cost of healthcare. We are asking physicians and other healthcare workers, ancillary staff, to work bare bones but yet crank out even more, for lack of better terms, rbus, and you can't put that with people, and so the system needs to change and actually look at us as people and understand that we have feelings. Every time we lose a patient, it never gets easier, whether it was expected or unexpected. But yet we have to go to the next patient and it's like, hey, nothing just happened. By the way, you can't talk about it. By the way, you can't seek mental help because you're grieving, because then we're going to use it against you when it comes to your license.

Dr. Mohammad: 8:00

Yes, yes, it's real struggle.

Dr. Shah-Haque: 8:04

And I think that's we've talked to them before this and your experience and my experience in residency were very different. Except for a couple of attendings, I absolutely loved residency. I agree with the amount of work that a resident has to do, and that is to get an education. That does not necessarily mean that lifestyle has to be continued. I love what you're saying. Yeah, when you look at structuring your rheumatology practice I'm not asking for details, but have you thought about that?

Dr. Mohammad: 8:32

Yes, absolutely, and let me start by saying one of the reasons why I chose rheumatology is because the patients even though they could get very complex and complicated generally speaking we're dealing with a happy subset of patients. There's this continuity of care that I really like, and also the flexibility of the working hours. As I just mentioned earlier, it's mostly an office-based practice. Basically, we'll be seeing more or less stable patients, except for one or two that might need to go to the hospital immediately, but it's not a very high-acute situation where you need to be as a sure in an ER, Even on the internal medicine ward as well. That's what I really like about rheumatology.

Dr. Shah-Haque: 9:27

Yeah, absolutely, and, like you said, it's very intriguing as far as the pathology that you see. So you get the best of all the worlds, really, exactly. So there's good work-life balance and you get to satisfy all those boxes that you just check off, and I don't mean that in a bad way. I think you're absolutely right about burnout regarding the percentage, and on top of that, I think all these businesses are seeing the great resignation status post-COVID, but medicine is one of them. Medicine as far as physicians is one of them. I think it was an American Medical Association back in January. February came out with new statistics about 20% in the next couple of years or either going to retire or cut back or look at other careers besides medicine, and we're already in a physician shortage. Thus the mid-levels. To me, that signals that our profession needs help in revamping and really restructuring.

Dr. Mohammad: 10:26

Absolutely. And it blows my mind because going into the track of medicine is not a short time period, but hey, I went in and out and it just did not take a lot of years of my life time or I did not invest a lot of energy and time and sacrifice a lot of stuff to get here. So it blows my mind that people have that much of investment in their time and energy and knowledge and everything and at the end of the tunnel not as thrilling as they thought it would be.

Dr. Shah-Haque: 11:04

So that's the major, until I'm out there Now see, I went through medical school here in the States and so I did four years of undergrad and masters in a year and then medical school. So that was almost a decade. And you did medical school in Lebanon, correct, that's correct.

Dr. Mohammad: 11:23

And how long was that? It was a seven-year program where you go straight after high school into the med school, so you immediately start with first-year med schools and you go to second, third and fourth, up until the sixth, and then the seventh would be purely at the hospital, just like an internship. It is a very interesting track, I would say, because comparing the track that I took versus the one that is here in the States, I would say there's a little bit more pressure in the seven or sixth year track, just because you would have to figure out what you want to do before you go to your first year of university, which I think, at the age of 17 or 18, is very ambitious. Yes, it is. So I feel like I would support the pre-med program because people would get more time to experience life, what they want, what they like, what they dislike, like.

Dr. Mohammad: 12:33

I'm not saying that I don't enjoy my field. I love it and, if time goes back, I would never trade it for any other specialty. However, I've seen some people quit medicine after four years of med school or six years of med school and even going into residency back home and then figuring out that, hey, this is not the track that I want and it's been like a lot of time investment there. That's what I find comparing both tracks together.

Dr. Shah-Haque: 13:05

Sure, so far it's almost the same time spent Correct, give or take, a year or so, and then you went from Lebanon. After graduating, you came here to the States and did you start residency right away.

Dr. Mohammad: 13:22

I did not start residency right away. I invested my time in a lot of research and did a lot of US clinical experiences, basically. So I moved almost all across the States. I've been in so many places been to Boston, been to New Orleans, Louisiana. I was in Toledo, Ohio. I was all good places. So I just love this experience and, again, I would never trade it with anything else.

Dr. Shah-Haque: 13:50

No, but how many years did you spend moving across the US? About three years, so you think seven plus three. And that was all on your dime, yes. And then you started residency and you actually got a paycheck, that's correct. And now you're in fellowship, that's correct, that's a decade.

