Kalea Wattles, ND:
On this episode of Pathways to Well-Being, we will focus on identifying burnout in all stages of practice.
Dr. Georgia Tetlow maintains both a thriving patient care practice and a mentoring practice for clinicians in transition to a functional medicine model. Over the past decade, she has pioneered a self-care curriculum for practicing clinicians. Dr. Tetlow mentors providers to honor self as the key to stress reduction in a practice.
Dr. Riva Robinson is a physician and holistic nutrition coach with a medical degree and a degree in kinesiology. Dr. Robinson has faced burnout both in her professional and personal life, which inspired her to find new ways of healing, both for herself and for her patients. She has overcome many obstacles and practice-related burdens to rediscover her purpose in medicine. Fun fact, she is also a body builder and competes regularly.
Burnout is largely the result of workplace stressors, and these are things that clinicians at any stage of practice can relate to. Things like workload burden, excessive hours, the burden of complex patient-related decisions, and patient mortality as well. As caregivers, we are invested in the health and the lives of our patients, so how can we began to deal with the psychological factors that can contribute to burnout? We are so fortunate to have Drs. Robinson and Tetlow with us today to help answer these questions. So I’d love to start hearing from you both.
How might burnout manifest throughout different practice stages? And selfishly, as a doctor younger in my career and experiencing some burnout, this is a fascinating question, so Riva, let’s start with you. From your perspective, how does burnout relate to different stages you might be in your clinical practice?
Riva Z. Robinson, MD, IFMCP:
I experienced burnout from the beginning of my medical career starting from medical school. And for me, I kind of went into medical school already not being in the best frame of mind, because I had already sensed from an early age that there was a lot of dysfunction in our healthcare system and that there wasn’t so much of a focus on wellness. Being the child of two physician parents, I was urged strongly, you can say, to follow that medical path, and when I entered it, it was confirmation of all of those doubts that I had had before. We all know how hard medical school is. It’s one of the most challenging things that you can ever experience. And so within, I would say, a few months of the first year of medical school, I started experiencing just feeling withdrawn. And that was something that I hadn’t really experienced before in any type of academic setting where I didn’t want to be around my peers. I had that constant sense of “comparison-itus”—that I am not a good enough student. I am not going to be able to pass this next exam. I’m spending so much of my time and effort on something that I don’t feel completely aligned with, but yet everybody else seems to have it figured out.
It was this constant churning, this constant ruminating in my mind, and that alone was burning me out mentally, aside from the physical and mental exhaustion of studying all day long. We had one general mental health visit that we got complementary as med students from the mental health services. And when I went there and I was met with kind of just a casual, like, “Oh, well this is normal. You’re probably going through an adjustment disorder, and if this continues, we might start some Prozac or some type of antidepressant to help you out.” And that in itself sent me further into that spiral. I wasn’t acknowledged for the mental struggle that I was going through. I didn’t have any type of tools presented to me to help figure out, how do I find space for myself? How do I create better rituals? I knew nothing about any type of mindfulness routines, and that could have been a huge game changer for me. Instead, I kept pushing through the next years of my medical career, going deeper and deeper and deeper into a hole where I felt disconnected from who I was at my core. Because I knew from a very young age that there was more to medicine than just grinding and hustling and being a martyr for everyone else.
There was no emphasis on the physician first or the medical student first so that we can show up for our patients and be grounded. From medical school onward into my first year of residency, or only year of residency, I should say, it was a continued spiral downward until finally—and this was the milestone in my medical career—to finally say, enough is enough. I knew the type of medical education that I wanted. I didn’t know where I would find it. Eventually, I found it with IFM. But I knew that I couldn’t continue on this path because I was depressed. I was just overwhelmingly exhausted to the core. I could sleep for 10 to 12 hours, go on the rounds with the attending [physician], and fall asleep standing up. It was so bad that I knew that I had to find some type of escape. And so after entering a second year of residency, within a few months, I resigned. That was me finally taking a stand to do what was best for me and find what I needed for my own medical path. And that’s when the healing really began.
I like how you mentioned “comparison-itus.” Is that what you called it? That should be a new ICD-10. I think so many of us will suffer from “comparison-itus.” Thank you so much for sharing your experience.
Georgia, how about you? Do you have some insight for us about how burnout might change over the course of our different stages of practice?
