Overcoming Unexpected Mental and Health Stressors

Summary

Podcast Summary: AOFAS Orthopod-Cast

Episode: Overcoming Unexpected Mental and Health Stressors
Date: October 9, 2024
Host: AOFAS Podcast Committee
Panelists:

• Joe Park (Host)
• Brett Smith
• Nick Strasser
• Pam Luke
• Anish Kadakia (“Ankle Man”)
• Matt Conti

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Episode Overview

This episode dives deeply into the increasing mental and health stressors facing foot and ankle orthopedic surgeons. The panelists—a blend of experienced and early-career surgeons—share candid stories and practical strategies about burnout, loss of autonomy, increased administrative burdens, and the all-consuming expectations of both the profession and patients. Emphasis is placed on self-care, boundary setting, and learning to let go of perfectionist ideals, offering actionable advice for surgeons at all stages of their careers.

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Key Discussion Points & Insights

The Escalating Crisis of Burnout in Medicine

[01:24–03:20]

• Physician burnout is at an all-time high, and experienced providers are not being replaced fast enough.
• Contributing factors include administrative overload, declining financial compensation, diminished professional status, litigious environments, and relentless patient demands.
• Memorable Quote:

  "As a professional, the rate of burnout for physicians is at an all time high. ...We're not replacing them fast enough... There’s a real potential in a decade we’re in a crisis within health care." – Brett Smith [01:24]

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Loss of Autonomy & Value in a System Focused on Productivity

[06:40–08:42]

• Surgeons describe feeling devalued as merely “RVU generators” or “revenue producers,” rather than as skilled professionals.
• Loss of control over clinic templates and schedules is cited as profoundly demoralizing.
• Mentions a trend of physicians moving from hospital systems to private or cash-based practices to regain autonomy.
• Memorable Quote:

  “Your administrators want you to think you’re just a number, you’re just an RVU generator... that really detracts from the value of what we are able to provide.” – Joe Park [06:40]

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The Hidden Toll: Emotional Challenges Unique to Surgery

[03:45–09:36]

• Older attitudes of stoic endurance have evolved; physicians acknowledge burnout as a real and pervasive issue.
• Surgeons express how the emotional pride and respect associated with the profession has eroded:

  "So when I tell my fellows and my residents is nobody cares about you. If you think anybody cares if you die tomorrow, the answer is no, except your family and yourself, hopefully..." – Anish Kadakia [05:05]

• The fragility of mental health amid unexpected personal and professional crises is discussed with candor.
• Cumulative, small stresses—such as negative patient interactions or threats of litigation—are powerful burnout drivers.

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Strategies for Handling Bad Days and Difficult Interactions

[09:50–13:03]

• Panelists admit the challenge of maintaining professionalism and emotional stability after negative clinical encounters.
• The importance of self-care (“be kinder to ourselves,” “give ourselves a break”) is emphasized.
• Recognize it’s “normal to respond humanly” and the need to let go and move past bad moments.
• Pam Luke:

  “We need to be a little bit selfish. ...To avoid kidney failure…” [12:06] (humorous tone)

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Generational and Practical Perspectives on Exhaustion

[13:03–17:44]

• Matt Conti observes that the mental and emotional exhaustion of being an attending is far greater than training.
• Older surgeons reflect that today’s documentation burdens and the inability to ever “make a mistake” have amplified the cognitive load.
• Consensus that “mental exhaustion” is real and not about weakness.
• Strategies include early morning workouts, chatting with peers, long walks, or decompressing before re-entering family life.

  “...The problem with our job is there’s no room for error and nobody allows you to be human.” – Anish Kadakia [14:34]

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Setting Boundaries in the Digital Age

[17:44–25:50]

• Difficulty disconnecting from work due to electronic health records (EHRs), patient messaging, and constant digital access.
• Strong advocacy for refusing to give out personal phone numbers or email addresses to patients—using institutional channels only.
• Techniques:
  • Turn off smartphone notifications for EHR systems
  • Restrict patient access to designated windows
  • Use support staff (PAs/MAs) to triage and filter communication
• Key Insight: Self-respect and boundaries are critical.

  “You’re not a bad doctor if you’re not available 24/7. ...You’re not a good surgeon if you’re exhausted and tired every day.” – Anish Kadakia [26:59]

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The Perils of People-Pleasing and Managing “Fancy” Patients

[30:06–34:57]

• Surgeons discuss the emotional labor required when dealing with “high-demand” or wealthy patients who expect special treatment.
• Importance of “setting the rules” and not devaluing one’s expertise by bending over backwards for anyone.
• Universal rules for all patients create respect—treating all equally, regardless of status.

  “The more you bend over backwards, the more these rich patients, privileged patients, think you’re no different than the French fry maker.” – Anish Kadakia [31:31]

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Communication Skills and Conflict Management

[34:57–35:45]

• Recommendations for resources to help improve difficult conversations:
  • Verbal Judo
  • Never Split the Difference by Chris Voss
• Empathy and directness, without sacrificing professionalism, are vital to defusing conflict.

