EP147: Micro-Changes for Major Impact: Insights from Dr. Diane Shannon

Exploring Burnout Prevention with Diane Shannon

In this episode, Christine interviews Diane Shannon, a former physician turned coach and writer, who shares her journey from experiencing severe burnout in clinical practice to her current role in addressing systemic healthcare issues. Diane highlights the importance of recognizing burnout, the interplay between individual and systemic factors, and the power of small, intentional changes in  preventing burnout. They discuss strategies for setting boundaries, making micro changes, and advocating for supportive workplace environments, especially for women physicians. Diane emphasizes the significance of having a growth mindset and not settling.

00:00 Introduction and Guest Introduction

00:29 Diane's Journey from Physician to Writer

02:28 Understanding Burnout

03:46 Systemic Issues and Individual Responsibility

05:13 Balancing Personal and Professional Life

12:22 Supporting New Physician Parents

15:23 Strategies for Managing Burnout

22:31 Final Thoughts and Advice

Transcript

Christine Ko: [00:00:00] Welcome to today's episode. We're joined by Diane Shannon, a former physician and now a coach and writer. Diane left clinical practice to focus on systemic issues in healthcare and to support high achieving women find balance. She brings a wealth of experience in dealing with burnout and will share her insights on managing stress and finding fulfillment both in and out of healthcare settings. Thank you for joining me today. 

Diane Shannon: Thank you so much, Christine. It's great to be here.

Christine Ko: My first question to you, Diane, would be, why did you leave clinical practice after all those years and years, I'm sure, of training?

Diane Shannon: I guess the easiest way to say it is I've now had three careers, or I'm in my third career. My first was a primary care physician and I experienced what I now know was pretty severe burnout as a resident. I had every component of burnout: emotional exhaustion, depersonalization, where I was really feeling like, what's wrong with me? I'm so cynical. [00:01:00] I've lost my sense of, compassion. This is not me. And then also feeling like I just wasn't doing a good job. I was doing fine clinically, but that severe burnout, I pushed through it. I said, I am going to get through this. I am going to finish training and then push through to take my internal medicine boards and practice for a couple years. When I decided to leave, it took several years to make the decision. It was not easy, but it was because when I looked ahead, I knew I would burn out again. I couldn't see a way to not burn out again. And this was many years ago. There was no talk about wellness. There was no talk about burnout, coaching, mentoring, none of that. And so I didn't see another way and ended up going into writing mostly because I just happened to land in a job as medical director at a communications company when I left clinical practice. I loved writing. I found that it came easily to me. It made sense to me. It was something I was good at. [00:02:00] So after a couple of years, I left and was a freelance writer for more than 20 years where I focused on the healthcare system, worked for foundations that were looking to improve the healthcare system. So really got very steeped in what are the system problems that exists in our health care system and, what are some of the innovative individuals and organizations doing to try to address those? And that was great work. Eventually, I stumbled across the definition of professional burnout. It's, Oh, my gosh, there's this thing. It has a name. It has a definition. There's research behind it. I started reading all that I could. Eventually I shared my story on an NPR website for the local affiliate here in Boston. There were 26,000 views in the first week, and that was, again, back before anything was written. Physicians started contacting me and telling me their stories and I thought, okay, this is what I want to do. This is what [00:03:00] I want to spend my life addressing: physician burnout. That led to writing a book about it with another physician, focused on the system issues.... eventually that led to me becoming a coach because I saw examples of where helping individual physicians gave them the bandwidth to join together to address some of the practice level and system level issues that exist. So for me, it's come full circle, and I get to help individuals, and that then has a ripple effect on the system. 

Christine Ko: Emotional exhaustion, depersonalization, and lack of a sense of personal achievement. I think those are the three things that make up burnout. And, it is a system issue. So it's not actually an individual issue is the way that burnout is defined. One thing that I have felt myself when I have been feeling burnout is that, still, I do feel like it's my [00:04:00] fault.

Diane Shannon: Yes. I would say it's an interesting interface between the system and the individual. I felt a hundred percent it was my fault when I was experiencing it. I labeled it as weakness or not being able to hack it. What's wrong with me? And when I looked around, it seemed like everybody else was fine. And so then it just reinforced this idea that I'm just not cut out for this. And I think it's very easy for the individual experiencing it, but also people around that person to say, Oh, that person has burnout. We just need to fix them, instead of it being a signal or reflection of problems in the workplace. 

