Ep 7 Doctor Burnout and Moral Injury

Heather Johnston: 0:04

This is Dr. Patient, a podcast that examines all the aspects of the patient provider relationship. I'm your host, Heather Johnston MD, a real life doctor and patient. Today we'll be talking about doctor burnout - what causes it, how to think about it, what to do about it. According to the Mayo Clinic, about 42% of doctors in 2021 reported feeling burned out. And while most doctors consider burnout to be a real issue, almost half of those suffering from it do not talk about it or seek help for it. Today, I'm talking with Dr. Karen Leitner, of Karen Leitner MD Coaching. Dr. Leitner has some really insightful thoughts about extrinsic and intrinsic forces that contribute to burnout, and what steps doctors can take to start helping themselves.

Karen Leitner MD: 0:49

I decided to go to medical school because I wanted to take care of people. I thought it'd be really easy to just be nice to people. You heard so many things about doctors, how mean they are. they don't listen, they, you know, they're rude. And I was like oh, I'm nice. I'll just be super nice. And I'll be a great doctor that way. So that was my plan. And then during training, I felt pretty good in medical school until we started to actually hit the wards. And I realized that I have a lot of anxiety around people being sick and worrying about doing the right thing. And they were going to be okay, if things were going to be my fault. I managed that okay, I would say. Residency was not super fun for me, but I made it through. And then I got my dream job during primary care for I did internal medicine and pediatrics. So I was caring for families and things were pretty good. Then I got married and had my first child. And then I had my second child. And then I was six or seven years in and I found myself feeling like I was drowning. I felt always worried something bad was gonna happen and that I wasn't doing a good enough job for my kids and for my patients. And I just remember the day I was on vacation with my family. And I was at the buffet and I was holding my baby. And my little toddler was running around and I was trying to get food but you can't like have a plate and a baby and feed yourself. And I was very nervous about coming back from vacation and opening that electronic medical record and seeing that tidal wave of whatever would hit me. And it wasn't the amount of work. I mean, the amount of work was hard, too. But it was like what if something bad happened to someone a nd it was my fault. I was exhausted, I was always stressed. I felt like I wasn't doing a great job anywhere because I couldn't split myself in half and do everything I wanted for my kids. So I left. And it took me several years to realize that I that that was burnout, what I had experienced. I thought I just couldn't hack it, and I had a lot of shame around that. I never told anyone that I felt that way. I never reached out for help at my institution. I just knew that like something wasn't working for me. And it was a crisis of conscience because this is what I had wanted to do. So when I left, I didn't really have a plan. I just knew that I wanted to be home more, but I still wanted to do some work. And I had another child and I just did a whole bunch of different kinds of jobs. I did a little bit in pharma, I did some student health, I did some teaching. I did urgent care. And I worked at a second opinion company. And that was the job that I really found to be the most fulfilling for me because it was helping patients navigate their health care journeys. They would call me like their physician guardian angel, because I wasn't actually directly providing care for them. But I was getting all their records, listening to their questions. And for some of them trying to help them solve, you know, how do I get the right care, what is even wrong with me just having the time to collect all their records just to see everything in one place. Because you know, care is so fragmented right now and I may have been helping 10 or 15 patients when, you know in primary care, I had a panel of 2000 patients. So it was just this luxury of time to be able to speak to people as long as they needed, answer their questions, pursue expert second opinion if they needed it. So I left that role. Long story short, the nature of the role changed and I wasn't happy anymore. And I was very frustrated. And I pursued coaching I had sort of learned about coaching along the way. When I had this career reevaluation period in my life, I invested in coaching for myself, and it was so helpful, that I decided to be a coach just to learn the tools better. And then the pandemic hit and I realized these skills are very valuable and I felt a bit of a responsibility to help other doctors who are on the frontline because I wasn't being exposed to COVID. I was safe in my house and so many healthcare workers were really under and still are under such severe stress and exposure and I wanted to help manage some of that. So I started coaching and now that's what I do full time for women doctors,

Heather Johnston: 4:56

Only for women?

Karen Leitner MD: 4:58

Only for women.

Heather Johnston: 5:00

What are some of the most common obstacles that doctors are facing that are leading to burnout?

Karen Leitner MD: 5:07

What they think or what I think?