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Vacation, Delegation, and True Disconnection

[35:45–39:30]

• Most panelists agree that true vacations should mean zero patient contact; trusted staff or partners should take over all communication.
• Some, however, still check messages or respond to colleagues, but strive to avoid patient-facing work.
• Recognize that mental rest, time for family, and genuine absence from work are not just “allowed” but necessary for long-term sustainability.

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Final Advice and Reflections

[40:13–42:50]

• It is “okay to be sick,” “okay to take time off,” and the myth of irreplaceability should be rejected.
• The profession does not define personal worth—family and health must come first:

  “What we do is not that big a deal... your family and you come first.” – Anish Kadakia [41:09]

• Avoid social media comparison traps and unnecessary status anxiety; focus on personal and family wellness above all.

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Notable Quotes & Memorable Moments

• "Burnout is a real thing. So I've come around to that. ...I want to quit every so often. I'm just financially in disrepair, so that's not an option. But if I was financially stable, I'd quit tomorrow. And that's sad because I love this job and burnout is a real thing."
  – Anish Kadakia [03:45]

• "I just come home and I just am completely fixed. ...It's the mental exhaustion of never being allowed to make a mistake... There’s no room for error and nobody allows you to be human."
  – Anish Kadakia [14:08, 14:34]

• "The more you look at [patient reviews], the more you go crazy. If you want to be liked by everyone, you’re going to lose your mind. Don’t be a jerk. Yeah."
  – Anish Kadakia [29:34]

• "You're not a bad doctor if you're not 24/7. ...you're not a good surgeon if you're exhausted and tired every day. It's not healthy. You're not a good doctor. So these people are not allowed to have you 24/7."
  – Anish Kadakia [26:59]

• "It's okay to be a person. ...And nobody tells you it's not weak. ...It's absolutely weak to not recognize that you're not invincible."
  – Anish Kadakia [41:09]

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Timestamps for Key Segments

• 01:24–03:20 — The scope and urgency of burnout in medicine
• 05:05–06:40 — Emotional toll and isolation; loss of respect and status
• 09:50–13:03 — Self-care, professionalism, and learning to let go
• 13:03–17:44 — Generational exhaustion; practical coping routines
• 17:44–25:50 — Digital boundaries and assertiveness strategies
• 26:59 — "You’re not a bad doctor if you’re not 24/7."
• 30:06–34:57 — Dealing with “fancy”/demanding patients; importance of saying no
• 34:57–35:45 — Communication skills resources
• 35:45–39:30 — Boundaries during vacation, role of trusted teams
• 41:09–42:50 — Final reflections: Prioritizing yourself and your family

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Takeaways

• Burnout is real, widespread, and driven by many modern factors beyond personal weakness.
• Establish boundaries early—professionally (with patients, digital communication, and admin) and personally (with family and self-care).
• Set realistic expectations for availability and allow yourself breaks from medicine without guilt.
• Understand that you have inherent value as a person, independent of your career.
• Prioritizing family, health, and self-compassion is not just acceptable, it's vital.

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This episode offers honest, hard-earned wisdom for orthopedic surgeons—and indeed all healthcare providers—navigating the unpredictable and often draining realities of modern medical practice.

Transcript

[A]

Welcome to AOFAS Ortho Podcast where leaders in foot and ankle orthopedic surgery discuss the issues that affect you and your practice. Please note that the views expressed on this podcast do not necessarily represent the views of the AOFAS or its members.

[B]

Thank you for joining us today for another episode of AOFS Ortho Podcast. And today we have our whole group together. So these are some of my favorite sessions and I feel like I've learned the most listening to my colleagues. I'm the host today, Joe park, with my guests and partners in this podcast.

[C]

So how you doing? Thrilled to be here. This is Brett Smith, I'm out in Durango, Colorado.

[D]

Nick Strasser, Nashville, Tennessee.

[E]

Pam Luke from la, California, Anish Kadakya.

[F]

But also known as Ankle man from.

[G]

Chicago, Matt Conti from New York and I'm from Charlottesville.

[B]

So should have mentioned that today's topic is something that's very important. I think today we're talking about overcoming mental and health stressors or how to overcome these unexpected events in our lives. And I think each of us has had unique things we've dealt with and I was just hoping to get our committee's ideas on how they've managed to overcome them.

[C]

Yeah, I mean, I think this is probably, if not the most, but probably one of the most timely topics currently in medicine. As a professional, the rate of burnout for physicians is at an all time high. It's never been this high ever. I think there's a combination of things. I mean, you probably pick anything from a laundry list of reasons why, and I think it's probably a culmination of lots of reasons why physicians burn out and get out of practice. And that's a problem because we're not replacing them fast enough. Especially experienced such as this group here, clinicians and surgeons, at a rate that we can sustain. I mean, this is becoming an issue where there's a real potential in within a decade. We're in a crisis within health care with having qualified providers with the amount of population that needs care, especially since we're in a situation where a lot of our population is getting unhealthier by the minute, not healthier. So this is a big topic to talk about and it doesn't get talked about enough. I think the issues that are at.

