Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Join us as we explore the emotional toll of high-stakes health care with physician, speaker, and thought leader Pamela Buchanan. Discover her insights on the “emotional flatline,” a defense mechanism that shields health care professionals but can erode empathy and connection. Pamela shares her journey of overcoming this state, offering actionable steps to transform health care and prioritize mental well-being for providers and patients alike.
Pamela Buchanan is a board-certified physician, speaker, and thought leader dedicated to transforming health care and championing mental well-being.
She discusses the KevinMD article, “Reviving the emotional flatline: Addressing burnout in health care professionals.”
Our presenting sponsor is DAX Copilot by Microsoft.
DAX Copilot, by Microsoft, is your AI assistant for automated clinical documentation and workflows. DAX Copilot allows physicians to do more with less and turn their words into a powerful productivity tool. DAX Copilot automates clinical documentation—making it available in the EHR within minutes—and clinical workflows, including referral letters, after-visit summaries, style and formatting customizations, and more.
70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences.
Discover AI-powered solutions for clinical documentation and workflows. Click here to see a 12-minute DAX Copilot demo.
VISIT SPONSOR → https://aka.ms/kevinmd
SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast
RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended
GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme
I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus
Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Pamela Buchanan. She’s a physician, speaker, and thought leader. Today’s KevinMD article is “Reviving the Emotional Flatline, Addressing Burnout in Health Care Professionals.” Pamela, welcome back to the show.
Pamela Buchanan: Thank you, Kevin. Thanks for having me on. I really appreciate it.
Kevin Pho: So tell us what this latest article is about for those who didn’t get a chance to read it.
Pamela Buchanan: So this latest article is about what I call the emotional flatline. I talked about it in my TED Talk because it was the analogy of what I felt when I was going through my episode of mental illness, like depression.
I had suicidal, you know, I’m a physician. I’m working in an ER in a rural area of Missouri, just outside of St. Louis. And the pandemic hit especially hard. We had a lot of COVID deniers, and we had a lack of resources, because it’s a rural area. And so, you know, when you’re a rural doctor, you’re left to be all things to all people.
It’s quite—I work there, and I work in the city, because the city’s not that far, and it’s easier to work in the city. The stressors just kind of took a toll. It’s just repetitive, unrelenting. People were reluctant to get up and weren’t following the guidelines. And so we had some really massive outbreaks.
I remember one we called the red wedding, where it was because there was a wedding that happened during COVID. And first the bride’s mother got sick and then the whole wedding party and the whole wedding. And then it just stressed our system to the bones. And a lot of people, a lot of our physicians, fell ill.
I never got sick. So I wasn’t more than really a human should… yeah. I got depressed, and I got suicidal, and it was odd for me because I’ve never been like that. I’ve never had that issue, and I didn’t quite know how to deal with it. And so, you know, I recall seeing a lot more flatlines than I’m used to.
And I was like, well, I feel like I’m going through like a mental flatline. And I felt like it was no worse than if your heart stopped—it was like my mind stopped, and I couldn’t go any further. And so that’s really what I call the emotional flatline.
Kevin Pho: So when you talk about the emotional flatline, just tell us how other people perceive you and then, in terms of exactly emotionally, what are you feeling or not feeling during that time?
Pamela Buchanan: For me—and I think it’s different for everyone else—but for me, I was feeling nothing. I felt… you know, I’m normally a very empathetic physician, very engaging. I just wasn’t communicating as I normally did. It was quite insidious. I could diagnose it in anyone else, on a patient, on a colleague, but I really didn’t recognize it in myself.
I was withdrawing, didn’t want to… just think city caps, right? We married to medical school. That’s what was going on with me.
Kevin Pho: Now, at what point did you realize that it was a problem? Did someone come up to you and comment on it? So how did you eventually come to recognize it?
Pamela Buchanan: I was having this thought. So, during the pandemic, I have about an hour commute to go to the ER that was rural, and I drive across this bridge. I kept driving across this bridge, and day after day after day, a voice would tell me to jump in. And I shrugged it off, and it was easy to listen to that voice because it was like the apocalypse during that time.
Nobody was on the roads—only the essential workers. And so I had that thought repeatedly. I shrugged it off, and I overworked, and I kind of tucked it away. I wasn’t seeing my family much either because we were quarantined. I have a son who has a chronic illness, so I was careful not to be around the family.