Heather Johnston: 5:09

Both

Karen Leitner MD: 5:11

Okay, well, I mean, okay, let's just look at the healthcare system. I mean, it does not value the physician, does not prioritize the physician, it's sort of with the development of electronic medical record, it was supposed to be this gift to the healthcare system to have everything put in one place. And it turns out, it is a huge amount of work for physicians to take on and everything sort of trickles down to them. You know, the healthcare system is in a trajectory that is unsustainable. Managed care, like fee for service, there's a lot of stresses on the system that have made it so that physicians are being paid based on like the volume of patients they see and hospitals are making money by how many admissions but short admissions, you know, this, there's a lot of strain on the system. That trickles down to physicians being asked to practice in ways that doesn't align with their desire to help patients and to spend time with patients and do what's best for patients. So, burnout, WHO definition it's a clinical syndrome that it has three presenting symptoms, let's say. The first is emotional exhaustion, pretty self explanatory. The second is depersonalization, so feeling like that lack of empathy for patients, whereas you made have once really felt connected or felt caring about who you're taking care of, you sort of lose that, you sort of, don't feel it as much. And the third one is lack of personal efficacy - you sort of feel like, nothing I do is matters, why why bother, why am I even doing this? I don't have any control over anything. So those three things together. The way I think about it is those are the end result of another term that's been described as moral injury, which is originally from sort of the Vietnam era. But Wendy Dean MD, and another co-author wrote an article a few years back that talked about how moral injury is when you are doing things that don't align with your values. So as opposed to like PTSD during the Vietnam era, where people were exposed to violence and death, and they're reliving that trauma, the moral injury piece, you've been forced to do something that really goes against your belief system. So imagine patient is in front of you, and they're crying, and they're depressed, and they need your time, but you have plenty more patients to see. And you're like running out the door, and you feel bad about that. Or, right now, you know, there's such a lack of resources, like mental health resources, so so many doctors are seeing, because of COVID, and all the isolation and all the financial issues happening, you're seeing depressed, overwhelmed sort of despondent, patient after patient you have nowhere to refer them to because mental health care is not reimbursed well, and it's not prioritized by the healthcare system. We're all about, you know, stents and procedures. So as a physician, seeing all those people and not being able to do anything for them, that creates that moral injury. How many go through the PA process like trying to get prior authorization for treatments that you know, your patient needs, but the insurance insurers are saying, you have to jump through this hoop, this hoop this hoop and get on the phone for an hour every time you want to order. You know, so all these things. Those are the external factors that contribute to burnout. So I just want to make sure I start there, because if I just start talking about the ways physicians are thinking, physicians get really mad because I like it feels like we're blaming them when we say they're burned out, like it's a personal failing instead of like a system wide problem that they do have some they do play into in certain ways. And that's where the coaching can help.

Heather Johnston: 8:48

You know, I was sort of like you, when I started. I was like, I just want to be nice and help people and make people feel better. And I want to hug my patients and I want to giggle with them and. But the problem today is that physicians are pulled away from patient care, and it's what most of us want. I know I'm totally speaking in generalities, but I mean, most of us want to be with our patients and help patients but the number of hours or minutes that people spend per day like where you don't have control over your work day. You're buried in hundreds and hundreds of phone and EMR messages. You're doing prior auths. You don't have enough time to document after you've seen patients which is really stressful.

Karen Leitner MD: 9:31

But I do think for most doctors there's you know, if you are feeling great in your own life and you are nourished and rested and fulfilled and have free time, you don't need your patients to like understand what you're going through. But when you are exposed to COVID, worried about bringing it home to your family, working crazy hours, not getting a break, not sleeping, you know running around all day. There's this sense that patients don't understand what we're going through, how hard it is, what we've sacrificed, right? There's this sense that like, patients think we just make tons of money, and we're doctors and right. And it's like, I think that if we were in a better place, if the mental health of physicians was better, that wouldn't need such attention. But I hear all the time, you know, patients are sitting there talking about their anxiety, their depression, their like, struggle, and the doctors are like, what about mine? You know, like, this is hard. It's hard to give of yourself when you're not cared for by yourself. And part of it is the system, but part of it is we don't take care of ourselves, which is where we're gonna get to, I'm sure.