Georgia Tetlow, MD, ABOIM, ABPMR, IFMCP:
I also just want to say it’s a pleasure to be working with you, Dr. Riva, and to also hear you share your story in a vulnerable way, where you are sharing your humanity, and you’re also saying, “Well, this is what happened for me, and this is how it started, and this is how it continued.” I think there’s something in that strength that comes through just being able to say, “This didn’t work for me, and I made these different choices.” There is something in our culture in medicine that I was really scared of. When I first embarked on my journey of applying and getting accepted to medical school, there was so much excitement and positive expectation, but I was also scared of losing myself. I did also go through a period of realizing, “Oh okay, I’m getting these strong messages, which are, there is a competition. There is a comparison. This is not a community where we’re necessarily all working together all the time.” And you don’t put yourself first. You put your work and your studies first and your performance first. We don’t want you to make a mistake, and mistakes are bad.
There is something implicit that I noticed when I first started my training, where it really takes a strong person to stand in your own experience and not feel bad and not feel any sense of shame for just being human, not necessarily going with this herd experience and having the performance and having the inner experience that you’re supposed to be having. So I would say, for myself, I really wanted to be a member of the community, and I decided to embark on really basically becoming a member of this medical culture. What I’ve been doing since that time is figuring out, what are the pieces that are healthy that I want to keep and what are the things that don’t serve? And I would say that it’s heartening—and what Riva’s doing when she’s sharing, that’s practicing that humanity and that vulnerability. I really do think it is the antidote, because it connects us with others. There’s a strength that comes through with speaking, “This was my experience, and it wasn’t the one that I was expecting.” If you go to a counselor and the counselor doesn’t say there’s something wrong with how we’re conducting our educational environment, they say, “Oh, well you’ll get over that. Okay, anything else?”
What I’ve noticed as a physician is that we have very difficult conversations to have every day. It’s not just difficult patient conversations. As a business owner, I have difficult conversations every day with my staff and my provider staff. I need to give feedback, and I need to be a business owner and manage many needs. And then the conversations that I have personally when I’m with loved ones, I’m managing my own commitment to my work and how hard I work with also managing the commitment to my own relationships as a partner, as a family member. I think that there’s a whole other level of the different phases that we go through personally, different phases of our career when our family is evolving and our family needs and family role is evolving. And there’s a lot of challenging moments. So depending on where we are personally and how our family needs are shifting, our ability to source our own strength to validate our experience and also speak the truth [shifts]. Not put all of our energy into a brave face, “I’m fine, I’m good, everything’s okay.” Takes a lot of energy to be something, and can we actually be ourselves and also be vulnerable?
Yes, absolutely! I think you both highlighted something really insightful and important, which is we tend to normalize burnout. We normalize feeling sad or down or that you’ve lost yourself. But it’s interesting that we don’t normalize needing help or normalize needing some more self-care. So from your perspective, how can self-care become more normative during things like residency or early practice? How can the culture of asking for support be normalized in a hospital or practice setting? Riva, I’d love to hear your thoughts on this.
I feel like so much of it is your environment. The one thing that I’m so proud and grateful that I did myself during medical school was go to the gym every day. That was the one thing, my outlet. No matter what happened, I knew that I had a gym right there on campus where I could escape and do something that made me feel connected back to myself. Me, being the gym junky that I am, I wish it would have been a nicer gym, but at least it was something that I had to go to every day. It was the one place where I knew that whether it was an hour or two hours, my stresses could be elsewhere and I could be present for myself.
I think it should be mandatory that every facility have some type of exercise space. Have some green space. Have some place like a meditation sanctuary or something where people have the option to find that tranquility. Because otherwise, if you’re just going up and down those sterile halls of the hospital and school and you’re just constantly focusing on everyone else’s needs, where are you going to go? Are you going to go to the bathroom stall? I did that a few times—just escape and cry your eyes out for a little while. We need more safe spaces and more spaces to feel like a regular person. Because when you’re always surrounded by the hospital walls or whatever it may be, you feel almost like you’re imprisoned. At least I did. I felt like, “These walls are closing in more and more the longer that I stay here.” So being able to have access is the first step, and I think being able to bring in the leaders who live it and represent it.
We had great faculty at Baylor College of Medicine, whom I’m so grateful for. One of the professors almost with a sense of pride would say, “I am the head of this department. I have this obligation. I slept two hours last night. I just came back from surgery, and now I’m teaching you,” and you’re just like, “Okay, is this what I’m supposed to be stepping into?” This is one of the chief faculty, and this is our mirror. This is what I’m supposed to be stepping into in the next few years? I don’t want that for myself. I don’t want to not sleep. I don’t want to feel like my life is just a constant hamster wheel, that I’m going from one thing to the next and never having space for myself. But we need leaders who are taking care of themselves. Who are choosing different paths where they can blend the work and the life better. We need people who reflect all different walks in life so that we can find ourselves within them, because I never saw myself in anybody, so that also left me feeling more isolated, more withdrawn, and not able to find those tools that I needed to thrive or survive a better way in medical school.
