Heart to Heart with Anna

Doctor Burnout in the Congenital Heart Defect Community

January 14, 2020 Dr. Ami Bhatt and Dr. William Novick Season 15 Episode 2
Heart to Heart with Anna
Doctor Burnout in the Congenital Heart Defect Community
Chapters
Heart to Heart with Anna
Doctor Burnout in the Congenital Heart Defect Community
Jan 14, 2020 Season 15 Episode 2
Dr. Ami Bhatt and Dr. William Novick

Doctor Burnout is not a new phenomenon but this episode of Heart to Heart with Anna tackles the topic from a unique perspective. How can members of the congenital heart defect (CHD) community come together to acknowledge that doctor burnout does exist and work together to offer some solutions to reduce some of the stress?
 
 Dr. Ami Bhatt and Dr. William Novick join Anna to discuss this important topic. What shift in framework is being taught to residents and fellows in some parts of the United States? What changes in the field of medicine in the last 20 years have contributed to doctor burnout? Are certain types of doctors more at risk than others? 
 
Tune in to hear the answers to these questions and much, much more!
 
Articles mentioned in this broadcast:

Many US Cardiologists ‘On the Brink of Burnout’

Burnout – preventing, recognising and treating

Beyond the Economics of Burnout

Annals of Internal Medicine. 2019; 170(11): 807-808. 

Additional links for Dr. Ami Bhatt:

Ami Bhatt: Closer at a Distance (Business Innovation Factory)

Telemedicine and Patients with Congenital Heart Defects (Heart to Heart with Anna)


Additional link for Dr. William Novick

Healing the Hearts of Croatia, Libya, Ecuador, and Beyond (Heart to Heart with Anna) 

Novick Cardiac Alliance (to donate during Heart Month -- February 2020)

Benson-Henry Institute
 
Please take a moment to follow us on your preferred social media platforms:

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If you enjoy this program and would like to be a Patron, please check out our Patreon page

Support the show (https://www.patreon.com/HearttoHeart)

Show Notes Transcript

Doctor Burnout is not a new phenomenon but this episode of Heart to Heart with Anna tackles the topic from a unique perspective. How can members of the congenital heart defect (CHD) community come together to acknowledge that doctor burnout does exist and work together to offer some solutions to reduce some of the stress?
 
 Dr. Ami Bhatt and Dr. William Novick join Anna to discuss this important topic. What shift in framework is being taught to residents and fellows in some parts of the United States? What changes in the field of medicine in the last 20 years have contributed to doctor burnout? Are certain types of doctors more at risk than others? 
 
Tune in to hear the answers to these questions and much, much more!
 
Articles mentioned in this broadcast:

Many US Cardiologists ‘On the Brink of Burnout’

Burnout – preventing, recognising and treating

Beyond the Economics of Burnout

Annals of Internal Medicine. 2019; 170(11): 807-808. 

Additional links for Dr. Ami Bhatt:

Ami Bhatt: Closer at a Distance (Business Innovation Factory)

Telemedicine and Patients with Congenital Heart Defects (Heart to Heart with Anna)


Additional link for Dr. William Novick

Healing the Hearts of Croatia, Libya, Ecuador, and Beyond (Heart to Heart with Anna) 

Novick Cardiac Alliance (to donate during Heart Month -- February 2020)

Benson-Henry Institute
 
Please take a moment to follow us on your preferred social media platforms:

Apple Podcasts

Facebook

YouTube

Instagram

If you enjoy this program and would like to be a Patron, please check out our Patreon page

Support the show (https://www.patreon.com/HearttoHeart)

Dr. Novick:

There are things that you can watch for in people once you have worked with them long enough to realize that maybe they're hitting their high water mark and they might need a break.