Heather Johnston: 10:47

You know, the AMA has this series of articles called 'What Doctors Want Patients to Know About...' and there's all these different topics. And one of them was What Doctors Want Patients to Know About Doctor Burnout basically went through a couple of things that it asked patients to do to make the encounter as seamless and efficient as possible, because that will, in turn, possibly reduce, like the doctor's stress of the visits. So it was things like bringing your list of questions to the appointments so that you don't have a ton of follow up phone calls and emails about things you forgot, being on time to your appointment, because it just helps everything run more on time. Connecting with your doctor as a person was number three - asking them how are you? And it went through a couple of real life scenarios where doctors said they were so appreciative when a patient asked 'how are you doing?', especially with the turn of the pandemic, which we're also going to talk about, because it's changed everything really, in terms of how doctors are feeling about their jobs. And then the last thing was about signing up for electric, electronic medical record portals. Because then there's some things that an office can do to minimize how many direct phone calls that it needs to make. Like if they just need to let you know lab result was okay, or you need a referral. Like, they didn't want to have to make the phone call. So I thought that was an interesting collection of items that a patient could do to help a doctor have a better visit.

Karen Leitner MD: 12:20

Yeah, it's interesting. I would love to know what how that was received. Because I think what's coming up for me now is like thinking that it's all one organism, like the doctor patient unit is all one thing, right? And I think maybe that's the whole point of your podcast is it feels like they're on opposite sides. It's doctor versus patient. But like if your doctor burns out, a) you lose access, b) you're dealing with a less kind human c) you get worse care. So, but you know, I think patients often feel like everyone is entitled to their own perspective. You know, the doctor was rushed, hey didn't care about me, they didn't remember this thing I told them, they didn't send theprescription where I wanted it sent. Like, I totally, it's not like it's one or the other. It's like, yeah, there's not some is not really designed around patients and making their lives easier. Nor is it designed around doctors and making their lives easier. Because they, they really want to give the best care like they really want to. And also they're human beings. Think like, that's what I would put just remember your doctor is a human being. I think that I do think patients forget that sometimes.

Heather Johnston: 13:32

That's part of my intro to the whole podcast, by the way. It's just two people in a relationship, you know. You have to recognize it's just a person on the other side. We talked a little bit about external forces. What about internal forces with doctors and burnout?

Karen Leitner MD: 13:47

Yeah, so where do we even start there? So I love to start with the culture of medicine, which is very problematic. And what do I mean by that? The culture of medicine is sort of like all the subliminal messaging we get as we rise up through the ranks as medical students. It's like, doctors are, I even had someone say this during a coaching call. It's like, we're not supposed to get sick. We're the helpers. We're not the ones who need help, right? We're supposed to be infallible, we're strong, we're stoic, we're we work all the time. And we just power through everything and that shows up you know, during our training, that they're not restrictions on work hours that you know, no one ever wants to call out sick when you're in residency because it means someone one of your peers who's already exhausted and sleep deprived is going to have to cover for you. So people are you know showing up like like wheeling their IV pole around before they go deliver, it's crazy town. So it's just, there's such a double standard. Like we are not told 'care for yourself, you need rest, you're valuable.' Maternity leave - so short, used to be, if you've got any, you know, two weeks you're back on the wards. So you, it's this, I mean, it was designed around men. The reason it's called residency was because they lived in the hospital all the time, because they had someone at home to like, raise the family and do all those things. So there's a lot of problems with the messaging from the system and the culture and how you're not supposed to make mistakes and how shameful it is, if you do make a mistake, and how humiliating it would be if there's a lawsuit against you, right? We do that. We doctors do that, as opposed to like normalizing humans, they're human, they make mistakes, we can all learn from it. We are not gods, we are not all powerful, we need to own up to when we don't know something. And it's okay to have feelings, all that stuff. So that's one piece is like, we've internalized some of that. So, you know, I mean, I love to joke about this, but like, name me a doctor woman who, who goes to the bathroom when she has to. Instead of like, holding it. We hold it, like hold it forever!

Heather Johnston: 16:01

Bladder strain in female residents is like ironclad.

Karen Leitner MD: 16:05

Right? It's not right. And I remember, you know, when I was even, like, I had my own, I was working for myself, I could set my schedule, however I wanted. And I would like, give myself two minutes to eat. And then I would like inhale my food. Why? Like, this is just something we just learned how it just became like, alright, I might not eat at all, or I might not sleep. So that kind of messaging like that we kind of play into like, oh, I don't want to be weak. So I don't want to, you know, ask for extra time off when I'm pregnant. I'm going to work up to like, the very last day, so I don't, right? It's just it's nonsense. It doesn't? I'm not sure what what do you think about me saying all these things? Like it's not, it's not sustainable.