What I have learned in the last six years that I've been coaching physicians is that the individual plays a role. And so it's this combination of both because you could have a perfectly fine system, but if the person is going in there with kind of assumptions and [00:05:00] attitudes and behaviors that make them churn, they could burn out as well. At the same time you could have someone who's totally resilient and all that. You go into a toxic system and you're likely to burn out, right? Both are true, and both need to be addressed and supported and really think about, how do we optimize both: the individual and how they're taking care of themselves and the system, the place where they work? There's work to be done in both. One of the ways I think about it is if the individual doesn't have the bandwidth to show up and help point out the system problems, then they can't be part of the solution.

If you are burned out to the point that you are literally just trying to get through the day, which is how I felt, you don't have any space to be thinking about, oh, maybe I could go upstream and make this frustration go away. So I think, this is where really looking at optimizing [00:06:00] yourself, how you lead yourself is important. And that's where I often start with people. Could they optimize some of the things they're doing just to free up the time to look at, how could I make a request of something in my workplace that would help me? 

Christine Ko: Busy people, especially busy physicians, are very busy. They have no time. They're time poor. Not to put the blame on an individual at all, but what you just said makes sense to me because I do think that changes that I've made and am trying to make in myself definitely helped me. Changes that I make in myself do make a difference. So I appreciate you're the first person that said that there is this sort of interaction.

Diane Shannon: Yeah. I really believe that there's this interface between the individual and the system. Physicians share certain traits like being perfectionistic. There's a reason why [00:07:00] so many of us are like that because you need to be detail oriented, very conscientious, have high quality standards in order to be a good physician. At the same time if that gets used to an extreme or you bring that perfectionism home with you, then that causes some problems, right? And that's where often we can make the changes, to recognize where are we taking some of our strengths and overusing them so that they become obstacles to what we really want. Understanding that these assets we have sometimes could cause us problems, right? And we don't want to get rid of them. We don't want to suddenly become people who aren't detail oriented. We just want to use that in a way that we can be most effective both in our work and in our personal lives. 

Christine Ko: I recently spoke to Chrissy Cammarata, who looks at perfectionism. The example she gave is puberty, that a lot of [00:08:00] teens who are perfectionistic, it was okay before they hit puberty and then they hit puberty and that perfectionism might turn into an eating disorder or something like that. Fascinating to me, she said the same thing can happen to women with perimenopause or menopause, all those hormonal changes. I feel like my own body system working against me and making me over ruminate on things in an unhealthy way, rather than use perfectionism in a positive way. 

Diane Shannon: Absolutely. The word rumination often comes up with the physicians I work with. They'll say, I just keep thinking about this. The other thing that I see commonly two others are self judgment and also people pleasing. Those three are some of the most common ways that I've seen the physicians I work with get in our own ways. Especially with women physicians, in terms of people pleasing and feeling I can't set that limit with that patient or I can't say no to that [00:09:00] request from my boss. I don't know how to set that limit and not feel guilty. 

There are ways around that. The first step is that awareness that this is going on and being with others who are also doing that exploration can help as well. It's like normalizing it. Others have modeled how to do this. But when you're so busy that you don't have the time to connect with others, with peers and talk about some of this, I think that only exacerbates the sense of, this is me. What am I doing wrong? Why can't I figure this out? 

Christine Ko: You feel alone. 

Diane Shannon: Yes, definitely. One of the things that I've heard so often is, there's something wrong. I don't know what it is, and I don't know how to fix it. This sense that there's just something about my life that's off, and I know it has to do with work, but I'm not quite sure what it is. I don't know what to cut back or change or how to do this differently. The unfortunate thing is that really leads people to feel like their only choice is to leave, which is what I [00:10:00] did. What I hope to do is provide folks with more options. There are so many other ways of carving out something that works.

Christine Ko: Yes. Would you say that those are signs of being burned out? That you over ruminate, you're hard on yourself, and you're people pleasing too much, are those signs?

Diane Shannon: Those seem to go with burnout. And the other two that women physicians have said to me that seem to correlate with burnout. One is, I'm irritated. So, I'm irritated with my kids. This is not me. Or, I've been told by the nurses that I'm irritable. This is not me. This is not who I am. And the other is dread about going to work. It's not dread about competence. It's dread about the workload that's coming that day and what your pace is going to be. One of my clients referred to it as a Sunday scaries where Sunday night, you're just dreading what the week is going to be [00:11:00] like.

Christine Ko: Okay. That's helpful. So a sense of dread. I think also the thing you said before, there's something wrong. I'm not quite sure what it is. And what was that third thing? 

