Speaker 1 00:00:08 What's up, everyone. Welcome to the finance for physicians podcast. I'm your host. Daniel Raimi. Join me as we dig into what it looks like for physicians to begin using their finances as a tool to live better lives. You can learn more about our
[email protected] let's. Jump into today's episode. Hey guys, today I'm talking with Christine Runyon. We have a great conversation around how the medical profession can sometimes make you feel like you got to always have it together and now like everyone around you, so perfect. But when in reality, the truth is we're all flawed. So, you know, you know, everybody's got struggles. We all have challenges. We're we're far from perfect. I think the real problem occurs when we pretend like everything is all good all the time. When in reality, it's not Christine. And I talk about how this negatively affects physicians, mental health, and we discussed some of the ways you can address this more proactively.
Speaker 1 00:01:02 So in our conversation today, it totally reminded me of a song. The song is a truth, be told by Matthew West. So I wanted to read a couple of the lyrics from the song lie. Number one, you're supposed to have it all together. And when they ask you how you're doing, just smile and tell them never better lie. Number two everybody's life is perfect except yours. So keep your messes in your wounds and your secret's safe with you behind closed doors. Truth be told the truth is rarely told. Now I say, I'm fine. Yeah, I'm fine. I'm fine. Hey, I'm fine. But I'm not, I'm broken. And when it's out of control, I say it's under control, but it's not. And you know it, I don't know why it's so hard to admit it when being honest is the only way to fix it. There's no failure, no fall.
Speaker 1 00:01:47 There's no sin. You don't already know. So let the truth be told. I would have sung it if I had a good voice. But so in this example, he's talking about the perfect Christian and uh, in the perfect church and how it's easy to become more concerned about looking the part, then living the part or more concerned about, uh, appearance than about what's going on in the inside and how that's all a big lie and how real people are not perfect at all. They're not always okay. And that's okay in itself. It's actually human. So I think it's, it's so similar to what working on your mental health looks like. It's okay to not be okay. That's where it all starts really. And so we're going to talk today about getting to this point in your mental health and more so let's jump in Christine, welcome to the podcast. Thanks.
Speaker 2 00:02:36 Thanks so much for having me. I'm happy to be here.
Speaker 1 00:02:38 Yeah. So I'm excited to talk about your expertise in some of the work you've been doing, particularly around the area of helping physicians with their mental health. I think there's a ton of value. There. It's a big topic. There's a lot of, a lot of growth potential there for people. Um, but before we get into kind of the, the weeds of talking about that, I was curious if you could share a little bit about your background and kind of where you got, where you are today and what you do.
Speaker 2 00:03:06 So I'm a clinical health psychologist, and I've spent all of my career working in mainstream health care, both inpatient and outpatient settings in a variety of different ways. I actually started as a psychologist in the air force and worked in primary care settings in the air force and then have, um, really enjoyed working at this intersection as a psychologist in medicine, because so much of our psychological health or ill health shows up in our bodies. And so I'm really working in a primary care settings primarily to be able to help people identify and then address their overall health often through psychological treatment, that then shows some positive effect in their physical health. So that's been my clinical practice and through that, obviously working alongside other clinicians, physicians, primarily nurse practitioners, pharmacists nurses. And so seeing through, uh, through that work, what opportunity there is to also support and work with my colleagues, just, I will, I will share a little bit in terms of how I got really interested in clinician wellbeing was I'm serving as the director of behavioral science for family medicine residency.
