Tackling physician burnout one story at a time

. 33 MIN READ

AMA STEPS Forward® podcast

Tackling Physician Burnout One Story At A Time

May 25, 2022

Jillian Horton, MD, associate chair of the internal medicine department at the University of Manitoba Max Rady College of Medicine and author of We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing, explains the importance of physicians sharing their own burnout stories and why personal storytelling is a crucial step to improving culture and effecting systemic change.

Speaker

  • Jillian Horton, MD, associate chair of internal medicine, University of Manitoba Max Rady College of Medicine; author, We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing

Host

  • Jill Jin, MD, MPH, senior physician advisor, American Medical Association

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Speaker: Hello, and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today, solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.

Dr. Jin: Hi, everyone and welcome. This is Dr. Jill Jin, senior physician advisor at the AMA. Today on our podcast, we are speaking with Dr. Jillian Horton, associate chair of the internal medicine department at the University of Manitoba Max Rady College of Medicine in Winnipeg, and author of We Are All Perfectly Fine: A Memoir of Love, Medicine, and Healing.

Dr. Horton, thank you so much for joining us. It is such an honor.

Dr. Horton: It's my absolute pleasure to be here with you today, Dr. Jin.

Dr. Jin: Would you mind telling the listeners a little bit more about yourself and your background?

Dr. Horton: Yeah, absolutely. So I am a general internal medicine physician at the University of Manitoba. I work in an urban hospital and primarily, at this moment in my life, I practice caring for people living with addiction. But for many years before that, I worked in roles in medical education, some of the heavy-lifting roles. I was an associate dean of undergraduate student affairs. I was primarily a clinical teaching unit attender. But like so many of your listeners, I'm also a person with a lot of other things that I love to do in my life. So, writing is really important to me. I do a lot of writing now. I had always dreamed of being a writer and now I get to live that dream. And I also have a lot of other outside interests including music and the arts and get to do programming in the area of health humanities.

Dr. Jin: Wow. I love it. You do it all.

Dr. Horton: I'm very lucky.

Dr. Jin: So by now I know you've told the story many times. But can you tell our listeners how your own experience with physician burnout began and where it is now?

Dr. Horton: Yeah, thank you. So like so many of us, I lived for many years cycling in and out of burnout without really having a name for it, or recognizing what it was, or knowing that the concept of burnout applied to me. Because what I thought it was in the literature and what I was experiencing for the better part of two decades in my own career didn't really align. So I would actually say for a lot of my career I had very little insight into the fact that a lot of the difficulties that I was experiencing professionally and personally traced to burnout and a severe lack of work-life integration.

But what happened for me, an overall turning point, was about six or seven years ago when I was working as an undergraduate student affairs dean, responsible for trying to help my wonderful students sort out their problems, figure out the bigger picture of their lives. It was actually a little more recently than six or seven years ago, but I happened to have the lucky experience of hearing a physician at the University of Rochester who was coming through giving grand rounds at our university. A fellow by the name of Mick Krasner. I happen to be invited to attend these grand rounds that he was giving about mindfulness for clinicians. And I think like so many of us and probably so many of your listeners, I was like, "Mindfulness for clinicians? Give me a break. That would be the last thing I need. The problem is this broken toxic system I work in, et cetera, et cetera.”

All of that is true, by the way. But anyway, I went. Heard this talk and was actually quite riveted. At the end of it, this colleague said, "Why don't you come down to one of our retreats at the University of Rochester? I think that you would really enjoy it." So I ended up going down, joining him for that, and had this quite transformative experience of learning mindfulness, sitting in community with other physicians and learning skills that subsequently had an incredible impact on my life.

And now I've invested a year in learning to teach that program and I have the opportunity to teach these skills to physicians all over North America. So it's really quite amazing.

Dr. Jin: Wow. Can you tell me a little bit more about how you got to that point of knowing you were burnt out though? What signs and symptoms were you noticing in your day-to-day practice?

