Special 005: Physician Burnout

Hi everyone. My name's Dex Randall, and this is the Burnout to Leadership podcast, where I teach professional men to recover from burnout and get back to passion and reward at work. So welcome to the podcast today. I am very lucky to have with me, three physicians who have experienced burnout. And what I would like to cover today is the specific issues and difficulties that may come with physician burnout, as opposed to other kinds of burnout. And what I'd like to do rather than introduce each of these, guys to you is allow them to introduce themselves much better. So, Mike, would you like to introduce yourself first, please? Sure. Thank you Dex. Happy to be participant in the panel this evening. Thank for putting this together. I think it's gonna be beneficial for all of us, especially myself, but, I'm a practicing physician on the east coast, the United States. And frankly, was introduced to you indirectly through my colleague buddy, the lower left hand corner, Jon. And so I kind... I'll leave it there, some questions get into. Terrific. Thanks, Mike. How about you, Jon? Yeah, thanks Dex. You know, I'm Jon I'm a physician in a Midwestern academic university. I've been physician here for... This is my 20... Going into my 24th year here. And we can get into the reasons why I'm here as we go into the discussion, but it's great to be on the panel. And I'm lucky to know both of these guys personally and can vouch that they're good people. And so this is gonna be a real valuable conversation. Thank you very much. How about you, Dustin? Yeah. Thanks Dex. So Dustin I'm, Midwest academic medical center was very fortunate to have Jon link me with you Dex. About six months ago, I would say, and so I think it it's been quite a journey and we'll talk about that a little bit and get into it specifically about as a physician going through the journey, but couldn't thank, you know, both you and Jon anymore. That's lovely to hear. So let's begin. So I might ask you a few questions, but feel free to respond to each other as we go through. But my first burning question for any of you, whichever one of you wants to jump in first guy ahead. What did burnout look like for you as a physician? I guess since I'm the OG of the group, I'll go... I'll answer first. And I didn't really know what was going on with me, to be honest with you. We were, you know, in the midst of when COVID the COVID outbreak started, I have a pretty heavy job here at the university for operations. And I was tasked with was sort of driving COVID operations on many different fronts. And was working a lot of hours. And I, you know, personally, I think I stopped putting fuel into my own self and was concentrating solely on helping other people and slowly but sure I, surely my tank, my personal human tank became more and more empty and I slowly morphed into human doing, which I've talked to Dex quite a bit where nobody at work would've known this was going on with me. But I sort of became numb and almost robotic in terms of what I was doing. I was just sort of very task oriented, not a lot of emotion. And then when I would have emotion, it was overwhelming and I would use strategies that weren't healthy to buffer. I would, you know, drink alcohol or eat, or have poor sleep. I mean all the above. And so this sort of escalated, kept escalating until you know, my family sort of noticed that there was something going on with me and, you know, my wife is a life coach and recommended that I find Dex and I totally out of my DNA to reach out and do something with this. When the first time I talked to Dex, it was very intimidating for me as a human being. And I could get into that later, but, that's sort of the nuts and bolts of how I found Dex and started my journey to sort of finding myself again. Thanks, Jon. Yeah, I guess I'll jump in. So I think really, for me, I had not noticed that I was in a chronic state of burnout probably for a few years. So I was, I got a secondary degree. I got an MBA, I was doing night classes several nights a week. And that kind of finished right around the same time that COVID started. And so coming out of that, going right into COVID, you know, probably about a year ago, I started noticing, you know, I would just try to put more hours in, you know, I'm trying to put as many hours into the day to try to get that high functioning, you know, work output that I wanted to get, but then I'd cycle there and I'd feel like I would just crash. And then I'd be to a point where, you know, I couldn't get myself motivated, things that should have taken 45 minutes were taking three hours. And then I just got into this cycle of beating myself up because I had this kind of perfect version of what I thought I could do in a day and what I thought I could get done. And then I get into these cycles where I just couldn't motivate myself because I just frankly, was burned out. And I couldn't concentrate. You know, we talk about buffering. I was doing other things to try to get my mind off of what I should be doing, just because of the mental power that it took and kind of the uncomfortable ness of kind of pushing myself into doing