Bottom line (spoiler alert!): You just have to say no! Start with one time...and go from there. Saying no is important to combatting the system problem of burnout while we wait for the system to make changes. I (and others I know, especially in academia) have trouble saying no, and starting small with one thing does help. Dr. Schukow also recently wrote an article related to his intern year (in press) and feeling the symptoms of burnout - important for all trainees and those past training to do the work of such self-reflection. Dr. Casey P. Schukow, DO is currently in his first year of pathology residency training at Corewell Health in Royal Oak, Michigan. He attended Michigan State University College of Osteopathic Medicine. Prior to that, he attended Hillsdale College and played football (defensive line unit), graduating in 2018 with a Bachelor of Science in Biochemistry. He is a Co-Ambassador for the Pathology Outreach Program, reaching out to students before medical school to increase awareness of pathology as a discipline. He is also an Ambassador for Knowledge In, Knowledge Out (or KiKo), where he promotes digital pathology, social media, and medical education.
00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today I am with Dr. Casey Schukow. Casey Schukow, DO, was previously on this podcast, and he talked about having a growth mindset. He is currently in his first year of pathology residency training at Corewell Health in Royal Oak, Michigan. He attended Michigan State University College of Osteopathic Medicine. Prior to that, he attended Hillsdale College and played football on the defensive line unit, graduating in 2018 with a Bachelor of Science in biochemistry. He is a Co-Ambassador for the pathology outreach program, reaching out to students before medical school to increase awareness of pathology as a discipline. He is also an ambassador for Knowledge In Knowledge Out, also known as KiKo for short, K-I-K-O, where he promotes digital pathology, social media, and medical education. Welcome back to Casey.
[00:00:53] Casey Schukow: Awesome. Thank you so much for having me back.
[00:00:55] Christine Ko: Yeah. It's fun. Can we start with you sharing a personal anecdote of about yourself?
[00:01:00] Casey Schukow: Gosh. Yeah. I like comedy. I can do a couple impressions.
[00:01:03] Christine Ko: What impressions can you do?
[00:01:05] Casey Schukow: I'm an old soul a little bit. I'm like a 50-some year old in a 20-some year old's body. Do you know Christopher Walking? He was on Saturday Night Live. He talks like this, sometimes I wake up and you smell the roses and the sunlight it comes in and the birds are chirping and, Wow. It's fun.
[00:01:26] Christine Ko: That's fun. Yeah. Thanks. You recently wrote an article on burnout. Can you talk about why you were inspired to do that?
[00:01:35] Casey Schukow: Last year, it was over the halfway points of my internship, and I was studying for my third board exam, step three. I had just reached a point where I was just feeling, wow, I am tired, I am worn. I do not have any fulfillments right now doing what I'm doing at this moment of time. I used that thought as an opportunity to really step back, pause. The article more or less was a manifestation of my reflection of just being tired, being fatigued, being worn, and really not having any fulfillment. Kinda a lot different things all at once. Full disclosure, I loved my internship program. I loved the faculty. I needed to take a step back and just write some things out.
[00:02:18] Christine Ko: Yeah, intern year is really hard. It's, there's nothing quite like it.
[00:02:24] Casey Schukow: Nothing quite like it. It's definitely a challenge.
[00:02:26] Christine Ko: What did you learn about burnout during your intern year and writing that article?
[00:02:33] Casey Schukow: The biggest thing that I learned about burnout: it's an occupational definition by the World Health Organization in regards to at work, you're feeling more fatigue, lack of career fulfillment, mental distancing. I was feeling all three of these things . What needs to be done from a systemic and individual level to hopefully curb those feelings and emotions? Because if things ain't going well for you individually as a doctor, how can you take care of others? Are there ways that we can make it a little bit less tough and more humane?
[00:03:07] Christine Ko: And are there ways that we can do that?
[00:03:09] Casey Schukow: I think so. I think from a systemic way, there's a lot of things I think that could be done by our healthcare systems. I think make more appropriate use of doctors times, the way we navigate charts, fighting with insurance companies for patient benefits. I think from an individual level, it's a lot of self-reflection and frankly saying no to things and putting your priorities where our priorities really matter the most.
[00:03:34] Christine Ko: As you said, burnout has a World Health Organization definition, and it's defined by the World Health Organization as a system problem. It's not actually any fault or blame on an individual, and it's not really even that the system is to blame, it's just that there are system factors, as you said, that do lead to a lot of physician burnout, especially as you said, the EMR, the electronic medical record. So you gave your tips on what you do, so self-reflection, stepping back, saying no. Yeah. It's hard to say no. Do you have tricks to how you do it?