[D]

Hand, yeah, I mean we've been talking for a little bit already and I think one of the things is we all run pretty high RPMs on a daily basis. We deal a lot with patients in clinic and cases and on call family And Aneesh, you mentioned already that it's the unexpected stuff that kind of catches you off guard and how do you prepare for that and what kind of strategies we can develop to. To know, you know, to have this kind of idea of if this happens, then I'm going to do this. And I don't think I don't do a great job of doing that. I kind of just get all fired up or freaked out or depressed or maybe all the above. And. But it is important to try to figure out what kind of strategies we can use to be able to manage those things and then what kind of things we use to ground ourselves. Whether it's working out, niche, you got your cars, whether it's just one now.

[C]

Just one, finally wised up. But it's. No, it's. It's a. This is a real. It's a real issue. If you really think about it at a deep level, what's going to happen? I mean, so the hospital systems are almost bankrupt. I mean, so then what happens? Government comes in, subsidizes, takes over, socializes everything, controls it.

[F]

Right.

[C]

It's not an un possibility at this point.

[F]

I think one of the issues when I trained, and I'm an old soul, is that there was no such thing as burnout. You know, we're an immigrant family. You work till you die, and that's what it is, and that's what I'm gonna do. But burnout. When I started hearing about burnout 10 years ago, I left. I was like, you're all weak, weak sauce. What is this burnout? No Such thing. Now, 10 years later, you know, I want to quit every so often. I'm just financially in disrepair, so that's not an option. But if I was financially stable, I'd quit tomorrow. And that's sad because I love this job and burnout is a real thing. So I've come around to that. And what I think I see is that as physicians, we've given up our life for the job, which probably shouldn't do. There's a lot more attacks from patients, whether it be Google Reviews, as we've been talking about. Your health system wants to know every interaction. And if it's a bad one, it's, you know, how are you going to get better every time? You know, financially, we're getting the same every year, if you're lucky. But that means with inflation, and it's getting less every year. Right. Litigation is a problem. And you're the same as healthcare. You're just a health care provider. So the stature is less. So that emotional pride that you had and that stature we had in society is getting crushed over the last 10 years has totally changed. And so I think for the middle aged surgeons like myself, for the young surgeons, it's a huge problem and no one cares. And so when I tell my fellows and my residents is nobody cares about you. If you think anybody cares if you die tomorrow, the answer is no, except your family and yourself, hopefully. And that's why I think there's burnout, because you are, you think you're important. I think I'm important at Northwestern, right? I get referrals for the high level rich people. The donors all come to me. But if I jumped off a ledge tomorrow, Northwestern would put an email out, one page, and then they would have somebody else, the doors would go to somebody else. Nothing would change. And that's hard to think when you dedicate all your life to this stuff. So I think that's what has been mentally challenging for me. And there's lots of unexpected things, whether, you know, I broke my arm, it hurts all the goddamn time. You know, your family dies. Patients threatened to call the State Department on you. Your family threatened to get you into a lawsuit with the federal government that you didn't realize what the hell was going on. Every day you live your life. And as my analogy, you're walking on the street, mind your own business, a smile on your face, and a car comes and whacks you. And that's really what life is. You will get up in clinic in the morning, first patient starts yelling at you, now you're done. How do you get up from that? And that's, I think, what the, those little things stress you out and who are you going to get mad at? You can't get online, you can't put a bad review about the patient. That's not legal. So it's very hard for us as physicians. Other people want to quit as fast as they can, which is sad because the job is fantastic. But hopefully everyone has some ideas to make this better.

[B]

So you were mentioning about your facility, and we're recording on September 12th. And so at my institution, there's a push to get rid of our CEO, of our health system and the dean of our medical school. And it's the same concept of them trying to make all of us as physicians feel replaceable. And I think when you talk about burnout and the importance of what we think we're doing and helping patients, and it's tough when your administrators want you to think that you're just a number, you're just an RVU generator, you're just a revenue producer. And I think that really detracts from the value of what we are able to provide. Especially, you know, if you've been doing this a while and you've learned how to take hopefully good care of patients. But you know, I think that's the other thing, like this whole healthcare management concept of, you know, doctors can't do it well enough, so we have to bring in these business quote unquote businesses, people to do it. And some of that is that loss of autonomy, I think, not being able to set your clinic day the way you want. Or they want me to see 50 instead of 40 or however many patients they think I should see.

[C]

They want to control your template, this block. And so yeah, it's, I mean, having moved on to a private situation, it became very liberating because now all of a sudden I'm in control. You know, I can be as busy or not busy as I want to be. And since having moved into that world, it's amazing how many more physicians I'm meeting all the time who are moving away from hospital based systems and going back into either a small private practice or catch based practices. It is an absolute. The faucet's turned up right now. I think it's about to go on full blast here. In the next little bit it's going to be. There has to be some sort of revolution in this or evolution in this because it's, it's not a sustainable system for bright people like those of us sitting at the table. Not me, the other people. By the way, I just want to say that that does say ankle man on your badge, right?