some of the tasks that I knew I needed to do, but at certain points I just didn't want to do them. And then I, you know, became to be almost like a stranger in my house because I was, as COVID continued to go through... There became much less of a blurry line of what was work and what was home. When you can leave work at work, when you're doing calls at home or taking meetings and that, all of a sudden the line became very blurred and I felt like I was just pretty much working through the whole day until I went to bed. And when I wasn't working, I was thinking about what I should be working on or feeling guilty about what I should be working on. And so, a lot of stress, headaches from stress, relationship with my wife and kids very much changed. And so I think that's what kind of pushed me... As the relationships changed, that's what kind of pushed me over the edge to seek help. Thanks, Dustin. Well thank you Jon and Dustin, going first. As I sit here now, I'd have to say that I probably had been a burnout for upwards of 15 to 18 years. As Dustin and Jon will probably agree, we at an early age figured, or kind of decided we wanted to go into medicine and knew that that required very good grades and you had to be perfect all around in school, extracurricular activity, so on and so forth. And so this perfectionism was kind of an entrenched in our mindset. And that was my theme throughout training as well. Things had to be perfect. I was trained to be astute and on point, evidence based, exact, precise in everything I did, my decision making had to be defensible. So I expected everything and everyone around me to be perfect. And we all know that that's just not reality. And that was the fuel for growing anger within me and frustration and anxiety. And then when things weren't perfect, I tried to control them more and that was futile. And that just, in a positive feedback loop, led to more anger and frustration and anxiety. But it all kind of came to a head over a span of 12 months between March of '19 and March of '20. I encountered two additional extremely... Stressors in my life. March of '19, I lost my father to a neuro degenerative disorder and then 12 months later, I had to close my practice for two months because of COVID, my only source of income. And I later learned that there's research showing that you can predict the probability of a health affecting illness when there's certain extreme stressor events that occur within the preceding six to 24 months and at the top of that list is loss of a loved one and loss of income. I remember one morning, this was months after shutting the practice and reopening, just waking up and feeling like I got hit by a truck. And I had developed symptoms of brain fog and just muscle aches, joint aches. And I knew that this wasn't acceptable. I had degraded from someone that was physically active routinely, ate well, was busy and productive and doing research, presenting, travelling to present, and then feeling like, just, crud. And I initially started working with a functional medicine physician and we... It helped, but really, I was lucky in that my wife, who's good friends with Jon's wife, she is also a certified life coach. But I saw her transformation going from similar type of stage that I was in back to this fun loving lady that caught my eye way back in medical school. And shortly thereafter is when I started more about you Dex and got plugged in with you. But it brought out... It was what, I think, to encapsulate my key point here is that I didn't realize really what burnout was. To me, it was just work harder, put the weight on my shoulders and plow ahead. And at the center of that was I didn't know what help I needed or how to go after help or what the help even looked like. I wasn't aware of the positive effects of things like meditation, self coaching, even how to tap into the quantum field. But now I'm in a much better spot after having been working with you for the past nine months ish I believe. Jon and Dustin, I'm keen to hear from you about, did you know you were in burnout and what brought you to me in the first place? I didn't know. To Michael's point, I didn't really know what burnout was. Michael and I are roughly the same age, Dustin's a little bit younger but... And I think Dustin was sort of at the tail end of what training was like for us when we were going through residency. We were routinely working 36 hour shifts every three days and fatigue was not an option. And we're not allowed to tap out and admit that there was something wrong. It was just this culture of medicine that permeated. And so you started to learn to sacrifice things for yourself and to move on. And so if you were exhausted, you still continued to move on. And so, now that's a lot different now in training, but nonetheless I was reminded of that when I was going through this process myself, but I didn't recognize it as burnout. I just figured,"Oh my God, I've got so much on my plate. I've gotta manage 700 physicians. I gotta manage COVID operations for this medical center." And that was the top job in front of us. The world had stopped and I felt a lot of pressure to execute a plan that