Unscripted | Episode 2

Tackling Physician Burnout with Dr. Menon

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46% of healthcare workers experience burnout in 2022, according to CDC

Addisyn Uehling: Welcome to Ah, unscripted. I’m your host, Addison Yuling. In this series, we have candid one on one conversations with physicians about common struggles that doctors face in today’s world. On today’s show, we will be sitting down with Dr. Menon to talk about the common issue of burnout. According to a study done by the CDC, 46% of healthcare workers experience burnout in 2022. We’ll talk more about that on this episode of Unscripted. Hey, thank you so much for joining us today.

Renathan Menon is helping women professionals beat burnout and trauma

Could you please introduce yourself and give us a little bit, of some background and what your career looks like currently?

Dr. Menon: Absolutely. Thanks for having me. I am Dr. Menon My full name is prahashada. Means Renathan Menon I am a board certified family medicine physician, practicing for over twelve years. I’m also a certified life coach and a hypnotherapist. And my passion is helping, women professionals beat burnout and trauma and build the best days of their life.

Addisyn Uehling: That’s awesome. So, what made you choose this field?

Dr. Menon: That’s a great question. So, I was a, practicing family medicine physician, and I was a perceptor as well. with a lot of teaching, all the things that I loved. So I was serving my patients and teaching till I recognized that I was going through burnout myself a few years back. And that changed my life around because I came to know firsthand what burnout can do to you. Not just emotionally or physically, but also intellectually, and sometimes even spiritually and energetically, I would say. And, it took, quite a few trials of different kinds of modalities for me to be able to come out through the other end of it. so I had already been doing yoga and meditations and journaling and other self care practices, but temporarily, I would find some relief. But that was not enough to stop the burnout completely. I would also slip back into burnout once I healed from it. Then I discovered coaching. And simultaneously, I discovered healing, deep healing via hypnotherapy techniques as well, which amplified the results from the coaching. And so then I thought, oh, since I was able to come out to the other end and be back to myself, I thought this would be something incredible I can help other people following my path with. So I was able to put together all the different elements that helped me in a very strategic way so that it’s foolproof. Ironing out all the nuances of what I had to go through, trial and error, so I can help people forward with it.

Addisyn Uehling: Yeah, that’s super cool.

How do you know if you have burnout? That’s a great question

Our audience is mainly made up of medical professionals in the training and newly, attending, place in their life. what would you say are some common ways to recognize burnout? You said you experienced burnout, but what were not the symptoms of it, but how’d you know it was burnout?

Dr. Menon: That is a great question. just before I start answering it, is it okay if I ask you to volunteer for me? Addison, if you have a pen or is there anything nearby, a small object that you have near you that you can hold up for me? Okay, perfect. I want you to hold it up a little bit above so that none of your hand is resting on the table. Okay. And I want you to hold that position till I ask you to keep it down.

Burnout can develop into anxiety or depression if not addressed properly

All right. So, in burnout, it may be a little hard to recognize the symptoms of burnout in the beginning because it looks like a lot of the symptoms of other kinds of stuff that we normally experience in our daily life, like, for example, sleep deprivation. So imagine the process where someone pulls an all nighter. They are sleep deprived for one whole night because they’re preparing for the text the next day. Imagine how you feel the next day. So you feel drained and exhausted. Now imagine doing that every single day for two weeks. No sleep. Imagine m how you’d feel. I bet you would be exhausted to the core. And on top of that, you would be irritable as well. And then later on, you’d find that it would be easy for you to break down. You would lose your emotional, ability to regulate your emotions. So it’d be easy for you to break down at things that never bothered you before. And then, you’re doing a great job with the hand. I’ll give you a rest in just a moment. Yes. And then, after that, develops, when it becomes deeper, it develops into anxiety or depression per se. And people can also have physiologic changes that go along with it, which means to say that if it’s not addressed in the long run, it can develop into real anxiety, real, major depressive disorder, or it can also develop into insomnia, other stress related illnesses like diabetes. You can set your hand down now. Okay. How do you feel, though? How do you feel with your hand?