Heather Johnston: 16:48

Well, I developed kidney stones and residency because I didn't drink water for three years. So, you know.

Karen Leitner MD: 16:55

Um, and I think that's part of like, we have these standards for ourselves that are not humane. And we, we don't go pee, we don't show up late for a minute, because we needed a drink of water, we don't care for ourselves, and we can blame it on the system. But at some point, we've internalized it and we're doing it to ourselves. And we don't want to ask for help, because we're worried we're gonna seem weak. So why do we do that?

Heather Johnston: 17:25

There's no room for that stuff. There's no room made for it. I mean, when I was in, this was just my particular group that I was working with, but it was a busy Medicaid clinic. And if I didn't show up that day, I couldn't even get a hold of half of my patients. They were, you know, either didn't have phones, or they were at work or whatever. And so they would all show up. Someone else just has to now add them on on top of their patient load. So why did that happen? a) partly because patients need to be seen, but b) because the clinic was unwilling to lose the patient, was unwilling to call and say 'we just can't do your checkup tomorrow'. And on the flip side of that, when I'm a patient, and somebody cancels my appointment, I'm very annoyed about so I understand. But I guess the problem is that it yeah leaves no room at all for things like doctors to eat and pee and have lunch and get sick.

Karen Leitner MD: 18:19

Well, it also leads to them leaving medicine, right? So it's like

Heather Johnston: 18:25

As evidenced by both of us.

Karen Leitner MD: 18:27

Yes. It makes total sense to be like, if I don't come in when I'm sick, someone else is gonna have to do extra work. So I'm in, but it's like, how I'm going to come in sick, and then I'm gonna get, sicker. Gonna be take off two months, because I, so it doesn't actually solve the underlying problem. Like, we're thinking that when I come and don't take care of myself, it's so that no one else has to cover for me, so then I'm gonna be hospitalized and everyone's gonna have to cover for me.

Heather Johnston: 18:58

Well, it's a choice you make that you'd rather suffer yourself than make someone else suffer.

Karen Leitner MD: 19:02

Like, what if when doctors actually take care of themselves, when they're sick, they are less overwhelmed, more able to help a colleague, when they're not there, provide better care, they're more efficient, they're more on top of things. Right? Like, what if the opposite were even true?

Heather Johnston: 19:23

I can't even imagine that world, Karen. Like, I can't. I can't imagine my clinic having told me like 'you don't look well, why don't you go home and take a break'. I just can't I don't even know. I don't know what that would even look like.

Karen Leitner MD: 19:35

So I'm, I'm not trying to deny the reality of the world. But then there's also like, for me, for example, I would be like, I can't, I can't leave my practice. I can't leave my patients. What's going to happen to them? It's like, actually, I went on two maternity leaves and everyone was totally fine. No one died. No one was overwhelmed. But it's this. I can't, or I can't have, what if people are mad at me? Oh my god, what if my patient is mad at me? It's like, that's because of our people pleasing tendencies and our desire to want to make everyone happy all the time as women. But also, the recognition that you're in a relationship with those people, right? I mean, I knew every one of my teenage patients. Like I knew everything about them, and they knew stuff about me. And we would hug when they came in. And I didn't want to let them down. Right? But is it letting them down to stay home when you're sick? It's like, where do we create some of our own burnout? Like it's possible, it's possible someone might not do as good as you. But that's not the most useful thing to be thinking when you need to take care of yourself. If we're always putting, like what I say to my clients, sometimes it's like when we run around, working so hard to avoid ever disappointing anyone else, it's when we end up disappointing ourselves. And sometimes you have to put yourself first. And that's what we all have a problem with. And this is why women physicians, like don't take care of themselves, because they're taking care of their kids and their families and their patients. And they're always putting themselves at the bottom of the priority list. And we use that.

Heather Johnston: 21:11

I guess, part of the thing too is that with training, you are at the bottom when you're a medical student. And you're told to like accept your role there. Like, you are going to get the worst shift, you are going to be up all night, you are going to do this worst jobs. And I guess, and you're really told as a resident, I mean, you really can't miss work. It is a huge thing when you're a resident because those people are overworked beyond belief. And so the problem is, it's like you have to come out of all that and then switch your mindset and you don't.

Karen Leitner MD: 21:48

So perfect! Know what you're describing? That is called learned helplessness.