was gonna help save people's lives potentially, and then protect the people I work with. And so, no, I didn't. I had no idea until... Maybe something Michael just said, I came home... I think Dustin said it too... I was coming home, I was drinking too much. I was not engaging with my family, it was like I was a stranger, I would come home, I would crash, I would go to to bed, I would get up, and we're talking 18 hour days, and then finally my wife sort of recognized that I was spiralling, even though I didn't and I was lucky 'cause she saw that in me and I thought not sure I would have seen that on myself until someone would have seen it for me. Yeah, I don't... I think if you know you Google burnout and you look at the symptoms, you think like, "Yeah maybe... " And at times that I thought, "Well, am I just depressed, like seasonal or? If I could just be a little bit more efficient with my time, it will all be okay." As you grow in some of your positions and you think about, "Well, this is just something new that I learned to do, I'm just not as good as I should be, and I need to be able to be more efficient with this." And I think coming out of residency, the expectation is like 12 hours, if you're working less than 12 hours, what are you doing? That's just kind of like a base expectation, and I realized if I'm not working at least that much, then you feel strange, and it's almost like you go in to work and if you're leaving after eight hours or 10 hours, it feels almost like you're cheating the system, in some way. And I was not seeking out any time for myself to kind of renew anything as far as exercising, got away from a lot of those things that I try to rejuvenate my own self and my own interest, I really had no interest outside of work, and I really struggled to find the things that really gave me any positive feedback from that standpoint. Dex, one thing that Dustin just said that reminded me of something that I think is unique for burnout for physicians, is that... The core principle of what we do is to help other people with... You're trained... There's plenty of people in other professions that work the hours that we do. Have the pressures that we do, it's just the concept of you're trained to help other people at all costs and do no harm and maybe it's sacrificing yourself to do so and I think that's a unique component of a physician in nursing and other health care fields where in nursing are probably even a huge area where we're seeing this as well, or that's the way we're wired to help other people and in spite of yourself. Yeah. I can add as well. We feel a sense of duty, responsibility to care for others, and it seems unnatural to refocus that or shine that light inward, at least it was for me, to realize I need to take care of myself differently than just eating broccoli and jogging or lifting. So it's not natural to look inward and take care of ourselves first at least as a physician, and I didn't recognize I was in burnout. Frankly, I was looking at other reasons why am I having this chronic fatigue illness or whatever it is, was there mold in my environment? I'm looking around and rule those things out, but still took a little while to realize, this is the outcome of negative thoughts or not taking care of myself emotionally, spiritually, so... When I'm listening to you there, you're all making it sound like burnout is normal. You wouldn't notice you're in burnout because that's how you're expected to conduct your work. I'm curious because physician burnout is so huge these days, if you think there are other specifics to physicians that have them ending up in burnout? Yeah, I think all the things we just said, but also I think there are barriers that are intentionally put in place to... In some, depends on the specialty you're practicing, but there are probably... There's cultural barriers that are put in place in different types of medicine where you may not recognize it yourself, but even if you do, there are people who aren't wanting you to admit that there's an issue. Work hours, pressure, performance all these things, and so we see that constantly in medical centers where folks are struggling, they may have the lucky ability to recognize that they're struggling, but it's not a cultural norm or encouraged to go out and admit that you may need some help. Yeah. I'd say there is very much a denial of anybody's personal vulnerability and the culture of no failures, I think from that standpoint, and I think perfectionism and trying to always do the right thing in every situation with patients, but it spills over on everything else, and then I think a lot of some of the pressures with physicians over the years with documentation, expectations, regulatory requirements and hassles, and frankly it can be pretty isolating as a physician in many practices, because a lot of times you're working at the top of the level. You may have people working along with you but it's a very isolating situation when you're seeing patients in many ways, that you realise a lot of high self reliance, and so it's a pretty introspective and leads to a lot of beating yourself up. Yeah. I think we're kind of touching upon