Dr. Horton: When we think about burnout, I think of how we expect it to look. We expect to experience depersonalization, a low sense of accomplishment and personal exhaustion. Especially if we've read the literature and done our homework. But what was really interesting for me was that in my academic and clinical life, maybe I had a low sense of personal accomplishment, but I really didn't have those other two things.

And this idea that our burnout can spill over primarily into our personal life, as opposed to being a uniquely workplace phenomenon, I think a lot of us aren't really prepared for that, therefore, we don't see it. But what's very interesting is I would get home at the end of my long clinical days, at the end of my long days tending to students. And what I'd experience in my personal life, emotional exhaustion, a low sense of personal accomplishment, and a deep feeling that there was a disconnect. Or a "Translocation," as Christina Maslach has sometimes called it, between what I was doing and what my life actually felt like.

Dr. Jin: I think that is such a good point. Where a lot of doctors, if you ask them if they're burnt out, their first instinct is to say, "No. I still like talking to my patients. When I'm in the room with a patient, that gives me a lot of meaning still. I just feel tired all the time.”

Dr. Horton: I think that is such a critical point. And it's also this idea, as we all know, from the literature, that once burnout for us manifests overtly in clinical care, I think of that as a late-stage finding. By the time that's happening, you are really in trouble. The situation has evolved quite profoundly.

But for most of us, of course, the place where we expect people in our lives to pick up slack is with our loved ones and our families and our friends. And certainly that's something that really rings true for me. When I look back at so many of the highest-pressure years in my life, academically and clinically, the people who I often say were getting the leftover garbage scraps of me, who should have had access, at at least some point to the best parts of me, that was always my family. They always came last, even though I said, "I put them first. They're the most important thing." They never ever got a crack at the day when I was well-rested or really ready to be fully present for them. To me, that's one of the saddest things about that long period of my life. And I also think it's a pretty universal experience for so many of us.

Dr. Jin: Yeah, as physicians, that's what we're trained to do is put our patients first, so we will always be compensating in that direction.

Dr. Horton: Yes.

Dr. Jin: I agree. That is true. I think that once patient care is actually affected, I love how you put the late stage, the infestation. That’s so true.

Let's talk about why―we were kind of getting into this already just now. But why is it important for physicians to share their personal burnout stories?

Dr. Horton: Yeah. So there are a number of reasons why I think we have to pivot to normalizing this, especially in the wake of the pandemic. I think one of the reasons and perhaps one of the most common misconceptions is people think―it's just catharsis. People who tell us we need to start sharing our stories. It's all because they want us to do this big emotional dump of all the things that have happened to us.

This can strike a lot of people as distasteful. And I'm not sure I would put catharsis at the top of the list in terms of why I think it is critically important. I think catharsis is actually a byproduct of telling stories in an intentional way in specific settings, as it pertains to our profession and our professional identity.

But one of the most important things that I have learned, as I've not only become someone who's actually quite comfortable now putting personal stories out into the public realm and mainstream media and obviously in a book. But what I've really learned is that other systems, other professions, other entities have figured out long before us that storytelling and using strategic storytelling is a critical part of how we change a culture. And in fact, John Cotter, who is obviously a very distinguished professor at Harvard and very well known in the field of changed management, talks about the fact that if we don't appreciate this―organizations and leaders who don't appreciate the power of storytelling and its ability to strike a chord and incite positive change―if we miss out on understanding that, we actually risk failure, he says. Not just for our organizations but for ourselves as leaders.

So I think so much of our focus, and I think of this looking at my previous life as an associate dean, has been saying to students and the most junior people in our profession, "Be honest about your experiences. Talk openly about them." And yet, we know what a hierarchical profession we are. How can our ask be for the newcomers to make themselves vulnerable, to tell their stories, to talk openly about their experiences, their fears, if we're not the ones doing that ourselves at the top?