Addisyn Uehling: It’s a little tired. Yeah.

Dr. Menon: Sorry. All right, so those are some of the main, symptoms of burnout that people may experience. I got you.

Addisyn Uehling: And so how does the pen relate to that?

Dr. Menon: We come into that in the next step.

How do you think emotional trauma plays into burnout

Okay.

Addisyn Uehling: Well, do you feel like, emotional trauma plays any role. And you kind of talked about anxiety and depression. are effects of burnout. How do you think emotional trauma plays into burnout? Either beginning, or after burnout, post burnout.

Dr. Menon: Okay, for this part of the exercise, I’d like you to hold your pen with the other hand. If your other hand is free. And each time I finish my sentence, you can put your hand down. But with the next sentence, I want you to bring it back up.

Addisyn Uehling: Okay.

Dr. Menon: Awesome. So, emotional trauma. That’s a very interesting question, because it’s not very common for us to associate emotional trauma with burnout. But, what happened was, to put it in perspective, a few years back, like, 20 years back, I lost my dad and a child within a few years of each other, unfortunately. And I had been through a few other kinds of trauma as well. And healing from burnout made me realize that any emotional trauma from the past increases your risk for burnout, and it also increases the risk for repeat burnout. You can put it now. Okay, I’m going to start the next sentence again. And, what happens with that is, if it is not healed adequately, it can always increase your risk for repeat burnout later on. And what was even trickier is that when you’re going through burnout, even things you did not consider traumatic from the past can act like trauma and make the same effect happen on you. You can put it down now back up again. Okay, that’s. We see that, emotional trauma is a significant contributor to burnout. At the same time, people who are going through burnout are at a higher risk for those emotional trauma to cause more traumatic symptoms in themselves. So it’s kind of like burnout has even been found to behave like trauma in clinical studies. You can put your hand down now. How is your hand feeling?

Addisyn Uehling: It’s a lot tired. Yeah.

Dr. Menon: Is it similar to the other side?

Addisyn Uehling: Yeah. but I’m getting more rest, so it’s not as tired.

Dr. Menon: It’s not as tired. Okay. Thank you. All right. Okay, go ahead.

Addisyn Uehling: Okay, perfect.

Anything that acts as a stressor on your body can lead to burnout

So do you feel like burnout is simply a response to stress, or is there, like, a deeper neurological explanation for burnout?

Dr. Menon: That is right. yes to both. So anything that basically can act as a stressor on your body, technically, over a period of time, can lead to burnout at the same time. there is a specific neurophysiologic basis for burnout as well. Even for trauma, there’s a specific neurophysiologic burnout, basis as well. So what happens is, anytime that we are, forced into a situation where we feel emotionally unsafe, it can be dealing with a very difficult patient encounter. It can be the risk of malpractice, lawsuit against you from a difficult patient encounter, or it can be a threat to maintaining your, livelihood for any reason. It can be ill health. It can be anything, basically anything that, makes your emotional safety in check. That is the starting point for a cascade, of different physiologic events that ultimately lead to burnout and trauma. So, yeah, basically, we have a stress response system, which is, in our bodies. It’s called the hPa axis, hypothalamic, pituitary, adrenal axis. And anything that affects the health of that can definitely increase your risk for burnout. So what often happens is, ah, the HPA axis is, activated each time we go through a physiologic stressor over a period of time. Your adrenals are so, involved into busting a stress response that your stress response system itself is starting to wear down because you are in the fight or flight mode for a long period of time. And, interestingly, it’s not just the physiotic changes that’s associated with it, but the emotions that you go through when you’re going through that process are also linked to these HPA access changes. And that is what we need to target so that we can completely heal from burnout. Most of the times, we are not able to make this connection between your emotions and the HBA axis. And that is what leaves that, area left where you are still at a risk for repeat burnout later on. So if you’re able to correctly adequately identify that link between them and then, invite in healing to that part, then it’ll be easier for us to heal from burnout faster and also to prevent reburnout.