Speaker 2 00:04:32 So I was in charge of all the overall curriculum for, um, for their behavioral science education and also did some clinical work myself in that setting and, and a little bit of applied research and found the work just frankly exhausting. And I have all the skills that I have as a psychologist to, uh, to be able to bring not just to my patient care, but to myself and realize that it, some days it just didn't feel enough and didn't feel sufficient. And I looked around kind of at my, at my medical colleagues to know that this is actually not at all a part of their training pathway and of their implicit or explicit curriculum. And so wondering how do they do this if I'm feeling so exhausted in this work and so under resource, how do they, how do they do it? And that's really where I got interested in clinician wellbeing. So I've spent my career both as a psychologist doing direct service provision as an educator, a little bit of applied research. And then, um, for the last five years have been pretty focused on clinician wellbeing through the lens that I bring to it, which is as a psychologist. And
Speaker 1 00:05:41 You started a business or helped start a business. How, how long ago was it that you
Speaker 2 00:05:46 I'm a co-founder of 10 health and 10 health? We focus exclusively on, um, mental health care for health professionals, primarily physicians and wellbeing within organizations, health, healthcare organizations as well. And we started, we actually just had our one-year anniversary from our date of filing. So June of 2020. Okay. Thank you. Thank you. So we're, we're brand new and, uh, started at, um, in some ways, you know, kind of, um, a precarious time and in some ways, sort of a perfect time based on the work that we do, we do a lot of, all of our work through a video tele-health platform. And, um, and again, care, uh, for, um, primarily physicians. We built the service actually with physicians in mind because of all of the external and internal barriers to seeking mental health care that exists for physicians. So I can say more about that if you're interested, that's really the framework that we built, uh, that we don't tend to health. And we work with individuals now in 31 states were available to see patients in 31 states and also work with organizations to provide the mental health care for a, an identified population, primarily trainee populations. We work with several organizations to care for the entire population of their trainees residents and fellows. Yeah.
Speaker 1 00:07:10 Let's talk about the barriers that's that's I think a good starting point is what are some of those barriers that exist?
Speaker 2 00:07:16 So there is some, I think, some known and explicit external areas for physicians seeking mental health care. Um, not the least of which is that a lot of the licensing applications for medical licensure as pretty invasive questions about mental health and mental health and substance use history and history of treatment. And so, um, you, um, you don't have to be around medicine too long to know that you don't, you don't talk about that. You don't seek care. And even beyond the initial licensing process, people have to get credentialed. So once you're in a hospital setting, um, you have to get credentialed to be able to provide various kinds of services. And that credentialing process, even if you've passed the hurdle of the licensure, the credentialing process can actually be even more invasive. And so people have to answer questions that yes, I've sought mental health care.
Speaker 2 00:08:11 Yes, I've been diagnosed with something. The inquiry can go very deep, very quickly into people's privacy. So that's a very, um, real external barrier. And people are scared of getting, um, getting denied privileges and getting denied, um, various kinds of opportunities because of that history. So that is a known external barrier that exists. And a lot of that gets internalized, um, through stigma and then the culture of medicine and the culture of medical training is one that really amplifies a sense of self-determination and amplifies a sense of strength and fortitude ability to get through anything and not show weakness and ultimately perfectionism. And so the, the notion of needing to quote unquote, talk to somebody gets equated with weakness for a lot of physicians and, um, and, and fear fear of what will happen because of these, um, parameters that are set up and then an internalized sense of something must be wrong with me if I have to seek help outside of my Hmm.
Speaker 1 00:09:27 Yeah. That's a lot of big ones. And I just think of the first, first ones you mentioned that those in themselves, I think would be, would make it challenging. I'm thinking if I'm in that situation, I would be like, maybe I don't even want to go see someone in mental health for not even to solve a problem, but to like, be proactive about my mental health. Like maybe I don't even want to have that on my medical record in the first place, in fear of that, it might get dinged my medical records. And, um, and that's not even assuming I have a condition of some sort like bipolar or something that's very manageable. And should, is that, is that kinda the, the feeling people you see people having is, they're just kind of fearful of even really having that on the record or even starting that conversation. Absolutely.
Speaker 2 00:10:14 Absolutely. And there are, I mean, there are stories of people getting denied certain things because things are, are in their record, that those, the, your, you know, your diagnosis can go into a national data bank. You can be discoverable in that way. So, um, I mean, I've been in a position because of previous services that I've applied, not at 10 health at 10 health, we have created, um, a, a service that does not actually go through insurance unless somebody wants, wants it to, they can actually have a choice in that matter. And so we have maximized privacy and confidentiality and accessibility in that model. Yes. And so, so people have had, and I've had to write letters for people even seeking certain kinds of insurance, because they have a diet, they have a mental health diagnosis in their record that is discoverable through the process of getting various types of insurance. And I've had to, um, you know, document that they're well-managed and well-controlled, and that there's not a risk here, but it's real. Yeah. Yeah.