So for me, that's one of the really important concepts that is also a marker very often of a really healthy culture. The people at the very top are not afraid to selectively share stories about some of their most difficult moments, their lived experiences in medicine, in a way that has a deeply permissive and normalizing effect. There are certain things we don't want to normalize, right? But we want to normalize seeking help. We want to normalize the struggle. We want to normalize healthy, emotional expression of the really difficult parts of our job, which sometimes we're conditioned to not do and not express in a healthy way at all.

So I think that's one of the key points for me. That onus. The first step really has to come from those of us who are most senior, who have the most social capital through the years in the profession. And when we do that, we open the doors for everyone coming up behind us to actually be similarly brave. To be similarly vulnerable.

Because this is sort of another thing when you think about it and this is a common question I get from students. They say, "Dr. Horton, I would love to write a story about something that happened. But what if then I'm applying to a program as a resident and the program director reads this and thinks ill of me?"

I would never say to a student that's not a reality-based concern. It is. So therefore, you look at that, and you see the cure actually has to be that the program director and the people around that the program director reports to have to be engaged in the exact same activity. Because that is the deepest possible signal then, for students to know, I am absolutely safe to do this; I'm part of a culture that has not only normalized but is championing an authentic dialogue about what it's really like to be a physician. Those are some really key points for me that come to mind.

Dr. Jin: Yeah. Yeah, I love that. The leading by example. So much about our field, these days is the whole sense of community and sense of belonging. How do you get there? You were talking about the organizational and practice culture being such a key factor in wellness versus burnout.

Dr. Horton: Yes.

Dr. Jin: That's kind of the make or break in many places. And yeah, I think part of that is that sense of belonging whereas the junior faculty or the students or the trainees, it's hard to get there when it's so hierarchical. But this is one way.

Dr. Horton: Another thing you really remind me of as you make that point is when we look at the factors that determine the health of our culture, whether we have a culture of wellness―certainly, one of the things, as we know and we know from the literature, is whether we have a sense of esprit de corps. A sense of a mission, a connection, a shared purpose. And we can also harness the power of our storytelling with, again, talking about it and thinking about it as something that's highly intentional.

We can tell our stories in ways that focus on meaning and purpose, that invite conversations about meaning and purpose. Even when I think back to the mindful practice program that I now teach. I mean a huge component of that program is using narrative medicine. Telling our stories in a way that focuses on meaning and purpose. That focuses on our narrative competence.

People say, "Well, that's nice. That feels good." But again, it's strategic. Because we know that one of the things that boosts our resilience, and we know in certain contexts in the literature that a connection to the work that you find the most meaningful and purposeful, doing that for about 20% of your time gives you some protection against burnout. So again, this is another way when we invite and set the stage for people to tell stories in a way that focuses on a meaningful experience. A time when a patient thanked you for something and you were proud.

I always say to people, how many of us would ever walk into a doctor's lounge and sit next to a colleague and say, "Man, can I tell you about something amazing a patient just said to me that resonated with the reason I am here? My deepest motivations and I'm so proud." We don't do that. If I go and do that, next time, somebody's not going to sit next to me, right? Because they'll be, "Whoa. She's arrogant."

But what we do is we go and sit down next to each other, and I say, "Oh man, Dr. Jin. Can I tell you about something so stupid that I did an hour ago? An obvious diagnosis that I missed that I just feel so bad about?"

I mean we talk about our failures maybe, maybe, if our culture offers some psychological safety to do so, but we don't talk about the good things. I think there was a time in my life when I would've said, "Well, that's just Pollyanna. Who cares about that? I want to focus on where I can improve."

But then we miss that opportunity to get not just the dopamine hit that comes from reminding ourselves of something good that we're proud of that happened, but we also miss out on the opportunity to look with a really―a critical eye in the sense of a discerning eye and say, "What is it that I do really well? What is it that I do exceptionally well? How can I build on that?"

