The Wandering Healer: Medicine on the Move

Have you ever found yourself at the brink of burnout, questioning the very path you've dedicated your life to? Dr. Sapna Shah-Haque and her guest, Dr. Goins, share an intimate conversation on the seismic shifts that can occur when a physician dares to blend their passion for travel with the demands of a medical career. Tune in to hear Dr. Goins' riveting account of facing burnout head-on, the existential questions amplified by the COVID pandemic, and her bold move to prioritize well-being over convention. This episode is a powerful narrative on the significance of aligning one's lifestyle with personal values, the courage to confront professional adversity, and the indispensable role of mental health in our lives.

Embark on a voyage with Dr. Goins as she narrates her transformative experience in Cartagena, leading to the innovative concept of Nomad MD. Through this lens, we examine how breaking the traditional work-life boundaries can ignite confidence and a deeper connection with one's intuition. Discover how support systems like NomadMD are empowering doctors to carve individualistic paths, fostering collaboration, and strategic life planning beyond the walls of the hospital. This episode is a dedication to the art of genuine connections, the unexpected kindness of strangers across the globe, and the importance of a global perspective that challenges the narratives we've been led to believe. Join us on this inspiring journey that promises to resonate with anyone who has ever contemplated the delicate balance between career and personal fulfillment.

Objectives:
1. Life is short. Follow your passion.
2. Be creative.  You're more than a physician.
3. Be true to yourself.
4. Create space for looking inward.

Connect with Dr. Goins:
https://thenomadmd.com/

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.


Learn more about female physicians' journey through burnout to thriving!
https://www.theworthyphysician.com/books

Let's connect for speaking opportunities!
https://www.theworthyphysician.com/dr-shahhaque-md-as-a-speaker

Check out the free resources from The Worthy Physician:
https://www.theworthyphysician.com/freebie-downloads

Battle of the Boxes

21 Day Self Focus Journal

Transcript

Dr. Shah-Haque: 0:01

And so it was an integral part of who I was. But I couldn't figure out how to combine these different lives and, like many of us, I had the questions and the longing, but I just continued the path, because the path is laid out for us.

Dr. Goins: 0:17

Welcome to another episode of the Worthy Physician. I'm your host, dr Sapna Shah-Haque, reigniting your humanity and passion for medicine. So, dr Goins, thank you very much for joining us today, and I think you have a really interesting perspective on how to combat burnout or moral injury. And we were just talking before the recording when we sent him from medical school or when we decided to go to medical school and make that dedication. What we think it's going to be like and what we end up encountering it's very different and can be soul crushing. But what's your journey? What's your journey and how has traveling been part of that?

Dr. Shah-Haque: 0:58

Absolutely, and thank you for having me. I'm excited to be here. My journey was having the desire to be a doctor since the age of eight, which is very young to make such a decision. But I've actually found that many of us have made this decision in our youth and, along with having that passion, also having had the passion for travel, which developed when I was a teenager and I never had the opportunity to do it, but I read a lot and so I traveled a lot in my imagination. So it was something that was feeling very real to me as a possibility for my life and, like you said, in the path to medicine it can be quite overwhelming at times. I didn't realize, I think earlier in my youth, that medicine required so much, I would say, dedication in terms of time, resources, energy, but almost to the exclusion of everything else. I didn't recognize that I wouldn't have. It felt like I really didn't have as much time for my other passions, which included travel, and so I would try to sneak it in.