Speaker 1 00:11:21 And then when you add on top of that, the culture of medicine and the perfectionism is really all that you're describing, like you said, is kind of wrapped up in perfectionism. Uh, that is the worst enemy of seeking medical help or, you know, particularly mental health
Speaker 2 00:11:37 Is that that idea gets doubled down. If somebody is really suffering. And if you swim in the waters of perfectionism and you should be able to handle it, you have an additional barrier that is, is present around your own sense of not being capable. So not only do you need help, but you're right. You're so incapable of solving that for yourself. And you get so much suffering is suffering in silence and, and kind of it's this paradox of a field where people are expected to be so empathetic and compassionate towards others and display so little of that towards them.
Speaker 1 00:12:22 Yeah. That's a tough time. Do you think, do you think, uh, in training it is amped up even more so
Speaker 2 00:12:29 Fit, you know, there are stereotypes for a reason. And so some of this really does depend on specialty. Um, so probably, you know, and, and geography and location and where you're training. There probably are some places that are trying to do a better job of making space for this, but in training, there is the explicit curriculum, and then there's the hidden curriculum. And the hidden curriculum is very much around culture. And how do people meet, not being okay. And what, what are people told and what do you hear about other people not being okay in that environment? And so I think in the training environment, it is, um, it's almost amplified because you're in a space where you are expected to know almost two steps ahead of what you actually, you know, probably should or could know based on your level of training in a lot of training environments, there's still a lot of very explicit.
Speaker 2 00:13:30 Um, what's been called sort of pimping, um, of asking people questions sort of on the spot and creating an environment where you have the person directly who's being asked it. But a lot of this training happens in teams still. And so there's a lot of vicarious learning that happens. And, um, you can see how somebody is responded to if they don't know the answer. So this is imperative to know the answer to be right, to be curious, to ask good questions, to be on top of things. And that's the expectation. And, and you can learn and see, even if you are not the person who's experiencing that you, you get the message pretty quickly of what is expected. And so like Inc and training, actually it, um, it may be worse than when people are out
Speaker 3 00:14:20 Of training on their environment. You know,
Speaker 1 00:14:23 You're, I guess you're more, you don't have as much control. So you're kind of just, if you're in that environment, there's not as much probably the indu or you're kind of subjective to the culture or whatever it's going to be, it's going to happen.
Speaker 2 00:14:36 Yes. Constant evaluation. I mean, the thing about being in training is that even when somebody is asking you a question, sort of right off the record, assuming they're there one of your attendings or one of your chiefs, you are constantly being evaluated in all aspects, not just your medical knowledge, but your professionalism and your interpersonal style. So, so there's not a lot of safety and protection for people to reveal what might be happening underneath the surface, without fear around it being evaluated in a particular way. Even if it's not always, I don't need to say that there's not some very kind of humane medical educators and trainers, but the perception is that this is not, this is not safe.
Speaker 1 00:15:21 Yeah. So I guess for all of those listening that are in training, it is okay to be not okay. I,
Speaker 2 00:15:30 You know, one of the reasons I really love working with trainees as a, as a psychologist and we do, we, this is really our primary work at 10 health. Again, is partnering with residency programs to care for their residents is I'm always looking at this in a parallel process of what is everybody's experience in their own suffering and how do they bring that to their role as a physician, because there's always a beautiful learning there of, of really understanding what it's like to not feel okay in themselves and how that can really, um, serve them in their role as a physician, because that's who they face every day, regardless of specialty, right. You're facing you're facing individuals and families, you know, probably not on their best day of their life with their own amount of suffering and anxiety and uncertainty. And so when you can really have a lived experience of that for yourself, you can show up as a doctor in that way with so much deeper presence and compassion.
Speaker 1 00:16:35 Yeah. Perfectionism is like, not really, it's not human, it's, uh, a natural, like, that's the, that's the part that's counterintuitive. It's like, you get kind of caught up in a cycle like that, and you're actually, it's not possible. Um, and it's not really human and catch onto that pretty quick that people are not being, I guess, totally, you know, vulnerable. And it just rubs off on people. But we, you know, if you're, if you live long enough, you realize humans are flawed at the end of the day. Um, you know, we actually have a lot of balls. So, and embracing them I think, is, is the opposite of perfectionism. And we've all
Speaker 2 00:17:14 Known that experience too. I think of, you know, either with a family member or seeking our own care is we can sense authenticity and we lean into authenticity. It feels a lot better for us to connect with somebody who's being authentic than somebody who is right. Has that air of ego or perfectionism to them. It's just really hard again, I think particularly in this crucible of training to toggle that, because it does feel like there's such an expectation for that, that armor and that to present up the chain, cause medicine is quite higher article. And then to toggle it and be able to then just sort of turn it off in other clinical settings.