[F]

I am.

[C]

Okay. I just want to make sure. I thought he had a cape on. I wasn't sure 100%. I kept looking for the cape. I saw ankle man on there. I loved it. But yeah, I mean, this is a situation and I'm old. See the gray hair, doing this for a bit of time. But you know, I look across the table at young guys and I get, I get kind of concerned, like, where are you guys going to be at in 10 years? Like, it really worries me, honestly. Like deep down it worries me because you guys are good, you're talented, like, you're the future. We're old, we're the has beens. We'll be out to pasture shortly. But you guys have to continue to move forward and like take over and innovate and create the next generation of stuff that we're not smart enough to know about. That's what worries me is like all these good people, like, what's going to happen? What's going to happen as a society when we lose that kind of innovative and sort of passion. That's what it does. It's passion.

[F]

Right?

[C]

That's what got us here to drove us here and keeps us, like, really honestly. That's what keeps me going is like, I'm just passionate about this. I love it. I agree with Anish. Like, I love this stuff. I wish I had to deal with a lot of the crap, but I love it.

[F]

Pam's kind of. How far out are you now? 12 years, 13 years.

[C]

I thought she just got out of fellowship 12.

[F]

She looks.

[E]

Thank you.

[F]

No, there's three of us that are old, middle, and then young. So we have three kind of three different age groups here. So I guess for the audience who's listening, you know, our goal is to give you some experience that we may have in trying to make our life happier, better and sustainable. So I would propose to the, you know, let's talk about, like, if you have a bad patient in clinic, you go to clinic and you just have a terrible interaction. Whether it's a you did a bad job, patient's mad at you, they're mad at you just because the sky is cloudy that day. And it's just a terrible interaction in the beginning of your clinic. Right. We all have that. You come out, you're just like, you're fuming. How do you have strategies for old, young, any surgeon? What do you all do to make it through the rest of the day and still be kind to your patients without just being like, I want to leave this job today. What do you all have? I mean, unless maybe I'm the only one that has patients yelling at me. So that could be me, a me problem. But what do you do?

[E]

I think I'm the same way. I think it's just instinctive and human nature. I think at the end of the day that we're all still human and it's normal to have those reactions. And so I'm still not good enough to not have that anger, to want to lash out, but to try to remember to be professional. But to Brett's point, I feel like this all kind of goes back down to. It's a little bit ironic, but it has to be with self care. And I think I would encourage our colleagues and us to be a little bit more self centered and just to be kinder to ourselves. I think it's easier said than done. And I'm working on it on myself. But to kind of change our internal mantra and, like, to what Anish had said before. You know that you're a good surgeon. You know that your patient, the majority of your patients love you. And it's not. It's not easy to think about all those things when someone. The right person right in front of you is, like, attacking you in those ways and saying those things to you. And I think. I think we have to respect ourselves and to be taking that in, do as best as we can, but still to kind of change and know that, like, we need to be a little bit selfish. We need to be sure to go to the bathroom and eat meals during residency, you know, to kind of know that. To avoid kidney failure and problems as we're.

[F]

Whoa, whoa.

[C]

Now you're going a little far. Come on, let's reel this in.

[E]

I see your dialysis back.

[F]

This is ortho. We don't know what the kidney is.

[E]

I think it has to go all the way to the self care to know that it's okay to, you know, if you're physically facing something, if you're mentally facing something, that it's okay to take that time and to reach out and to ask for help and that it's. It's normal to respond humanly, but to also give ourselves a break and to ultimately let it go if you're. If you can. I think just to get past that one. That one patient, and then extending what Brett was saying, you have to be able to separate yourself from those situations, just be able to move on.

[G]

Can I ask a question? Because I have no strategies to deal with stress, but I'm hoping to get some information here. But what I found the most interesting about turning into an attending after being in residency and fellowship was in residency and fellowship, I just work all the time, and I'd come home and I'd have energy to write a paper or whatever, but now I'm just interested if it's just a me problem or if everyone else feels like this. Now I come home and I'm exhausted at the end of the clinic day. I mean, I. I might feel like.

[F]

Barnes and shit in the evening.

[C]

Yeah, he would have kicked you out of his fellowship.

[G]

But, like, I find that, like, in. On the weekends and. And at nights now, I need more time to decompress than I ever needed before. And, like, it's like you just. Because when you go home and you have a problem, it's no longer like, well, the attending did that, you know.

[E]

Responsibility.

[C]

Yeah.

[G]

The full responsibility is on me. And so now I'm like more tired and I need more time to decompress and, and I was just wondering if it was because I was weak or if other people had that experience.

[C]

That's your answer.

[G]

It's just easy answer for you, man.

[F]

So I will tell you, it's funny, I had this conversation with my, my junior partner. He's about eight years out now. And both of us, we have about a 45 minute and I have like an hour and 20 hour and 10 drive because of traffic. And I finish clinic, like I'm powering through all excited and I get home and I just am completely fixed. And I would blame it on my age. So then I was like, okay, ma' am is old. I'm not that old.

[C]

But Centrum Silver.