Anna:

Welcome to Heart to Heart with Anna. I am Anna Jaworski and the Host of your program. I'm so happy you're here with us today. Our program today is a little bit different than other programs. Today we're featuring two doctors from the congenital heart defect community. But before we get started I'd like to welcome Alicia Lynch to the HUG Podcast Network family. Alicia Lynch is our latest Patron. I met Alicia at the Care. Hope. Discover. Conference and really enjoyed talking with her and her mother. If you’d like to join Alicia, it’s so simple! Just visit our Patreon page – www.patreon.com/HeartToHeart and choose the tier you’d like to join. The second step is just to Add your Payment method and confirm your membership details . Step 3 is to Review the Details of your monthly membership . Step 4 is to click Confirm to finalize your payment. It’s as simple as that! Now on to our program about Doctor Burnout. "And it all starts with performance drive and a quest for perfection accompanied by chronic stress. It ends with total exhaustion, maybe even depression and thoughts of suicide. Burnout is a symptom of our times, but it can be prevented and treated." This quote is from a blog post by Artur K Vogel entitled Preventing and Treating Burnout. Sadly, burnout in the medical community is a growing concern. I'd like for us to brainstorm ways we can curb or prevent doctor burnout in our own medical communities. So with me today, I have Dr. Ami Bhatt, a cardiologist specializing in the lifelong care and empowerment of teens and adults with CHDs. Her practice includes addressing valve problems and heart failure, working with professionals in multidisciplinary surgery, arrhythmias, pregnancy transition, telemedicine and wellness programs. And I'm sure a lot of you will remember her from when she was on my program before. And then Dr. William Novick is a cardiothoracic surgeon and the medical director of the Novick Cardiac Alliance. He created this nonprofit organization in 2014 to care for children's hearts in developing countries and to train doctors and medical staff in those countries. And I'm sure my loyal listeners, while remember Dr. Novick from when he was on my program before. So I'm thrilled to have these doctors on my show. So let's get started. Our program today is talking about Doctor Burnout in the CHD community. So welcome back to Heart to Heart with Anna, Dr. Bhatt!

Dr. Bhatt:

Thanks so much for having me.

Anna:

So I wanted to start with you, Dr. Bhatt because it was while you and I were recording your first appearance on our show that we talked about the possibility of having a show devoted to doctor burnout. What are the warning signs of doctor burnout and how might you recognize those signs in a colleague or member of your team?

Dr. Bhatt:

Absolutely. So thank you for addressing this today. I think something that's important is that burnout and has actually been around for quite a long time and it's not even just limited to doctors. It's really all clinicians and caregivers and later in the show we could even get to how sometimes family members feel that way when you have a lot of clinical responsibility. But some of the signs that we look for are when people have a significant amount of burden of the number of things that they have to do. Just the structure of how people's practice is set up can oftentimes tell us that those people might be at higher risk. Then I think some of the signs are ones that we're familiar with with stress in general and that's people who start to feel overwhelmed easily. People who start to feel that they can't give everything and as a result either detach from what they're doing and are not the kind of people they used to be. Sometimes personality changes. Other times it's people who snap very quickly, can't seem to manage things. And what is interesting is the average clinician is actually really good at holding it together when they are with their patients and doing their job of caring for patients. It is oftentimes back in the office or at home and other places that they then don't have the wherewithal to be able to continue to be that emotionally strong. And so oftentimes it's outside of the clinical arena that we first see signs of people who are starting to become burned out. And so engaging the whole community of people who interact with clinicians is important.

Anna:

That's so true. And what you said about burnout can happen to anybody. That's true. I think what a lot of people maybe tend to forget is that doctors wear many, many hats. You're also a mom, you're a wife. I'm sure you have other interests outside being a doctor. And I think in having to wear all those different hats and do what you need to to fulfill your obligations with all of those other roles on top of being a doctor can add to the stress.