Instead of, "How can I improve the things that I'm no good at, that I'm terrible at, that secretly haunt me like a ghost?" What is it that is my ... I don't love the term "Superpower,” but what is the thing that I know in my heart I do really well? How can I continue to cultivate that and build on that?

Because I think this is just another incredible thing about our profession. Our drive for perfection, which can begin as really adaptive for us early in our lives, it can transition so quickly into something maladaptive where we no longer see the really special things about us as individuals. That if we build on them, develop them, really allow ourselves to run with them, they can become our greatest offerings to patients. We can actually amplify what those talents are.

But it's really hard to do that if we can't even see those talents. And that was definitely part of my own experience. Not really appreciating my own strengths or thinking that the things that were unusual about me were things that I had to hide away. For example, the way that I see and work with relationships in the arts and the way that I write about things. I would've said, "Well, that's weird. That's not serious business."

And now I see that's knowledge translation. That's how you make something vivid, not just to your peers but to the public. And so that reframing for me, I don't think it's any accident that at the time in my life ... going back to the time when I really acquired these skills, started looking at my own life from that perspective. That is when my career lit up and went to a completely new level. And so I think there's a really powerful lesson that I have learned in that for me. But also for many of the rest of us.

Dr. Jin: It's so true. Actually, as you were speaking, I was thinking that at that table of sharing, it should not just be other physicians. It should be the administrators and the health care leaders. Because they're often the ones who don't ... even if you shadow a physician for a day in clinic, you don't get to see all those stories of good and bad.

Dr. Horton: Totally. You remind me of another point, Dr. Jin, which is really about where we tell our stories. This is something I have given a lot of thought to and where I tend to write now. It's quite intentional, actually. And even having written a book about medicine that I meant to be read by people who are not physicians. I hoped it would resonate in particular with physicians, but really I wrote that book meaning for it to be accessible to everyone.

Because I think you've touched on a key point. When we put our stories in places that only we will read them ... and I don't think most of our non-physician administrators read the New England Journal. They don't read JAMA. Those publications are read by clinicians, right? And so if we are only putting our stories, our personal narratives, in places where other doctors are going to read them, we are going to miss out on these other two key stakeholders that we really need when it comes to addressing our physician burnout crisis.

We're clearly the one group of stakeholders who bear the consequences of burnout in terms of how it impacts us as individuals. But when we burn out, as we all know, as the literature tells us, our organizations suffer. Our efficiency is reduced. It costs them a lot of money when we leave prematurely. And then, of course, the other stakeholder group are our patients, who likely experience more medical errors from physicians who are burnt out. There's a little bit of conflict in the literature about this, but that does seem to be the overall suggestion.

Of course, it's harder for them to access us if we leave, if we have to reduce our clinical hours. Because as Tait Shanafelt sometimes says, "We pull the only lever that we can pull. Reduce the hours.” Patients who experience us as burnt out aren't as satisfied with our care, is another thing that there is signal about that in the literature, too. Again, that has variation depending on the individual and individual characteristics.

But the bottom line is if our stories are only shared in a forum that is a closed forum just for us, you're absolutely right. Other people can't say, "My goodness. I had no idea how these individuals were suffering. I had no idea. Had I known …" I mean, I know there's the cynic in me and the cynic in all of us that says that won't motivate them. Because that's not the primary motivator in some systems in which we work. We worry that the primary driver is money and similar concerns.

But I don't think it's as simple as that. And I do believe that a lot of our non-clinical leaders who don't know the lives that we live and the experiences that we carry as clinicians, they really don't understand. And that again, for me, takes me back to this idea. What is our best strategy from making them understand? It is personal narrative? The business world knows that, so we have to be ready to harness that, too.

What's interesting is there is a bit of an inherent tension for some of us in this idea of using stories as a serious vehicle for achieving our goals. We tend to think we want a randomized controlled trial. We want something that is the same paper that we can show a particular medical intervention works. We want to speak in that same language sometimes when it comes to the crisis of physician burnout.