[F]

Yeah. Hey. Hey. So I think it's, it's, it's, it's the mental exhaustion. Like you see, I see like 49 to 50 a day and that mental exhaustion of never being allowed to make a mistake. And my brother and I was an orthopedic surgeon. Talk about all the time. I think the problem with our job is there's no room for error and nobody allows you to be human, which is what Pam was saying. So you do that clinic, you're stressed out. Even if I don't exhibit stress outwardly anymore, it's you're trying to do the right job, come up with the right answer. Then you look at your post ops and not all of them are doing great. So you're trying to deal with that stress. And it's never that. Look, it wasn't a great job on my part and that's never an option. That's an option. That's a good answer. It's not okay. You're constantly mentally just fried. And I don't know what the solution is to this. I have no answer except what I do. What I've learned to do is I get up, I get to work early in the morning and I work out very early. So I get to work at like 6, 5, 50, and I work out for half an hour. And then I just chit chat with the resident or the fellow. Just relax. And then in the evenings, I talk to my partner before I go home or I listen to podcasts on the way home. And then you talk to your family. And what I learned to do is I don't bring my work home anymore. So patient got mad at me or whatever happened. I come home and I Married my wife, in my case, I just, I went home, I talked to her, I'm like, what can I do for you? What's the plan with the kids? And then go for a walk. I started doing that. I get home, get out of my car, grab my little dog, just go for a walk, get the hell out of. Just go for a walk, look at the air, look at the sunshine. If you sit on your couch, turn on the tv, open your computer, answer a message, you're done, get out.

[G]

I mean, I have to go for a walk because I only live in 500 square feet. Pace really quickly.

[C]

Why am I envisioning like a teacup poodle? That's Anisha's dog.

[F]

He's a little cab of poo noodles. But I think going for a walk with or without an animal, it just, it gives because you got work, all the lights, all the hectic people, people are bothering you. Just go for like a 10, 15 minute walk. And then I try to go for an evening drive at God awful speeds. That's how I deal with this. But that's. You do something, but don't sit down, don't look at your computer. Like the biggest mistake I used to make was go home, let me answer the messages, let me dictate everything. Just, you know what? The hell with work. Go home, be yourself, self care, do anything but the job, at least for an hour. And then do some work at night if you have to. And it's just rough. I think that the real answer, Matt, is that it's a hard job. It's not what it was 20 years ago. Your notes 20 years ago were like three lines. You guys remember, do you. Anybody remember notes from our old attendings? Yeah, it'd be like six visits on a piece of paper. Yeah, well, no wonder they were seeing 150 patients and that stressed out. You have a six page note for plantar fasciitis. I do? Yeah, you do.

[C]

I've seen your note.

[F]

What does a dissertation. So you're mentally drained and it's okay. It's okay to say, look, I'm not weak, it's not me. It's just a rough job.

[B]

I think adding to that, I think the hardest part is trying to leave your job at the office is impossible now because there's my chart. Right. These patients can reach you in all these different ways, or they're your colleagues trying to get you to see their wife or daughter or something. And it never ends. Whether it's emails or as Anush was saying, they come from so many different angles. And one of my partners always says, I can never rotate off my own service. Right? And when you're a resident, you might have a few tough patients, but you might rotate off in two weeks, and you can count it down and say, two weeks, I'm never going to see this person again. And I think that's the part. I think patients treat us differently. They treat us as though we are. I use the Nadja. It's like we're the person making the French fries. You know, there's no sense of the training that we've been through or the fact that those of us in the room are probably some of the few people that can do any number of surgeries that no one else in the country would even want to do. Right. And it's often that reminder that makes me say, okay, I guess I should still try my best.

[F]

You know, how do you set that expectation up so we all let patients walk over us? I'm probably, of the group of us, the one that lets patients walk over them the least because of my personality that I developed the last five, 10 years. So I'm curious, because patients feel like we are the French frame. That's a great analogy. You're not the owner of the place. You didn't design the French fry maker. You're just the dipshit that puts it in and out. And there's no so how do you make them. How do you not let that patient body out? So I don't have EPIC on my phone. I refuse. And nobody's allowed to have my cell phone or call me or email me. Patient has done that once or twice. Don't ever email me again. It goes through my chart and never to me. So I've set boundaries for me, that's how I do it. Nobody gives me flack. Patients don't seem to mind. But I'm curious how you all. Because that's not what I did for years. This is just over the last five, seven years, I've developed this. What do you all do? How do you. Do you limit patients? Do you always check in your phone all the time?

[B]

I try to limit as much as I can, but. And I tell my staff, I say, when I'm in the operating room, I don't want to get an email about, can you fill out my disability paperwork? Because that's not fair to my patient that I'm operating on. Right. But I think it's getting progressively harder to separate yourself from your job. And that's the part that I think leads to the most burnout is that if you have a bad complication, it makes you not sleep properly. You stop taking care of yourself because you're so stressed about wanting to make this person better. And I think that's the thing I didn't learn as a resident or fellow is just how impactful that would be emotionally. I guess the best advice I would give is, you know, early on, you have to kind of do the numbers to feel like you're an expert at something. And then to me, that's the only way I can temper that is to say, okay, well, I've done 100 of these, and the vast majority have done great. But when they call you and page you and email you becomes tough to ignore.