Dr. Bhatt:

Absolutely. And I think that is part of the frame shift that we are trying to make when we address burnout. And it's funny even that is a frame shift . We're really trying to call it promoting wellness rather than preventing burnout sometimes because I think that's really what we're aiming for is we want people to be, well, even caregivers, not just patients. But as we think about it and we shift that frame, it's not, 'Wow! I have so many things I'm responsible for and it's so stressful.' Although that's true. It's, 'I have so many different things that I want to be doing and are valuable, interesting, important to me. How do I maintain my interest in them and feel fully capable of giving myself to them at any given time?' And that's something that interestingly clinicians are good at. We can do research at one moment. We can be a surgeon the next moment. We can be an office doctor in the next moment and people will be able to do all three things and do them well. And what we're trying to now teach people is - how are you a good physician but then you go home and it's absolutely okay to let the physician part be to be a good mom or to bring that into part of who you are and what works for you. So again, it's really wellness. How do you take all those things that could feel 'This is too stressful, these are too many things.' And instead say, 'These are all the things that make me who I am and therefore I'm proud of that.' That takes time, but that's the focus.

Anna:

Right! I love that. It's all about frame of mind and it's all about probably teaching everybody how to compartmentalize better. Well, I love what you said about training people to think differently and to think in a more positive way because then it's more about appreciating all the different facets of your life and not getting too overwhelmed. I just think that's a tough thing to do in today's day and age. And I hope that is something that maybe even the colleges are realizing they need to help the doctors with while they're in training. Because one of the things that I read about was that doctor burnout sometimes happens before you're even a full-fledged doctor.

Dr. Bhatt:

So that's absolutely true. I think even in training, learning to be able to cope is important. Resilience training is actually very helpful for many professions. There's a Benson-Henry mind body Institute that's close to Mass General where I work and we work with them on doing resilience training for our physicians, but also our fellows who are in training right now to help them build the tools they need to help promote wellness or to fight burnout.

Anna:

Well that sounds like the kind of training that maybe we need in high school. I mean, promoting wellness for the rest of your life is something that's so important.

Dr. Bhatt:

Well , absolutely. I think we can never start too early.

Anna:

Okay. Well, Dr. Novick, according to an article published by the Annals of Internal Medicine, mission-focused executives, nonprofit employees, teachers, principals, nurses, and physicians are some of the people most at-risk for burnout. And of the people that I listed, you account for a lot of those. So how does doctor burnout affect your organization?

Dr. Novick:

Anna we have, as you know, a unique organization. And I think one of the things that really prevents doctor burnout with our group is that we're not gone on a continuous basis. We have breaks in between our pediatric cardiac workshops around the world. So although we may be in a country somewhere for an entire month, you're able to come home and decompress and you've got a week or two weeks off. I think that's one of the big differences between our organization and you know, most physicians that work in the United States, I mean you get a vacation every once in a while in the U S but you're really working basically around the clock except for breaks on call and we don't have that problem. Yes, we work very hard when we're out in the field, but then we come home and we're able to be completely away from it for two-week periods at a time. That's I think number one, and I do believe one of the other points that you both have made earlier is really consequential and that is you need to be able to compartmentalize the different aspects of your life. And for me, as much as I'm out of the country, 36 to 40 weeks out of the year -- when I come home, it's only about family. And so I'm able to completely decompress, enjoy my time with my family and manage a few things in the office. But I think if you're juggling a lot of balls or spinning a lot of plates like the Chinese acrobats do , you've got to be able to compartmentalize each one of those areas and try and prevent excessive overlap.

Anna:

That makes so much sense. And I love the way you actually have structured your organization so that you do give those frequent breaks even though when you are out of the country, it's really intense, isn't it?

Dr. Novick:

It's pretty intense when we're out of the country. The team is responsible for the care of all those children 24 hours a day, seven days a week, and there's no off time in actuality. So although you may get back into the hotel or the guest house and get a nap, you never know when you're going to be called upon during that month time period to rush back to the hospital for some emergency. So being able to decompress when you come home I think is really critical to the wellbeing of all the individuals that are on the team. It's not just the physicians on our team. Our nurses work exceptionally hard as well and are pushed frequently to the limit by the acuity that we may run in the intensive care unit. So their having the ability to take a break and get away is vitally important to the functioning of the team quite frankly. And you start to see burnout when as mentioned earlier, there are changes in the characteristics of the individuals that you're working with that are a little bit unusual. Your usual happy-go-lucky nurse practitioner in the morning who's running rounds is all of a sudden short, or your anesthesiologist is having difficulties. I mean, there are things that you can watch for in people once you've worked with them long enough to realize maybe they're hitting their high water mark, and they might need a break.

