riverside_copy_of podcast #1 wilderness medicine_adry's_studio 0:01

Hi, I am Dr. Adrian Silver, and I am Dr. Fri. From the ER to the great outdoors, from clinic, to the quiet corners of the mind, this is life and practice.

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Hi, this is Propri and you're listening to Life in Practice. Today I have as my guest, Dr. Mark Williams, one of our physicians from the emergency room. Dr. Williams, thank you for joining us today. Would you like to introduce yourself? Sure. My name is Mark Williams and I'm an emergency physician at Kaiser Santa Rosa. How long have you been with Kaiser? It seems like eternity. I joined the group in July of 2000 freshwater residency. Oh, wow. And what has it been like so far? It has been a real journey. It's been interesting. I've seen a lot of shifts in healthcare policy technical advances. There's been a lot of change over the many years.. I have to imagine, it's that you have to have seen a lot, especially in the emergency room. How long have you been with Pfizer Santa Rosa? I moved up to Santa Rosa in May of 2023. Okay. Has there been a difference in Santa Rosa and at the other Kaiser where you were before? There are a lot of differences and for me the move was very personal. I ran into a lot of burnout after COVID, so a big change of scenery complimented by a lot of change in myself and. Figuring out what it was gonna take for me to achieve some level of happiness and feeling successful. There are a lot of shifts that happened in 2022 for me, and that's what prompted the move up to Santa Rosa in 2023. That's, that's quite heavy. And I have to say that it's very brave of you to move because I know that's quite a significant shift and, we as physicians are always looking to preserve the balance of things and to make sure that we don't rock the board. So I have to say that you're very brave for making the move. Would you like to talk to us a little bit about, what helped? What was the big shift that kind of happened around that time for you? I think it was a series of a lot of things. I think COVID was a big accelerant in the whole process. And that was, it just, it was a very trying time emotionally with work. It was difficult and I felt as frontline person a lot of the. Burden fell to the group I was in. And there was, I think there, there was a moment, a couple of moments where the most COVID in California was in Santa Clara County and in Santa Clara County, the most COVID that was at hospitals was at Kaiser San Jose. So it was just a hotbed for this problem for what seemed like a long stretch. It was really a trying process. And I think too, there was a big part of me as I felt like I was in a bit of a mid-career slump. I didn't feel like I was getting fed and watered by the organization as a whole in my practice. I didn't feel like it was it was feeding me. And I felt like I really wanted to finish well in my career and with where I was. How things were going. I didn't see me being able to finish well. So I thought it's time to do something drastic. And the drastic was the move. How did your family, respond to this suggestion of a move? My family was very supportive, thank goodness. At that point, both of my kids one was in grad school, the other was in college. So for them it didn't change their world much at all, but they were happy to see me doing something different. That was more satisfying and that seemed to be more fulfilling for me. Wow, I'm glad that you know that your family was supportive and also, again, really good job for making that change and for taking that huge, big, scary step. What have things been like since the move? Since the move? Things for me personally, have felt and been. So much better. I was at such a place of burnout in my career earlier in the mid career around COVID time that I had actually circled a date in my calendar where I was gonna hit eligibility for early retirement or the other date that I circled. Was it just a quit date? I was just ready. I was 53 years old. I would have zero to gain. By leaving the group. But I was so frustrated and burnt out that it seemed at that time that was the best solution. And when I took the steps a couple steps back from that and realized how foolish and how short term what I was thinking was it just made me reflect and think about things on a deeper level and really lean into. What the issues I thought were, and why I felt unsupported, unhappy, et cetera. And I also read this book by Dan Pink. He's a social scientist from University of Chicago and it was called When, and there was a very short. Mention in the chapter about mid career slump, and I was like, yeah, mid career slump. That's where I'm, that's what this is. And it didn't say much about how to get out of it, so I just had to lean into that myself in terms of figuring out, fighting my way out of this. And it seemed like the most reasonable thing was to, A, want to finish strong b. Take some drastic measures to really find what I was looking for. And what I was looking for was a group that seemed supported in the hospital. With with a hospital leadership that was supportive of the group. And I've really found that at Santa Rosa. I really came in an interesting time when the leadership in the emergency department was transitioning and the PIC was in a state of transition and I felt like it opened a lot of doors for me in terms of figuring out, where I wanted to put my energy. The first thing I got involved in when I transitioned up to Santa Rosa was a physician recruitment and retention. I was less interested in the recruitment angle, to be perfectly honest. So I was really interested in how do we, as a group, as an organization, how do we retain our mider people? And I. Deal with that was not running away or quitting, but it was actually investing in what I could do for myself, investing in ways where I could connect with other people and help them and have them at the same time help me with with our own journeys in career. I'm really grateful to you for sharing this journey with other physicians who are listening to this podcast and with me, and I think it's. It is very powerful, the connection that we can help each other through. And I'm glad that you're in Kaiser Center, Rosa, and that the physician recruitment and retention team was a big step in helping you transition here. What