Addisyn Uehling: Yeah, absolutely. That’s such good, valuable information. Would you say? So, just so that the audience and the listeners can connect with you? What’s your testimony? What did you go through with burnout? Kind of share a little bit about what made you so passionate about burnout?

Dr. Menon: Yes. almost everything I went through in my life when I was going through burnout, I actually experienced, firsthand. So, like I was saying, it’s similar to a sleep deprivation effect when it first starts off and then your emotional shock absorption is reduced. That means I consider myself a very strong, emotionally strong person. Before and in the medical profession, we also have to maintain a certain amount of clinical detachment from the patient. Where we would not be affected by any uprisings or, anything that can happen unanticipatedly or even if it’s clinical. But even then, in the beginning stages, your emotional, shock absorption is intact so that you are able to clinically detach consciously from it. But later on, this shock absorption is worn out. So even if you’re consciously detaching from it, it can still cause the same physiologic effect as if you’re going through a traumatic experience. For example, I was in the later stages when I was in burnout. I had, ah, a difficult patient encounter. Everything seemed settled. Towards the end of the encounter, I was able to consciously put it behind me. I was not thinking about it. I know what happened. I know how we fixed it. I know everything. Everything was settled. Everything was said and done. It’s free to move to the next patient. I was okay consciously. I was detached. However, once I start moving to the next patient, my heart started racing. Then I started feeling like I was feeling lighted. Of course, my blood pressure was going down. My heart rate would be unreasonable. It was not easily regulated as before. So there are different kinds of bodily, symptoms that can happen when you are going through burnout. So that’s one example of how it can affect you.

Addisyn Uehling: Yeah, for sure.

What is the most beneficial amount of sleep that a physician needs

And so you mentioned sleep. And what would you say is the most beneficial amount of sleep that a physician needs? Right. It’s really hard to come to when you are a physician. But what would you, say about sleep?

Dr. Menon: That is a very good question as well. I would, recommend minimum of seven to 8 hours of continuous sleep, which is sometimes hard to get by because our schedules are very random. And especially if you’re doing nights, if you’re doing 24 hours shifts or 30 hours shifts, or if you’re on a difficult, long surgery, it is hard to determine when and how you get that sleep, but it’s important to get at least seven to 8 hours of continuous sleep in a 24 hours period. If you’re not able to get that, at least try to catch upon it when you can next time. And again, it’s also important. the timing of the sleep is also important because, there is a diurnal variation to certain hormones that control our HBA axis, like the Acth release. And all happens at a certain time during our sleep, around three to four in the morning. So because of that, it’s important to get sleep around that time. So nighttime sleep is usually beneficial than daytime sleep, though you can use daytime sleep to catch up on what you missed. But hopefully it’s not, ah, a routine thing.

Addisyn Uehling: Got you. That’s super.

Sleep is a trigger for burnout, but dehydration is also important

Good to know. would you say, so sleep is a trigger for burnout, right? What are some other things that you think are triggers for burnout for our, target audience? So the residents, the fellows, the newly attending.

Dr. Menon: Absolutely. So the three common things in our daily life which can be easy, triggers of burnout, which we usually do not pay much attention to, is one, sleep, as we discussed. Second is dehydration. You may not believe it. Dehydration, because our adrenal glands mainly thrive off of adequate, water intake and vitamin C. So, adequate water intake. Dehydration is a very important cause because it can be easily slipped under a nose. As we are so busy with our lives professionally, we may not stop to make sure we are drinking that much water. And a third, I would say, would be caffeine. Because, one, it causes dehydration, or it adds to dehydration. But two, it’s a physiology stressor as well, especially when your stress response system is already taxed with having to deal with other kinds of stressors. Caffeine just worsens it.

Addisyn Uehling: Yeah. Okay.

You cannot go wrong with 64 to 80oz of water a day

What would you say is the good amount of water for a physician to drink? Does it go by? yeah. Just what does it go by?

