Shrinking Burnout

On this episode of Shrinking Burnout, we interview Lorraine, an outstanding nurse currently working in New England who describes her experiences working both as an ICU nurse and travel nurse (1:15). She shares some of her coping strategies that have helped her through this trying time (3:20), describes her role within the hospital ecosystem and her day to day life as an ICU nurse (4:00), her varying responsibilities within nursing (7:10), and the challenges of serving in a patient and family -facing role with respect to holding grief (9:00). Together we explore some of the particular challenges that nurses face with respect to burnout, current systemic issues, and the intense trauma that nurses have faced during the COVID-19 pandemic some of which has led to clinicians choosing to leave the profession altogether (15:20, 31:00). This episode was initially recorded earlier this year, and while the state of hospitals has changed over the course of the year, we are still in the midst of an ever evolving pandemic.

On this episode, our co-resident guests, Drs. Austin Greenhaw and Sam Sheffield, join us to discuss the unique challenges of being LGBT-identifying medical professionals. Together we take a brief look at the scientific literature (2:57), why a doctor's sexual orientation would matter to patients (10:45), the importance of supportive co-workers (19:40), and what the medical profession as a whole can do to better support LGBT providers (25:46).

On this episode, we bring a new guest, Allison, to discuss vicarious trauma (1:32) and the link with burnout, discuss personal experiences of encountering vicarious trauma as medical students and resident doctors (4:17), and possible solutions to vicarious trauma (22:25)

Articles:
1. Franza F, Del Buono G, Pellegrino F. Psychiatric caregiver stress: clinical implications of compassion fatigue. Psychiatr Danub. 2015 Sep;27 Suppl 1:S321-7. PMID: 26417788.
2. van Mol MM, Kompanje EJ, Benoit DD, Bakker J, Nijkamp MD. The Prevalence of Compassion Fatigue and Burnout among Healthcare Professionals in Intensive Care Units: A Systematic Review. PLoS One. 2015 Aug 31;10(8):e0136955.

On this episode "The Covid 19 experience revisited", second year psychiatry resident Chris* joins us to look back on his experience working on the medical floors during the covid surge several months out, (2:25), his paradoxical denial of his own burnout symptoms (7:05), the hardest part of seeking help (11:05), and how Chris has modified his personal definition of resilience to normalize being able to seek help (14:16).

Bernard Chang, MD, PhD joins the Shrinking Burnout Podcast to discuss clinician burnout research. We talk about his research in the Emergency Room settings (5:50), the importance of destigmatization of physician mental health (11:28), the assessment of burnout (17:30), his experience of being an emergency medicine physician in academic medicine (28:40), the importance of increasing peer support for clinicians and researchers (33:30), and the "strange curse" and blessing of being a physician (35:20).

This is the second part of the racism in medicine series, where we continue with our guests Dr. Maya Khandker, Dr. Audrey Li, Dr. Elyon Obamedo and discuss how clinicians experience and deal with racism at work (1:31), why it is so difficult to bring up issues of racism as a clinician (9:20), the importance of examining the history of institutional racism (12:10), the pitfalls of "professionalism" (14:40), combatting clinician burnout through patient advocacy (17:30), and the model minority myth in medicine (31:20).

In this first of a two-part series on racism in medicine, we discuss why racism relates to burnout (1:10), a brief history of the racism in medicine (3:20), and with our contributing guests Dr. Maya Khandker, Dr. Audrey Li, Dr. Elyon Obamedo (6:22), joining the discussion to provide individual experiences of being clinicians of color (8:52), the significance of advocacy work as physicians (25:15), and the need for continued discussion on issues of race in medicine (31:35).

This week we interviewed Angie, a social worker working on an inpatient psychiatric unit who tells us more about her experiences during COVID19 and beyond. Burnout is not a concept unique to physicians and certainly affects all medical specialties (1:40). Many clinicians are fearful of being perceived as a patient by their colleagues which serves as a barrier to seeking care (5:50). Angie tells us more about her role on the inpatient psychiatric unit (6:46), challenges that arise with an interdisciplinary framework with respect to the medical hierarchy (10:10), and the inherent emotional challenges that arise when working with mentally ill patients (21:00).

Tammy, an emergency room resident doctor, joins us to talk about her experience working in a medically underserved population during covid-19, the expanded role she has needed to serve in the emergency room during this time, and how her institution adapted to the increased patient volume . We also spend time talking about why emergency physicians tend to have higher levels of burnout , what Tammy finds meaningful about her work in the ED, how burnout can be reduced for ED doctors , and Tammy's personal experience with burnout and the dangers of delayed gratification inherent in medicine.


(1:22) Working in a medically underserved population during covid-19
(6:30) Her increased role in the ED during covid-19
(8:56) Institutional adaptation during the pandemic
(9:55)Why do ED physicians have higher levels of burnout?
(12:30)Why Tammy finds ED work meaningful
(16:00) How burnout can be reduced for ED doctors
(18:15) The dangers of delayed gratification

Rohan, a psychiatry resident, discusses his time working as a medical intern at a community hospital (1:06), the difficulties of being an intern (7:23), hierarchy in medicine (9:29), inpatient psychiatry during covid-19 (15:25), physician guilt (19:17), and physician redeployment (21:57).

The psychiatrists of Shrinking Burnout, Dr. Wu and Dr. Radhakrishnan, discuss the controversy about clinician burnout (1:40), burnout's overlapping symptoms with clinician distress (3:03), depression (4:56), and moral injury (9:59), and the stigma of seeking mental health as a clinician (17:38).
Topics discussed in this episode:
(1:40): The lack of consensus on the burnout definition
(2:28): The Maslach Burnout Inventory definition of burnout
(3:03): Clinician distress
(4:56): The reduced stigma of calling it clinician burnout rather than depression
(6:28): Systemic issues contributing to burnout
(7:36): Why we decided to make the Shrinking Burnout Podcast. The benefit of decreasing stigma
(9:59): Moral injury
(11:00): The limitations of current burnout research
(13:48): Future directions of addressing clinician burnout, the need to redefine the burnout construct
(15:22): Burnout and Covid-19
(16:40):The need to assess clinician willingness to utilize burnout resources
(17:38): The stigma of seeking mental health as a clinician
(18:40): Dr. Wu's opinion on burnout terminology and the under-utilization of clinician's seeking mental health resources

So what's really going on behind the scenes? Join us on our first episode of Shrinking burnout as we interview John (0:24), an internal medicine resident working in a major academic hospital in the Northeast. He gives us his experience of working during the covid-19 pandemic (0:40), how patient care has changed (3:00), ruling out his own covid symptoms (7:30), his appreciation for co-resident support and for Tiger King (9:37), and the most difficult thing he's experienced working during the pandemic (11:30).

We are two resident psychiatrists who are passionate about wellness and combatting clinician burnout especially amidst this COVID-19 pandemic. Join us as we interview clinicians across the country on their experiences, challenges, and incredible resilience during these trying times.