H2HwMichael:

"Texas Heart Institute were offering us a mechanical heart and he said, "No, Dad, I've had enough. Give it to someone who's worthy."" "My father promised me a golden dress to twirl in. He held my hand and asked me where I wanted to go." "Whatever strife or conflict that we experienced in our long career together was always healed by humor." Heart to Heart with Michael... please join us every Thursday at noon Eastern as we talk with people from around the world who have experienced those most difficult moments. as we talk with people from around the world who have experienced those most difficult moments.

Home2night4ever:

Home. Tonight. Forever by the Baby Blue Sound Collective, I think what I love so much about this CD is that some of the songs were inspired by the patients. Many listeners will understand many of the different songs and what they've been inspired by. Our new album will be available on iTunes, Amazon.com, Spotify. I love the fact that the proceeds from this CD are actually going to help those with congenital heart defects. Enjoy the music. Home. Tonight. Forever.

Music:

music.

Anna:

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The opinions expressed in the podcast are not those of Hearts Unite the Globe but of the hosts and guests and are intended to spark discussion about issues pertaining to congenital heart disease or bereavement.

Rejoiner:

You are listening to Heart to Heart with Anna. If you have a question or comment that you would like addressed on our show, please send an email to Anna Jaworski at [email protected] That's [email protected] Now back to Heart to Heart with Anna. .

Anna:

Do you feel that there are a ny personal qualities that attract medical professionals to the cardiology field, which might also make them at-risk for burnout?

Dr. Bhatt:

That's a great question. I think we never want to categorize cardiologists or cardiac surgeons as a certain subtype, but I do think that there's certain qualities that most all of us carry. The first is a willingness to be very thorough and careful about what we do. The second is being willing to be in intense situations and be able to make decisions on the spur of the moment when necessary -- so able to do that and willing to do that. But the third and maybe the protective part is we all want to be part of that child's journey into adulthood and in congenital heart disease being part of that family and that community may actually be what protects us the most from burnout.

Anna:

Oh, I love that. That completely goes in line with what I read about. But when we were talking earlier, you also said that a lot of people who are attracted to the field of cardiology are perfectionists and that's one of the characteristics that can put you at risk for burnout.

Dr. Bhatt:

Absolutely. And I think that is where we really try to think about what is right for our patients, what is right for our team in a given situation and what is perfect. It's hard to say that we want to be just good, not perfect. You won't hear us say that. Sometimes we all say that about other things in life. That's not the case when you're taking care of an individual with congenital heart disease.

Anna:

Right,

Dr. Bhatt:

But have to therefore frame perfection a little bit differently and I think with, partly a team outlook on what we're doing. Now, I'm curious as to what the surgeons think about team versus the-buck-stops-here. For us in the office practice, we really do have a chance to have many people involved in multidisciplinary care and oftentimes have the time to think about what comes next and I think that's very protective for us.

Anna:

Oh, I love that. Dr. Novick, how do you feel working with people with different CHDS differs compared to how other medical or allied health fields in terms of factors contributing to doctor burnout?

Dr. Novick:

Well, we are really a team-oriented group. I believe that no cardiac surgeon would be able to function without the surrounding team providing the support that's necessary for the care of these sometimes fragile and complicated children. So depending upon other people from time to time is something that we all have to do and it can, I think, help you disperse the burden of the stress at times of the excessive responsibility that we all feel towards these children. So being able to share your feelings with your teammates I think is a critical part to being able to prevent burnout in yourself. We always have sessions where everybody can come with their complaints, their beefs, their problems, and I think this is helpful to our team in general. It is a mechanism by which we can offload some of the stress into the larger pool.

Anna:

I love that because from what I have seen, you have people who volunteer their time with you, not just once, but over and over again. So you must be doing something right.

