Sound Mind: conversations about physician wellness and medical culture

 Burnout, depression, anxiety: These are long-standing challenges within medicine. But since the pandemic was declared, physicians’ mental health has continued to deteriorate. Now, new health and wellness data from the Canadian Medical Association sheds light on the seriousness of the situation. "I've never seen so many physicians feeling so demoralized by the system and so deeply burnt out. I think we are in dark times, but I still have optimism because my colleagues remain committed to being at the table to try to make things better."  -- Dr. Katharine Smart, CMA past presidentOn this episode of Sound Mind, Dr. Katharine Smart joins host Dr. Caroline Gérin‑Lajoie to reflect on a year of doctor-to-doctor conversations across the country while advocating for physicians’ well-being. 

Medical school is tough enough. For Indigenous students, it can also be fraught with racism, and the pressure to share their cultural ‘expertise’ with teachers and classmates.“A lot of the time, the stereotypes they’ve grown up with, their internal bias, the racism they don’t realize is there, comes to the surface, and it can be very traumatic as an Indigenous student to hear that, to sit through that, to sometimes have the questions directed at you.” - Jayelle Friesen-EnnsOn this episode of Sound Mind, Dr. Caroline Gerin-Lajoie speaks to Josha Rafael from McMaster University and Jayelle Friesen-Enns from the University of Manitoba, about the blessings and burdens of being an Indigenous role model, and where they find support. --------------------------------------------Read more: Physician Wellness: A Perspective from Indigenous Physicians | CMAPhysician Wellness: A Perspective from Indigenous Medical Students | CMABeing a culturally safe physician | CMA

The shortage of health care workers in Canada is a growing crisis. The daily tradeoffs of caring for patients while keeping up with administrative demands is leading to burnout – and prompting some professionals to trade private clinics and hospitals for team-based practices. “Working in a team makes me feel valued. I feel like I have a team that supports me just as much as I support the physician… There's no worrying about rushing to finish your shift and having to choose between not giving care rounds to my patients or not documenting in the EMR.” – Shawna Pasiciel, HealthWORX Medical ClinicIn this episode, host Dr. Caroline Gérin‑Lajoie speaks to Vancouver family doctor Christie Newton and registered nurse Shawna Pasiciel, of Medicine Hat, Alberta, about the wellness benefits of interprofessional collaboration – both for health care professionals and their patients.If you're looking for resources, tools, and research on the topics covered today, please visit the CMA Physician Wellness Hub at cma.ca. 

The strain of working in a health system on the brink – not to mention two years of a pandemic – can erode the sense of meaning that motivates so many physicians. But two emergency doctors, Anthony Fong in Vancouver and Daniel Kollek in Hamilton, found inspiration by going towards, rather than away, from crisis on a volunteer medical mission in Ukraine. “We provided emergency care in a setting that was really needed... And we didn't have all the bells and whistles you might find in an emerg (ED) in downtown Vancouver. But it doesn't matter. All that matters in that case, in that situation, is that you're communicating as a team and doing as much as you can.”  -- Dr. Anthony Fong, Vancouver Coastal HealthIn this episode, host Dr. Caroline Gérin‑Lajoie speaks to the two physicians about the conditions they faced at the Ukraine/Poland border, the care they provided and the impact of their experiences on their sense of purpose in medicine.“It certainly charged my batteries. It reminded me that what I’m doing is helping people in a meaningful way. It also reminded me that we are phenomenally fortunate, not only because we're away from war, but because of all the resources we have. All that context is important.” – Dr. Daniel Kollek, Centre for Excellence in Emergency PreparednessIf you're looking for resources, tools, and research on the topics covered today, please visit the CMA Physician Wellness Hub at cma.ca. 