Dr. Shah-Haque: 2:12

We have that summer right after the first year of medical school and I went away to Costa Rica and stayed with the family and fell a shit we had on month off when I was in child and adolescent fellowship and I had gone through that year was also really heavy and difficult, a lot of call and things like that, but we had a month where you could go abroad and that was the reason I even went to. That fellowship was, I'll have a month abroad and I went to Nepal and stayed in a Tibetan Buddhist monastery and studied mindfulness for a month and it was life changing. But every time I had these moments whether it was like a week vacation, 10 days off, these opportunities during training I always got a sense that travel, it was more than just like time away. It was this opportunity to gain insight. It was an opportunity to slow down, to be more introspective, to gain clarity about where I was trying to go, and so it was an integral part of who I was, but I couldn't figure out how to combine these different lives. Like many of us, I had the questions and the longing, but I just continued the path, because the path is laid out for us with like an algorithm that we follow. You do this and this, and so I continued, and so it was an integral part of who I was, but I couldn't figure out how to combine these different lives. Like many of us, I had the questions and the longing, but I just continued the path, because the path is laid out for us.

Dr. Shah-Haque: 3:54

You'd on, and when I reached my second year of being and attending, things just started to fall apart. My health started to suffer first and was like chest pains in the middle of the day. Then it was abnormal, like spasms all over my body and everything. I ignored in a way or tried to push it down. Okay, just keep going to yoga, just keep breathing, just keep doing all the things. But when I got to having suicidal thoughts, I thought, yeah, this is when I decided I really need to make a change. I don't know why all the other things that make me think I really need to make a change like an abrupt one. But that was really the point where I said, okay, if I, as a psychiatrist, have to be at this point that I'm questioning whether moving forward is worth it, then I really need to rethink how my current lifestyle aligns with my values and what I want and who I am.

Dr. Shah-Haque: 5:02

So I started off going to an appointment with a neurologist for all the spasms and five minutes in, I'm like my job is super overwhelming I'm doing this and that I'm thinking about leaving. He just cuts me off. He says, look, do you want Lexa Pro? And like when that was the answer, I was just like, are you not hearing me? And so it was my first time being a patient and seeing that aspect of like where healthcare was going. It was just this focus on medication, at least from this provider and I'm sure not all providers are that way, because that's not the way I practice either but it was just showing me that there was this aspect to patient care that was not as holistic as I hope, and that was always one of my ideas and what led to my passion for integrative medicine and that's why I ended up doing integrative medicine After that. I had been thinking about that for years.

Dr. Shah-Haque: 6:01

So from that appointment I left, I decided that I would figure out how to lead my position. During the same year, both of my grandmother's died during COVID and that really helped me to appreciate the commodity of time, like. It just showed me that you could say that you have this much time. I had a five-year plan. I was going to make it happen and I was like you don't know if you have five years to make this happen. So between the mental health issues and the physical issues and just seeing where aspects of the healthcare system was and then seeing how precious time was, I just didn't talk to anyone. I booked a ticket, one-way ticket to Columbia, and I said I'll figure out everything after this. That's amazing.

Dr. Goins: 6:50

That's amazing. It takes a lot of guts to book a one-way ticket to another country not really knowing, but it also shows where you were to make that type of decision. You had a lot of changes there and I just want to honor the fact that I'm glad you're still here. I'm glad those were just thoughts and odd actions. Thank you for acknowledging the fact that we have we really don't know how much time we have right? That's that in the rival fallacy, or exactly that fallacies we're not promised tomorrow, so what can we do today? And then, when you have the fact that you were a patient not just a physician, but also a patient and showing how, instead of getting to the root of the problem, we try to cover it up with medication in order to keep going on this rep race. Why Columbia? Why Columbia? Of all places? It's a beautiful country from what I've seen, but what went to Columbia?

Dr. Shah-Haque: 8:01

I had several reasons for going there, one with still during quarantine it wasn't during quarantine, but COVID was still rampant and I wanted to make sure I could go somewhere, that within three hours I could be back if something else broke out. That was one aspect. I was a Spanish minor in college, and so I wanted to make sure I went somewhere to practice my Spanish. We were in the same time zone, so I knew that would give me some time to adjust to where I was going and the new life I was living, and at the time it was also really important for me to go somewhere that was where I could see other people from the African diaspora, and so I went to Cartagena, where I could be away from home but still see people who reflected me in different ways, and so that was really important to me as well.