Speaker 3 00:18:01 It's a big ask.
Speaker 1 00:18:02 So what happens when, I guess I'm thinking more in the younger setting and training, or kind of early in the career field, uh, what happens when this gets a little out of hand, or maybe even just, you continue to bury your head in the sand? That's the, it seems like the temptation is you just kind of let it be and don't address anything. What are some of the symptoms that start to present themselves? Uh, when you've, you're in this situation where you're just locked into this kind of setting? What, what, what, what might people observe?
Speaker 2 00:18:35 Yeah, I mean the, the most tragic and result of that right, is, is, um, taking one's own life or dying by suicide, which we see a rate among physicians that, um, you know, over 400 physicians die by suicide every year. And the rate is, you know, is certainly well beyond what would be true for their age match, um, sort of gender and peer cohort. And so that's kind of the, the end result, but shy of that because of this phenomenon you're talking about, which is kind of bearing it, hiding it, not, um, not seeking help, you actually can get a lot of distress positions, um, where you're, it's manifesting in other kinds of behavioral problems. So substance use is not an uncommon one, right? That initially starts as a solution to the stress and to the problems and kind of trying to quiet all the internal noise and eventually can take on a life of its own, become a big problem or other kinds of ways of behavior really acting out that often are in the shadows or have some shame elements to them.
Speaker 2 00:19:42 So that can be, you know, sort of gambling or misuse of money. It could show up in other kind of, um, pornography or sex related behaviors, even, you know, uh, shopping those kinds of things can, can show up and they, for some period of time can be kept private, right? You can, you can have those indulgences and have those ways of like meeting the stress that don't show up easily to the world as a problem for some period of time. And, um, you will also see a lot of tension in relationships and this can show up in people's bodies. It can certainly show up physically. I will often see that that is a, a more socially acceptable way. And not that that's a conscious process of somebody saying, right, I'm going to manifest migraine headaches, or I'm going to me, you know, sort of manifest something in my body, but because it's so hard for it to show up emotionally for people and it gets suppressed, it ultimately has to come out somewhere. And so, so some kind of physical manifestation can be there as well. And even before people will say that they're feeling really sad or really overwhelmed or really anxious, I will see it show up as prob problematic interpersonal relationships. People get really much, much lower frustration tolerance and have much higher irritability. And so people will have in ways, you know, in the workplace where somebody will be like, Hmm, that's unusual. That's not really like,
Speaker 1 00:21:18 That didn't make sense eventually. Or inevitably, I guess everyone has like a public failure or something along those lines where they screw up or something. And I feel like that can be kind of a blow up situation where you've hidden it for a long time. And then when you have a, and then the culture on top of it is probably not helpful, but when you have something that becomes like public on top of all this making that creates prob you know, potential, or I would think higher likelihood of the spiral spiral, making it a lot worse, fast. Yes.
Speaker 2 00:21:56 And it's people are afraid. And I saw this in the air force as well as a psychologist, right. Nobody wants to go see the mental health clinician because they're afraid of getting their weapon taken away. They're afraid of getting, you know, do not fly order or something like that. And the same is true, right? In a culture of health care is nobody wants to have certain privileges taken away. And yet when then something comes to light like that, or there's some problem. Medicine is also very quick to say, what did you do wrong? And, you know, you have, you know, sort of risk management gets involved when there's a, you know, when there's a negative outcome and even, you know, in negative outcomes happen, even if everything was done correctly, but, but there is a little bit of a knee jerk reaction in that culture of like, what, what did you do wrong? And so again, people internalize that. And so if you're not feeling okay emotionally as well, it's a very small step to right. What's wrong with me. <inaudible>
Speaker 1 00:22:54 And I think so if we're looping in some of the financial aspects of the, of the life setting career track, some of those like amp it up too. So in training, you know, you got the average resident or fellow has like six figure, like 200 to 400, sometimes a lot higher 800,000 student loan balances and, um, you know, a modest income, uh, that has no, it's like you're making 50,000 a year and you owe 500,000 in students. So it's like this, I've noticed this pressure, you know, as you would expect financially, um, which kind of feels like restricted. You're like locked kind of, you know, to the profession. And I would think that it would probably amp all this stuff we're talking about up even more.