Thank you for mentioning we need to normalize that people need support, people need help, they need avenues to find themselves during these particularly challenging, exhausting times. But Georgia, how about you? Any thoughts on normalizing the need for support and self-care?
I think that I’ve learned this because I have a personal need to create balance for myself, but also as a business owner where also I’m supervising other healthcare providers. One thing structurally that I’ve really tried to put in place and that helps me as well is that it’s really important for the provider staff to know that cross coverage is in place. So if something happens and they need to call out or a life event occurs, that we have that coverage in place. The clinic needs to continue to run without us and that life continues and that there is a forgiveness and a safety net so that we can have life experiences and that things can continue with continued good quality care. Also, I think that it’s really hard for some of my providers and for me to actually take a sick day. Now, this is not true for everyone. Some people have more confidence in, just if they don’t feel well or if there’s a reason for them not to come in, they just call out sick. I can say, personally, I had a major life event, which was incredibly challenging, difficult, emotionally painful, and I actually had a miscarriage. I miscarried twins, and it was an extremely emotionally challenging and draining experience with some very unexpected turns, and I didn’t miss a day of work.
Going through that experience and seeing how I was and the choices that I made really helped me to see that that idea of having a sick day and having time for myself and knowing and feeling safe that if I needed to not be there, everything is going to be taken care of, it really helped me see myself. Something for me to address and to look at and to also make sure that this is something I’m modeling for other people. I’m modeling for administrative staff and provider staff how to be healthy. And these wake up calls and making mistakes is how I learn and how we learn. Another structural issue, something that I’ve tried to create to help myself, which also helps the functioning of a business and the healing environment of the clinic, is I want to have a friendly culture where each person matters. We’re very careful about understanding and making sure people feel comfortable. The clinical manager that we have in our clinic has a wonderful, friendly, people quality and approachability and an accessibility. That’s a very important skill to choose in my employee staff member who’s managing others.
We also have daily group meditation, and that’s not something that’s required, because you can’t require meditation, but we’ve got the administrative staff and all the provider staff participating every day, and then each of us will lead it. It’s not just led by one person. There was a period of time when I first introduced it where my provider staff did not attend. Then that was a process of not making anyone wrong and understanding what were the dynamics that were occurring where people didn’t feel they had time or they didn’t feel it included them or that it wasn’t important and also not making them wrong but also creating the condition so that we could all attend so that it can be managed and brief enough—something that was accessible for everyone that we could all participate in as an important scheduled time in the clinic. I also have made time in the schedule for some authentic communication with the providers themselves. So that means we discuss things that are hard. We talk about things that are challenging. We talk about things that we’re not doing well and where we need input. This could be about maintaining healthy boundaries with patients. Working with boundaries in functional medicine is different from a conventional medicine model where you have more contact sometimes between appointments and you need to manage expectations and also your own time boundaries and self-care.
We talk about how to manage time with preparation for appointments, documentation time, ways in which we’re doing personal and professional development and growth. Sometimes that’s shared, sometimes that’s individual. So as professionally appropriate in a business setting, we talk authentically and also support each other and are helping to lift each other up.
Really, it’s boundaries, and I think you’ve really highlighted the importance of boundaries. What we know from practicing medicine is we spend time in the office with the patient, but then there’s so much time outside of that encounter, whether it’s prepping, charting, or portal messages, that takes time. And if we have competing interests with family or our personal development, that can be really challenging. I’m glad that you brought up kind of this intro into having healthy boundaries. One of the most common pain points that we get from our conventional medicine colleagues is this concept of the treadmill practice, where you see patient after patient after patient. And that sounds exhausting, but it’s the reality for many clinicians. So Georgia, what kind of resources do you have to support clinicians who are currently in these treadmill-type practices, or what advice can you give to create better balance? You’ve already highlighted some tools, but I’d love to hear your thoughts.
Well, I think that one thing that’s very important is that it’s very important to recognize if we don’t manage some of the mental health conditions that we’re experiencing as clinicians, it’s more likely that that’s going to negatively impact our professional reputation and also our practice rather than just reaching out for help early. So that’s very important. When you’re in a treadmill practice, when issues are coming up—and they come up in life whether or not we’re in the most well-designed practice or when we’re in more of a treadmill practice. When we have quite a heavy work expectation and also where the way that work is conducted and the way that people are communicating and working together is, it can be pretty tough. So I did want to communicate that many clinicians are concerned. People come and mentor in our clinic and learn how to apply functional medicine. They’re concerned about state licensing boards and about reporting personal problems.