Dr. Shah-Haque: 14:09

Yeah, exactly. And so that puts you behind the eight-ball, a decade of Not earning, sure, not having any type of investment. And you can't tell me that you just did it for the money. Of course not. You can do business or become a CPA in less time and make a hell of a lot more money without the pressure yeah, with a liability, 100%. And yet if you had gone through the US system, you might be close to half a million dollars of debt. Yeah, and making debt also adds to burnout. And they didn't give you a Mercedes when you graduated medical school or residency, right, oh, gosh, I'm. That means just to break the stereotype.

Dr. Shah-Haque: 14:54

Yeah, it would be a cool gift, though it would be a cool gift, and I'm bringing this up to show that it takes about a decade to get to where you want to be. Yes, absolutely. And you lose out on a lot of things, a lot of life experience yes, and then, at the end of the day, we sign up for the system that is treating us like absolute shit, and I think you had a good point. As a resident, how does one practice self-care because you're working about 80 hours a week?

Dr. Mohammad: 15:24

Yes. So I had to do a lot of like reflection, self-tour, have this secluded moment to myself to try to come up with it for myself, because it's not easy. No, nobody teaches you that. No, nobody shares that experience and you're expected to be that hero who has 100% energy 24-7. It's that image of over-achievement and over-production and over-everything and I think it just poisons the reality of medicine, because that's not real and beyond human nature. Even a computer needs some time to start working. It's purely impossible.

Dr. Mohammad: 16:15

What, like my guide to myself and I really hope that this would be helpful to other young budding physicians, residents and even med students I think the first year of everything would be just trying to keep your head above water.

Dr. Mohammad: 16:32

Just try to survive the first year because, like within a new year comes new responsibilities, new expectations, new atmosphere, sometimes a new electronic medical record system, which adds to burnout, but so lots of variables.

Dr. Mohammad: 16:48

So I think just knowing that keeping your head above water would be a great concept, at least during the beginning. So what I would say is if we divide that into two categories first category is eliminate and the second one is cultivate, and with eliminate I think it's really important that we should totally forget about perfectionism, like it's just detrimental not only to our health but to our career, to our performance, to everything. It's just a myth that I really wish that nobody has talked about it or even came up with this term, because it does not exist. The second thing I think we need to eliminate comparison because, like we're always taught not to compare apples to oranges, everybody has a totally different experience, totally different background, culture, life experiences, stories. Everything is different. I can never be you, can never be me. Everybody has a unique package of things and I think this would, if we just change the concept of comparing people to each other to actually sitting together, talking together, having those rich conversations, I think the atmosphere would be way, way more productive and way more rich.

Dr. Shah-Haque: 18:19

I'm going to clarify that we should be 100% every time for our patients. But that means that I don't have to look. I can go ahead and go out and go in with without makeup and in scrubs and look like I have woken up at three o'clock in the morning, because that's reality. I don't need to be 100% in high heels and you would never catch me in high heels. You're going to catch me in boots and take away that external perfection. Yeah, my house isn't always. It's gonna be clean, but it might be a mess, if that makes sense. It's not gonna be a showcase. And then can you expand on not comparing? Because I know that in residency there's always this we have to meet certain benchmarks, of course, absolutely, but when you're, can you expand on not comparing?

Dr. Mohammad: 19:04

Yes. So if we start from the thought that different people have different personalities, I think this helps us not judge other people, Because I think, based on observations, lots of people get either judged for being quiet or thought of differently or you know fact that they're not, but they're not that vocal. It does not make people less of efficient, productive or all of the positive attributes that every medical provider has. I think that would be the essence of in-residency. I think one of the pitfalls is that the more times we spend with each other, the more we feel like family. However, that in that part it's a very good thing, Because with time you tend to experience different people's personalities, get to know them better.

Dr. Mohammad: 20:09

On the other hand, I think with that time people start forgetting the basics of human interaction, for example. And like, spending that much time together does not mean that we lose our boundaries. It does not mean that we can say whatever we want at any time we want, and it's really important to remember that I can be sociable without talking about XYZ. That's just a sham way to think about me being sociable. If I'm somebody, it tells you a story about friend X or friend Y.

Dr. Shah-Haque: 20:54

So you're not there to gossip, you're actually there to have quality conversations that actually maybe philosophically what the meaning of life is.

Dr. Mohammad: 21:05

I am a firm believer and a strong advocate of all of those conversations.

Dr. Shah-Haque: 21:14

What better conversation to have with colleagues who are some of the best and the brightest, exactly so, conversations that will add meaning to your life. And it tells me about the cultivation part. So we've talked about eliminating the idea of perfection, where I've got to be put together all the time. I have to have an answer of what I'm doing with my life and as long as I meet the measures 100% for my residency and I take good care of my patients, I give my 100% there. I'm okay with not trying to lose my mind with doing all these other superficial things. Yes, what about?