Speaker 2 00:23:43 I think you're speaking to something I will have conversations with, but it's not well appreciated. I think in general, as a, as a really substantial stressor, because people do feel like they get tighter and tighter into a process where there's not very many off-ramps. And so that amplifies the sense of, I can't not be okay or I can't seek help because I have to get across this finish line. Cause it's the only opportunity for me to deal with the financial, my financial profile that is here in, in pursuit of this goal. And so I can't have anything that might present in a barrier to that. Absolutely.
Speaker 1 00:24:28 And that's what that does. It just limits your future choices. And this is kind of a big example of it, but in, in for a lot of people, it's kind of the, you know, unnecessary aspect of getting into the career field, but it's just one of the added factors, but that's a lot of stuff, you know, like, uh, how do you, how do you start to deal with all that? And I think that the temptation for, I mean, I'm kinda like this, I'm like I'm going to work through it and that's not the right approach, by the way, that's my, I don't know, personality type, but I'd see that being a very tempting route. But, um, the problem with that in this sort of circumstance is it, it definitely compounds it, it probably increases chances of these blowups, but, and even makes it harder to seek help in the future. So what is the right way to do it for people even in, and maybe they're hopefully early on in this and kind of resonating with some of these things we're bringing up. Yeah.
Speaker 2 00:25:27 I mean, this is one of, again, one of the reasons that I really love working with trainees and I'm, and I'm hopeful, just generationally that the idea of talking with, um, a mental health expert is becoming less scary for people over time. Um, but it is one of the reasons I love working with train trainees and partnering with, with organizations to care for their trainees, be can limit the barriers in terms of scheduling. So it, it, you know, at 10 health, I said, we prioritize access. So we see people, you know, in the evenings or on the weekends, we're we can be responsive to people's residency schedules because they don't have control. So if you can minimize the barriers for access, that's really huge, right. To make it really easy. I've noticed in working with physicians through a video format, there's actually something about them being in their own space that is quite facilitative.
Speaker 2 00:26:23 So you don't have the in-person and there's all this sense of like, oh, well you lose the in-person. What I've noticed I gained, um, is that they can be out of uniform. They don't have to wear their white coat. The stethoscope is in around their neck. They're in a place where they can be human first. They don't have to, you know, show up and worry running into patients to come into my office. They can really be human first. And so that creates, I think, some accessibility, interpersonal accessibility. And when we can, when we partner with organizations, we can work with trainees in a way, right. Again, that doesn't go on their health insurance. We're not invested in making a diagnosis. We work with some organizations where they basically set everybody up for, um, a wellness visit just as you would have a physical with your PCP. And so they can have this conversation and it can disabuse them of all of the worries and fears about talking to a mental health expert. I remember talking with a young surgeon once who was, you know, was able to name how he was so anxious talking with me and so nervous about it. Cause it felt so intimate to him, which right to me is like, how does it get any more intimate than being like in somebody's abdomen?
Speaker 2 00:27:45 That feels pretty intimate to me. And he's like, I'll do that all day long. This is really, this is really tough. And so to, to be able to have institutions actually invest in their trainees and in their workforce in a way that really normalizes this and gives people an opportunity to just start with a kick, the tires conversation, to know that it's it, doesn't, I'm not trying to have some big reveal or find, you know, sort of the thing that's wrong with you, or have you tell me, you know, your most precious, deepest, darkest secret is just to create a space where people feel like they can have, um, some, some confidentiality and a chance to talk about things in a way that is actually different than their other regular conversations in a non-evaluative way. So that's the biggest thing is just if, if there is an opportunity for people to kind of walk into that space and then, um, and also not have to be in charge of it, right. There's so much that they have to hold and be in control of is just for a little bit of time, kind of be a recipient of and see where that process goes.