Dr. Goins: 8:56

Oh, thank you for that and yes, that does exist in Latin America. I think we need to look at history and understand all this. So how did that travel? How did this excursion or, as we were talking beforehand, answering that call from the soul for Wunderlust? How did that help? How did that help Dr Goins, who is at a very low point and pretty frustrated with practice of medicine and had just lost two matriarchs of the family?

Dr. Shah-Haque: 9:32

I recognize now, looking back, that my mood, the anxiety, the depression, all of that started to lift before I ever left, and I think that initial lifting was because I had shown myself that I was important, that not just everything else around me was important but what I desired. Making a decision to live my life in alignment with my values and honoring that really helped to lift my spirit. So I think that piece of it just making that decision and following through with it was the first step. Once I left, I had this immense sense of freedom. I had always thought working five days and it was really more than that when you count all the notes that everything I was doing on the weekends probably seven days, but working five days a week and having two days off always seemed very backwards to me. So the number one thing I said I would do as soon as I left and I still do this now is I worked two days a week and was all five Like that. Now that makes sense to me. So having a lot of time, freedom, spending a lot of time on the water. When you travel you have so many novel experiences, like every day just doing a simple thing like going to the grocery store, figuring out where's the next yoga class, where am I going to eat, everything becomes a novel experience and so it really enhances your moment to moment awareness and, I think, facilitates your joy of living through that A lot more openness, I was able to experience my cognitive flexibility.

Dr. Shah-Haque: 11:18

I had to get really comfortable with uncomfortable situations like always not being able to speak the language perfectly and meeting new people all the time, and you're entering into a different culture and it's a constant learning how to really find joy even in the unexpected moment, and that's something that I learned how to do. And having that time freedom really opened up this ability to do deep introspective work that I couldn't do when I was working 60 hours a week, and that deep introspective work allowed me to really better connect with myself and, I think, made me a better provider. Because when I thought back on it, I said who wants to see physicians who don't have time to connect with their own bodies and minds and don't have time to do that kind of work? And think it brought me to a different level and different place within my abilities as a physician that I couldn't really access before. I was able to consistently make decisions, and much quicker that were in alignment with my highest values, because I knew what they were, and I also noticed this broadening creativity.

Dr. Shah-Haque: 12:46

It's really interesting how, when you have more time, you're better able to tap into your imagination, and that is really hard to do when you feel pressed and stressed and everything it feels urgent, and so that allowed me to really explore the diversity of ideas, languages, the food, the art, the music. It promoted for me a willingness to think outside the box. That's what created Nomad MD, because I had spent so much time thinking outside the box. There has to be more than one way to do this. I know I've been taught that this is the way it goes, but there has to be other ways to get to the same outcome or even something better that I haven't even thought of yet.

Dr. Shah-Haque: 13:32

Those were some of the learnings that I got meaningful connections.

Dr. Shah-Haque: 13:37

It's amazing.

Dr. Shah-Haque: 13:37

Growing up in the US, you get a lot of media and a lot of information about what it's like to go to another country or another city and what the people are like, but having now lived in almost 10 different countries where all of my medical care is outside of the country, and so experiencing these different systems, I have learned so much about just how giving and how lumping humankind can be.

Dr. Shah-Haque: 14:11

I don't think that's something that we're often told in the media or anything like that being in situations where I have an urgent medical need and have strangers or people I just met a week ago Come to my aid, make sure I get to the hospital, stay with me, cook me dinners afterwards, and you just see how cute they're, so kind. There's beautiful people everywhere, and so being able to develop meaningful connections with people all over the world has been one of the. I think it's one of the beautiful experiences about travel and maybe, lastly, I'll say it's enhanced or increased my confidence. I learned how to trust myself more trust. My decisions lean on my inner knowing and my intuition about what's right for me, so that I don't have to always question it and ask everyone else, but I could tap in and know what's next for my path.