Dr. Mohammad: 21:48

cultivation. As far as cultivation, I think and it took me a lot of time to understand this about myself I would think of my body, my mind, as a battery and whatever extends the shelf life of this battery. I would be doing so at first off, like focusing on the foundation, which again took me a long time to understand this, and I'm sure it's a work in progress, like I'm not. I can't tell you how many times during residency I heard sleep is overrated, like you can go without sleep, and this was not from the, just to emphasize that our faculty was really proactive about wellness. They were proactive about self care, so they emphasized on that.

Dr. Mohammad: 22:40

However, sometimes with competition that could go in residency, some people probably say what they don't mean. So this was one of the one of the sayings that I really did not say that you can go without sleep. You are taking care of patients. You need to sleep to be focused, to be making the right decisions. So, definitely, sleep is an important thing and as much as you can get sleep, that is Riso's. Go ahead and do that. Number two is food. I can't tell you how many times during residency what I finished with my long hours. I just was too tired to go for real grocery shopping and I just went for a drive through, got whatever snack food that is a comfort food and ate that. Obviously it was not a very clever decision, but it was the most convenient thing to do at that point.

Dr. Shah-Haque: 23:44

But just to put that in perspective, we had done a full day and then an overnight call or a 24 hour call on a weekend, Absolutely when sometimes you only ate One today during that call shift. How you can only survive on peanut butter and crackers or the processed cheese from the nurses station for so long.

Dr. Mohammad: 24:07

That's true, and no matter how much you try to tag your white coat pocket with those necks and brinola bars and stuff like that, you'll be like, okay, I'm done, I need real food at this point. Yeah, once you leave the hospital, it's like I have the energy either to walk to the parking lot or to go grocery shopping. I need to choose between both and that's why, like, the most convenient thing at that point was to go through a drive-through, get whatever I can get and then go back over and sleep, to wake up the next day and do the same thing over and over. And I would say the third thing would be exercise.

Dr. Mohammad: 24:52

Gosh, I started with like religiously going to the gym during my internship. I was signed up for four classes a week. I had a personal trainer, I was enjoying my time, feeling very healthy and not reflected on my productivity a lot. However, like when residency happens, things can get a little bit more intense. So I had to stop that and, honestly, it did not make me feel good. Luckily, in our hospital there was a gym that we could go to, very close to the call rooms, so that was a good outlet to exercise, but also towards the end of residency. Especially after my night float, I made use of the daylight just to go to the park, walk around, get exposed to sunlight, and that made a lot of difference.

Dr. Shah-Haque: 25:49

Yeah, now, what you're saying is all true. The body was made to move and not be in fluorescent light as much as we are. I still detest fluorescent light to this day, but there's something healing about nature, and I think that nature has really yes. And Wichita, where you did your residency. It's my hometown's right in residency. There are a lot of nice parks, absolutely, and even in Kansas City as well. We're just discussing one and a lot of that's free.

Dr. Mohammad: 26:22

Yes, almost everywhere that I go to is free and you can get to see a lot of different types of species that live there, including deers, and this is something really cool about living in Kansas. I think we're exposed to a quite good number of parks and hiking trails and outdoorsy activities. That makes you get that kind of balanced life whenever you seek it out.

Dr. Shah-Haque: 26:51

What have you done in fellowship to maintain your sanity and self-care?

Dr. Mohammad: 26:56

That's a very good question. So I think I'm a person who is very much logical, so I have a lot of self-talks. I think acknowledging that easy come, easy goes was the first thing that I think of. Everything needs time, nothing would come easy. And visualizing the end of the tunnel or the end of the trail or the pathway I don't like to refer to it as a tunnel because it feels like it's miserable, but it's not, but it's more of a pathway that I intentionally chose and I'm enjoying every moment of it.

Dr. Mohammad: 27:36

But also, we tend to be like a type A personality where we want everything to be done at the same time. We want to figure it out all at once and this is simply not doable. It takes 50 years old to be 50 years old. So just give it time and grow with time. I think this is where I start from and I always try to remind myself of that, because with a fast piece of everything, I think sometimes we expect a lot from ourselves, not to say that we need to meet certain expectations, be productive and this is all the essence of medicine, especially nowadays but also we need to learn when to slow down and when to take it a little bit slower. So what I've been doing is finding out what is my pattern, because I'm still in that phase of finding out my personal pattern, knowing what restores my energy, what fills my tank, trying to spend as much time in nature. Try to be more active.