the de personalization of medicine, we as physicians are now consumed by... The need, the feel or the impression that we have to toe the line, we have to document a certain way, we have to match this EMR, we have to do this, we have to be compliant with all these regulations, MIPS and SACRA, so on and so forth. And these are different pressures than just drawing a connection with the patient. Demonstrating compassion, and being present in the moment remind ourselves of what our intention is. I think that's probably... I mean, I can tell you that and these guys probably share this sentiment with me, it's frustrating to think about, I gotta get this information so I can document properly and check this box when... By the way, I'm there to figure out what's going on with this patient, not just why they're hurting or whatever, but what they're not able to do because of that symptom. Are they disconnected from their sense of purpose because of this? And what role do I play in getting them back there? So to me, the sense of satisfaction is, at a minimum, deluded by the current healthcare delivery system in the US at least. Yeah, that's quite interesting and I'm hearing that quite a lot. Well, what other barriers do you think that physicians might experience though, to getting help with this? You've mentioned a couple of them. I'll go first this time. I think so someone like you, Dex and Jon's wife, Melissa, my wife, Arpita... People who've gone through the steps of dealing with burnout to the point of, I don't know... You guys know Dexter's story, but Dex... There were physical signs of your burnout at one point and then you emerge on the other side of that successfully, then are sharing with us how resolve this for ourselves... But I mean, if I were to look... If I were to first say, Okay, I need help... Recognize I need help and admit to myself, I need help. What kind of help... What would that help look like? And it's hard, it was, for me, at least to put a picture to that question or that answer is... It's another professional, what kind of professional, other physician? I went to some internists here locally, and became apparent to me early on that this was gonna be a non traditional, if we let that be the label for a moment approach to get any better than the traditional medical approach. So I think what I'm getting at is just asking for help and recognizing where the help would come from, professional life coach who has expertise in this exact area. So I think the awareness of that probably needs to be improved among physicians. Okay, let's investigate for a minute this non traditional aspect. And I don't mean that because I'm advocating that, that's what I think probably maybe Dustin and Jon, you tell me what you think, healthcare providers might label a non traditional or a non physician based approach to this problem. And the whole... Dustin touched on this earlier, you look at burnout. It's a contentious topic, because there's not a legitimate or a well accepted diagnostic process to figure that out or criteria. And that's kind of what I encountered early on when I was talking to some local colleagues too. I think that's right. And I mean, Michael's said it a couple of times, my wife has got a bunch of certifications as a life coach, and even when she was asking me, or suggesting that I talk to a coach, I was like, "What are you talking about?" And it was like, "what?" and it was sort of ironic, because she's a coach and everything but I really think for me, it's like you don't know where to go. And you don't know who to talk to? Is it your personal primary care doctor? Like Michael was saying, probably, I mean, maybe but maybe not. And to me, that's part of the reason why once I figured out what I was doing and how you helped me, I wanted to pay it forward to people I recognized were in similar situations and I remember the conversation I had with Dustin vividly about you and it was like paying it forward to you buddy, you sound like me. You need something 'cause I remember you talking about your family and you were struggling and I could see it and no one else could and nobody else at work was seeing that in you but I did. And then I remember Melissa telling me through Arpita that Michael was struggling and when I talked to him about Dex and and I think that's really way raising awareness of this option for people is really where it needs to go. And it just takes some time for that to spread. Not to belabour it, but I don't hide that I do this from anybody I put it... My admin knows it's on my calendar, I don't change the name of it. I mean, everybody in my office knows I do this. I'm not ashamed of it. My kids asked me how's Dex even It's just something that's part of what is become part of my life. So, that was a long winded answer, but I think figuring out where to go is a huge barrier for physicians. Can I just add a little to that for a minute, we should point out that not only is your wife a coach, Jon, but she's also a pediatrician. And I think that there's a rapidly increasing number of physician coaches, and now we're seeing more research coming out that this style of coaching has efficacy. There was