have been some of the highlights of your time while in Santa Rosa? I think probably the biggest thing for me is, after joining the Recruitment Retention Committee and doing a project with that, I got involved in the Physician Wellbeing Committee, which for me seems like it's the highest and most important thing that I could do for my fellow physicians. I don't think there's anybody that really. Quite gets what it's like to work the job and the challenges of healthcare. And I think physicians, taking care of physicians is probably, just the need to thing I could be involved with. I was really pleased to be welcome to the committee and to be a participant and to be involved to, to help out the pac. You, my colleague on the Physician Wellbeing team, and I, again, greatly appreciate all you do as part of the Physician Wellbeing Team. For those who are listening, tell them a little bit about who Physician Wellbeing Team is and how it can be helpful. The Physician Wellbeing Committee, as I see it. Is about making connections. It's not a watchdog group. It helps people that are going through rough times in terms of having somebody to talk to that's not administration, that's not maybe an intra departmental colleague, just somebody outside of it all that maybe doesn't know the politics or maybe doesn't know all the situation. But at the same time, it's just there as a friend to listen. And if need be, help connect people to different services that Kaiser offers to help us through our rough edges. Because you know what career is that is without a rough hedge. Oh, absolutely. And there's I think as physicians we often hesitate to share our journeys through mid career slums, through burnout, through all the obstacles that we face, but it's important to talk about them. And physician wellbeing is here to really help support you with whatever challenges life at work or life outside of work brings. Thank you for being part of that work. I do have a few further questions about your burnout. You've talked a little bit about your journey and what has been helpful so far. Are there things which didn't help? Are there things which you know, which other people offered and which were not helpful or which just felt like an added burden at that time, even if they were intended help? I don't really remember reaching out for much help, and I don't really know the extent. Of help that could have been possible. And maybe that was shortsighted on my part. Actually looking back on it, I would say that it was shortsighted. I think perhaps I would've come to a different answer, a different outcome, a different set of solutions. Had I reached out, sort things out on my own. Frankly, probably wasn't the best way, but getting emotionally honest with myself and really leaning into the vulnerability of what I was feeling at that time and working on a solution was helpful. I think what's helped me most since then, frankly, is sharing my experience with other people. I think that's, you said earlier something about it was it was brave for me to make a jump from facility to facility. And really I suppose it was, but I think being able to talk about that now and be open about it is great. And I feel like I see a lot more heads nodding and people saying, I won't do something like that. Or me too, I get that and it's nice to be a resource and again, I feel the strength and this whole thing is like leaning into vulnerability. And that's really, I think that's challenging to do in itself, to be that emotionally honest with yourself. Did things help you get to that place? Was there, was there a conversation you had with yourself or some change which led you to this place of this honesty within yourself? I think more of it was just looking at the alternatives, which frankly were terrible. Quitting at age 55 without some of the long-term benefits or even just leaving the company before at age 53. That's crazy. I think looking at the alternatives were terrible, so I realized not running away just to work through it, look at all the available options and find something that really worked for me. I was actually lucky enough in the summer of 2022 Santa Rosa Emergency Department was terribly understaffed. And they were looking for people to help 'em out. So I drove up and did a shift which in some way I suppose ended up being an audition shift. But at the same time, it really showed me what the power of collaboration the support I felt there. The people I met there really seemed. In spite the fact they were understaffed and things were super difficult. This group worked together. And the people that I met that day that helped me through some really challenging situations, I thought were pretty extraordinary. I met people like Wayne Freeman and Josh Weill, and I realized this, if I can do it, this is how I wanna. End up, this is how I wanna finish my career. This is the type of person, the position that I'd like to be. This is where I would like to land. And fortunately a thought was open, the interview process happened, and just my prior chief was was willing to let me go without any without any hiccups and the process enroll. I was super thrilled. That's awesome. That's awesome. I appreciate you giving a shout out to, the ED physicians who helped your day. I think that is so important. Very often, we always hear criticisms or we always hear about things which we could have done better. I think it's also powerful to hear about things which we did do well, and which shaped other people's experiences like yours. Again, we are so happy that you're in Santa Rosa. If someone listening to this podcast is going through burnout, what advice would you give them? Look at where you are in your career. Look deeply into yourself and try to figure out what you want. Connect with the people around you and share your story. And look for different solutions,. I wasn't stuck and I had the power to make my own decisions regarding my career path. And examine alternatives and finish strong in the way that I felt best suited me. It's what I wanted for myself. Yeah. Yeah. And I think that's powerful advice, to look within. I think we are so focused sometimes on taking care of everyone around ourselves that often it feels so hard to take care of ourselves, but we can only take care of other people if we really take care of ourselves. Is 100% true. It's interesting that as