Last year, a Texas A&M University professor predicted a mass exodus of workers in the wake of the pandemic, as people reflected on whether their jobs provided them a sense of purpose.  He called it “The Great Resignation.” In medicine, job dissatisfaction, combined with increasing levels of burnout, is also forcing many doctors to reflect in the same way. Preliminary data from the Canadian Medical Association’s National Physician Health Survey shows nearly half of those surveyed (46%) are considering reducing their clinical hours in the next two years.Some, like Dr. Kathy Bonapace, have decided to quit the profession altogether. “The day I knew I needed to stop was when I was operating on a patient, doing a hysterectomy, and I became so nauseous. I thought, “Oh, my God. I'm going to throw up..  And as soon as I finished that case, I went to the area where we usually dictate. I closed the door, laid on the floor with my feet up, and thought, “How am I going to get through the day?”  That was the realization I needed to do something different.”In this episode, host Dr. Caroline Gérin‑Lajoie speaks to Dr. Kathy Bonapace about the difficult decision to leave her busy practice in rural Quebec and what she’s found to fill that void. And clinician researcher Dr. Nadia Khan shares findings from two studies looking at why so many doctors in BC are disengaged with medicine.   

Working mothers have suffered tremendous levels of stress throughout the pandemic – and doctors are no exception. A recent study found that physician mothers scored substantially higher on measures of anxiety and depression than physician fathers, in part because they’ve had to take on a disproportionate share of the increased childcare and online schooling needs. “When COVID-19 first started, my thoughts as a mother and a physician were… overwhelming. As women, we often make such frequent micro and macro decisions for our families, or patients or partners, and I think I speak for many women when I say the weight of those decisions felt so heavy and overwhelming.” — Dr. Rita Watterson, PsychiatristOn this episode, host Dr. Caroline Gérin-Lajoie speaks to two mothers in medicine — Calgary psychiatrist Dr. Rita Watterson and Winnipeg cardiologist Dr. Shelley Zieroth — about their mental health and careers in the face of COVID-19 and what medical culture can do to better support physician moms. Want to learn more about physician wellness? Visit the CMA Physician Wellness Hub for curated, clinically-based tools, resources, and research on all the topics covered in this podcast. 

“Code White” is a term used in many health care settings to alert workers to a real or perceived threat of violence. Unfortunately, they are being called more frequently, especially in emergency departments. The reality is that health care workers face four times as great a rate of workplace violence than other professions. In emergency departments, more than 50% of nurses will be sexually harassed or assaulted this year. More than half are physically or verbally abused in any given week. And nearly 70% of emergency physicians -- like Dr. Howard Ovens at Mount Sinai Hospital in Toronto -- say ED violence has increased in the past five years. “The pandemic has escalated all of this because everybody's testy and patients have shorter fuses, families have shorter fuses. They are acting out, especially around things like visitor restrictions as well as wait times. And with masks on, it's harder to establish rapport and a human connection... The entire atmosphere is much tenser, and it's contributed to an exodus from the profession, especially by nurses.”  - Dr. Howard Ovens, ED physicianIn this episode, Dr. Ovens describes the rising threats of violence in the ED and talks about why hospitals have a responsibility to keep doctors safe. And host Dr. Caroline Gérin-Lajoie speaks to medical psychotherapist Dr. Marcia Kostenuik about steps health care workers can take to prevent patient abuse and how they can recover from emotionally-charged interactions. 

Physician advocates never imagined being the targets of intimidation and death threats for supporting public health measures during the pandemic. But it’s happening. Three doctors -- Nili Kaplan-Myrth, Naheed Dosani and Jennifer Kwan -- open up about the impact these violent threats have had on their wellness and the steps they’ve taken to protect themselves, their families, their staff and patients. “In my office, we added cameras indoors and outdoors. And we keep our door locked, which is sad because if we look through the door and don't recognize the patient or person standing on the porch, we don't open the door. And sometimes that is a patient. It's just not somebody we were expecting to arrive at that time.” -- Dr. Nili Kaplan-MyrthIn this episode, host Dr. Caroline Gérin-Lajoie holds a candid conversation with the three physicians about what it’s like to live in fear of an attack, how peer support is helping them cope and what social media platforms and governments can do to help protect those who choose to speak out. Want to learn more about physician wellness? Visit the CMA Physician Wellness Hub for curated, clinically-based tools, resources, and research on all the topics covered in this podcast.Pour voir la description et la transcription de l’épisode en français, cliquez ici. 