I was in an area over the garage, so isolated too.
And a colleague of mine—a mentor, someone I really respected, the nicest guy—you know, get to work one day, he committed suicide. And so it’s a shocker in the whole ER, it’s like, not him.
How? Why? Beautiful family, active in his church, beautiful wife, kids. And so then I was like, if he could do that, then I should—I need to get some help.
Kevin Pho: So what did you do next after recognizing these symptoms in yourself?
Pamela Buchanan: So the first thing I did was I contacted the hospital’s EAPs to see if they could help. They were no help. And I got this from my colleagues, because when you work in the ER, a lot of your friends are firefighters, policemen, paramedics.
And within their system, mental health is embedded as one of their benefits. Like, if we have a hard call where maybe something traumatic happens and you see maybe children die, someone burns—something that sticks with you—they are required to do counseling. It’s embedded. They have it there. But the hospital didn’t have that.
I was surprised. So then I go down the back of my insurance card, try to call. It was… this is a pandemic too, so nobody had any room. And then when I finally found someone, I thought, great, I can find somebody, but she didn’t take my insurance. So I just paid out of pocket. And that’s when I really realized that this whole mental health system is abysmal.
And if it’s that hard for me as a physician, it must be way harder for other people. And the only reason I was able to kind of figure it out is through connections, and one of my best friend’s husband is a psychiatrist. He made some recommendations, and that was the way that it moved the needle for me. I kind of think, and I became passionate about helping people with this because I think if I weren’t me…
Would I be here?
Kevin Pho: Now, the pandemic was several years ago. Tell us the type of techniques that you’re implementing to prevent yourself from falling into that emotional flatline state.
Pamela Buchanan: And so I started off with therapy, and that helped for a period of time. But then what helped me more than that was I found a coach—and a physician coach.
And the reason that helped me is because they got me. They understood, you know, the day in and day out of a physician, because the day in and day out of a physician is unique. I don’t think the generalized public gets how much that stuff—how much self-sacrifice we have. So physicians do a lot of self-sacrifice.
You know how that goes. And it’s ingrained in our brains from residency on, like martyrdom is the way.
And so what I learned is that that is not something I have to be. I don’t have to be all things to all people. Like it’s possible to have a work-life balance. There’s more than one way to be a doctor.
And so I had to reconnect with my purpose. I love being a doctor. So why did I ever want to do it? What’s my why? So I went through a journey, reconnected with my purpose, and it helped me figure out how I wanted to practice and how much was enough for me, what I really needed, and tailor it to that.
Kevin Pho: Now you mentioned earlier that some of our colleagues, like firefighters and paramedics, that wellness—that a culture of behavioral health wellness—is embedded in that culture, but not so much with medicine. Do you think that’s changed over the last few years because we’ve brought some attention to that phenomenon of physician burnout and physician suicide? Have we moved that needle a little bit over the past few years, from what you’ve seen?
Pamela Buchanan: A tiny bit. So I am an ambassador with the Lorna Breen Foundation, and its focus and mission is to help prevent health care suicides among physicians and nurses. And so there’s some legislation that’s come through the pipes that has made it so hospitals are supposed to have physician wellness programs.
Now, in theory, that’s nice, and there’s government money for it, but in practice, I’m not seeing it just yet. And that’s why I think it’s important for people like me to be vocal. I’m happy to partner with Lorna Breen, and I’ve made friends with different people, like Kim Downey. She’s a physician advocate, and I think it’s got to be a grassroots movement.
I don’t think that the general public really understands the gravity of the situation, because we’re already at a shortage of physicians. It’s been that way. You’ve heard that since—I’ve heard that since I graduated. But then you have a pandemic, and you have people who quit, and you have people who want to quit. And then the average length of time of burnout is getting shorter and shorter.
So we can’t keep doing what we’re doing or we’ll be in crisis—like real crisis. And I don’t want to see that. I don’t want to be an older person not being able to find a physician. And that’s one thing I’m afraid of. So I’m committed to working, and I’m now coaching physicians to stay in practice because I think that we aren’t given alternative ways to practice.
Like there’s just not one size fits all, and I think that needs to be made, you know, something that is made available to physicians to consider.