Heather Johnston: 21:52

Oh, I had that.

Karen Leitner MD: 21:54

Learned helplessness. We don't think we can change anything, because all our power is like we put it outside of us. We all do this, like part of being trained. Why is it do you think that like, there's a nurses union? MA union, they get breaks, they get lunch, because they speak up. And we, when it's us, we don't speak up. Here's another example. Like I have a client I worked with briefly who, you know, is similar sort of situation where she and her colleagues, they were up against this hospital system that was being very abusive, whatever. And they said, No, and they stood up and they had a lawsuit, and they spent all this money and all this time. And in the end, they did not win. So you know, you get to decide what you want to think about that. Like if winning means changing the whole system? Is that what it means? Or is winning, being true and being in integrity with yourself and standing up for the things you believe in, regardless of what you are able to change or not? Like, that's where so much power lies, and we don't harness our own power to be like, Well, you did. Eventually. You're like, I'm out of here. I'm not doing this anymore. But we think we can't leave. We think we can't ask for things. And if we ask once and we get told no. Or we asked why it's like, what if we just keep asking? Like you didn't get fired for doing that. You just decided I'm tired of doing this.

Heather Johnston: 23:24

Yeah. That's really true, yeah. Where were you in 2012 when I needed you?

Karen Leitner MD: 23:33

Oh, it's never it's never too late.

Heather Johnston: 23:35

This might be too difficult to answer, don't know. But what are some common pieces of advice that you end up giving to people?

Karen Leitner MD: 23:40

Yeah, so coaching isn't really giving advice, which is really fascinating. Like so many people, I felt like I've figured life out. And I'm just like zen. It's more about noticing how you're thinking, developing an awareness of the thoughts you have during the day and realizing that some of them are helping you and some aren't.

Heather Johnston: 24:01

Is it like a lot of self reflection, is that?

Karen Leitner MD: 24:04

it's not self reflection, just noticing that when I come into work, and my MA, like, hasn't roomed the patient yet and I get mad at them. And I sit there fuming. I may get ruin my whole day because I'm so mad at them all day, like what does that do for me? And like, what if I chose to think about that differently? So I can either communicate my expectations to them repeatedly, look at the system, look at a process so it flows differently. It's like if I'm just stuck in the like, my MA is Oh, like in the blame. And thinking that I'm angry because of what my MA does. I have no control over my day and I'm just like carrying around anger and annoyance on top of everything versus me realizing that the reason I'm angry is because I'm thinking something about that MA and I'm making it mean something or I'm thinking something about that patient who came late. There's another example like patients are gonna be late. They just are. We can't stop it. We wish we can We can try to have processes in place for when they're late. But what happens sometimes is we think, Oh, that person is being disrespectful to me. And actually, the patient has like their own crazy life, they're not thinking about you at all. They're just like in their experience, but you you like, physically feel disrespected all day because your patients are late, and you carry that with you. And like, what does that look like and how you help yourself get through your day when you're feeling angry and disrespected. So oh, you can just get rid of all of that if you don't want to and just like let things go. So it's a way of sort of not just being complacent, but taking control over you don't have to lie awake at night for three nights because your boss made a comment about you that is totally untrue. Like you get to decide what you want to make it mean that they said that.

Heather Johnston: 25:51

So in the patient being late scenario, would you talk about in a coaching session, would you be talking more about how somebody can think differently about that encounter? And like change their mental reaction to it? And how they think about it? Or would you? And/or would you be talking about how they could learn to give feedback to that patient to not be late, you know, what I mean? Like, part of what's been on my mind about burnout is what physicians can do inside their own head to minimize it and prevent it more. But then the other part of it is, some of the things that help lead towards physician burnout are inherent problems in the system. And how much should we engage with that? On one hand, I think it's incredibly beneficial for people to just learn to deal with things more positively. But on the other hand, if I come to work, and I'm supposed to see 12 patients and a half a day, but somehow I'm overbooked, and I've got 16, how do you figure out how to spend your time if you're trying to minimize your own burnout, like by changing your own mentality, or by changing the system around you?