What’s going to happen if I actually seek help for depression or for anxiety or for panic and if I ask for help? Many states have updated their reporting so that only functional impairments and malpractice issues need to be reported so that you don’t have to be penalized for getting a diagnosis or for receiving treatment. A lot of clinicians are confused about that. They’re scared, and they might pay cash for diagnosis and treatment when actually some of those regulations have really been updated. So I also think, when we’re in a treadmill practice, we sometimes don’t even think of the possibility of volunteering or giving of ourselves. One thing that I’ve noticed is that caring about ourselves, it is actually more about the “we” and being involved in these meaningful endeavors where we are connecting with others and also sharing our values. In my own clinic, we have brought in a consultant who’s working with us about a mindful anti-racism training. This has just changed so many dynamics in our clinic where we’re discussing things at a different level and working with strategic partners, and that’s actually more of a giving of ourselves and working toward a higher goal of giving back.
My keys for if one is in a treadmill practice are really about routine and rituals and relationships. It takes a certain amount of discipline for me to see how I can create my own joys rather than my own suffering. So how do I create a schedule where I fit myself in? Where I can actually begin the idea that I’m first—and this is something that feels very alien to healthcare providers, the fact that we put ourselves first. I’m new at this. Is there a sacred time every day for silence, even if it’s just for only a few minutes? And when can we have that contact with that unlimited part of ourself every day? When is there time for us to let down and release those pressures? Riva was talking about how she uses that time or used that time at the gym for that. When are the breaks in the day? Am I taking a break at any time? Or also, when is lunchtime? Am I taking lunch? And we talk about this as a provider team. Am I setting a timer for patient preparation? How much time is there for me to prepare my patients and document my patients? What time is my day supposed to end? And do I actually end the day at that time? And sort of keeping track of that.
Great. Thank you for so many of these clinical pearls. How can we build space in our day to focus on ourselves? Riva, you talked about sometimes when you were seeing patient after patient after patient, the only time you got was to take a moment in the restroom, just to decompress for a minute, and maybe some tears were involved. So based on your experience—Georgia already gave us several kinds of pro tips—anything that you would add to how do we cultivate a culture of self-care in the office?
One thing I would add, and Georgia, you’ve done such a great job of creating this within your practice, is I have a solo practice. It’s me, myself, and I doing my boutique concierge practice. I don’t have any staff yet. But one of the things I would recommend to people like me who might be doing functional medicine in a telemedicine space is to have your tribe of mentors and your tribe of, like, “master minders.” People who you can go to, especially outside of just the medical career. I found it so important to have alternative perspectives on how to navigate our way through the stressors of running a business. Right now, given the unique COVID situation, we’re all dealing with a lot of unique stressors, which we haven’t faced before. I’ve had to restructure how I’ve operated my practice, and I’m grateful that I do have the flexibility to make those shifts as I needed. But I wouldn’t have been able to do that had I not had people in some of the personal development programs that I’ve done who I could turn to. Some of the incredible mentors.
Shout out to my dear mentor Gladys, who’s been just a guiding light for me for the past couple of years. Seeking help within your career and within your space but also with people who can broaden your mind to how to operate within your work, within your family, because we’re not in this alone, and it’s so easy to feel in the midst of a stress that it’s just you carrying the burden of everything on your shoulders. You’re the only one who has to figure it out. You have to carry it, and there’s no end to whenever you’re going to be able to put this burden down. Some other things I would recommend for people is to create that sacred space for you within your home. I have a lovely patio, which I get to escape to, and sometimes, I’ll just sit on the sofa out there and stare at the sky and just watch the clouds move by for a few minutes. Going back to the environment thing, creating that sacred space for yourself within your work environment so that you can, whether it’s just for sipping a glass of water between your patient consultation or taking an extended break, you have that sacred outlet to restore yourself.
The other thing that comes to mind is having a regular vacation. That’s something that all of us, I think, are needing, like a six-month-long vacation after what we’ve been experiencing. But it might seem like the work is never going to end, and there’s so much to do always, especially when you’re a business owner. So giving yourself not just those breaks in your day, but something to look forward to on the calendar that might be a mini vacation for the weekend. Having something so that you know that there is going to be a temporary pause in the demand. I like to go unplug. Actually, I was kind of unplugged this past weekend, which was so nice to just know that there’s not going to be that demand for your time and that you can be completely present with your loved ones or even just completely present with yourself for a span of time. It’s so key. One of my goals for the rest of this year is to have at least one week of vacation every quarter. So Georgia, Kalea, please hold me accountable to that. Make sure that I actually do it, because we all need help. But taking time: short, long, whatever you need, is so important to keep ourselves in balance.