And I want to be really clear. We have had in the last two decades, some really amazing literature to support that what we say about burnout is true and factual, and correct. But the distinction is that doesn't mean that paper is the best vehicle for us to communicate what needs to happen and what needs to change.

That's our platform. That's what allows us to say what I'm telling you can be corroborated in the literature and through research and through expert study. But that does not then fill that gap between, here's the paper; now, how do I render it vivid? How do I make you leave understanding that this is the most important problem threatening your organization and the people who work in it? How do I make it so you are so troubled by this as an administrator―and I don't mean this in a cruel way―that you literally can't sleep at night because you suddenly understand this is the gravest threat that your organization has ever faced in its history?

That is where the power of our communication and harnessing the power of stories I think really comes into play. As we know, Brené Brown talks about the idea that stories are data with a soul. But we also know this concept that a million deaths, a million lost lives is a statistic. One vividly depicted story is a tragedy.

This is how our brains think. This is how we're wired. So we have to say, "This is one of the most effective ways that we're going to be able to communicate to the public, to government, to administrators, to our organizations that this crisis is now. It is urgent unlike anything.”

The situation two years ago was brutal. It has, of course, been put on steroids since then and dialed up to the highest degree. So to me, this is one of the best ways that we can begin to make that vivid for people and really make them understand, that is through telling stories.

Dr. Jin: I agree 100%. Even just based on talking to the people who've been on this podcast. Many of them are leaders and CMOs and physicians for the most part. But still, fairly detached at this point from their clinical experience. Again, they've heard all the data. They've seen all the metrics at their organization.

But every time we ask them something on our podcast, they'll respond with a personal anecdote. A physician who emailed them about what's been going on. Or the physician who was about to leave practice and then stayed and actually expanded her clinic because of what they did. It's always the personal stories that come back.

Dr. Horton: Totally. 100%. That's such a key point. Also, if we think about it in our clinical lives. The clinical cases that often precipitate massive change, system change or safety shifts. New regulations to prevent something from ever happening again. We know that certain things that occur in our hospital and clinical environments are risky. But suddenly, when one person suffers an adverse outcome, when they have a name, when they have a face, when they have a story. That is often what tips things over the edge, and suddenly―well, it's not really suddenly because there's all that long preamble. It looks sudden from the outside. But that is often what that catalyst for change is.

Actually I think the Dr. Lorna Breen Foundation is a poignant example of that exact same pattern. We have known about the crisis of physician suicide. That is not a new conversation for us anymore. It was certainly not a real conversation for me 20-plus years ago when I was training. But for the last decade, we have recognized, I think most of us, lots of experts have recognized it for a lot longer than a decade. But in terms of the general awareness among us as clinicians, that this is incredibly common and sickeningly common. We've gotten to that point. But then we see―this tipping point for me was, why has the Dr. Lorna Breen Foundation been able to be so effective? Because it's not just about an issue. It is about an issue, but the vehicle for that issue, tragically, sickeningly, is one person's story.

You hear Dr. Breen's story and you cannot forget it. It is so real and so visceral. And in addition to the incredible skills and resolve of her surviving family to move the issue forward, I do also believe, at least a part of why they have made so much progress on this issue in the last couple of years is because it is about Dr. Breen.

Nobody can say, "Well, it's an issue. Yes. It's serious ..." You cannot look away. Again, that one tragedy versus the statistic. What a sickening loss of her. And at the same time, what an incredible contribution will occur in her name. But of course, how totally unacceptable that her life was ever lost in the first place. Just heartbreaking.

Dr. Jin: Yeah. Dr. Breen actually did inspire two of our STEPS Forward® toolkits that have been published in the past couple of years. One on stress first aid. And the other one on physician suicide. Specifically, after a physician's suicide, what to do as an organization.