[G]

Well, I've. I mean, not that I have, like, great advice, but I found that one thing that really helped me was because, like, I am. Like I said, I'm like, high anxiety. So, like, anytime the patient would message in on epic, right? It would come to my phone, and then I would think that the patient was dying in the er. But most of the time, it's like. It's like, yeah, I need a refill for, like, you know, like, my anxiety medication. So I felt that. And so. But, like, now, like, I changed. So you can change on your phone. Like, if you're. If you're not going to totally take EPIC off your phone, you can change the patient messages. So, like, you get it in a scheduled summary. So, like, you can question for a minute.

[F]

Why do you keep EPIC on your phone? Why do you feel you, as a human being, are obligated people on your hip when there's computers everywhere? Why do you. I mean, you're young. I know you're in New York at hss, so it's probably a different world than I live in, but I'm in Chicago, downtown, so it's not New York. But why do you. But why do you feel you need to be that available? That's, I think, the crux of what.

[C]

I'm trying to understand.

[G]

Yeah.

[F]

What makes you feel like that's okay?

[G]

I mean, I feel like I just want to be the. Well, part of it is I feel like when I. When I knew I was going back to New York, I was like, I'm going to be like, it's a little bit of customer service. So I think that's. That's part of it. But also, I, like, wanted to be, like, the best doctor I could be. And I was like, if I was a patient, I would want my doctor to respond Back And I started like that, right? Because like, if I was a patient, I would want. If I messaged in and I was like, I'm in pain or I need my anxiety meds, then I'd want the doctor to read that and get back to me. The problem is though, it just is. It's like soul crushing for me, right? And the patients. Don't patients understand it because they're like, I get in New York, I get like, well, the doctor just. Can he just call me for five minutes? So sometimes when that happens and the patients are really persistent, I call them back and I'm like, if every patient wanted me to call for five minutes in the other day, I would literally just have to call patients all night until enroll. Until the next day. Right? You're not the only person. So. But it's like hard because the patients don't see it. They see as you're their doctor and you're like the only patient to them. And then when we're seeing like 40 patients a day, you know, like, it's hard because I just, I see it from the patient perspective and I, like want to be like there for them and I want to be a good doctor. But then it's like hard on the.

[D]

Other side in terms of the strategy. Like, I have EPIC on my phone, but I have the notifications turned off and I try to treat it. Like I should probably treat my email, which is. I will look at messages between this time and this time and I will answer everything and I'll check them before I go home and make sure there's nothing urgent going on that I need to take care of prescription or whatever else. Everything else is fine to wait till the morning or that's an urgent care after hours emergency room. Other areas that they can go to if there is other stuff that's going on.

[E]

And you can also set up policies. Like there should be no medication that is so urgent. We will tell them, like your pain medications, 24 to 48 hours. You should know, you should be able to count how many pills you have remaining. There should be nothing urgent in terms of medications from an orthopedic surgeon. If you are, you go to the ER and like that took me a long time to have to just figure out because I feel the same way that you do, Matt. Like, how would I want my mom or brother to be treated? But I think this all still goes back to how we were trained. I think the majority of why everybody's been stepping on medicine, like the lawyers step on medicine tech Step on medicine. It's because the people going into medicine, like, I think everybody is typically of a giving personality. Like, you don't go into medicine thinking about yourself. I think we all went in, everybody's like doing industry, doing other things, innovative. But everybody went in to help somebody. That's why we all went to med school. I'm pretty sure, like, I feel that way.

[C]

No, I was actually sold by a band of gypsies to medical school. So that's how I got there.

[E]

It's the personality type, you know, like, it's the protector, it's the caring person. And it's easy for other people to take advantage of that. It might not be their intention all the time, but when you think of yourself, you automatically put other people second to you. And so I keep sounding like a broken record, but I think that's the part that I'm working on still. Like, yes, you want to help out other people, but if you're wounded, you can't help them out either.

[C]

So, yeah, I'm 100% with Anish on that. Nobody gets my cell phone number. That's sacred. And my staff knows that nobody gets that number. My email, no, you don't get that either. And I don't look at anything after work. It's work, it's work I'm there for, but when I'm not at work, I'm not at work. Call's different. I get it after hours. If you're dealing with a call, fine. But otherwise that's a great way to kind of turn some of that spigot off. It doesn't completely shut it off. It doesn't take away a lot of the other stressors like the bad patient first thing in the morning or the post op complication you get as your second patient in the morning or whatever it is. You know, those are all things that we're not going to get rid of.

[F]

Right.

[C]

But there's ways you can kind of help yourself. Just turn off that access component. Because unfortunately, with these things here, these fancy computers that we hang in our pockets all the time, you can get access to everything and anything 24 7.

[F]

Right.

[C]

And so now I know listening is not my song.

[F]

You're right.