Diane Shannon: Being irritable. You come home from work. You're spent. All you want to do is go hibernate somewhere. And your family's there and you want to be there. And yet you're in this place where you are exhausted from the day emotionally and physically, cognitively as well. And you have this second role, which is as a parent and a spouse. And yet you feel like you can't show up for that. 

Christine Ko: I think it's hard. Especially when you have very young kids. I do remember where I felt like I didn't even have time. It sounds silly, but I didn't have time to drink water. I didn't have time to eat lunch, but that was when I was I was breastfeeding, so I would be pumping milk at work. And so again, like, it seems like, why would it be so hard to maybe get myself a glass of water [00:12:00] to drink while I'm pumping? But I just was rushing around always. So I just didn't feel like I had the time. It seems crazy, but it was survival.

Diane Shannon: Absolutely. And I think especially for new parents. That is a really tricky time. Either you're going to figure out how to come back as a new parent or you're not. What if we change that to, what do we as an organization, as a practice, as a clinic need to do to support women physicians? And then that changes everything, because then you give breaks for pumping. You make sure that there's a clean place to pump, you maybe change the schedule a little bit, right? You do something to support that person in that period of time where they're going through this additional stress of having a newborn and probably not sleeping well, right? That phase doesn't last forever, but if you [00:13:00] don't support that person, there's a good chance that she is going to cut back on her clinical hours or leave. By investing, you keep that person healthy, happy, functioning, and you keep your employee. 

Christine Ko: That's a really great example that you give saying that the system could ask, what can we do to help a new physician parent? To phrase it that way does take the pressure off the individual, who becomes overwhelmed. I think most new parents are overwhelmed. If the system could say, okay, any new parent that's going to be breastfeeding and pumping milk, we give it to you no matter what, you have 20 minutes off every three hours, and you do with it what you need to.

Diane Shannon: Absolutely. I'll just share and highlight, two physicians who are doing something about this exact topic. Dr. Josephine Lee and Dr. Laura Dictel. And they are at Mass [00:14:00] General Hospital. And they both went through the, this experience of how difficult it is to be a new parent and created this program there, which they've piloted, that has a number of different aspects to it. But one is, to have a peer that you're connected with who's been through that same experience. So it might be having triplets or twins. It might be coming back and, maybe, you've adopted, right? Whatever that experience is, matching you up with someone in their network, who's been through that same experience, and then having the resources and the answers all available in one space. They've really built out this program. One of them had a child before and then after this program started and really could feel the difference in support and what her experience was like with that second child, having all of these resources available. They're sharing that with other [00:15:00] organizations. So really highlighting that there are ways to support physicians. That can help reduce stress and really recognize the role of the organization in doing that.

Christine Ko: It really does start with awareness. That's a great example of how individuals can influence the existing culture and make things better. Coaching clients or just people that you talk to who are either struggling with burnout or see a problem, do you have strategies and tools? 

Diane Shannon: I do. There are three places where physicians have agency. The first is who we show up as every day. The second is how we lead, whether that is a formal leadership role, title or position, or leading a clinical team or leading a family. The third is how effectively we advocate for change. Especially starting with the first, who is it that I'm showing up as every day? And what is getting in the way of [00:16:00] me showing up in the way I want to? When I work with a new client, we do a lot of assessments in terms of, what are those negative thought patterns? What's the level of burnout that they have? Is there any imposter syndrome or self doubt going on to really have a sense of where are the sticking points? What is getting in the way of them showing up at their best? And to get a sense of what the system or practice level issues are. What are those frustrations that are getting in the way? And then we do small experiments of change over time to see what's going to work. I've been so amazed by the power of microchanges, small changes that you make with intention. Making a change and seeing if it works. If it doesn't, it's not failure. You just try something different, but those micro changes adding up to having a big impact. I've seen this especially in terms of setting boundaries, small changes in scheduling. Small changes like how [00:17:00] you're doing your charting. I have been surprised at the impact that those small changes make, and I think that's really important. With burnout, we feel like almost there's this wall of all that's wrong, and all that's exhausting us, and we can't find the crack. We can't find where to start. It feels, well, I better just throw my hands up and leave, right? Because I don't see any way to change this big system. But with those small micro changes, there are ways. Once people have the bandwidth, then they can start making requests or take on a leadership position if that's what they want. But you can't do that from a place where you are just totally spent.

Christine Ko: I like these micro changes. One thing that I started doing more recently is to pack a lunch, and it does really help my mood. It helps how I show up because I am less irritable.

