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Amelia Bueche, an osteopathic physician, discusses her KevinMD article, “This perspective will change how physicians address pain and recovery.” Amelia explores the interconnectedness of trauma, pain, and recovery, emphasizing the importance of addressing pain’s root causes on physical, mental, and emotional levels. She shares her personal journey of overcoming substance use, injury, and career challenges to embrace transformation and self-compassion. Key topics include the stigma of substance use among physicians, the systemic barriers to sustainable care, and actionable insights for fostering empathy, connection, and systemic change in health care.
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Transcript
Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Amelia Bueche. She’s an osteopathic physician. Today’s KevinMD article is “This perspective will change how physicians address pain and recovery.” Amelia, it’s been many years since you last were on. Welcome back to the show.
Amelia Bueche: Thanks so much for having me back. Glad to be here.
Kevin Pho: All right. So we’re going to talk about your latest KevinMD article. Before talking about the article itself, what made you write it in the first place?
Amelia Bueche: Yeah, well, I was thinking back to when I wrote articles in 2020 around coaching and the transformation of my practice from clinical medicine into that space. I experienced this film, which was kind of the impetus for the article, and it just dawned on me that the way to share that experience on the broadest scale was here. I was so grateful for the opportunity to come back to this platform. It felt like a rejuvenation, and it’s another pivot of my current work. It just feels like the right formula presented itself.
Kevin Pho: All right, fantastic. So tell us about this film, and tell us about the article for those who didn’t get a chance to read it.
Amelia Bueche: Absolutely. “Tipping the Pain Scales,” a documentary, is somewhat about the opioid crisis and substance abuse, but really it’s about how we address pain. It follows a number of different stories throughout the film. There’s a psychiatrist who speaks to how we’re mismanaging pain and often not asking those deeper, core questions.
I watched it initially to support people I know who are in recovery from substance use. Also, because I’m a neuromusculoskeletal medicine physician, pain is the primary chief complaint that walks through my door. As a coach, I think about how we connect all those different pieces of past trauma and feelings.
As I sat watching this documentary, it was talking about the approach to others. For patient care, I saw great opportunities, but what really dawned on me was how deeply it impacts physicians in their own self-care. In my coaching practice, many of my clients and participants are physicians and other health care professionals, and pain appears in a lot of different ways. Helping people identify how pain might present, what questions we might ask, and how to treat, process, and integrate it more effectively was so profound. I left the film and went home immediately to write four different articles and reflections. The one that came through most strongly was an encouragement to bring more compassion, awareness, and curiosity to how we approach patients—and also to how we care for ourselves in the practice of medicine.
Kevin Pho: So talk to us about some of the cases you’re seeing in your coaching practice. These clinicians see patients in pain all the time. How does that affect their professional psyche, and what are some stories you can share?
Amelia Bueche: Absolutely. I think it’s both “and.” When you’re a physician seeing pain presented in lots of different ways—emotional, physical, acute, chronic—you’re faced with, “How do we manage this with medications? Do we have time to ask deeper questions? Do we have a team in place?” We have an opportunity but we also have to look at our capacity—do we have the time and resources? If we open up this wound with the patient, can we help them handle it or connect them to people who can support them longer term?
We also don’t have to hold it all ourselves. But if someone isn’t getting well or is labeled “noncompliant,” maybe that’s a sign to ask different questions. Could we get deeper into root causes?
On the other side, in how we care for ourselves, pain can look a lot of different ways. In working with many physicians—especially high achievers—personal pain doesn’t always look like dysfunction or inability to perform. It can show up as overworking or overachieving. We look at physician suicide rates and how to address them effectively, so checking in with ourselves and each other—”How are you, really?”—and giving space for those answers is critical.
Kevin Pho: One of the things you mentioned earlier is that sometimes clinicians aren’t asking the right questions about a patient’s root cause of their pain. What prevents them from doing so, and what tips can you share about the right approach?
Amelia Bueche: If someone has, say, a misuse of medication or a substance use issue, we can ask, “When did this begin? What was happening then?” Often it ties back to a childhood experience or a specific traumatic event; the substance becomes self-medication. Can we ask, “What were you feeling? Did you have tools to handle those feelings?” Often, they didn’t.
In a busy clinical practice, we might not feel we have time to open that door, because we worry about destabilizing a patient if we go deeper. But especially if you’re having the same appointment over and over with no progress, maybe that’s the invitation to come at it from a new angle: “Let’s peel back a layer and see what’s actually going on.”