[C]

My drum solo next.

[B]

Hold on.

[C]

Yeah, so I mean, that's one of the things where, and I learned that early on, it was from one of my mentors, was like, you don't leave it at the hospital, at your office, you don't take it home with you at all. And I agree with you 100% matt with the whole like, I found the same thing when I was a resident, a fellow, I was like, damn, this is great. I'm loving life. And then you become an attending, you're like, damn, this sucks. Cause all of a sudden you own it and you can't get away from that. And you're right. I get home before my other practice. I get home, I was exhausted, I didn't want to do anything, but for me, my outlet was I go ride my bike. So I just get on my bike and I go ride mindlessly for a couple hours and hopefully not fall off of it, which I do a lot of.

[F]

I think the advice I have, because you know, there's not kind of now the old older guard, because the old old guard is retired and living the good life, so, you know, us 50 year olds are the old guard, is that you're not a bad doctor if you're not 24 7. That's what I'm trying to make you understand. Yeah, you're not a bad person, you're not a bad doctor if you're not available 24 7. It isn't unsustainable. You're going to lose your mind, your family. I don't know if you're married or have kids. I don't five weeks away from a baby. God bless you.

[G]

That's why I'm getting all the advice now.

[F]

Baby will change you. And I was a terrible father for 10 years. My wife wanted to leave me and I wouldn't have blamed her. In hindsight. I was a horrible father husband because all I thought was a stupid job ofas academics was all that mattered. And I gave up everything. I missed birthdays, missed weddings, missed so many things that I barely remember my first child for the 78 years of his life. And I have regrets. And that's why you don't see me at a lot of ao fastings for many years. That's very complicated. But I'm not so excited I'm going to be hopefully member at large. But it's with hesitation that I do that. Because what you forget is your family is only thing that matters. When you leave this earth, nobody will care about you except those people. So you're not a bad person by putting them and yourself first. You have a family, you have a life. You should be healthy, you should be happy. You're not a good surgeon if you're exhausted and tired every day. It's not healthy. You're not a good doctor. So these people are not allowed to have you 24 7. So small things patients like. Can I get your cell phone? Nobody's allowed to have it. Can I email you? You're not allowed to email me. Why? Well, medical, legally you have to only use epic, so you can use that to your advantage. What if I have a problem? You can call the ER at night. It's all done before you get PAs and MA or athletic, somebody to help, as he's mentioned, during the day. And if they bother you the day of the clinic, you don't have to operate on anyone. You don't have to treat anyone. If they first day, they're giving you a lot of grief. Say what? I'm not the best doctor for you? This interaction has gone terrible. You should go see another doctor, whoever. But what about. We're done. I choose not to be your surgeon and I'm sorry. And yes, we talked about Google reviews. They're going to go on a Google review and write, Dr. Kadak is a horrible human being, blah, blah. That's fine. It's fine to have bad reviews. Stop looking at the reviews. Do not go online and look at one review. If your practice is busy and you have more than enough patience to see, what do you care about the Google reviews? Nobody's going to like you all the time. At LFAs, there's probably 50 people that hate me and it's okay. Brett Stone.

[C]

Well, sorry, I thought it was show of hands.

[F]

I apologize if you're all over Seinfeld. His mom's like, how can anybody not like you, Jerry? But people are not going to like you. Patients are going to like you. Let them put it online. The more you look at it, the more you go crazy. If you want to be liked by everyone, you're going to lose your mind. Don't be a jerk. Yeah.

[G]

I mean, the good thing is that the Medicare hammer toe patients are not going online.

[F]

80 and above.

[C]

You're 80.

[F]

And they're like.

[B]

Anish, you and I have spoken about the different types of patients and I think one struggle you have are these kind of what I call fancy patients. Right. They're the ones that talk about how much money they have and how they own multiple homes and how they could have seen anybody but they waited to see you. And I think as you get further along, like for Matt in your practice, like you work in New York and that's the patient population that, you know.

[C]

Counter one of my patients.

[B]

Right, right. And so the question then is, how do you set the boundaries when these patients have no boundaries? Right. Because when you're very wealthy, and you're what I call fancy. You're used to getting everything that you ask for. And we are, like I said, just making French fries. Right? So if. If I've taken anything away from. From those interactions, it's that you have to set boundaries and say, I'm absolutely trying my best. And this is. This is what I think I would do for you. But when they ask for 14 different opinions and they see six other surgeons from New York and Pennsylvania and all over the place, I don't try hard to capture that patient.

[C]

I encourage it. Go seek a second opinion.

[B]

I give them names, actually, I do too. I tell them, Lou Schone in Baltimore or New York, wherever you want to see them. And I give them the names of people who are excellent surgeons. But sometimes it's a personality mismatch. Knowing that that person doesn't fit the way you practice medicine is probably the most important thing to know.