a research paper came out a couple of weeks back... I should have also throw it out there that Michael's wife is also a pediatrician, so it's physician central here. It's almost as if it's kind of growing amongst physicians by stealth. Oh, yeah, I mean and I'll let Dustin chime in 'cause I called him out I don't remember the conversation we had about this, but I mean, he had all the signs of it. I could see it but I don't think anybody else including the people... He works a lot. And Dustin and I work together, but he has people on his squad that he works a lot closer with than me. And I'm not sure they would have known there was something going on with him. Not to that degree. And I think you know, after having conversation with Jon, and having some of the insight into his journey was pretty empowering for me to reach out and talk to Dex. I think it probably wasn't until several months into our conversations that I could have a better appreciation of more of what burnout was. I think, as I started peeling, some of the layers away and started feeling better about certain situations. I couldn't really, I couldn't see it. I couldn't looked at somebody else and say they're in burnout. But I feel like now, the further I've gotten down the road, the more that I can kind of see it in other people and the more that I feel like I can now say, that's burnout. And I think a lot of it's... Still there's a stigma of people reaching out and help. There's this thought that if I just work harder, I can figure it out myself. Or when I have time. And I know Dex loves talking about time as, as not being ours and how we... How we build it ourselves. And I think people just got... Get caught in a cycle and they don't know where to go. Yeah, I now agree that a lot of people in burnout don't know they are in burnout. Specifically, physicians often don't because that's the pace they've always worked at and the experience is not a new one for them. And I think you don't really need to know. I mean, I can encapsulate it as burnout. Burnout really is the exhaustion when throwing effort at a problem stops working. So we're fixers right? We're type A personality typically, we think we can just solve any problem by trying harder and I think one of the identifiers of burnout is that isn't working now the way that it used to. But when people come to me, I don't really require they self identify as being in burnout, but they will experience, chronic stress, chronic anxiety, extreme exhaustion, ongoing despair, and lack of motivation. And inability to perceive success or reward and fulfillment in their role usually come with it. But because some of so many of those experiences are kind of baked into people in physician training overwork particularly and giving, giving, giving, giving. That I think a lot of physicians may not notice they are in burnout and now I'm glad that you guys have mentioned that today 'cause my whole thing really is that... Because there's such... Almost an epidemic of burnout in the medical profession that I would hope to be able to reach more people who are suffering. How long do you guys think it took for you in coaching to just turn that around a little bit? What was your experience there? I had several tours with Dex. So I hesitate to say that I've ever solved... Ever moved on, I think this is gonna be an ongoing. Process for me. But I still have times where I have a setback and I need to kick... Get back on the rails and stuff. But I would say, initially for the first session we worked together I'll be honest, the first two or three sessions I'm like... I'm, "Russell what the hell am I doing here?" I mean... Like, "What are we doing here?" And then it sort of just started clicking. And some of the strategies you suggested to me sounded like for a physician who often of... A lot of us are cynical. Was like, okay, like Michael was talking about like this is sort of in our world a non traditional approach. But once I just said, okay, I'm gonna do this and I started doing some of it. It was really pretty amazing. I will tell you one strategy if you wanna give an example, that worked for me the best was my future self. What will my future self say about where I am? Like my future self five years, and in the future looking back where I am now, what would where I wanna be say to where I am now, and how would they talk to one another? And it almost felt like I was talking to myself a lot of the time, because I was. But once I had these sort of ability to see that I was able to see where I was improving and how I was interacting with people and how I was feeling and how I didn't care as much what other people thought of me. I wasn't measuring my success by other people's perceptions. It was what I was experiencing myself. I just sort of... The anxiety and stress sort of started to melt away like... Just started melting. And then I started to see the... Who the real person that had been sort of buried in this snowdrift of burnout really was. And I hadn't really been there to Michael's point probably for a lot longer many years probably than I would have known. Yeah, I looking back, let's say it was the first six weeks within