I also wanted to add, because it’s specific to this question that you’re asking myself and Riva about treadmill practices, I was talking with a physician colleague this week, and because of COVID and also the work distribution of duties and the life issues that are going on in their clinician team, there’s a maternity leave issue that’s come up there too, and there’s a new hire that’s delayed her start date because of a maternity issue. My friend actually has a daughter who contracted COVID, and she was trying to figure out how to handle the work expectations, and she’s getting emails from the administrator saying, “You need to close your charts, you need to get these done.” While she’s staying at home caring for a child who is in quarantine, she’s got another daughter who’s not, and there’s homeschooling taking place where she’s supposed to be working and also supervising the school at home.
We talked about how she was trying to figure it all out, thinking, “Well, I don’t think I’m going to ask that person because they’re very busy, and I’m not sure I can ask this colleague because they’ve got a lot on their plate, and I don’t want to keep on asking.” We talked about, especially in that type of treadmill situation where we start to feel like, “Well, I just have to suck it up, and I just got to figure it out,” that she needs to bring it up the chain and say, “This isn’t working, and I don’t have anyone to ask to cover me, and I need coverage.” And so, even if we’re not in these more ideal practice environments, we’re trying to create better work environments for ourself, and if we’re in a situation, we need to actually find our voice and speak up and say, “This isn’t working” or “There’s a need that’s not met, and I’m not sure what the answer is. Can we find another way?” As opposed to just, we make it work, and there’s something that we’ve been talking about more and more where we talk about trauma.
Trauma can be more widely defined as, it’s just too much for me or it’s too fast for me. It’s just too much at this time. That’s something that we normalize in medicine, and we just deal with it, and there’s a cost to putting on a brave face and moving forward. That’s a cultural learning that we can also unlearn. We don’t need to forget ourselves. We don’t need to deny ourselves. We can honor ourselves, and we can find our voice. And we do that by supporting each other to practice a new way of relating to self and others.
Thank you both for this advice. I love how we’re bringing the conversation into reaching out to others, reaching out for support. Riva, you talked a little bit about mentorship, and I just wanted to revisit that for a moment because that’s been one of our top priorities at IFM, is creating opportunities for mentorship. And I know, Georgia, you do a lot of mentorship as well. I think it’s really important that we kind of remove the shame of saying, “Wow, I really want to actually take advantage of the collective experience of those who have come before me because that insight is really valuable and can help me be a better provider.” So taking advantage of mentorship opportunities and just putting it out there, owning that it does—that you don’t have to know all of the answers, and that it can actually relieve some of your burnout if you use the tools and the resources that you have available. So just wanted to highlight the importance of mentorship, and I love that you brought that up.
I want to shift a little bit and talk about how physician burnout might affect patient outcomes. Because who we’re showing up as in the room can definitely, I think, play a role in how we interact with our patients. So Riva, let’s start with you and get your thoughts on how does physician burnout affect the care? Are patients still getting quality care when their physician is burnt out?
That is a fantastic question. I think we all have a good idea of what the answer is. Patient outcomes are not going to be optimal whenever we’re burnt out. So flashing back to my residency days, I was completely detached. I was dehumanizing everyone because it was just like, ugh, this next thing I need to get through before I can get home and just numb my pain. So we’re not able to see this person, the human. We’re not able to relate to them. We’re not able to see those subtle signs that we normally would if we were connected to our own spirit. Because as doctors, as physicians, we’re healers. And yes, it’s physical work we’re doing, but it’s also spiritual. We’re all connected as human beings, and part of that—and what I love about functional medicine is the center of the matrix is mental, emotional, and spiritual factors. I think all of us who’ve been burnt out can recognize that mentally and emotionally and spiritually, we’re just energetically bankrupt when you reach that point.
We have no energy or insufficient energy to bring to our patients to aid their healing process. And so at that point in time during my residency, yes, I was able to check all the boxes, follow the protocols, do what I needed to do to get them discharged within a couple of days, but were they truly healing? No. I was doing status quo medicine, and I didn’t feel good about it, they didn’t feel good about it, because they were coming back into the hospital within a week or two, and it was that same hamster wheel again. Fast forward to now and where I am today in a solo practice. I have burnt out, not because of any lack of connection to the people I’m serving or connection to myself, but it’s the sense of: okay, I’m the administrator, I’m the marketer, I am the physician, I am all of these roles, and it never ends.