Dr. Novick:

Well, we do have a lot of repetitive volunteers. What we don't want is to contribute to the stressors of our volunteers that would lead them to burnout . We want them to be return players. I think one of the things that we haven't talked about, which perhaps Dr. Bhatt can address is how things are different today than they were 20 years ago, and how that may have contributed to what it looks like is an increase in doctor burnout. What do I mean by that? Well, 25 years ago, the generation of new knowledge ran along at about, I don't know , an entire body of new knowledge in four or five years. Now, there's a hundred percent increase in our knowledge every 1.8 years. And we're expected to know that in order to take care of our patients. That's not just in cardiology and cardiac surgery, but that transcends all specialties. A generation of knowledge is coming about so quickly now that it is difficult for some people to keep up. And that, I think, contributes to some of the stressors that we see.

Dr. Bhatt:

I think that's exactly right. So I think there's three key things that have changed over the past two decades in medicine. So one is absolutely the fast-and-furious pace at which we have new knowledge, not only in cardiology but in all of the different fields or organ systems, if you will. But then I think there's two other things. One, and this you'll see brought up a lot, but it is true -- is our change to the electronic health record is actually probably excellent for patient care. However, it generates a lot of extra work that does not require physicians to use their full license capacity to do. And so we generated that extra work and we haven't figured out yet how to decrease the administrative burden and that field -- decreasing administrative burden for physicians -- will , I think sincerely help the problem of burnout over the next few years and people are working on it but need to continue to do so. The third thing is unique to congenital heart disease patients and that is that they are always changing. As our surgeons improve upon what they do in the neonatal period, in the childhood period, we face a different version of the same congenital heart defect every couple of years as they grow up. So it's exciting because it's always new, but it is also demanding because we don't have the same answer to the same questions year after year and it's always evolving. And that's a unique challenge for the congenital heart disease caregiver.

Anna:

Yes, I would agree with you. I've seen that in my two decades as a heart mom that the changes that are happening in the medical world are directly impacting the length of time that our heart warriors are surviving, the complications that they're having to endure because they're living longer and so now they're living to menopause age for the women. Now they're starting to have new problems that they didn't have decades ago because they didn't survive that long. And so I think that is making your job so much more complicated and just the rate at which researchers are finding new information. Looking at the stem cell research that's going on that is going to undoubtedly affect your practice in the future. How do you keep up with all of that? I mean, my husband's a nurse and he has to get a certain number of CEUs, but I don't know how all of you can keep up with everything new that's happening in the field of pediatric cardiology or congenital heart disease I should say because Dr. Bhatt you're dealing with adults, but Dr. Novick, you're dealing with people of all ages.

Dr. Novick:

Well, I think one -- I think you have to recognize that it is not possible to be expert in everything. You know, we only use a certain percentage of our brain capacity and once the disk drive becomes full, you have to start throwing certain things out. I have looked at this from the point of view of my particular areas of interest and where I want to be expert and then I just want to be well-grounded in the other things so that hopefully I can provide optimal care for my patients.

Anna:

So does that mean that you work with other surgeons who, like Dr. Calhoon, is interested in the Ross Procedure -- so if you knew that you had a doctor that was on your team who had a keen interest in one type of procedure, would you let that doctor be the one to perform that procedure when you go overseas?

Dr. Novick:

Uh, yes and no because the Ross Procedure happens to be one of the areas of my interest actually. But I do understand what you mean and yeah, we do have certain doctors on the team that are better at certain operations than others and try and filter those types of cases through them. But there are times when you have no choice. You may be the only surgeon on that particular trip and you get presented with an operation that you don't perform very often and you know that the surgeon on the team that does perform that often is not going to be back in that city for another six months and the child can't possibly wait that long. And then you're put in a position where you're going to have to do this. Yes. That increases your level of stress. It does. But we all have certain aspects in our practice that are more stressful to us than others. And being able to control those as best you can, I think is part of this concept of compartmentalization.