And then, just to briefly touch on the other set of stakeholders, as you mentioned, the patients. I actually think it is equally crucial for physicians to be humanized in the eyes of our patients. Because I think oftentimes we're kind of put on a pedestal, for better or for worse. That we are superhuman. We have such high resilience. We're so intelligent or whatever to get to where we are that burnout and all these kinds of personal weaknesses shouldn't happen to us. Or sometimes they kind of feel like it doesn't. And I think sharing our stories with our patients is ...

Dr. Horton: Absolutely. I've had the privilege of hearing so many beautiful stories about people's reactions to reading my book. I think it's a reflection of the fact that I'm just the lucky one who got to tell this story. I think the story about what training does to so many of us is really quite universal. And that is sort of the feedback that I've heard.

But probably one of the stories that really sticks out to me is a physician who told me that one of her patients last year came in for an appointment, took my book out of her bag, and said, "I think you really need to read this. I really want you to read this book." And for me, that broke my heart open. It was so beautiful. Because this was really one of my goals, right? For patients to see us in the way that we so often are forced to keep private by nature of the culture that we work in.

But I thought to myself ... and I have heard that type of anecdote and feedback more than once. People saying, "I'm going to give this book to my doctor." or "I had no idea." I've found this really peaceful place too, in my adult life. I've experienced as a family member of two disabled siblings growing up ... in particular, my sister, who I was very close to. My early interest in burnout, when I look back, actually emerged from my rage at how health care providers could have been so cruel. So callous. There were some really wonderful ones as well. But the problem is, as we all know, from any time we've ever sought care in the system, the things that we remember the best and the things that leave the deepest scars are those traumatic encounters. The times when someone disregarded our humanity. Spoke to us cruelly at a moment when we were vulnerable. Or for me, my sister is a visibly disabled person. The amount of ableism that she experienced during her life. The amount of discrimination that my parents experienced trying to advocate for her and just complete disrespect. The trauma of that.

And so, I think what's really interesting for me at this phase of my life is being in a place where I really inhabit both perspectives. Because I think it's not effective if we just go and say to the public, "Look at what we have to deal with." Because the public also has a lot of terrible stories about horrible things that they've experienced during the course of medical treatment.

At one end of the spectrum, that people experience, as we know, horrible impacts from systemic racism and homophobia and transphobia and ableism and ageism and discrimination based on weight. We know all those things happen to our patients. We know our patients sometimes have disgusting and awful encounters with the medical system. So I think finding a place where we really are trying to help the public understand our lives, that can go awry if it doesn't also come simultaneously with an acknowledgment that what happens to a lot of our patients seeking care in the medical system is unacceptable to us.

We're not trying to ... perhaps what has been effective about my voice … I'm not saying people act like that because our system is so awful. It's really going much deeper in showing our humanity. Reminding people of the fact that "Yes, we have a lot of privilege in our roles. But our families are patients. We are also patients." We are motivated by things that often would surprise people and are unknown to them. Just as we cannot make any complex group homogenous, we're not a homogenous group. We have a wide range of motivations and a wide range of life experiences. But I do believe, in the work that we do day-to-day, most of us really do care if we cause harm. The vast majority of us. And not just clinical harm but emotional harm. Sometimes, once we are deep into a state of burnout and suffering, we can no longer see that harm. And that insight for me was a peaceful place that I've come to in my life. It helped resolve that early question of how could anyone scream at my parents to get it through their head that my sister at the age of six was going to die. Or some of the other just unspeakable, unfathomably awful things that they experienced.

Some of it is the system can break us and can change us into something that we do not intend to be. But it occurs at such a slow, glacial pace that we can sometimes become quite blinded to that.

I think that's all part of the complexity of what we want the public to understand. Because really, we need their help. We need the public to stand shoulder to shoulder with us and say the conditions under which our health care providers work are inhumane. They are not sustainable. They are creating an unacceptable degree of workplace-induced injury. And they are leading to them, in some cases, providing us with care that is not aligned with the ideals on which every medical school that I know of in North America is built.