Dr. Goins: 15:11

And so you're really talking about breaking away from that algorithm that, okay, now that you're in attending, you need to work five days a week and check this box for having a house and having a car and having increased debt. And you've really flipped that by working two days a week. And okay, you've come up with that for you and for the listeners who say that might be crazy. Let's flip it. We're prioritizing being human and answering the call to our human nature of being creative, being immersed in all things that are part of human experience, those interpersonal connections, those doing that deep dive, looking at what your core values are, making sure that your decisions align with that, and really that is we're always taught to push that to the side. Make sure you know what you stand for, but do they? There's nothing that allows us to really cultivate that. No, it's not society's responsibility for that, it's ours. But you answered your true calling for those that are listening. And how are you able to practice and travel? That is, to me, mind-blowing, but it's being done. And what's your secret?

Dr. Shah-Haque: 16:32

Yeah, and I realized that I began this journey earlier and people can begin it at any time. Really, it's just a decision that you make. But as soon as I left training and I went into academia, I simultaneously started my LLC, and so I had started to do contract work with different medical institutions and continued doing contract work and consultant work, and so when I left my full-time position, I continued doing the contract work for a couple of days a week, and it's something that any of us, as physicians, can do. We all have. We have our medical expertise, we have talents, we have skills, we have our life experience and when we put all of those things together, there is something that each and every one of us can offer the world that no one else can, and I think that when we really honor that and it's something that's in alignment with what we want and our passion, it's something that we can offer, it's something that we can do, and it's work that we typically already do, but someone else is our employer and so they're getting a large percentage or probably the value that we're bringing, but it's being a consultant is something that all of us can do, even and I've had a lot of these conversations, especially lately, with surgeons or dermatologists or different physicians in different specialties, and they're saying but what about proceduralists? And I can't do?

Dr. Shah-Haque: 18:13

I'm saying there's aspects of what you do, there's something that you do that you could digitize, whether it's your education, whether it's teaching other providers. There were the dermatologists who were in practice and one of the things that he started doing during COVID was actually teaching other providers how to do Botox online, and that allowed revenue that far surpassed what he was doing in the office, and so it's just an example of even when you think of the focus is procedures. There's just some aspects of what you can do that can also be digitized and you can always create that balance that you want. For some people, it might be they do wanna come back and be in person and have a percentage of their life be, let's say, in the OR or doing locom, where they will be physically located somewhere, but maybe they want also aspects of their life a few months of the year or every few months or even half of the year where they work more in their abilities and their skills that are able to be digitized.

Dr. Shah-Haque: 19:19

So I think it's just being creative in that way and really recognizing our transferable skills as well, not only to medicine, not only to clinical work, but also to non-clinical work in different industries that really could utilize our skills and really need our skills. I think that we've been taught to think of ourselves. We've been taught to think of ourselves in one kind of dimension and one aspect, and I think that, as physicians, we really need to broaden that. I think that one of my missions really is to just empower other physicians to recognize the great leaders that they are and the great abilities that they have in how they could, with the compassion that most physicians have for giving to others, how much more value we could bring to the earth when we actually practice in a way that allows us to care for ourselves and is in alignment with what we really want in life.

Dr. Goins: 20:23

I couldn't agree with you more because once we have that, our true values or core values, and that aligns with what we're doing, even whether it's clinical or even non-clinical we have to identify those or we're really pretty much floating around in an open sea without any direction. That's the North Star always has been for me, but it's having to create that space, that time where, okay, I'm gonna get really uncomfortable with myself and have those conversations with myself and, yeah, that's really uncomfortable. Like, how would you suggest to physicians to start those internal dialogues? Like, how do we start those?

Dr. Shah-Haque: 21:08

I think it starts by having intentional periods of self-reflection and intentional periods of silence where you really allow yourself to hear your own thoughts, to actually hear what you want. Journaling can also be really helpful. Sometimes it's just free association what comes to your mind in writing that out, and over time, patterns actually start to develop that, you see, that can really guide you towards your values. I think also taking time to reflect on what you stand for, what you're willing to advocate for, even with your life like how something that's very serious for you spending a lot of time in Nepal one of the things that comes up a lot in Discussing Buddhism and mindfulness is thinking about death and how that can be very helpful to helping you consider what's most important to you. So that's something I think about.