Especially now that we’re all working and living at home, it’s like, where is that division of work and life? That line is so much more blurred now. I’m grateful that I have the ability and have had the ability whenever I recognize I’m tiptoeing that line again toward burnout to say, I need the space. I’m taking a one-week mental health break. My patients understand the value of mental health because I’m coaching them on it every single day, I’m setting that example for them. I have been able to bring myself the healing that I’ve needed whenever I’ve reached my limits. But it’s very hard to do. I was up against that limit, and it was, again, my mentor who had to tell me take a week off. And I was like “Oh, right. I can do that because I set the rules.” My practice is for me. Of course, it’s in service to my incredible patients, but I’m doing this work because I want to feel whole doing it. Whenever I reach that point where I start to feel depleted, it’s my responsibility to take a step back and fill my own cup.
It’s a constant reevaluating process that I have to do to check in with myself to evaluate where am I to see, “Okay, am I okay to move forward or do I need to take a step back and preserve my energy so that I can keep this momentum going in the long run?”
Yeah. Thanks for highlighting it’s not just the image that we present when we walk into the treatment room, but it’s also modeling. Modeling for patients that things like boundaries and self-care exist is important and is a priority, so thank you for that. Georgia, how about you? Any thoughts on how physician burnout can affect our patients’ outcomes?
This is such a good question, because there’s this continuum. So on one end is burnout, where we’re not in a good place mentally, emotionally, physically, spiritually. And there’s this continuum. Then somewhere along the lines there we’re going through the motions or we’re sort of keeping up, we’re keeping up with our roles and expectations of ourselves and then our expectations from others. I really feel like the full transition to functional medicine is a little bit farther along on this continuum where we’re actually starting to embody what Riva’s talking about. We’re talking about embodying health. There’s non-verbal messages and a lot communicated in an appointment, and it’s partly, “Yes, I’m taking care of myself, self-care and modeling,” but there’s something even more profound when we actually make a full transition to functional medicine and to integrative medicine, and how are we supposed to have a doctor-patient relationship if we’re not present? It’s not easy to be present. There’s a lot of competing areas to attend to when we’re in medicine. There’s many things to keep track of, and there’s so many things to accomplish in an appointment. How are we supposed to also be embodied? Remember that we’re connected and actually feeling and in ourselves while this is happening. This is not easy to do.
I think we’re really missing the essential piece. It’s like I feel like the art of medicine does arise from the mind, body, spirit, and the integration of the provider. So when we’re mentoring, we want to be mentoring so that we’re getting our questions answered, and we’re having a more dynamic understanding of where symptoms come from and how testing plays a role and we have a deeper understanding for the body. The body doesn’t lie, and it’s not wrong. We’re not trying to fix it. We’re trying to inquire and to learn from each patient. But there’s also another aspect where I feel it goes hand in hand with mentoring and really learning the medicine and applying the medicine, which is the internal integration of the healthcare provider, of the doctor, of the nurse practitioner, whoever is practicing the functional or integrative medicine. It’s a personal healing process. It’s a paradigm shift. We are the ones that are in the appointment, so we are defining, who am I? What’s my identity? Who are you? I’m the doctor. You’re here to get fixed or I have the answers you don’t. This is about me giving you something or me taking care of and checking these boxes, and then we’re done.
That’s one way to define medicine. I define the identity and what the transaction or the interaction is and what the relationship is and who you are. I can’t see you, and I don’t know who I am unless I also have that as part of my training curriculum. The training curriculum is mentoring, but it’s also a rite of passage, it’s being a member of a peer community and also feeling like someone cares for me. I care for me, but I’m also being cared for. I’m not just a productivity unit, and that’s why many of us transition to functional medicine, is because we want a different quality of life and way of practicing and a medicine that reflects our values. I just want to pair those together. The mentoring and the applied training with the internal shift and paradigm shift and the health and honoring of ourselves, which really is necessary and goes hand-in-hand to fully transition to functional medicine.
That’s great. Thank you for connecting those dots for us. It reminds me of when I’m first introducing patients to the functional medicine matrix and I’m talking to them about all of the body systems. So I’m showing them the nodes and I’m saying, “I certainly care about your physiology, that is crucially important. But at the center of all of this is this mental, emotional, spiritual component. Your lived experience. So we care about what your labs say, but we also care about how you’re walking through the world.” I think that kind of touches on what you just spoke about. It’s like all of the business aspect of it. Riva, you’re doing all of these things. So the admin part of doing medicine is important but also our lived experience as practitioners. So that sense of meaning and purpose, which is so vitally essential, and I would love to hear, as we’re coming to a close, as you both have worked through various stages of burnout in different practice settings, how do you remain anchored in your own purpose? Especially with working in maybe a treadmill situation or being a solo provider and so you’re wearing all of the hats. How do we remain anchored into that sense of meaning and purpose? Georgia, we’ll go ahead and start with you—and love to hear your insight.