[00:04:11] Casey Schukow: Yeah. Gosh. How do you say no to things? You just gotta do it. I think you just gotta say no to one thing. I think make it really simple. You have to understand what your priorities are, and that's the big take home punchline. In any job, and I'm a believer of this, in any job, anyone can be replaced. You can be replaced at work; your family, your friends, those people who mean the most to you can't be replaced. That's a hard thing to tell a medical student and resident sometimes because you're in such a position to where you have zero power, for whatever that term is worth. I just want to change that narrative a little bit though.
[00:04:48] Christine Ko: I think that social media and KiKo maybe in some ways distributes power a little bit more equitably or is trying to, because anyone can make a Kiko account, for example. Anyone can post, become, known in whatever they wanna become known in. It takes a little bit away some of that, I don't know, academic nonsense.
[00:05:10] Casey Schukow: Like you said, Christine I totally agree. It just gives people a chance, gives students a chance. It's a way to just do it a little bit differently, for good intentions, ethically.
[00:05:19] Christine Ko: Yeah. There's a lot that we could do differently and better in medicine as a whole, [mm-hmm], and anything that tries to change the paradigm is worthwhile to try to support. So yeah, I'm a fan of Kiko. I'm a fan of Jon Ho who founded it. It's inspiring what he's trying to do with that.
[00:05:40] Casey Schukow: I totally agree for medical students, you're trying to get exposure, and you're trying to just connect and collaborate.
[00:05:47] Christine Ko: In terms of saying no, I don't have any great answers, but two pieces of advice that I got was, one is remember when you're saying yes to something, you are saying no to other things. Because I don't have unlimited time. And then another tip was that when you say no to something, you could put it in your calendar. So say you were asked to give some talk somewhere and you don't wanna go and you say, no, you can put okay, September 15th I was supposed to be here. When that rolls around and you realize, oh, I'm not far off someplace that I don't wanna be, and I'm here with my family, it helps reinforce that you made the right decision.
[00:06:22] Casey Schukow: Yeah.
[00:06:23] Christine Ko: Yeah I enjoy listening to other podcasts and I like the ones by Adam Grant, and I was listening to one yesterday. It's Work Life, and he was talking to someone about projects. They were saying how projects are good when they're meaningful, but also manageable, but then also they should have a net negative or positive. So even if something's very meaningful and even manageable, but it's negatively affecting, X, Y, Z or a hundred percent of the rest of your life, it's not a good project. Meaning, managing, and net negative/positive on my life.
[00:06:59] Casey Schukow: I love that. I love that so much. That's such a great way to think about it.
[00:07:03] Christine Ko: It sounds like you had an experience with burnout during intern year and it, I'm not sure, but it sounds like you've come through it. 60% of doctors are burnt out across specialties and pathologists are traditionally less burnt out as a specialty than other physicians, but I think it's nearing 50% now even for pathologists. So what helps motivate you? What helps keep you going?
[00:07:27] Casey Schukow: Frankly, I want to give my kids and my family, hopefully, a better life. That really motivates me. I don't want my kids, for example, feeling, oh my gosh, are we doing okay? Are we gonna have a house still? Or, are we gonna have food? I don't want them to have those worries. I also wanna make sure I'm setting aside enough time so I am having meaningful time with my kids down the road, with my wife down the road, that we're still having date nights.
[00:07:52] Christine Ko: Yeah. I love it. I think you're an idealist, and so you are doing what you're doing cause you wanna make a difference. Your work, make a difference for patients, make a difference for your family. That's really admirable. In addition to being a system problem, in burnout for physicians, there's moral injury when patients aren't maybe quite getting the care that you would ideally want them to get. And there's not any one clear reason why they're not getting that care. So it's not exactly clearly obvious how to fix it. I think that can really lead to a lot of burnout.
[00:08:24] Casey Schukow: Socioeconomic factors, man, that's as big of a barrier to great, efficient, proper healthcare, whether it be a primary care setting, a specialty care setting, any setting in the world that is. What you are actually doing as a healthcare provider, I started feeling like it wasn't making any difference. That was a huge part of my motivation for myself to really look at other options. Pathology really, it just fit the bill for me. We're still working a lot of hours, but we're having fun doing so.
[00:08:56] Christine Ko: Yeah. To have fun while you're working hard. That's always the best thing. Do you have any final thoughts?
[00:09:02] Casey Schukow: I think that's a take home message: just try to have fun doing what you do. You're gonna have setbacks. That's life. Take it in stride. Your priorities, stay true to them.
[00:09:12] Christine Ko: Thank you for doing this.
[00:09:14] Casey Schukow: Thank you as well. It's a lot of fun being on the podcast again.