Dr. Shah-Haque: 22:17

A lot I think about is there anything that I would regret not having done, not having become, not having said? And those things can really help you to see. Okay, these are things that I might need to start focusing on now. So books, coaching, sometimes just getting a therapist you can gather in supports from other areas as well to help you to. One thing that I think is really helpful in coaching, in therapy, is sometimes it's helpful to have a structured time that you're going to dedicate to doing this work, and sometimes just having someone who can provide that support and that accountability to showing up for yourselves can be really helpful in terms of that overall process. But I think it just starts with having that decision that it's something that's important enough that you're going to make time to even think about or explore, and it starts from there.

Dr. Goins: 23:20

Those are all very excellent points and I appreciate every time I hear any of these because it just reiterates the importance of making that space and making that dedication to the self. And it's not just like you as a person or the listener as a person, but you're I'm going to say soul, you're inner being, your own divinity. We're also human beings and we deserve that. If we tell our patients to do it, we should also do it ourselves and really make ourselves a priority. And it's not selfish, Like you said. You believe it's made you a better physician, because when we're replenished we're able to continue to heal. We can't heal with, one word, completely depleted. So tell us more about the Nomad MD. I'm intrigued.

Dr. Shah-Haque: 24:16

Yes, so at the Nomad MD is where the health physicians break free from traditional medicine and the rigidity thereof to achieve location freedom and create their own ideal nomadic lifestyle, whatever that looks like for the physician.

Dr. Shah-Haque: 24:35

For some physicians that looks like having the time freedom and the location freedom to be done with work by two so they can pick up their children from school and that's according to them, or be able to take their parent to a doctor's appointment.

Dr. Shah-Haque: 24:51

For other physicians, that looks like being able to take their family abroad for three months out of the year, or allowed them to experience their life and culture and languages around the world for half a year.

Dr. Shah-Haque: 25:04

For people like me, it means traveling full time and living in different countries every three months.

Dr. Shah-Haque: 25:11

So the beauty of it is that it's the life that you choose to lead and it's all up to you and it's living your life by your design rather than by the, rather than by what someone has handed us. This is the way to become a doctor, this is the way to live out your life as a doctor, and I think it's really shaking up that premise and allowing physicians to recognize and be empowered to engage and interact in medicine and clinical work or non-clinical work, if it's something that they want to shift out of or a combination, it's being able to do the things that they want to do and practice in a way that they want to practice. That is really an alignment with why they came into medicine to begin with. I think a lot of us have really lost some of that. Like you mentioned in the beginning, before we started recording, I think we all had our ideals of what this career was going to be, and I'm coming to the place of recognizing that it can still be, that we just have to create it.

Dr. Goins: 26:22

We have to create it. So it goes back to choice. It goes back to choice. Dr Shabir said on last week's episode it's all about choice. But to make that choice you have to line out not just what values are, but if you have a family, what is that going to look like financially? So it's going to take some planning. Some is going to take more planning than for others, but it's obtainable. Why do you think that we don't think about these things until we're in crisis mode? Or why don't we think about out-of-the-box solutions from day one?