Dr. Menon: That’s another good question as well. I would recommend you cannot go wrong with 64 to 80oz of water a day. unless you have some medical condition related to your kidneys, your liver, or your heart, or any other thing that makes you want to restrict it even further. Otherwise, you cannot go wrong with 64 to 80oz of water a day. Then again, depending on your caloric requirements, if you’re trying to lose weight, gain weight, maintain the same weight, or your weight is more than a, typical 120 pound person, then the water requirement may vary, but you cannot go wrong. Still with 64 to 80oz of water a day.

Addisyn Uehling: Okay, awesome. That’s good to know.

Um, if you had a room full of residents, um, and you wanted to

so if you had a room full of residents, and you wanted to tell them some simple steps to avoid burnout, what would some of those steps be?

Dr. Menon: I would like to first emphasize the effects of some things that can happen. so I would like to draw back on the experience that you had with lifting the pen. So, I, would like to let them know that burnout can happen either when you were holding the pen on your left side so you were holding it for a long time, that’s a prolonged time of stress or a significant stressor or significant life changing event in your life that can lead to burnout, or it can happen with simple, minor things, like lifting that pen with every sentence, which is like micro traumas in your life, professional life. Micro traumas, which may not be significant enough when they happen, but their effects add up over time, and ultimately, it can lead to burnout. For example, one example is microaggression. And microaggressions at the workplace, which is like microaggressions that difficult patient encounters. An example of a microaggression. so what happens in that is we usually feel a jolt inside, but most of us are trained to, have that clinical detachment. And because we need the clinical detachment to make our clinical judgment correct, we cannot allow those emotions to listen, to ruin our internal makeup. Right. But at the same time, it’s actually already doing its job, especially if your burnout process has started, even if you’re consciously detached. Like I said, that internal physiologic process is already going on. And then what we usually do is we make a note that, oh, I cannot afford to deal with this right now because I do have 20 patients in front of me right now. I had to finish seeing them. Okay, so then put up your best professional face after stuffing that pain back inside, because you think, yeah, that’s not the time to deal with it. And then professional face, you’re into the next patient encounter. But if we do that continuously for those 20 patients, at the end of the day is when you notice the symptom, you’re extremely drained, and you don’t know why. There’s something that they can easily do at the very first step itself, when they feel that they’re feeling off. the point is to recognize that they’re feeling off. How do we do that when we are already clinically trained to not be in touch with that emotional side? Because we have to maintain that clinical detachment. Right. So that’s where our key healing tools of, increasing self awareness comes in. So especially meditation, yoga, journaling, all those can increase our visceral connection to ourselves, so we can detect that right away when it’s happening. The next step is what I usually teach my, clients, in my program or even offer in the free webinar classes that I host. So that’s something that they can do from there, which will actually change the whole trajectory without leading to burnout.

How do residents recover from burnout? That’s a great question

Addisyn Uehling: Awesome. So would you say we’ve kind of talked about preventing burnout? We’ve talked about steps of, when you’re in burnout, how do you recover from burnout so how would a resident, first you got to recognize it, right? But then how do they recover?

Dr. Menon: That is a very great question, too, because it depends on the individual person, because everybody has a certain trigger or, certain triggers for burnout, and they have certain triggers for repeat burnout as well. And what happens is, when we are in the trigger, we are in the flight or fight mode. So, typically we have learned coping mechanisms over the years whenever we face that specific kind of fight or flight mode, which meant, to keep us safe in that time. But that may not be the healthiest coping strategy, keeping in view of our HPA axis. So what happens is, over a period of time, when we practice those same coping strategies, it’s wearing down our HBA axis. It’s wearing us out from the inside. That’s how we end up burned out. So the key would be to, figure out your link between your emotional patterns and your HPA axis anti stress response pathway so that we can, modify how your emotions are related to your stress response pathway. And that happens, ideally in theta brainwave state, which is in the subconscious mind. That is a deep, relaxed, state between the awake state, which is the beta state, and the sleeping state. that’s one of the main things that we can do apart from all the other smaller strategies that we mentioned, which is, meditation, yoga, journaling, sleep hydration. And my last but not the least, it’s very important. This is something I share in all my, webinar sessions as well, which is doing something you love every day. Every day. Find at least 1 minute or how muchever you can to do something that you love. And it may sound like cliche or like grandma’s tale, do something you love. But it’s not that there’s a neurophysiologic background behind it.