Kevin Pho: In your article, you said physicians who treat pain need to practice self-compassion to manage their own personal pain. What might that look like?
Amelia Bueche: I think it’s the willingness to ask ourselves those same questions and figure out what taking care of ourselves actually looks like. We’re so often tasked with taking care of others that we don’t even know what our own needs are. In a group coaching session, if we ask, “What do you need?” we might get silence because we’re not used to talking about that.
It’s acknowledging that we have needs, and they might not be met. We can have compassion for ourselves, noticing places where we weren’t cared for, then start to care for ourselves or recognize that maybe some of those needs are being met but we’re not seeing it. Sometimes not much externally changes—our perspective changes. Then we can build on that.
Kevin Pho: What does a typical coaching session look like when a clinician comes to you with these issues? What do you say or do to move them past obstacles?
Amelia Bueche: The beautiful thing about coaching—and what helped me pivot from clinical medicine to coaching—is connecting people with the wisdom they already have inside. As physicians, we know about the inherent self-healing capacity of the body, and that applies to us, too. We hold space, let them tell their story, and then reflect what we hear: “I heard you say this—tell me more.” We ask, “What does that feel like in your body?”
I was so out of touch with feelings when I started coaching. I spent a lot of time in logic mode, so letting people actually feel their pain, even if it’s intangible, is crucial. Sometimes we don’t realize how much we’re tolerating. Realizing, “Oh, this doesn’t feel good or isn’t sustainable,” is a key awareness. Coaching is about holding that space so people can find their own answers. It’s one reason I love coaching—it’s connecting people back to themselves, their source, their origin stories, which we can lose through all our years of training.
Kevin Pho: You also touched on substance abuse in the medical field, and the stigma surrounding it. Tell us what you wrote about that.
Amelia Bueche: It’s interesting—we recently saw an article about how there’s “no safe amount” of alcohol, for instance, and there have been all sorts of dialogues among physicians. Many times it’s socially acceptable to have a glass of wine after work, but we need to check: “Am I masking something?” If you recognize overuse or abuse, how do you find safe outlets to address it? Because it comes with professional and licensure risks—there can be shame.
Can we do better with those systems? The film addresses policy from a broader perspective, not specifically for physicians, but as a health policy fellow I’m always asking, “How can we improve the system so it’s safe to ask for help and not a threat to our practice of medicine?”
Kevin Pho: From a policy standpoint, what changes can we make based on that film or your own experience?
Amelia Bueche: A key point in the film was letting people get inpatient admissions—even involuntarily—for substance use, rather than just sending them back to the streets. Those successful interventions showed that if we create safe, accessible pathways, people can get help.
For physicians specifically, this is a frontier I’m still exploring, but if you’re a physician who needs help, there are physician-specific AA groups, for example, where you can remain anonymous. Some formal systems aren’t always safe or effective, so we can do better. If anyone listening has experience or success with this, please share it. We have different social media platforms—including this one—for discussing these issues. Let’s share meaningful, safe spaces and push for reforms so it’s not so risky for physicians to seek help.
Kevin Pho: The last thing you mention in your article is how addressing pain at a cellular level can contribute to systemic recovery and change. What exactly do you mean by that?
Amelia Bueche: For me, some of that is experiential. While watching that film, I felt that all of me—physician, health policy fellow, coach, parent, friend—was called into action. It was transformative, a full-body shift. A few weeks earlier, I’d gone to a Yo-Yo Ma concert; as a cellist myself, I’ve admired him for years, and he spoke about “planetary humanism.” I felt my whole self resonate—like, “Yes.” The music and the message integrated everything in me.
In coaching, that can happen when we connect our feelings and core thoughts, recognize patterns, and something clicks. So I invite listeners: Where have you felt all your parts activated? Not in a reactive way, but an invigorating way, where it’s like, “This is what I’m meant to do?” Be open to that resonance, see where it can happen, and create space for it in yourself and others.
Kevin Pho: We’re talking to Amelia Bueche. She’s an osteopathic physician, and today’s KevinMD article is “This perspective will change how physicians address pain and recovery.” Amelia, what are some take-home messages you want to share with the KevinMD audience?
Amelia Bueche: Enhance your barometer for sensing pain in others and in yourself, and recognize it might look different than you expect. It’s not a judgment; it’s an opportunity to recognize pain so we can care for it better. That means showing up with patients in a more robust capacity to ask and hold space for meaningful questions—and doing the same for ourselves.
Kevin Pho: Amelia, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.
Amelia Bueche: Thank you for the opportunity.
