In the third Prosperous Doc podcast episode, “Global Health and Innovation”, Spaugh Dameron Tenny was excited to connect with Dr. Joseph R. Hsu, MD, the Vice Chair of Quality at Atrium Health Musculoskeletal Institute.
As the founder of RESTORE (Reconstructive Surgery and Transmission of Operative Resources and Education), Dr. Hsu is a hands-on advocate for global humanitarianism. RESTORE, a partner of Atrium Health, started in 2011 through humanitarian work, as part of medical readiness missions for the US Army at Hospital Escuela in Tegucigalpa, Honduras. Dr. Hsu is an Orthopedic Trauma Surgeon and Director of the Limb Lengthening and Deformity Service at Atrium Health’s Carolinas Medical Center.
In this episode of White Coat Wellness, Dr. Hsu discusses uplifts and hassles in the workplace and how to avoid feelings of anxiety and depersonalization. He explores the common drawbacks of practicing medicine, including burnout, and offers advice on how to combat these common feelings using uplifts from daily wins and humanitarian efforts. Below are Dr. Hsu’s answers to Shane Tenny’s (of Spaugh Tameron Denny) questions. You can also listen to the full episode below.
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Shane Tenny:
“Dr. Hsu, you were just talking a little bit about the work as a physician. And perhaps for all of us, there are things in our lives that kind of make withdrawals from our energy bank, and there are things that make contributions to our energy bank. Our podcast here, of course, is White Coat Wellness, and I guess that’s kind of...the phrase that comes to mind when I hear you talking about the work that you’ve been able to do in Honduras really helping to...I guess what I hear you saying is almost make you a better physician when you’re here on a day to day basis…”
What does that concept of wellness mean, and how does that integrate with what you've been doing?
Dr. Joe Hsu:
“I alluded to earlier that there are a lot of theories around burnout and resilience or grit. To me, the easiest one to understand as a non psychiatrist, non psychologist is this concept of hassles versus uplifts.
There are so many hassles that we have to deal with during the day that get us into a situation where we get disconnected from our work, or disconnected from the purpose of our work.
And those are the things that really kind of break us down over time. And that depersonalization is really one of the first signs of burnout.
There are other things that are uplifts, there are these little things that we have, these little bright moments in our day that counteract the hassles. Now what does that need to be? Does it need to be a 1:1 ratio, a 10:1? It sort of depends on who you are as a person. It probably may be 100:1, is the right mix.
But part of it is being aware of when it is an uplift, and recognizing in a positive moment, say, "This is an uplift for me," and that's what RESTORE has become. RESTORE is a huge uplift for me. I'm excited to talk about it, as you can tell. I do a little bit every day. I tell people this kind of work, it's not ... You go down for a week, there's a little bit everyday that you're doing logistically on the background, and electronically mentoring the surgeons there. But that's an uplift to me. That's not like, "Oh, this is a hassle. I've got to answer this email or WhatsApp." It fulfills me to do that.
And so as that is an uplift, It helps refocus our purpose, gets us back to the why of what we do in medicine. The same thing can be said, there are some of the wounded warriors that I'm still in touch with now from the military. And I tell people that I draw resilience from my patients and I have a whole theory about how if we really recognize that one of these people has accomplished and moved on with their lives and displayed tremendous amount of grit, we can draw from that. And it gives us purpose in what we do. And I think that that's the real challenge with wellness and burnout is losing that purpose, and you get to where that personalization becomes a problem, and you start to withdraw from that.
What advice would you give doctors to combat feelings of depersonalization, stress, anxiety, burnout, etc. in the workplace based on your own experiences?
Dr. Joe Hsu:
I think most of the focus on it has been this concept of work/life balance. But the reality is this. The majority of the waking hours of your life are going to be at work, really no matter what your work is. And so my strategy has been to find these uplifts at work. And not only do I find them, but I'm willing to share them with other people. And that's something that is a little bit different. We're taught this tremendous humility as physicians, right? If a patient does well, it's almost considered bragging to tell someone, "Hey, look what this patient did." But the reality is, the rest of the team needs you to share that story as well. Because the nurses, the technicians, the same people that deal with the same struggles that we're dealing with, they don't get to know what happens to the patient.
They don't get to know that that patient went on and got married and got to walk down the aisle because we fixed their limb. They don't get to know that. And so sharing that not only helps me, but it's going to help the rest of the team. So I think that that's one of the tips that I give people ... Is first and foremost, recognizing you've got to find that in your work. It can't just be I'm going to take a vacation or I'm going to do more yoga. All things that I encourage people to do and I try to do myself, but finding that in your own work and sharing those stories with other people. The other thing is because of this humility barrier that we feel in medicine sometimes, if a patient thanks you, we downplay that thanks a lot of times.
But the reality is it's important for that patient to give that ‘thanks’. That is part of their healing process, for the grateful patients to give that ‘thanks’. It's also important for us to accept it. And I think that that's a real challenge is we often ... it's downplayed for the most part. And there are strategies to doing it, there are strategies to accepting the thanks. Like I tell people, "Thank you for extending your gratitude. That means a lot to me. It's a huge team effort. We're fortunate to be able to care for people like you that are so motivated to do well and we played this part. I'm glad that we're able to work together on this." And that may be a more comfortable strategy for someone who is not willing to take that ‘thanks’ or has not been taught to take that ‘thanks’.
So it's not really something that we really do in healthcare. And in reality, when you open that conversation with a patient, you realize how meaningful you are to that patient in their lives. And that's why we got into medicine in the first place.
We got into medicine for that meaning, we got into medicine for that connection. And then we lose it through all of the different processes and the requirements and the regulation, and the technology that actually doesn't seem to work.
I don't know what the barrier is in medicine, but if you put medical before the word technology, it usually is not technology.
So those are things that hopefully moving forward, some of the work that we're trying to do is to help fix some of those interfaces to improve that. That's a pretty heavy lift moving forward.”
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Dr. Hsu highlighted the importance of embracing uplifts at work such as patient gratitude, and sharing that with your medical team. Reciprocating the gratitude with the patient will also combat the hassles of day to day life practicing medicine. Read more about Dr. Hsu and his recent trip to Honduras through RESTORE here. Listen to the entire White Coat Wellness Podcast episode 3: Global Health and Innovation below.