the first six weeks of working with... Starting working through Dex is when I started to notice change. And you used the term in one of the sessions... Do you feel... You asked me, do you feel like you have greater buoyancy now? I said, "Shit, that's a good term." Yeah. That's exactly how I feel, little more resilient, little more buoyant, less angry, and you want... And you asked me to choose a metrical, we chose a metrical and that was used to measure my anger levels early on. And then after that it was anxiety levels. But for me, my career largely is centered around an impair basis from how I diagnose and treat patients and been heavily involved in research. So I needed to see some evidence that this was working and you help me understand it. Well, at the end of one is fine. Do you see changes that are evidence of the positive impact of what you're doing, that's all you need and you are correct. But I'll tell you, I was very fortunate because, there were folks ahead of me. Jon is the OG of the group and that's correct. He started working with you before I did. And it was the positive things I heard about Jon's experience with you Dex that... And then my wife, Arpita was like, "Hey Jon said I get experience with Dex." I think... And I heard this several times gently from my wife. And I knew in the back of my mind that I need to work with Dex. And then it just seemed the right time to do it, July last year. So... Yeah anyway, within the first six weeks is when I noticed change, positive change. And it's been a little positive from there on up since then. Yeah. I'd say, I had a lot of motivation very early on and I think the first... Yeah, I agree, probably the first six weeks when you started learning a lot about tools, some of the self coaching, figuring out what I was doing to buffer and acknowledging when I was doing that, trying to set schedule, those things that really try to coordinate my life in a better way, but I've had definitely... I've been at this for six months and, and I know I'm not what I would define as like at the end of that road, as far as... At a burnout. Because I think as Dex would agree to... I've had some bumps in the roads specifically in the last couple of months where I think I did struggled with situations where then I became a little bit more cynical about myself or, and got a little bit more down on myself. And I think going back to the things that got me in a better place, the self coaching models, the scheduling and those things, and then recognizing where... At some point I had to get past this idea that perfectionism is in my DNA. Like I was born this way. My dad was this way. This is how I'm supposed to be. And trying to figure out why that doesn't work for me, and what's a better model, it was pretty empowering for me? And that's one that... More recently I've been trying to tackle and move forward with... Because it's a difficult thing I think, to try to move past that and try to look past some of the criticism that you expect to get from others and, look a little bit more inwardly at the positive things that you feel about yourself. That's an interesting perspective. How much of the criticism do you think was coming from outside of you, in fact? And How much from inside? That would be 100% was self, I don't know, 95%, 100%. I mean, it was... That inner voice was mine and that's where all the criticism came from. I think that's something that people may not really recognize in themselves if they're having a difficult experience with stress anxiety. That's one of the angles that we can take, because this... If we self generate, if we... If our inner critics is on fire then that's something we have control over. Not everything about our work is something we do have control over. But I'm curious now, after I'm listening to you talking about this, how you're thinking about your future in medicine. Yeah. So I'll make a comment about that. I can confidently say that I'm not burnt out anymore, I think. And one of the things I've after I've sort of moved through that... Even though when I do have days where I'm... Yeah, Dex and I last couple weeks, I've had a couple of bumps in the road myself and I've had some grace for myself and realized that doesn't define me, and it's not... I'm not back to ground zero. It just got stuck in the mud for a couple weeks and I need to get towed out and back on the road. But one of the things that maybe we didn't talk about is Dex also helps with goals and vision and dreams, and where do you wanna be in five years, and how can we navigate your brain about being curious and being excited about those things and not being stuck in perception of what other people do for you. And so, for me, I was terrified of talking about my future to the point where Dex, I would've wait... I would try to shut it down. I decided I didn't wanna talk about it. Because as Dustin knows, I mean, the job I have now is a pretty high powered power job. And I don't wanna think about what the next chapter was, 'cause I... What if it's not as good as this chapter and then you start to... Your mind starts spinning. And... But I sort of gave that away after a while back and now I'm