Kevin Pho: Now you mentioned Kim Downey. I actually just had her on the podcast right before you, and she’s done wonderful work in terms of advocating for physician wellness. Now you talk about a grassroots movement. How much of the responsibility, however, is needed from our health care leaders? Because a lot of the reasons why physicians are burned out is because of systemic causes, right? Top-down decisions. So tell us the responsibility that our physician leaders, our health care administrators, need to have if we want to move that needle and improve physician burnout.
Pamela Buchanan: Well, I’d like to see us as physicians have more of a uniform and united mission of what we want, what we need, and clearly articulate that. And, you know, I think that our leaders need to understand—I think our leaders think that money is the answer, that pay you more, and that is not the answer. I think they need to realize that we’re humans.
Like, for instance, I work in a particular ER that I work in because they treat me like a human. They consider me as a whole person, ask questions about what I need, what schedule benefits me, and involve me in the process. They do that for all of us. Example being this holiday season: I didn’t work most of the holidays because I have colleagues who are Muslim.
And they don’t—they didn’t want to be off on holidays, but they like to be off for other things, their holidays, such as Ramadan, and I’m happy to work it. So we just—we have more humanity. I think that’s what it’s going to take. And I think our leaders need to realize that we’re not rote things that do a service like an assembly line, but we are humans handling other humans.
And I want us to do a good job, and we need to do a good job because we need to be responsible, alert, and empathetic. OK. You know, you can’t be robotic in delivering bad news. We need to be rested and well and not sick.
Kevin Pho: So just to clarify what you said: You’re seeing stories where health care administrators see the problem of physician burnout and think a solution would be just simply to pay them more and throw money at the problem. You’re seeing that commonly either personally or through your colleagues?
Pamela Buchanan: I see that a lot, very much so personally. An ER where I used to work raised their hourly rate there so much that it seems unreal. But I’m like, the answer is not that. The answer is don’t use me like a workhorse. I recall working a shift and then someone not being able to show up and working 24 hours straight, and then it reminded me of residency. And I’m attending—that’s not what I want to do in my life.
That’s not how I want to feel.
And so, yeah, money is not the answer. You know, when you have enough, you have enough. We all want our basic needs met. And there are even studies that there’s a certain amount that’s enough. And I think it was somewhere around 70,000. You know, doctors do better than that. But for me, I don’t need to work until I’m sick for just a large sum of money.
Kevin Pho: So you talked earlier about physicians needing to unite and create that grassroots movement. So for those doctors who are listening to you now or seeing your TED Talk or read your articles on KevinMD, how can they rise up and join such a movement?
Pamela Buchanan: You know, I think ask for what you need because I think the times changed where I work because more people were vocal about “This is what I need.”
And I can’t continue—I mean, just really at our wits’ end—I can’t continue on if I can’t get some concessions. And I think some of us were or are afraid. I think it’s the perfect time to be more vocal because it’s not an easy task to make a physician. It’s not something—you know, all of us can’t quit; it would be tragic.
And so I think our administrators are at a point where they have to listen, particularly in places where it’s sparse, like in rural communities. It’s already difficult, even before the pandemic, to get someone to work there. And then after—and I really feel for people in rural communities because you see hospitals closing left and right, OB-GYNs are leaving left and right—they need us.
And so I think that administrators have to realize that. And if you’re an administrator, and you don’t realize that, I really think you need to do it before it becomes that emergency, that tragic event: we have nobody here, we need somebody, what do we do? So that’s where we are.
Kevin Pho: We’re talking to Pamela Buchanan. She’s a physician, speaker, and thought leader. Today’s KevinMD article is “”Reviving the Emotional Flatline, Addressing Burnout in Health Care Professionals.” Pamela, as always, let’s end with some take-home messages that you want to share with the KevinMD audience.
Pamela Buchanan: I just want to encourage all of our physicians and medical students that, you know, if you’re experiencing an emotional flatline, if you feel like you’re at your wits’ end, you know that there are resources. I mean, you could go online on the Breen Foundation—you can look me up. I’m happy to coach and work with people. And in addition, you call 988. They are always there for you to talk. So I don’t want anyone to go through that situation and be at their wits’ end and end tragically.
Kevin Pho: Pamela, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.
Pamela Buchanan: Thank you, Kevin. Have a good day.