Anna:

So let me ask you, Dr. Novick about something that Dr. Bhatt just mentioned and that is the whole electronic medical record. Do you do that in the countries that you're visiting?

Dr. Novick:

I'm not going to say we don't do EMRs. Every child gets a discharge summary. Every child gets a operative report, every child gets a profusion and anesthesia report, and those all go into our database. Now, whether or not we can pull up x-rays on every kid that we've ever operated on, it's really not possible when you consider that we're in 34 different countries around the world. So we have a form of electronic medical records, but it is nowhere near where my colleagues in the United States have to put up with. And I would say the number one complaint from my colleagues in the States when they travel with us, 'Wow! This is fantastic! I can actually practice medicine instead of sitting at a computer terminal all night.'

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HUG Message:

Heart to Heart with Anna is a presentation of Hearts Unite the Globe and is part of the HUG Podcast Network. Hearts Unite the Globe is a nonprofit organization devoted to providing resources to the congenital heart defect community to uplift, empower, and enrich the lives of our community members. If you would like access to free resources pertaining to the CHD community, please visit our website at wwwcongenitalheartdefects.com for information about CHD, the hospitals that treat children with CHD, summer camps for CHD survivors, and much, much more.

Anna:

I think it's fascinating how Dr. Novick you have a completely different experience than Dr. Bhatt since you're traveling all over the world and working with people and I would think that you would have a lot more stressors because of having to not only practice medicine, but you're also having to do fundraising or maybe you hire people to do your fundraising. I'm not so sure. But I'd like to know what is the biggest stressor that you have in your practice as a doctor?

Dr. Novick:

My biggest stress was not actually being a physician. I mean I am most relaxed either in the operating room or in the intensive care unit or most jovial sitting in front of the echo machine with the children and their parents. The biggest stressor for me in our organization is the actual fundraising and logistics of putting 25 to 30 teams out a year all over the world, and it's that balancing act of adequate funding coupled with really what have to be precise logistics in order to carry off what we do around the world.

Anna:

Right. To me that makes perfect sense and I can see where that could be a stressor that could lead to burnout because you're obviously passionate as a surgeon, you love actually doing the hands on part of being part of that team and not just being a person in charge of all the logistics, but you have to have the logistics in order to do it. So it's kind of a Catch 22

Dr. Novick:

Well, it is. I mean we do have some administrative staff, but I think one of the qualities that we're very proud of within the foundation is that our program service costs represent 96 cents on the dollar. So we try and keep fundraising and expenses and administrative expenses to a bare minimum.

Anna:

That's really admirable. Dr. Bhatt, what do you find to be the biggest stressor in your practice as a doctor?

Dr. Bhatt:

That's a great question. I think it probably depends on the day -- to be very honest. I think probably the better way, and you know me, I'm all about reframing, is the days where I have a really good team-based interaction, where I need a liver and a kidney doctor and they are there with me because as we talked about, the volume of knowledge out there is growing at a pace that is challenging to keep up with; I think when a family comes in and we have enough time to bond in addition to do health care -- those are my best days. And when those things are missing, or God Forbid, all three of those things are missing in any given one day -- those are the days I feel more tired, more alone -- maybe rather than even stressed? -- And therefore stressed.

Anna:

That makes so much sense. And it seems like the practice of medicine is becoming more multidisciplinary all the time.

Dr. Bhatt:

It absolutely is. And I think that's very important for us to recognize. And it was mentioned before by our surgical colleagues and appropriately so that is what makes us stronger is that multidisciplinary nature of our willingness to work together as a team. And that team includes our patients and their loved ones.

Anna:

Thank you so much for saying that! As one of the loved ones, it means so much to me that the doctors value what we can do and there are things we can do!

Dr. Novick:

Well, we certainly believe that in our practice, a lot of the countries that we travel to, the parents have been forbidden from visiting the children in the ICU and we've had to convince -- not only the families that they're important in the recovery of these children -- but also the local caregivers. It's sort of an iconoclastic maneuver for us to come in and say, "No, look, the parents at the bedside are one of the best ways to improve the recovery of these children." Having the parents realize that we value their contribution to their child's care only provides them with more momentum to want to help more.