looking to enjoy what I do on a daily basis for me. And I'm not afraid of doing something differently for the first time in my life. If I find that I'm not enjoying what I'm doing anymore, I'm willing to workbook around and think about doing something different if I want to. And I... Jon, what do you think about your potential though for the future? Do you think it's the same as before or different? My potential is limitless because my mind is open to whatever it may present for me. And I'm sure, I know Michael, very well. He had a path laid out in his brain for, how this was gonna play out, we all probably do to some degree, what's the next step? How is this going to work? All the way to your retirement. And when there's anything that might deviate from that path, it's like totally anxiety provoking and stressful. So for me, I wasn't a very curious person about that kind of thing. But now I'm actually looking forward to my future and not dreading it. That makes sense. I'm excited about what the next chapter may bring, for the first time, maybe in my entire career, instead of just sort of worrying about what people think of me, about me right now. Yeah. I find your question, an interesting one Dex, because part of what I was grappling with during burnout, up until the end of last year, was this anxiety about the future and what I perceived as insecurity about the future or the insecurities of the future, my future. But now, thinking about the stage, where I'm trying to... Where I'm starting to understand, we've talked about coherence and moving from personal coherence, individual coherence to team coherence. And that's a strategy, that I've learned more about to help grow my practice, different divisions within my practice. And so for me, as a physician, I'm looking forward to the more immediate future and the long term future, first to re establishing, Kindle, re establish and promote compassion and connectedness with patients, restore some of that genuine satisfaction of taking care of people. And then, using that, to build over abundance and then using that to grow my practice, more bring on additional physicians, who share that vision. We talked about that... You know I have more recently, I'm trying to get my arms around, how exactly to accomplish that. So, but that's a... Area of my... Whether it's a mindset, or a vision or area of focus that is new for me, I've wanted to do it for some time, but never gotten as close to it as I am now. Yeah, I will, second the notion of trying to connect with patients, I think that de personalization and being burnout, I think, with everything going on, start to lose some of the joy in it. I think I've been trying to reconnect on that level. Because I have expectation that... That's something that, Dex, we talked about is... At the core, we're physicians. So, having that relationship and understanding and being able to enjoy that connection, is something to try to aspire to. Secondarily, the other thing, talk about my future, as far as, I think a lot of it is self doubt. You're looking at 2 feet in front of you and you can't see further than that, because you're just trying to get through the day. And a lot of it's just a scare of change, being scared of what people would think of you. Moving past that, I think for me, really in the last few weeks, I think, I've really been able to have that concept of where... Much larger scale, I can go with my career and what are the opportunities? What are the things that I would do if I couldn't fail? And trying to think of what those things would be? Hey Dex, one thing I just, maybe I sort of, but I'm not sure, when you're burnout, it's almost like, you've got like a bag over your head. And you can't see anything, it's like, this like foggy place and you can't see anything except what's right in front of you. That, Dustin, sort of said that. You can't imagine anything else because your brain is sort of in this fog. So curiosity and imagination and excitement is sort of... Can be very difficult thoughts and emotions to capture when you're in burnout. And then... But the ironic thing about this, when other people look at what you've done and you look at, these two guys on this call, externally like "Wow, man, you guys are amazing." No one would know, you have this, you guys have a great job. And Michael's practice is amazing. Dustin is a fantastic physician. But you can't see that yourself. It's so you're sort of trapped in this, sort of caged Jon... Like future. That's what the, hell you talking about. I'm thinking about tomorrow. Yeah, and that's common to everybody in burnout. The future is just, "Can I get through another day." What would you say to a physician, who was in that state now maybe there's somebody listening here? I mean, I guess I would say that it takes courage to take the first step to recognize, where you are, but if you aren't able to be... To derive enjoyment. And be excited about going to your job and be able to connect with people at home and at the workplace, then you should look into, what's going on in your life right then and re evaluate and there are options to explore, even if, Dex may not be the person, there