Speaker 1 00:28:59 There's no, um, diagnose diagnosis. I think there's a misconception. Sometimes when you go to see someone in the medical field, it's like the, like you're saying the problem, what are we going to solve here? And what's the, like, what's my diagnosis at the end of the conversation. So it's more, it sounds like what you're describing is very much more preventative kind of focused as in everybody has mental health is a part of everyone and you're not, I think personally, every person that exists Bennett would benefit from having conversations about their mental health and the, the chances are the less you've talked about it. The more likely you had been just kind of interesting,
Speaker 2 00:29:40 Right? I mean, right. The truth is we all have an inner life. We all do. And, um, and once you get into this space of, of, of medicine, like ultimately it's a human endeavor. You may operate with some robots as well, but ultimately it is a human endeavor and I hope it always will be for the most part. And you bring your, you bring yourself to that. So if you're not, if you're not tuning your instrument and, and even, even if you're in a specialty that is so highly technical and procedural it's, there is still a part of you that you have to bring to that, even if it's just as a translator for what's happening in the technical or procedural space. And if we're not tuning that instrument and spending some time with our inner spinner world and how that is manifesting in our professional life, it will get rusty. It just will.
Speaker 1 00:30:42 Right. And the worst is when you don't realize it, I think, you know, and it just kind of shows up and that's where you get the situations like you were describing, like that doesn't make any sense out why they were doing that. And that also, probably it's good to remember that when you think of people that like blow up out of the, you know, out of the blue, and you're probably thinking what a jerk, but like in reality, there's probably some unaddressed issues that they that's causing it all, usually people don't. Exactly.
Speaker 2 00:31:15 Yeah. I mean, that's the lens that I work. I love through when I see people who are just sort of behaving in a way that feels like overly aggressive or overly dramatic for the situation. I just think that what's going on with them. Yeah.
Speaker 1 00:31:30 Your focus is counseling. And how does it, how does counseling differ from like a therapy and a and coaching? And those are maybe there's a lot of overlap or maybe not. I'm, I'm curious your take on the differences.
Speaker 2 00:31:44 Yeah. I mean, I think about this sort of, again, kind of on a continuum, right. In the same way you might think about other sorts of medical care or medical interventions. And so I think this idea of like a, check-in a kind of a wellness visit for your, for your behavioral health, the same way you would do as a physical is really something we could all benefit from and is truly at this preventive level and often finding and, and naming very explicitly the helpful coping strategies that people are using because life is stressful. Medical training is incredibly stressful. And so to just call out, what's working well for you. And because some of, some of the effective stress management is, is dialing down the things that, um, are unskillful and unhelpful and just amplifying the things that that are, and we all have coping strategies. It's just a matter of how skillful or unskillful are. Yeah.
Speaker 1 00:32:43 So like, what are some examples of the, what are examples of the coping I'm thinking of like working out versus drinking or two coping strategies potentially. Yeah.
Speaker 2 00:32:54 And so it's kind of like, yeah. So talking with people that really gets it, I mean, self-awareness, I feel like it's sort of the bedrock and the superpower in all of this. If we can sort of be honest with ourselves and be aware because drinking a beer in and of itself, or, you know, a glass of wine that is not a problem, it may be very healthy coping strategy at that level. And then, you know, what is happening when that sort of ramps up to a level that's, that's unhelpful exercise, even at the extreme right. Can show up in an unhealthy way if it's too, if it's too prescriptive and too intense. And so, you know, I've definitely worked with trainees where, um, that as a coping strategy has gotten is interfered on their training pathway because they have needed to do it in a particular regimen.
Speaker 2 00:33:42 Right. And, and a little bit more obsessive than is actually helpful. So, but you know, certainly exercise looking at sleep. Now there's a lot of ways in which trainees aren't, aren't, um, don't have a lot of control over their sleep and their sleep schedules. And it's one of the things that, um, as much as we've learned about sleep for the years, most training training programs still mess with sleep in a way that on one hand there has to there, you know, the service has to get covered and it has to happen. But I don't, you know, if, if you had a sleep scientist overlooking all of the training schedules that would surely send them into some sort of seizure activity, scientists would just not approve at all. And then, uh, social connection and, um, finding really consistent and healthy ways to be in community that, that really supports, um, supports us and can get challenged in times of residency of working 80 plus hours a week.