Anna:

That's wonderful. I appreciate the fact that more doctors seem to be wanting to include the caregivers and it just makes sense because those parents, they're going to be the ones who are caring for the children for most of their lives. Unfortunately you doctors are only with our children for a very small period of their lives and if we don't feel confident to take care of our children, then our children could have bad outcomes just because their parents don't know what they're doing.

Dr. Novick:

I think that's true.

Anna:

Yeah.

Dr. Bhatt:

I think from the adult congenital heart disease side, one of the great things about picking up kids in their teen years is getting to know the person and their family before you know them as an individual adult. I think it gives us a lot of perspective. So for us, that longitudinal relationship when it starts at a younger age and the children transition from their pediatric cardiologists to adult congenital, which is a very hard transition, but when they do that, when the family is still involved, really makes a difference. I think for all of us. One thing I will say is that you had asked earlier when we were preparing for this, how is it that families and patients can help us? And I think in caring for our patients with the electronic health record, if we can manage to get health records across state lines, if we can have health records which are interoperable and can communicate from one hospital to another, it makes us more confident in the care that we provide for you. I think that's important for patient safety and patient health, but also helps us feel less stressed about the care that we're providing. So that's one place where advocating even at the congressional level in your own States could be very helpful for us.

Anna:

That's good to know that first of all we can be advocates in Congress, or going to our state government. I think that's good to know but also on an individual basis. It's interesting that you said what you did because I was just part of a panel in Houston in 2019 and it was all for adults with congenital heart disease and one of the panelists said that he has all of his medical records from the time he was an infant. He has a binder where he has all of his medical records so whenever he goes to an appointment, he brings that binder with him just in case he needs it. That's something that all of our heart warriors can do if they just knew how important it was.

Dr. Bhatt:

Absolutely. That's our model patient, if we can get one, but one of the things is we're making people do all that work and shouldn't our system do that work for us?

Dr. Novick:

No, they shouldn't have to do that work. But you know, one of the unique things about working abroad is the parents carry the medical records.

Anna:

I do. I have all my son's medical records. I think it's something that we could train the parents to do. I mean, if I knew from the time my son was an infant, yes, the hospital should have all of these records, but sometimes records get lost. Sometimes things happen. And if I knew that from the first time my son was in the hospital, I should be keeping all of his records, I would do so. And so it wasn't until a little bit later that I realized the importance of those records an so it costs me a little bit of money and it cost me a lot of time to go back and get his first surgical reports but I felt that it was really important for me to have that and so now Alex has a binder with all of that information in it. This is something that, yeah , it may cost a little bit of money, it may cost some time, but if people knew right now, wherever you are in your life, whether you're the parent of a child, whether you're the parent of an adult, or whether you're an adult with a heart defect yourself, no matter how many operations you've had, your hospital should have those records. Get a copy of them. It's your right as a patient or it's your right as a parent to get those surgical notes, to get any of the information that you need. I think what we need to know is what do we need? And I think that unfortunately the hospitals make it a challenge for us to get those records. So what advice would you give parents and patients then to help them not only be advocates for themselves and having your own medical records is a form of advocacy, but would also help prevent doctor burnout ? Because I think that's something that all of us would love to do. And I'll start with you, Dr. Bhatt.

Dr. Bhatt:

When I think about old surgical records that the original operative reports are the Holy Grail to me. When a patient walks in with that or when I have access to it, I am just a generally happier physician. Having said that, I think that, I think recent imaging, or even a summary note if they're actually transitioning from one institution to another, is helpful for us to have with us. The other thing that we do ask sometimes the families is if they don't have it and we don't have it, patience with us in the system to go and find that because that's sometimes frustrating and I say that as a mother as well. When you go to an appointment and the records have not arrived before you, and to recognize that that's not the individual physician's fault per se, but a little bit of the system and to then be advocates together to change that system.