I had a lot of needs and kind of figured out by stumbling through and moving through my own personal development and clinical process. I kind of identified that there were some things I really would have appreciated being supported in and certain types of help. So what I’ve done while I’ve evolved personally and as a business owner, I’ve tried to create those things for others by listening to what I would have really liked to have had during my early and middle and onward journey. The daily meditations that we have, like these resources on our website where you can just sign up for free, just download, you can just do your five-minute recorded healthcare provider daily meditation. This is something that we’re doing every day, and we wanted to share those. We noticed that those resources have been very helpful. Also, what I created about six years ago was a monthly group where I created it for myself. It was a self-care focus. It’s not a networking meeting, it’s confidential, and it’s for healthcare providers, so we call it Healthcare Workers & Integrative Professionals Monthly Group.
And now it’s on Zoom, and at six months, we have what I feel is an opportunity to actually practice mindset, address emotional health, create a sense of community. I find it’s my favorite thing to do every month, and it feeds me and it feels like a soulful activity that that’s how I help to keep myself oriented. Fully oriented in the way that I like to be oriented. Also, we’ve created some other free resources on our website. So we have a little kit. You can download your free kit, and it’s like a little bit of a blueprint for the things that are hard and the solutions, and what’s the potential for functional medicine and self-assessment? We want to have more online retreats. We had retreats for healthcare providers since 2015. We want to have that place where it’s safe to tell your story and also to practice the types of interacting, the relationships, and those relationships really last when we connect at that level.
I also wanted to mention another resource that the Functional Medicine Health Coaching Academy had offered, and that is because they are very much in support of addressing provider burnout. So they have an initiative called Work With a Health Coach Initiative, and they are offering six free or reduced cost sessions for the healthcare provider. Now, you can also give a free set of these to a patient. I hope that we remember to do this ourselves; that we do the health coaching that already is offered, we don’t just offer it. Oh, there’s these free sessions, why don’t you do these free health coaching sessions? And the way to contact that is to go to functionalmedicinecoaching.org.
It sounds like you’re really finding your purpose in sharing this work with others and helping to guide other practitioners to how they can live optimally healthy and still take care of patients, so that’s great. How about you, Riva? How are you anchoring into your purpose to continue doing this work?
I love this question so much because it can go in so many directions. It’s infinite the ways that we can anchor ourselves and the journeys and figuring out what works best for us. So I recently came up with this acronym for my morning routine, which is P JAM S. This has been the most anchoring thing for me in staying connected to my work and my ‘why’ is having my sacred space in the morning. My morning routine. And so the acronym that just came to me is, PI JAM S, pajamas. So prayer and setting an intention. So P, I. Whether it’s a religious prayer or simply just speaking to the universe, like this is what I need to get through this day or this is what I’m feeling and just releasing that and saying this is where I would like to go. There’s so many mornings I wake up and I’m sensing that sometimes dread, sometimes anxiety, whatever it may be, or I’m starting to drift away from that purpose. It’s like, “Oh wait, I have everything I need within me already, so it’s just a matter of bringing myself back to that. Coming from a religious background, prayer is part of my morning routine.”
Simply just saying, like, today my intention was to step through this day with calm and peace and speak my truth, and I believe I’ve done a decent job bringing that so far, but again, it’s like a moment by moment thing. Checking in with myself and seeing, am I connecting back to that intention? The J is journaling. So it might be doing 10 things I’m grateful for. Sometimes it’s a little bit more of a struggle and I can only think of two, but committing to getting something down on the paper so that I can see the abundance all around me. There’s going to be hard days. There’s going to be days where you feel like nothing is going right. But if you commit to the practice, you’ll find there are more things going right than wrong on a daily basis. It’s just those wrong things are stickier, and they stick to us, whereas the good things, they tend to be a little more slippery, and we forget how wonderful our life is, even in the midst of all the chaos around us.
So the J is journaling. The A is actually what I have right here in front of me. Apple cider vinegar and water. Getting my body anchored. Getting my gastric juices stimulated so that I can digest my food well and provide all the energy I need for my body. That’s something I struggle with so much is going through my day and not hydrating appropriately. If I can start my day, and I’m little bit delayed, because here we are, and I still haven’t finished my morning routine, but committing to the practice of knowing that, okay, I’m going to make it through this bottle before this day is up. Having at least that goal in mind of where I’m going with my body is so important because it’s easy to leave our bodies behind whenever we get into the hustle of our day. Then the M is meditation. I like to spend some times in meditation. It might just be in complete silence. Sometimes I’ll play one of my favorite meditation tracks. There’s this heart meditation that I love.