Dr. Shah-Haque: 26:59

I think that we're used to being taught in a certain way and we're used to following. I think there's a certain aspect to medicine that is very hierarchical and you really look up to the people before you as to what direction you should go in. Is this right or is this right? And we're starting to notice, even within medicine, just within society in general, there's all these intergenerational differences in terms of how we're deciding to live our lives and what values we hold. When I talk to physicians and I've spent the last couple of weeks doing this because I'm going to my third medical conference this week, and so it's been a lot of talking to physicians and I noticed that physicians who are more mature in their years they look at younger physicians and they say, wow, I wish I would have had the audacity to say I'll do something different. They're now making some of those changes, but I think that what they've said to me was I didn't even. I didn't consider it. I didn't consider it a possibility, and I'm noticing, looking and meeting different trainees, that they're thinking about this from the very beginning. I think it's a turn in terms of how we're even imagining medicine, that I'm a millennial, so I'm in that kind of group but we are swinging on both sides. I've been taught it just had to be a certain way, but I'm very open to maybe there's another way, and I'm seeing that younger physicians, right from training, they're like I'm going to decide to do my own thing. I'm not going to continue being part of a system that's not serving me as a physician and not serving my patients the way that I really hoped. And so I think that, though we're taught a certain way, I think that the mindsets of physicians in general are shifting and I think that's really, in the future, going to really impact the healthcare industry and how we add physicians, our relationship to the industry and the power that we feel that we have, because I think right now there's a lot of the rhetoric in the talk is that we don't have power in the system and there are a lot of systemic issues and we know that and moral injury is very high and it's real. But I don't think we've been enough time talking about what we can do and the power we do have and the decisions that we can make that can enrich not only our lives and our families lives but also the patients that we serve.

Dr. Shah-Haque: 29:39

And, like you said, it does take some planning, and that's what the NUMED MD and people who are engaged in doing this type of work I think that's what all of that is about is partnering with other like-minded physicians that really do believe in this ability for us to change, for us to create businesses and engage in medicine in a different kind of way. And it does feel easier when we have partners that can help us think through what is our strategic plan, because it does take some planning, but we've created plans. Treatment plans are our thing. We know how to create a plan. That is part of our expertise as well.

Dr. Shah-Haque: 30:24

Again, it's about tapping into the skills that we already have. We know how to lead. We know how to plan. We know how to come up with creative situations that we have a patient and they can't afford their medication. We will jump through loops, we will make 10 calls, we will do anything that we have to do because we know that it's the right thing and we want to serve, and it's time for us to also serve ourselves with the same earnest compassion, the diligence. We have to use all of that and give that care to ourselves as well.

Dr. Goins: 30:56

Thank you that. I think that's empowering, very truthful, and I'm excited about what you're saying. I have hope for the future of medicine because of this conversation here, exactly as part of that. Five years ago I wasn't in this space. This overlining of the pandemic is that this is coming to the forefront. But also I agree that, oh hell, we know how to take out, build some awesome, create some awesome assessment and plans off out of thin air, and it's because we've trained, but we have the critical thinking skills.

Dr. Goins: 31:35

I actually went through a loss a couple of years ago and I really sat down and wrote a sub note on myself. I wrote a sub note on myself. The assessment plan was problem one, problem two, problem three and then how I was going to tackle that, and for me it really helped put into perspective the things that I needed to address at that time and in which manner. So if we apply the same concept to okay this is what I'm feeling, this is where I'm at and that's where I want to be we can use our skills, and thank you so much for pointing out the fact that we have so many different skills that are transferable. I just think that we get lost in this algorithm and we forget how our critical thinking skills, our interpersonal skills, our connections, our quick thinking can be translated into other areas. How can the listener reach you? How can the listeners reach you and come in contact with the Nomad?

Dr. Shah-Haque: 32:41

MD. Yes, they can find me online at thenomadmdcom, on Instagram, at the Nomad MDs Facebook, at the Nomad MDs this will be in the show notes.

Dr. Goins: 32:53

So I really appreciate this. And what is one last pearl of wisdom that you would like to leave our listeners?

Dr. Shah-Haque: 33:02

I would say that if you have a deep spiritual longing for travel, don't ignore it. It is an outward journey for an inward purpose, so go after it.

Dr. Goins: 33:21

So beautifully said and just thank you for being vulnerable and candid. So thank you so much, dr Goynes. Thank you for everything you're doing and letting us in on your travels and your personal journey. Thank you for having me. So, if you have found this helpful, share with a friend, because we could all use camaraderie.