Anna:

Um hm. I love that. Okay. Dr. Novick.

Dr. Novick:

I'm going to have to agree with Dr. Bhatt there. I think we see a number of children who've been operated on in other countries and having the operative note from wherever, regardless of whether it's in a different language or not, is really crucial to our being able to plan their next operation or to know what additional diagnostic study has to be performed. And although I like to see the images, I would agree that having a detailed report of a diagnostic image would also be very helpful. You know, I don't know why we don't do this more in the United States. This is something that I think would make stress drop in everybody's mind. The parents wouldn't have to be worried about 'Are we going to be able to get those records? Are they archives so far back that somebody can't find them?' And the cardiologist saying, "Well, wait a minute, what operation was actually done? We don't have the records on that." So parents being able to carry all of this I think, or at least have duplicate copies. I think it's critical to relieving stress across the board for everybody involved in the care of this child -- parents, physicians, nurses, everyone.

Anna:

Wow. You know what I love about this? This is something that we can really do. It will take time to help spread the news, but this is something that we as a community can do. And if we start training the parents, the teenagers and the adults as well, who are coming to see us about the importance of this, this is something that will make them better advocates for themselves because people will get curious and they will start reading their reports, which a lot of people don't do because they don't see those reports and that will make them a better advocate. But also if we can reduce the stress of our doctors. I know that the hospitals have the ability now to burn CDs for patients or put them on a flash drive. But I don't think all patients know how important that information is. I just think that a lot of people don't realize how important the information is and that they have the power to get this information, but they have to ask. Nobody's going to offer it. Thank you so much, Dr. Bhatt, for the information that you provided today. I am excited to see that there are some things that we as a heart community can do to do our part to prevent doctor burnout.

Dr. Bhatt:

Absolutely. It's my pleasure and thank you for focusing on this for a session. I think it's really important for all of us to be healthy as a community together and we appreciate the interest that our patients take in us as well.

Anna:

I love that. Dr Novick , thank you so much for coming back on the program and telling us about the unique challenges that your organization faces, and before I let you go, I want to announce to everybody that you'll be able to see Dr. Novick on a program in January or February. Can you tell us a little bit more about the program that you're going to be on?

Dr. Novick:

Yes , I can. Thank you for this. CBS has an afternoon television show called The Doctors and I was just recently out in Los Angeles filming the studio session of that. They're going to have a lot of footage from our work in Libya that they're going to put into this and we believe the airing date will either be the last few days of January or first few days of February for the start of heart month . So we're looking forward to it.

Anna:

Don't you have an amazing opportunity for people who are interested in donating to your nonprofit?

Dr. Novick:

We do. So during heart month we've had an anonymous donor come forward and pledge to match any donation up to $100,000.

Anna:

That is just amazing. That would really reduce Dr. Novick's opportunity for burnout.

Dr. Novick:

It's true. And if anybody wants to go over that, we're fine with that also.

Anna:

Oh , that's just an amazing opportunity. Thank you so much for coming on our program and for doing this other program. The more we promote awareness of congenital heart disease, the better for everybody. I'm so happy that we've had a chance to talk about how we can reduce burnout and I have a feeling this is not going to be the only show that we do on this topic. It's so important. But thanks again. This has been a great program and that's it for this week's episode. Our episodes are archived on YouTube and iTunes as well as iHeart radio, Buzzsprout, Spreaker, Stitcher, and many other places where you can listen at your convenience. If you enjoyed listening to today's episode, please consider becoming a patron. Just go to www. patreon .com/ HearttoHeart and pledge, a monthly amount to support our programs. It's super easy. It takes you less than 10 minutes to do. We appreciate your support and I hope everyone has a great day and remember my friends, you are not alone.

Conclusion:

Thank you again for joining us this week. We hope you have been inspired and empowered to become an advocate for the congenital heart defect community. Heart to Heart with Anna, with your Host, Anna Jaworski, can be heard every Tuesday at 12 noon Eastern Time. [inaudible] .