And so, I think the public, that's another huge opportunity for us to continue to, in a very humble way, what my colleague Mick Krasner calls "bidirectional healing," really allowing ourselves to align with patient groups in a way that has not necessarily been historically a huge part of how we operate in medicine. Allowing those people, those patients, and our community members and our friends and neighbors to help us fix this. To bring in their perspective as advocates for us, too, I think is going to be one of the things that will eventually help to turn the tide on this over many years.

Dr. Jin: Absolutely. Ok … you made so many good points. But I want to take a moment to highlight some of the key ones.

So in terms of the importance of sharing our stories, it is primarily to create a culture change. This esprit de corps and meaning in work, which then drives system-level and organizational changes, which of course, ultimately benefits patient care.

And perhaps as a byproduct of that, getting some personal catharsis, which is not a bad thing. And in terms of to whom or with whom we're sharing our stories. That includes physicians, peers as well as administrators. Leaders as well as patients. But of course, this message should be tailored to each group for the purpose of creating trust and connection specifically with that group.

Well, any final thoughts that you want to share with our listeners?

Dr. Horton: Well, the one thing I think that comes to mind is people sometimes say to me when I speak on this subject at conferences, they say, "Well, how do I start? Where do I begin? Where is the forum?" I talk a lot about writing about our stories, but we can also be here looking at the question of where do we speak about our stories. Where do we tell them? In conference keynotes, in boardrooms, at meetings that we attend, et cetera. I think every setting in which we work is an opportunity to tell a well-considered well-boundaried―by well-boundaried I don't mean we shouldn't push the boundaries. We need to be pushing the boundary. But also considering this question, would it help me to hear this story if I were a person being led by someone else and my leader told the story, would I be helped by that story? Or might it be not quite as well-boundaried as I might need as a staff member, et cetera? Sometimes asking that question.

But then really thinking about how to start and where to start, I think we can begin this work by telling stories with our clinical teams, with our learners. Sharing personal stories of our own difficulties in meetings in a consistent way, kind of making what I think of as transparency of thinking. "Here's a challenge I encountered recently. Here's how I dealt with it. I just wanted you to know that I'm experiencing a lot of uncertainty related to care of COVID patients in these circumstances. I want you to know that's weighing on me, too. Any thoughts? Comments?" Et cetera. That could be the kind of thing we could do at a meeting.

But then, moving more broadly, people sometimes say, "Well, what if I want to write about it? What if I want to write something for JAMA? Or what if I want to write an article for the L.A. Times or something? How do I do that?" My comments to people are really, again, think about what your goal is. What do you want to accomplish through telling that story? Do you want to inspire people? Do you want to normalize conversation around an issue? Do you want your article to be a conversation starter for groups of your colleagues who maybe are struggling with mental health issues, for example, and don't know how to create a culture where those things are more commonly discussed?

I hope in the coming months and years we continue, as we've been seeing, to hear more and more physician narratives, physician voices. The greatest thrill for me is to think that when I speak or write that someone else will be inspired to do the same. Because for me, that's one of the things I hope to incite. Because that chorus of voices, that is what we need for culture change.

Dr. Jin: Yes. We at the AMA certainly share that perspective. And hopefully, through this podcast and perhaps webinars and other resources in the future, we can be one of many channels that physicians use to share their stories.

Dr. Horton: Yes.

Dr. Jin: Thank you so much, Dr. Horton, for joining us today.

Dr. Horton: Thank you so much, Dr. Jin. It really has been my absolute pleasure to be here with you talking about a subject that is so close to my heart.

Dr. Jin: For additional resources on combating physician burnout, please visit the AMA STEPS Forward® website at stepsforward.org.

Speaker: Thank you for listening to this episode from the AMA's STEPS Forward® podcast series. AMA's STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, stepsforward.org.


Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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