Speaker 2 00:34:40 So there's a variety of those, you know, of those things that kind of, we can look at in a wellness visit to, um, to also see what happens when people are humming along and do it. Okay. And then what happens when you hit a period of really intense stress and for most of us that when we hit that period of intense stress, all of our good intentions go out the window, because our ability to use our, our thinking part of our brain and our willpower and our executive functioning gets compromised because we're exhausted or really stressed. So that's when you'll see people say, well, you know, now I'm just stopping for fast food on the way home every night. And now I'm, you know, I'm instead of like going into bed, I'm watching Netflix for three hours and falling asleep on the couch and I'm waking up with a crank in my neck, cause I'm not going to bed.
Speaker 2 00:35:26 Like it's the high stress periods. Like you'll see those things happen. So trying to problem solve and plan for those, um, in advance is something that we can do. And then, so in coaching really has to do with sort of backing up the continuum. Coaching is really around people having kind of an identified, um, either target thing that they want to work on kind of behavior or it's coaching is really effective in transition times or planning for transition times. So it, hasn't not, it has a more sort of narrow in its guardrails around sort of the purpose and function of it. And it tends to be much more, um, directive than you might see in, in kind of counseling or therapy and then sort of backing up from that would be counseling or therapy. Again, it doesn't have to be based on a specific diagnosis, but just on a, because there's a level of distress and there's some level of impairment that's happening and that's kind of trans diagnostic. So it doesn't really matter what is there, but counseling can be really effective if there is distress and impairment and then more intensive services beyond that, including, you know, medication management.
Speaker 1 00:36:36 Yeah. I think if you're into improving your overall health in which I think most physicians would probably agree that they're into being responsible with their overall health. I mean, that's just kind of one piece of pie and it's probably one of the most overlooked areas is, is their mental health. And you mentioned emotional intelligence and that's kind of like almost, I dunno, super powers, right word, but it, did you say superpower earlier? I think that's like a good, it's just a hidden, I mean, it's such a basic and fundamental thing, but so much overlooked and, and it ties into what, what you're doing and you can almost help people make huge steps towards, towards that, um, that area. But I think the more people that realize or connect the dots with that, cause I always, um, I used to think of, uh, anytime you talk about mental health, it just goes negative. It's like, ah, you know, I don't have a condition. Right,
Speaker 2 00:37:35 Right. I am one of the reasons I love the model that we've created at 10 health and why Penn not going through insurance companies and ideally having organizations support their trainees, getting the services because it frees us up from all of that. I don't have to spend my first hour with you doing massive data extraction around your history, you know? And, and I, you know, and, and truly, I mean, I don't, I really it's been stressful for me to work in a model where I've had to give somebody a diagnosis in order to get insurance reimbursement, to cover their care because there's no diagnosis of residency induced distress. And yet it's mostly right. What I see is like you are in this time of intense, personal professional, um, growth and development with very few levers of control. Like I don't need to put a diagnosis on that. And I have a lot of things I can offer you that would actually that more easeful and more useful for you going through that doesn't require me saying that you have some pathology. Right.
Speaker 1 00:38:43 So what does the process look like? It's sounds like starting out, you are typically kind of focusing just general wellness and understanding situation, but what, what is, how does that process work? How does somebody in your all's set up typically go through?
Speaker 2 00:38:58 Yeah. So we, so if we are partnered with, when people can come to see us sort of direct word, like a direct to consumer, so anybody can access us in any of the 31 states, we deliver care. But with the organizations that we have contracts with, we, some of them have opted for these kinds of, you know, everybody gets a wellness check-in, which I think is an incredibly insightful and proactive way to be in this space, knowing how stressful residency is. And otherwise it's all self-referral people. We just continuously get our message out to the programs that we're here and we're available. All of our clinicians have lived experience in healthcare settings. So they all know, and most of them in training settings. So they all know what it's like to be, you know, in terms of working alongside medical students and residents and attendings, and to work in that space.
Speaker 2 00:39:43 So they you're not explaining what it, what it means to be on night float, or you're not explaining what it means to be post-call or something. You, they have a, they have an understanding of that and all the various hurdles that people have to jump through through their, through their medical training. And so it's all self-referral people can just come to us and nobody has to know about it. And their training program doesn't have to know about a GME. Doesn't have to know about it, and there's no other reporting out. So if we have built something that we feel like is really safe and protective and, and our hope is to see as many trainees in those settings as we can to, um, to normalize it and, and really to normalize their experience during an incredibly stressful time and, and ideally to help them grow as people and mainly as professionals as well.