Dr. Mohammad: 28:45

Also, I would highly encourage to have one thing outside the realm of medicine, outside the hospital, outside the clinic, outside the textbook and away from your screen. No matter what this thing is Could be reading a book, could be photography, could be scheduling a, let's say, zoom call with a friend, whatever, but something that totally detaches you from books and medicine. I used to have a mentor back in Lebanon who trained in the States. He was in nuclear division of radiology and he used to tell me I was very young at that point, but he used to tell me Maaha, it's really important that you go and do something with your hands just to free your mind, because your mind is always busy about clinicians and books and references and new guidelines and stuff. You need to engage your body with something different At that point. Just to do gardening, which I found very fascinating. I don't do a lot of gardening now, but I have a lot of hands around my apartment and I think that has really helped a lot, as well.

Dr. Shah-Haque: 29:59

I think that's a very good, excellent advice. Previously I had discussed with my cousin who's the ophthalmologist, dr Mitha, about that and he's into woodworking. My thing is this podcast and audiobooks and a lot of hiking where we're not in the middle of a pandemic, like to go out to Colorado, new Mexico. I think it's really important to reconnect just with Earth and nature. It's something that even healers across all cultures in the past have always taken that time to restore themselves. We are physicians and even though we have the science, you cannot say that we don't pour our souls into what we do. Absolutely. I think we pour a lot of our own essence and thus need to fill up that cup.

Dr. Mohammad: 30:50

Absolutely.

Dr. Shah-Haque: 30:52

What are some last pieces of advice that you would give medical students getting ready to enter residency, because July 1st is right around the corner? Absolutely. Or even somebody that's graduating and will become a new attending.

Dr. Mohammad: 31:04

Yes, I think it's really important to, as I mentioned earlier, think about you as a battery and think of what things I should do to feed this battery and keep it going on, including maintaining your body health-wise. It's scary that you start seeing these changes when you're in your 30s, when you're done with med school, done with residency, and you're in this career that you're supposed to take care of others, physically and mentally, while you're forgetting about yourself. That's something really important. I cannot emphasize enough on how important it is to plug yourselves in with a primary care physician. I think it would be interesting just to conduct a study to see how many of the residents and providers actually see a doctor. I think that's where I would put my money and make sure that the younger generation of med students and budding physicians are investing in their healthcare, whether physically, whether mentally, in addition to investing their time with their knowledge as well.

Dr. Shah-Haque: 32:24

Absolutely. When patients come in they say I don't like going to the doctor, I always say, yeah, I can relate to that because you have to remember, I'm a patient too. Exactly. So, yeah, don't skip your annual, don't skip your mammogram, your prostate exam, your colonoscopy, all that, because if you don't take care of yourself, at the end of the day, what you're doing does not mean squad. It's a moot point if you're not going to be around to enjoy it.

Dr. Mohammad: 32:50

Oh, exactly Exactly. And if you don't find joy in what you're doing, just sit with yourself and have this self-talk reflect. Talk to others, seek out their experience, because everybody has went through this experience. Not everybody talks about it, but it's very common. Seek out these deep conversations and stir up those parking discussions. It's really important and you'll see that it's not always rainbow and sunshine. It could get really intense, but at the end of the day it's worth it.

Dr. Shah-Haque: 33:28

Yeah, and if you're not happy, you're in charge of your own life. Figure out what will make you happy, exactly, exactly. Nobody's going to well. If they're true friends, nobody should really pitch down for trying to make yourself happy. Yes, and if they're doing that, you need new friends.

Dr. Mohammad: 33:47

Absolutely. You are okay to change the circle, expand it, make it narrower, do whatever you need to do to take care of you.

Dr. Shah-Haque: 33:56

Just don't cut yourself off completely. We don't have that ends and it does not end well, absolutely so. Are you giving the listener permission to put themselves first and say self-care is okay. Is that correct?

Dr. Mohammad: 34:11

Oh, please do, and it's not selfish at all. I know some people have families during residency, have new boys during residency, but you come first. Remember to be able to give to your family, to be able to give to your patients, you need to be at home. You cannot be disintegrated. You won't do a good job.

Dr. Shah-Haque: 34:36

And it always comes back to boundaries. Absolutely, I really do Thank you for your time and thank you for coming on. I know you're busy.

Dr. Mohammad: 34:45

Oh, thank you so much. I had a great time with you, samma, and I really want to thank you for what you're doing. You're shedding light on the real aspect of medicine that would change people's lives. This is really important to talk about because, again, it's very rare to talk about, and this makes the conversation really precious and invaluable.

Dr. Shah-Haque: 35:10

Thank, you very much for your insight and time. If you have enjoyed this episode, click subscribe. Share it with a friend, because we could all use a little bit of normalizing the topic of burnout, knowing that we're not alone.