What do you think causes reoccurring burnout and how can people avoid it

Addisyn Uehling: You’ve m kind of mentioned in your testimony how burnout has been a consistent thing, or was a consistent thing in your training in your early years. what do you think causes that reoccurring burnout, and how can people recognize that and avoid that?

Dr. Menon: That’s, a good question. Again, like we were mentioning earlier about the symptoms of burnout, initially, it can look like a period of sleep deprivation. It’s very hard to make out if you’re going through burnout or if it’s just a physiology change of a tough schedule. Okay, so the most common symptom would be exhaustion, extreme exhaustion. And this exhaustion is not like something that can be relieved by just sleep. This is like bone tired soul tired exhaustion, which just doesn’t go away. later on, it leads to irritability, it leads to effect, changes like you can develop anxiety and depression, or you can feel anxious with small triggers very easily, which you were not doing before. You can break down easily with small triggers which you were not doing before. Things that did not bother you seem to bother you now more. Those are all the signs that it’s starting to creep in. And then later on it can become real, MDD, that’s major depressive disorder or general anxiety disorder. And, towards the end, it can also lead to stress, related medical conditions like diabetes and insomnia. And many people often even develop, if it’s severe enough. Based on the severity, it can develop adrenal insufficiency as well, because the adrenals are constantly taxed in the process. So those are all the main things to keep in mind to see whether or not you’re going to go through or whether or not you’re going through it. So another objective way to find out if you’re going through it is also to take some testing. There’s a testing, neuropsychologic testing. It’s called maslux burnout inventory. you could use that. usually coaches or even, I believe psychotherapists, offer that. I would recommend having a therapist for sure. And, my website also hosts a free quiz that they can take to assess how they are on the burnout spectrum. And, there are some free resources on my website as well, which is my blog, which contains all my hard earned, lessons of burnout. So they don’t have to reinvent the wheel and go through the trials and errors and make the mistakes I did so they can heal faster. I also share this on, my YouTube channel as well. And very recently I’m expanding also into, TikTok and Instagram as well. Awesome.

Addisyn Uehling: that’s super.

Praharshaman offers a 12 week immersive coaching program for residents

So, like, where could a resident, what exactly is in your program? So your coaching program? So if a resident wanted to be a part of that, what would that look like for them?

Dr. Menon: Absolutely. So it’s a twelve week immersive coaching program. so there would be an online course material that they can complete at their own, pace. but we would have weekly meetings, group meetings via Zoom. they would be a supportive and safe Facebook community to support their healing. And they would also have, this is the key point. They would also have, two, one on one sessions with me every month during the course of the program. And that’s a little unheard of. Usually. Typically, coaching programs may not have access to the coach per se. Personally, other than the group coaching. Sometimes they may have it less than what I’m offering. But because I know that trauma and burnout are very important to heal from and I believe in being able to hold them by their hands and guide them to clearing it for good so that they can live the best days of their life. So I’m offering it, two sessions in a month as well.

Addisyn Uehling: Awesome. That’s super cool. those are great resources. Anything else that you would like to share about how we could get in contact with you? how a resident could, see some of that stuff or, be in contact?

Dr. Menon: Yeah, absolutely. On my website it’s called ww dot praharshaman.com. And, they can also book a, discovery, session with me so we can go through the specifics of their situation and decide what may be able to help them and chart a path out for them. They can also, like I mentioned, the previous resources that I mentioned, they can also avail the free resources available about my experiences and how certain things that I was able to, transmute in my journey if it may help them. And that’s all shared in the blog and in the YouTube. awesome.

Addisyn Uehling: Well, thank you so much for your time today and I really appreciate you coming on and sharing more about burnout and how we can prevent that.

Dr. Menon: My pleasure. Thank you for having me.