MedPEP

Hi. I’m Dr. Marie Curious from MedPEP, the Medical Professionals Empowerment Program. We’re releasing this one-minute reminder to let you know that MedPEP physician listeners are eligible to receive as many as 20 FREE AMA PRA Category 1 Credits™ for listening to MedPEP.  Just go to MedPEP.org/CME.

This is the 20th and final episode of the first season of MedPEP. Along with the first and eighth episodes, this is one of three episodes in which Marie and Les engage in a two-way conversation without a guest expert. Their two-way exchanges, relative to the more didactic three-way conversations, are particularly personal and heartfelt. In this final episode, they review Marie’s MedPEP journey, which commenced with a focus on the “self” and ended with a broader focus that encompassed teamwork, conflict management, and career development. Marie reveals that the abrupt departure of a valued colleague and mentor from her practice is what prompted her to participate in the MedPEP project. It was professional burnout that led her colleague to leave the clinic, and Marie decided to become proactive so as to avoid succumbing to the same stresses and strains that befell her friend and colleague. In this final episode, Marie and Les take stock of her struggles, her learning, and the mentorship and coaching she received from the MedPEP experts and, most importantly, from her MedPEP guide, Dr. Schwab. In the first MedPEP session she spoke rather poignantly about NOT wanting her children to become physicians. Now, in the last session, she explores with Les the possibility of having her children join her on home visits. She has gone from having a beleaguered and overwhelmed attitude to being more of a “can-do problem solver.” Both she and Les attribute this shift to what they learned on the MedPEP journey, and she expresses a great deal of gratitude to him for his skill, compassion, and support. Their positive connection exemplifies what often happens when a struggling physician is coached by a trained colleague, and the series ends on a hopeful and positive note, with them agreeing to stay in touch

At the beginning of this episode, Marie acknowledges to Les that she is continuing to mull over Dr. Green’s paradoxical suggestion (episode 18) that one way to overcome a sense of powerlessness is to embrace it. In today’s discussion with Dr. Liebschutz, they consider the possibility that some physicians may be able to overcome their sense of being overwhelmed and downtrodden by actually taking on more. Dr. Liebschutz, an accomplished physician leader at the University of Pittsburgh Medical Center, proposes to Marie that she may be able to overcome the frustration of being a “cog-in-the-wheel” generalist by “leaning in” and embracing a subspecialty area, a teaching role, or committee work that might open up the path to medical leadership. When Marie conveys her skepticism to Dr. Liebschutz, they then consider the possibility that Marie might leverage her value to her clinic by pushing for a temporary sabbatical or by reducing her work effort. They also discuss practical ways for getting more help at home. It is clear throughout this podcast that Marie is paying close attention to Dr. Liebschutz’s every word. Dr. Liebschutz comes across to Marie as a wise and experienced veteran physician, wife, and mother who has crafted a meaningful career by overcoming many of the same obstacles that are daunting to Marie. By the end of the conversation, Marie comes across as energized and inspired, ostensibly ready to put into practice many of the tips and strategies offered by MedPEP’s experts. All three physicians seem to share the view that going forward, Marie is going to chart the course of her career.

Every practicing physician has had the experience of feeling powerless in the face of patient expectations that come across as overblown or unrealistic. Addiction psychiatrist Mark Green, MD, shares with Drs. Curious and Schwab that an effective strategy for managing such expectations is for the health professional to join with the patient by acknowledging their shared experience of powerlessness. In this episode, Dr. Green reflects on the work he has done helping primary care physicians manage challenging patients with chronic pain and so-called “drug-seeking behavior.” He observes that sometimes physicians who are rushed for time and feel compelled to “do something” may inadvertently end up hurting their patients, rather than helping. Sadly, this problematic dynamic may be one of the root causes of the opioid epidemic. Although patients may expect physicians to alleviate their pain and meet other expectations, it is the professional’s job to help them differentiate between unrealistic hopes and achievable goals. By taking time to listen to patients and gain a deeper understanding of the causes of their distress, it is sometimes possible to accomplish more by doing less (fewer unnecessary tests, less medication). Empathically engaging with patients, understanding their helplessness, and sharing in patients’ powerlessness all may reduce their suffering, loneliness, and desperation. Although Dr. Green acknowledges that taking the time to forge these kinds of connections to patients may be draining to the professional, he describes it as potentially fulfilling and even invigorating. In fact, he believes that burnout ensues when physicians and other professionals find themselves in practice situations that deprive them of the opportunity to connect with and listen to their patients. Dr. Green recommends acknowledging one’s powerlessness as an act of self-compassion. His counterintuitive perspective provides Marie and Les with much food for thought.

Dr. Steve Adelman, founder of MedPEP and the former medical director of the physician health program in Massachusetts, has a frank discussion with Marie and Les about physicians’ use of addictive substances like alcohol and marijuana. In this era of stress, burnout, and medical “battle fatigue,” doctors may be especially susceptible to numbing themselves with substances that have the potential to impede their performance. Steve’s perspective is that physicians are safety-sensitive professionals who are responsible for the health of the public. Consequently, they have an ethical obligation to stay above reproach by avoiding problematic use of psychoactive substances. Physicians with a history of problematic substance use should abstain; others should consider practices like “clean margin drinking,” a minimalistic approach that is fleshed out with specifics. Marie acknowledges that sometimes physicians cross the line in the name of celebration or stress relief. Steve points out that physicians are at risk because they have easy access to controlled substances and may also resist seeking professional help despite needing it. Marie and Steve discuss a specific case involving a patient whose therapist appeared impaired during a psychotherapy session. A guiding principle is that the safety of the public should never be compromised. Les asks Steve to comment on the use of marijuana by physicians. Steve focuses on the downside, advising licensed health professionals to avoid marijuana altogether. He links this MedPEP episode to earlier podcasts by suggesting that health professionals should avoid misusing substances; instead, we should focus on improving our self-care with diet, exercise, meditation, and better work/life balance, all of which may counter personal and professional burnout, and preserve our careers.Disclosure InformationNone of the individuals in a position to control the content of this CME activity, and/or their spouse/partner, have any relevant financial relationships with commercial interests to disclose.