Diane Shannon: It did take some intention, right? To [00:18:00] remember the grocery store, to buy the things that you want to pack for lunch, to take the time to pack it, to remember to take it with you. There's some intention involved but often it's going upstream to invest the time now that's going to pay off later. We would hope that leaders of organizations would start to invest time now and invest money now to prevent some things in the future, to build up the physician workforce. Sometimes we have to do that ourselves, invest our time, our money, our focus to go upstream and make some changes that are going to have a ripple effect and really change what our daily experience is like.

Christine Ko: It's really great to talk to you because you put into words, just like your initial story about how you basically were experiencing burnout, but you didn't have the word for it. And I think the way that you describe things really helps. I'm realizing for the first time, why didn't I just pack a lunch earlier? As you just said, it takes [00:19:00] intention, it takes awareness for one, but it takes intention, it takes a certain amount of future planning. That was really the barrier because I wasn't intentionally thinking about what I might need because I was just surviving, barely getting through.

Diane Shannon: 99 percent of what I've learned comes from working with my amazing clients. They try something and that works. Their willingness to be intentional and try something new, willing to be open to doing something differently, even if it was uncomfortable. They're willing to experiment and try something new. 

Christine Ko: I do think it takes a growth mindset. You've mentioned several times about trying something out. If it doesn't work, don't consider it failure. Just, okay. That one didn't work. You try something else. And being uncomfortable, right? Trying something new is harder than sticking with what already exists, even in a broken system. It's just easier to be like, this is the way it's always been. What's the problem? For me, at least, it was hard to even really [00:20:00] think about those things when I didn't have a growth mindset.

Diane Shannon: Absolutely. I knew about growth mindset, but when I was thinking about it, it was like small experiments. And when you try that experiment, don't beat yourself up and give up if it doesn't work, which is having a growth mindset. I think that expansiveness to be willing to try something is especially true with setting boundaries, right? Which is something that a lot of, especially women, physicians find really difficult. It is not going to feel easy in the beginning. It is a skill. It's a practice and you may want to start with an easy one, right? Of making that request or saying no. Understanding that you could ask for something, and it might not happen. One of my mentors used to say, when people pleasers stop pleasing, people, people will not be pleased. If we've had this habit of saying yes, every time at work, when somebody wants to trade a shift with [00:21:00] us or take on, can you double book this patient? Yeah, sure. Go ahead. And then we start saying no, of course, they're going to be upset. It's been easier for them the way we've done it. Being aware of that is so helpful because then when you hit that place where you're getting that pushback, you can be like, Oh, okay. I expected this, and it's going to get easier.

Christine Ko: I love that. Sometimes it's the most simple things. In my dream world, I would say no to someone. And they'd be like, Oh, great. No problem. But that's not what happens. You say no, and they might push back a little bit. Oh, but can't you really do it? Or, people are surprised for one thing, but I feel are judging me adversely. Oh, you can't do this? What's wrong with you? I feel like I get that kind of pushback from them like, Oh, okay. I guess you're saying no, because you can't cut it; you're not good enough to take this on.

Diane Shannon: There are [00:22:00] actually different expectations of women physicians by patients, by staff, and women physicians tend to be more responsive and also because of that, get more inbox messages from patients and staff. The other piece is that women are judged more harshly if they have certain behaviors. So if you are assertive, that can be judged as negative if you're a woman but as a strength if you're a man. It may well be that when you say no, you get more pushback than someone else might. 

Christine Ko: Can we end with one key piece of advice you'd offer to people who are currently feeling the strain of whatever it is they're doing? 

Diane Shannon: I would offer them the hope that there is a different way. I'm glad not to settle. I didn't settle. I'm glad I didn't settle for staying in something that wasn't working. It's not worth staying in a situation that's not working. That does not mean quitting. [00:23:00] It means, What can you do? What are the micro changes? Where's the support that you might request or the help that you might get to tweak your situation? So that you're not just settling for something because it's always the way it's been. 

Christine Ko: Yeah. I like that. Don't just settle. Be aware. Try to be intentional. Really think about what are the pain points in your life? And what are some micro changes that you might be able to make that make things better. 

Diane Shannon: I have so much hope because I've seen the power of these small changes and how they really can transform your daily experience at work and in your home life. 

Christine Ko: Thank you so much for spending time with me. I've learned a lot, and I really appreciate all of your thoughts and knowledge.

Diane Shannon: Thank you so much for having me.