For most physicians, the fight against COVID-19 took place away from public scrutiny. But for public health physicians, their words, their work, and sometimes their raw emotions, have taken centre stage. Two of Canada’s chief medical officers of health – Dr. Saqib Shahab from Saskatchewan and Dr. Catherine Elliott from the Yukon – share the toll the pandemic has taken on them and their colleagues. “It was only a few months in where I thought, no human can really keep this pace: new evidence coming in every day...the pace of meetings and press conferences, and evidence-based decisions, and the weight of these types of decisions.” – Dr. Catherine ElliottIn this episode, host Dr. Caroline Gérin-Lajoie speaks with Dr. Elliott about what causes moral distress among public health physicians and recent survey results from the Public Health Physicians of Canada showing high rates of burnout among its members. On Dec. 8, join Dr. Gérin-Lajoie and other physicians to discuss this topic in a CMA Wellness Connection peer support session. Register by clicking here:Want to learn more about physician wellness? Visit the CMA Physician Wellness Hub for curated, clinically-based tools, resources, and research on all the topics covered in this podcast.

Dr. Amy Tan shares how she endured months of online harassment during the pandemic for defending racialized communities. “There was a racist, misogynistic, violent threat made to me by phone, which is different than keyboard warriors on Twitter, tweeting or emailing terrible things. It's different when somebody seeks out your workplace and asks to speak to you.” -- Dr. Amy Tan Dr. Amy Tan is an academic family and hospice palliative care physician on Vancouver Island.During the pandemic, many physicians, like Dr. Tan, have found themselves in the spotlight of both traditional and social media as spokespeople and policy or medical experts. Yet, they’ve also been on the receiving end of online threats, abuse and harassment. Dr. Najma Ahmed knows what they’re going through.  She is a trauma surgeon based in Toronto and co-founder of Canadian Doctors for Protection from Guns. In 2019, she faced intense harassment by pro-gun activists after launching a public campaign for tougher gun control laws. In this episode, Dr. Ahmed talks to Dr. Caroline Gérin-Lajoie about the backlash outspoken advocates often face, how it can affect their mental health, whether “speaking out” is really worth it and what medical schools and health institutions can do to support physicians who advocate publicly for their patients.On Nov. 10, join Dr. Gérin-Lajoie and other physicians to discuss this topic in a CMA Wellness Connection peer support session. Register by clicking here:   https://community.cma.ca/en/wellness-connection/p/peer-support-eventsPhysician Wellness HubCanadian Medical AssociationCanadian Doctors for Prevention From Guns

"We've often been stalled by the fact that medicine is painted as this altruistic, noble, honourable profession, forgetting that medicine is built on such heinous acts of racial violence that we don't often acknowledge." – Dr. Joseph MpalirwaDr. Joseph Mpalirwa is a family physician at Toronto's Casey House and recently co-authored a study on Black physicians' experiences of racism and discrimination in Ontario. In this episode, he joins Dr. Kenneth Fung, an award-winning psychiatrist and clinical director of the Asian Initiative in Mental Health at Toronto Western Hospital, in conversation with Dr. Caroline Gérin-Lajoie about how systemic racism affects both the mental well-being of physicians and the overall health of patients.  Speaking from both personal experience and as leaders in the field, Dr. Fung and Dr. Mpalirwa describe the “highly demoralizing” impact of racism and how it increases the risk of burnout among physicians.Want to learn more about physician wellness? Visit the CMA Physician Wellness Hub for curated, clinically based tools, resources, and research on all the topics covered in this podcast.