are lots of other opportunities or the folks that could potentially help you. But just, sort of erasing this stigma and trying to knock down barriers, which is, sort of what I tried to do, a little bit with these... My buddies on the call here. You Know... Some peer encouragement is... It goes a long way, I think in this situation. I suppose I would say to any physician who was listening that anything they've heard sounds familiar or resonates to not hesitate to reach out for help. I would say that one thing I've thought about more recently that I wish I had done what I'm doing now a long time ago. One, for my own health, two just... I'd be further along and accomplish whatever I'm gonna accomplish earlier on, and I think the interpersonal skills that were degraded over time because of being in a burnout, who knows what kind of relationships I would have had or fostered help. What would have happened there, if I wasn't a burnout burnt out at that time. So anyway, if any of this sounds familiar to anyone listening, I would say,"Don't hesitate to ask for someone like Dex, but burnout is real, but there's clearly a path to overcoming it." Dex I think I like... One of the things that you've said, multiple times I think in conversations is this self critical voice that we have in our head, is that the way that you would talk to a child? And, I've got three kids, and when I go and talk to them, I think to myself, like some of the stuff that I say in my own head, there's no way that I would say that to my kids. Or if I do, I feel really bad about it later. And so thinking about, is that normal? Is it normal to just continuously beat yourself up? And I think we've tried to normalise it for years, decades probably, and that's not a healthy experience and that won't lead you to challenge some of the beliefs you have about yourself. Which a lot of times we just, put ourselves inside of a box, my DNA is a perfectionist That's what I have to be, and I don't think you'll challenge yourself in that way. And I think we have this... At least for me, I idolise this kind of perfect version of myself and I'm always trying to reach that version every day, and I think as we start breaking that down and recognize the successes we have every day... Now, my wife says,"You did these three or four things today, those are fantastic." For anybody else, they'll also be fantastic, but you know, you notice the two or three things you didn't do. And it's celebrating those successes and giving yourself grace, which I think is something that is greatly needed. And I'm glad you mentioned family because I think that's one of the biggest upsides of recovery, is family relationships as well. We're really running out of time now, and I'm just wondering if any of you has anything to say. Anything else that we didn't touch on today, you'd like to say before we close. I think we've been pretty comprehensive in our stories and think over... Maybe the message that's weaving through the fabric of our talk today is that this is extremely common, and there are ways that are available to you to get to a place where you probably didn't even know you could get to. And I'm sure that my buddies on this call probably didn't think they were gonna get to where they are right now and on this call tonight, when they first started with you, and so I admire them both very much. For taking the step, and we're praying a lot of people out there that could as much as they have, and myself as well. Yeah, I'll just add it, at the beginning, I didn't know what I didn't know about burnout and about how I got there and more importantly how I was gonna get... Recover from there, and I think that's a core issue for physicians 'cause we lack that central knowledge to help ourselves, unless we have a guide. Yeah, I don't think that I've probably changed as much... Personally, as much as I have... Probably the last six months. And it's just been a lot of introspection, it's been a lot of trying to build up that self coaching and like Jon, I probably had a very healthy amount of cynicism, but also motivation kind of equal parts. At the beginning of the process, and I think there's probably gonna be quite a bit of that idea that this won't work, that this isn't for me and it is very much... I think a very life changing thing, to go through that process and recognize. Superb. Well, I salute all of you because you've taken yourselves on this journey... And you've created something really amazing, and really it's just about bringing the amazing ness that's already inside you out for inspection. And I think that's the capacity that people return to once they emerge from burnout and also capacity they have lost contact with when they're in the struggle. So it's good that you've highlighted that. I thank you all very much for being here today and telling your stories so that other physicians can basically have access to whatever it is that they need. Thank you Dex. Thank you Dex. If you're in burnout and ready to recover, come and join my burnout to leadership programme. You can book in to talk with me at burnout.dexrandall.com, just tell me what's bugging you and let's make a plan to fix it.