a part of this wellness journey, which. Found itself, like in the pit of an unwellness journey was a complete revamping of my attitudes. It was a fresh journey into physical exercise. It was a journey into nutrition. It was a journey into self-exploration therapy. There were so many aspects to this. It took an entire remodel in order to get myself to a point where I. Make these decisions. Yeah, and I think, again, this is a culmination of, all of your hard work which you have put into yourself, which I think is essential for all of us to really look at ourselves and see, how we can live our best life so we can help other people live their best life. Yeah, I agree. One of the thing that I got into once I got up here to Santa Rosa. I got certified in lifestyle medicine and funny, somebody had brought up lifestyle medicine to me. Maybe in 2017, 2018. I looked at it, I wasn't really sure if there was enough science behind it, how I felt about it. It just seemed a little soft. Then in the past seven or eight years, it's gained a lot of momentum. There's a lot more information, there's a lot more science behind that. Getting certified and trying to figure out ways to use it in the emergency department, one patient at a time or even on a bigger scale, is something that really excites me. And having found a passion project like that again for me has been everything because I felt for the longest time, I'm not a show horse, I'm just a workhorse. I'm gonna keep my head down and grind this until the end. And really that's. That's not the best way to operate. I feel like being able to contribute in a number of different ways on a number of different fronts, from my experience, has been way more satisfying. That's so cool. Tell us a little bit about lifestyle medicine. I'm glad you asked., It's based on six pillars. And the six pillars are evidence-based therapeutic interventions that are used to prevent and manage and reverse chronic diseases. So it is nutrition, predominantly whole food, plant, diet, physical activity, restorative sleep, stress management. Social connection and avoidance. Risky substances. Awesome. Can you give us an example of how a setting like the ED would best be able to use some of these pillars of lifestyle medicine? It's interesting because I feel like people that come through the emergency department are usually in some sort of a crisis. And crisis can also be a moment of opportunity. In these moments of crisis, we have a unique opportunity to intervene. And it was funny, I remember talking to a woman who was in her eighties and had recently had a stroke and she came back for another reason. But we were chatting in our patient encounter and she asked me, what can I eat now that I've had a stroke? I just took the opportunity to share what I had learned about whole Food, predominantly plant-based diets. And she said what does that really mean? And do I have to give a butter? And it was just such a funny, interesting question. And a year or so ago, I decided to become a vegetarian, but that doesn't mean. That I've given of dairy or butter and or that she had to either. And I also mentioned that, there are plant-based butter alternatives that are actually really good and very close to what you know to butter. I think people come in with questions and concerns. Using the pillars of lifestyle medicine, even if it's like talking to 'em about sleep or talking to 'em about cutting back on their, six steps of coffee in the day, or caffeine use, or cutting back on alcohol or cigarettes or even just, getting out to the gym or some sort of physical exercise that feeds them. I've had a number of opportunities to share these things with people, with patients in their moments. And I don't know to what degree it sticks. So part of what I'm in the midst of doing now is designing a study to see if we can. Find and identify patients that come into the emergency room with chronic medical problems and get them clicked into services that we have here at Kaiser Santa Rosa, or even just regionally. There are cooking classes, there are nutrition classes, there are weight loss classes stress reduction classes groups that start out talking about health and nutrition and informing social connections. There's. So much that is available for patients to help themselves and become more of a driver in their own healthcare than just a passive passenger. And I think too. Some people are motivated to make these changes, and I think we catch 'em at an opportunity where they're really ready to hear it. That's when change happens. And if we can register. If these interventions are leading to some sort of a positive change, whether the change is weight loss or an increase in exercise, or a reduction in A1C, a reduction in their cholesterol. If we can find a way to measure how interventions can lead to positive change in positive health outcomes, I think that's a really interesting question. It's funny enough, I feel like. That is the Kaiser message, right? Yeah. Prevention. We've been following this for decades. Yeah. I think it's time to get people clicked into services so we can see if these programs and programming that we have benefits them short term, long term. That's awesome. I look forward to reading this study when it's out and I think this is very exciting work. Thank you for sharing it with us and thank you for all of your work with. Physician recruitment and retention with physician wellbeing in the emergency room with lifestyle medicine. We are truly grateful to have you in Kaiser Center. Rosa, my last closing questions. What helps you get out of bed in the morning? Now you mean other than my alarm? Yes. I'm in the exciting joys thing. I think again, some of the wellness journey involved a lot of physical exercise and just being active makes me feel good. Drinking a large glass of water in the morning before I eat breakfast makes me feel good. Getting some sunshine in my face in the morning makes me feel good. And when I feel good, I feel like doing the best that I can for myself and others. So little things, little changes. Seemed to cause a momentum shift and that momentum shift seems to point me towards a positive. That is very cool. Thank you again for sharing your story and for sharing some of your time with us. My pleasure.

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This is life and practice.