“In medicine we’ve been held to really unreasonable expectations of what it means to be a physician. Even the idea of ‘health care heroes’ during the pandemic, which came from wanting to honour providers, has actually had the reverse consequence – making health care providers feel they need to be superheroes.”– Dr. Jo Shapiro Dr. Jo Shapiro, surgeon, Harvard professor and founder of the US-based Center for Professionalism and Peer Support, is internationally recognized for her work in physician peer support. The program she helped create at Boston’s Brigham and Women’s Hospital pioneered the “reach in” approach, where trained peer supporters seek out medical professionals immediately after a serious medical error or other crisis events.  In this episode, she talks with Dr. Caroline Gérin-Lajoie about the “reach in” approach, the “must-haves” for successful peer support programs and how she sees the COVID-19 pandemic affecting her colleagues and physician health programs in the long term. Want to learn more about physician wellness? Visit the CMA Physician Wellness Hubfor curated, clinically-based tools, resources, and research on all the topics covered in this podcast. 

"We aren’t actually part of normal society, not anymore. Medicine does something to us. It teaches us another language, one only other doctors can understand. Eventually it scripts our emotions, neutralizing them whenever they threaten to overwhelm our senses.” – Dr. Jillian HortonDr. Jillian Horton is an internist and award-winning medical educator, and a writer and expert on physician health. Yet like more than one-quarter of physicians, she has struggled with severe burnout.Her new book, We Are All Perfectly Fine, chronicles her personal journey to overcome it.In this episode, Dr. Jillian Horton talks candidly with Dr. Caroline Gérin-Lajoie about her book and the themes it addresses: the flawed system that shapes medical professionals, the rarely acknowledged stresses and trauma that lead many physicians to burnout, her own quest to rediscover the joy and meaning in medicine.Want to learn more about physician wellness? Visit the CMA Physician Wellness Hub for curated, clinically-based tools, resources, and research on all the topics covered in this podcast.

“To me, the hidden curriculum is the little things — the off-side comments, the facial expressions. It’s trying to breed a certain type of physician, in a culture that says physicians should be infallible.” – Alexandra Morra, 4th year medical studentFrom the cafeteria to the clinic, medical students pick up many unspoken messages about physician attitudes and behaviour. Today, this “hidden curriculum” is increasingly under scrutiny for the signals it sends about the pressures of medicine and seeking help. In this episode, fourth year medical student Alexandra Morra talks about her experience with the “hidden curriculum”, and Dr. Caroline Gérin-Lajoie speaks with Dr. Geneviève Moineau, CEO of the Association of Faculties of Medicine of Canada, about how medical schools are confronting the issue.Want to learn more about physician wellness? Visit the CMA Physician Wellness Hub for curated, clinically-based tools, resources, and research on all the topics covered in this podcast.

“If we have a system where asking for help is not a normal part of medical training, it creates this perception that if you’re struggling and need help, it’s a weakness.” – Dr. Stephanie KleinStatistics reveal that burnout, depression and suicidal ideation are at a peak during residency, compared to any other time in a physician's career.  Why is residency such a difficult time and how can we ensure people get the support they need? In this episode, Dr. Caroline Gérin-Lajoie speaks with Dr. Stephanie Klein about losing her twin brother to suicide, just as he was beginning his residency, and the wellness program she created specifically for residents, in response.Want to learn more about physician wellness? Visit the CMA Physician Wellness Hub for curated, clinically-based tools, resources, and research on all the topics covered in this podcast.This episode is available in English only.

“I can honestly say I have never been through anything like this in my life.” – Dr. Sabrina Akhtar, Toronto.When a global pandemic was declared in March 2020, medical professionals went into hyperdrive to try and contain the virus, treat patients, and keep themselves safe. Nearly a year later this work continues, but what is the cost to physician wellness? Do we need to re-think wellness supports during COVID-19?In this episode, Dr. Sabrina Akhtar explains the stress and burnout she’s experienced since the pandemic was declared, and Dr. Caroline Gérin-Lajoie talks to Dr. Joy Albuquerque, medical director of the Ontario Medical Association’s Physician Health program, about how she sees the pandemic impacting physicians.Want to learn more about physician wellness? Visit the CMA Physician Wellness Hub for curated, clinically-based tools, resources, and research on all the topics covered in this podcast.