Karen Leitner MD: 27:09

I think they go hand in hand, I think when you're burned out, you're not really in a place to be able to go make huge changes in the system. It's a little bit of a leap of faith. But like the coaching work and the thought work, leaving the system exactly as it is, like decreases, emotional exhaustion, decreases, overwhelm, increases your feeling in control of your life, that's something. So when women come into my program, it's eight weeks, and we do only thought work, I'm not changing the healthcare system during these eight weeks, right? It stays the same, and a lot of them are burned out. And by the end, they all say they feel better. They all say they feel more in control of their lives, they have more compassion for themselves. So the way they're talking to themselves. A lot of what we experience is coming from how we like beat ourselves up in our minds all day, every day. So unlearning some of those things. In coaching, we always talk about feelings, our feelings drive everything we do, not in like a woowoo way. But honestly, like you wanted to become a doctor, you had to feel motivated and determined and keep going even though lots of obstacles came up in your way. So if we want to change the healthcare system and make it better, what are the feelings we need to feel? We need to feel like strategic, motivated, determined, resourceful, empowered, or nothing's going to change. Those are feelings you have to feel to have make something change. And our feelings come from how we're thinking. And so when we're burned out, we tend to feel hopeless, exhausted, resentful. Those feelings are not going to change the system. They're not even going to allow me to see where there's the possibility for change. Because those feelings keep me very stuck and narrowly minded. And the other feelings, suddenly we see opportunity and possibility where we never saw it before. So it's like learning how to get out of those feelings that are just, they're justified. They don't serve us, they're not useful. Feeling resentful, is like, have you heard this expression? When I'm resenting my clinic because it's not valuing me enough. It's like drinking poison and expecting your enemy to die. Like, I'm the one feeling it. When I'm angry, I'm the one feeling it. My CEO doesn't feel it, my nurse who's not doing their job, doesn't feel it, I'm feeling it. If I actually want to change something, I need to feel open. I need to feel empowered to go talk to someone about it. I need to like this example of the late patient. I coached someone recently they had a patient who was late for like two years they were late every time Why hadn't my client said anything to them about it? It's that fear of it that people pleasing. It's like, able to feel the discomfort of saying to someone like Hey, I noticed you're late each time it's, you know, even like saying it from like. We go to like defensive, resentful, they don't, they don't respect me, blah blah blah. And then we just like, don't want to talk about it. We like shut down, you know, we want to avoid. Versus like, alright, this feels a little uncomfortable, I'm going to, I'm going to assume that person's doing their best. I'm going to approach them with from a loving place and just say, Listen, it's not okay for you to be late. So here's the boundary. If you're late the next time, I can't see you, or I'll see you but it has to be the end of my session. Or if you're late more times, I'm gonna have to find you another doc. Whatever it is, like we just avoid all those feelings. So learning how to feel the uncomfortable feelings is like our path towards making really big change.

Heather Johnston: 30:41

My guest today has been Dr. Karen Leitner, of Karen Leitner, MD coaching, she coaches women doctors who are looking to feel better in their lives.

Karen Leitner MD: 30:51

I coach women physicians exclusively And primarily, I offer group programs. So I have a group virtual coaching program that's called Feel Better. And I offer it three to four times a year. It's a smaller group, so there's usually 20 to 25 women, and I teach the tools towards helping with some of the thought work in mind management and overcoming things like impostor syndrome, and just really empowering them to feel like they have more control over their work life balance. And so they can find out about those programs on my website, which is www.KarenLeitnerMD.com, it's l e i t n e r. The cool thing is that I'm able to offer CME. And so for a lot of women physicians, they're able to get this covered by their workplaces. And the reason why, you know, this is considered a kind of professional development. But at the same time, most institutions realize there's a really big problem with physician burnout right now. And in addition to just wanting what's best for the workforce that they're in charge of, it also is a financially smart investment for an institution to make because the cost of replacing a physician who has left is way more than paying for them to learn skills that help them feel happier, be less tired, be more in charge, be more productive, and just be more self actualized.

Heather Johnston: 32:17

Thanks for listening today. To catch up on more episodes and to get new ones delivered directly to you. Subscribe wherever you find your podcasts, Apple, Google, Spotify, iHeartRadio and more. If you'd like to be a guest or have an idea for an episode, let me know at www.drpatientpodcast.com That's doctor patient podcast.com. Here's the disclaimer. Even though I am a doctor, I'm not your doctor. These stories, my comments and all discussion is purely reflection about what's working in the healthcare system and what isn't. Don't use any medical information that you hear in these episodes to diagnose or treat yourself. If you have a question about your health, get in touch with your doctor or local health clinic