Speaker 1 00:40:31 So I heard you saying you don't have a long list of intake questions, which I definitely, and I think you said you kind of have more of a non-directive more inquisitive or question, is that kind of how it flows, you typically help, you know, asking questions to help guide the process? What does that, I mean, do you have some examples of what that looks like? Because I think it can be an intimidating little step there. It's like when Pete, but what I've been, I've worked with therapists or counselors, and when you have the first meeting, I mean, as long as you're working with someone that's solid and does it the right way, it's much less intimidating than it. Maybe if you could give some little snippets of what that actually looks.
Speaker 2 00:41:14 Yeah. And I appreciate you calling that out because I mean, one of the reasons we don't like have people fill out all of this stuff, you know, these forums and information is if you've ever tried to seek mental health care, a lot of places do that and then may or may not have availability for you to see anyone. And they've been through that process for family members as well. And it's just, um, it's painful before you even sort of get, you know, to, to sit down with somebody. And, and so I often start actually, you know, and I'm just an inherently curious person and enjoy people. And so I really like to start with the things that, that people have probably shared and talked about many times over, which is, you know, tell me about your journey into medicine. Right. It's, it's really disarming because they're like, oh, I know this, right. I haven't done this, but not in a way that somebody is evaluating whether you're right for this program or not, but just like, oh, why pediatrics? I'm so curious or, you know, um, was this a place you wanted to match? Tell me about that process. And so we can, we can get into it through a storyline that feels familiar and comfortable to them. So, um, that's usually where I start.
Speaker 1 00:42:28 Mm. Yeah. And you're just asking no judgment and very curious questions. And there's not a, a lot of you having the no insurance, no lack of institutional. I mean, that, that, stuff's a big deal and helps you kind of really hone in on what, what, uh, is best for them. I am. I did not realize I'm S I'm very happy to hear that some of these institutions are adopting it as a program. That's I guess definitely a nice positive sign, because I think, like we said, at the very beginning, some of the big underlying issues are that the culture and medicine in general has not really embraced this as an issue, but, um, is that what you're seeing is that something you've seen in the future is more and more, is it something that's, that's being adopted? Well, we're getting good
Speaker 2 00:43:19 Traction. How much of this is pandemic related? How much of this is sort of a movement in the field? I will say some of the larger institutions I think have, well, a couple of things have happened. I think, uh, ACG AME, which is the accrediting body for, for residencies and fellowships has paid more attention to wellbeing and has put some imperatives in place for accreditation that have recognized the need for, for mental health care and how that gets operationalized and implemented varies a lot by institution. So there has to be some attention to it so people can sort of screen and identify and get services. And then you see all over the map, what that means for some, it means sure they can go to the local emergency room for a psychiatric emergency and other places have it much more dialed. A lot of big institutions have solved for it through their own departments of psychiatry, kind of internal in the department of psychiatry, which on one hand can capitalize perhaps on some trust and some, some access, because it's so close, we have built a model where it actually, in some ways that closeness we feel like is, you know, under the roof, it actually, if he doesn't feel as protected and private and safe and also increases likelihood of conflict of interest or, or having run-ins with somebody in some other capacity who might also be providing your mental health care and leaves a lot of the psychiatry trainees, or anybody who cross covers in psychiatry kind of out of service.
Speaker 2 00:44:55 So we feel like we've built something that, um, that really is, we'll have a close relationship with the institution, but really maximize that privacy and accessibility. So we're starting to get traction and are hopeful for more. Yeah, I like
Speaker 1 00:45:11 It. Well, as we start to wrap up, how can people find out more about your company and what you're doing?
Speaker 2 00:45:19 I appreciate you asking, so you can find us online. We're at, uh, ten.health, www dot 10 T E N D like tending to, um, dot health. And, um, you can read more about me on that, um, on that page as well, and about my co-founder and our philosophy, and we love to hear from people. So my email is Tina T I N
[email protected]. And I welcome, uh, emails from any of your listeners or inquiries about our services or anything we talked about.
Speaker 1 00:45:50 Awesome. Well, Christina, I enjoy talking with you and, uh, thanks for sitting down with me to talk about this.
Speaker 2 00:45:56 Thanks so much for the opportunity Daniel. I appreciate it as
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