The app I use is Insight Timer. Really great. It’s free. There’s so many resources out there for meditation, and so having a ritual of going to this one track day after day is so grounding. I know at what point that I really drop in and I know how to regulate my breathing to the rhythm of the song. If I’m having a particularly stressful day, I might go back to that meditation several times, but getting my day started with it has been such an anchor for me and connecting my mind, body, and spirit and aligning myself. Then the final part is S, stretching. This morning—you asked if we did our little shake out before we got on the call today, I did some foam rolling. Doing something. It might be some gentle stretching. It might be yoga. I haven’t been in the gym as much lately because gyms are still closed here, but doing something so that my body can release the tension. I can get the blood flowing and just feel the power within myself is so key. And so between the elements of PI JAM S, prayer and intention, journaling, apple cider vinegar, meditation, and stretching, I’ve covered the mind, body, and spirit, and I’m walking through my day feeling completely aligned when I’ve done all of those.
I think I’d love to follow in Riva’s shoes and also say that some things that are really important to me that I’ve had to learn how to do is to plan my day. I do have that quiet sacred time in the morning, and I do meditate every day. One thing I didn’t do as routinely was actually look at the day and say, what’s really important for me? I’m pretty good at having lunch, but is the lunch rushed? Am I breathing? Do I actually see people when I’m sitting next to them and sharing that lunch meal? So planning my day and maybe even deciding at the beginning, it’s really important for me to have a little bit more time when I’m having lunch today. Looking at what’s important today and some of those transitions or priorities. I have a bunch of patients in the morning, and then I can dive right in and do patient messaging or right in and address email or right in and address projects or look at all the questions that are coming in from the rest of the team members and the providers.
So now after I do my patient care, I have in my schedule, I want to take a break. I want to stand up. I’m doing telemedicine. I need to walk around before I dive right back in and just keep on loading up tasks. Going to bed on time and just identifying what I want to remember to do, that has helped me. It’s amazing how things can actually shift and feel different and be possible, because I’m changing and I’m so heartened by that. Now, some things that I have not accomplished and I’m working on are actually exercising every day. So I do exercise, but do I really exercise and get the steps in every day? No. And am I perfect at the end of the day finishing it when I’m supposed to end it? No. So I’m working on those. And I really loved what Riva said about we forget the good things that happen every day. We have these beautiful experiences or these exchanges or just someone reaches out with such compassion or someone says something to me and I think, wow, do I really let that land and do I remember that? It’s easy to forget all those wonderful moments. It’s important for me to somehow savor and safeguard and prioritize those in my memory and my experience, because I can remember a lot of other things throughout the day, but do I remember those joys and pleasures?
I had just a paragraph, very brief poem that I’d love to share. Something that we sometimes share in the monthly healthcare provider’s group, and I just love that group. I hope that people will consider joining. It’s the first Monday of the month from 8:00 to 9:30, which is early, but there’s never a good time to have a healthcare provider group because we’re working. But it is at 8:00 in the morning. It’s not recorded, so you have to attend. This is a poem that we sometimes share by Martha Postlewaite, and the name of the poem is called Clearing. And it says, “Create a clearing in the dense forest of your life and wait there patiently, until the song that is your life falls into your own cupped hands and you recognize and greet it. Only then will you know how to give yourself to this world so [worthy] of rescue.”
So [worthy] of rescue. Thank you. That was a beautiful way to close. Thank you both so much for sharing your truths with us. I want to honor the vulnerability that comes with having these types of discussions and what we kind of call these crucial conversations. So as physicians, we just wanted to take care of people, and as rewarding as that is, it does come with a certain amount of pressure. The world at large is grappling with this COVID-19 pandemic, and in many ways, healthcare providers are bearing the brunt of that with increased work pressure, increased demand—expected to work long hours. So these insights that you both have shared from your experience are more important and more relevant today than ever. Thank you both so much for being with us. It’s been an absolute pleasure to talk with you today.
Clinician Support Resources:
Resources from Philadelphia Integrative Medicine and Georgia Tetlow, MD:
- Provider Wellbeing Framework
- Find community and fellowship with the monthly Healthcare Workers & Integrative Professionals Group.
- Participate in a nine-minute loving-kindness meditation led by Dr. Tetlow.
- Download a free Honor Self Starter Kit or visit the Provider Resourcespage for additional five-minute morning meditation, self-care talks, and more.
- Functional Medicine Coaching Academy is supporting provider burnout with six free or reduced cost sessions for the provider and/or one of their patients. For more information, email email@example.com Work With a Health Coach Initiative in the subject line, or call or text 833.225.3265 for support.