[F]

I'll also tell you the more you bend over for a patient. So we had a horrible interaction with the patient. Somebody local operate on them. They had a bad outcome, and my partner saw them maybe need a total ankle allograph, which I do, nobody really does around the area. So they saw me, and I was like, you have arthritis. And the person lost their mind. Like, I don't understand what. You have injury. You're not going to be normal. And for two years, nobody told that patient that. And we just. She started just like, questioning, yelling at me, why are you so confident? You're so flippant. I'm like, you know, you're doing okay. You're not doing that bad. And the issue was my partner snuck her into my clinic. First patient in the morning, waited only two weeks instead of two months. And so he was trying to do her a favor. I do that for people all the time. Well, just come and see me. We'll add you on. Or I want my surgery in three. Okay, fine, I'll add it on. But what you're doing is you're taking away from your importance. So if you go to a. Let's take a restaurant, for example, and you can't get in this restaurant for three months, but if you just make a phone call to somebody that I want to go to this fancy restaurant, no problem. We'll get you in next week. You don't put that restaurant at the level that it was if you waited three months. The more you bend over backwards, the more these rich patients, privileged patients, think you're no different than the French fried maker. So I Had one guy, the Guy gave me $100,000 for research and every month he'd demand I do his ankle replacement early. This is before he gave me the money, obviously. I was like, no, the rules are the rules. You get when I can do it, I will do it. Can't you move them up? Can't you? I'm like, stop asking me. The CEO called. I'm like, he will get it done when he gets it done. The guy saw me, he's like, you're a hard guy to deal with. I said, the rules are the rules. You're no different than anybody else. I treat them all the same, nice, kind. And I did his surgery and after three months he's like, yeah, you're not so bad. I said, yeah, give me money for research. And the more you just set the rules, not in a mean way, that they're no different than anybody else. Patients are patients, they either hate you and they walk away. But I will tell you my interaction with billionaires and all these people, not in New York style, but these people have a ton of money. They treat you with respect. But if you lower yourself that this person is better than me and I'm going to bend over, well, they're going to bend you over more. And so respect yourself is. The whole point of the podcast is respect yourself as a human being. These people with money are no better than you. The person off the street, the homeless person, you're not better than them. They're all the same, somebody you have to take care of, use your skills. But the homeless person on the street, you're not adding them on at seven in the morning, are you? No way. That person's not coming.

[G]

Those people don't come into my correct.

[F]

Right.

[E]

In la, we'll drive them home for them, we'll drop them off.

[F]

Can't give them dinner money, treat rich. But my point is, you treat yourself with some self respect. That's the problem with burnout is we're treating ourselves like a fast food worker. We're letting them treat us like that. Take control back and yes, you'll lose 5%, but you gain 100. I'm busier now and have higher ratings now than I've ever had in my career. And I'm an absolute jerk sometimes. I'm kind of. But if you upset me, I'm done. And that's it.

[D]

One of the. You talked about strategies before, but there's one of the books I read or listened to was a book called Verbal Judo. It's kind of similar to, like, never split the difference if you've read Chris Voss's book. But those are, like, really good books to read because we learn a lot about the technicalities in residency of what we're doing, the diagnosis, all that kind of stuff. And I used to think it was just about being nice to people. But what I love about the books is that they teach you strategies for how do you show empathy. But be direct with them so you can be direct with them, stand up for yourself for what you think is the right thing to do. And yet they come across and they're like, okay, yeah, I understand it. I have respect for what you're saying. You're not doing it in a, you know, being a jerk or whatever. You're doing it in a way that kind of diffuses the situation. So that worked really well for me.

[C]

I'll tell you one other, and I'd be curious to hear what everybody's take or sort of, I guess, you know, use of. This is vacation. You accept calls from your staff on vacation?

[G]

Do I? No, actually, that's the one thing.

[F]

What?

[C]

All right, Matt. Just a lot work through here, buddy.

[G]

Yeah, no, I got a pa and then I was like, the PA is trained. And I trained this. I trained. And he's really good. And I was like, you don't. There's no need to contact me on vacations.

[F]

So you're at LFAS right now. Yeah.

[G]

This is not vacation.

[C]

This is work. You know, actually, I do. I do agree with him. Like, when I am available at a business meeting, I will allow my staff knows. And actually, it's not my staff. My pa, that's the only person who contacts me, nobody else. And. Right. Yeah. But true vacation, nothing true vacation.

[F]

I'm never not working.

[C]

So I've answered, well, you can't go on vacation. You have too many damn nice cars. You just keep working.

[F]

I take a lot of vacation, but wherever I am in the world, I answer my. I look at my messages every night. Not a good. But I do, because as much as I may come off as a tough person, I try to answer every night so that patients don't have to wait four days, five days. As much as I love my PAs, who are phenomenal, because the PAs will send me a message, and that means I need to answer. So it could be a wound, it could be this. But I try to. I do answer every day, spend a half hour, whatever it is, just answering the message. My PA said patients can never contact me, obviously, but yeah, 20. Every day I check Epic. Wherever I am in the world, we're born to be good surgeons. And I'm very kind in the clinic and everything you said.

[C]

Right.

[F]

You got to be direct and be empathetic. But the question is, what do you think a patient deserves? And everyone has a different bar. And to me it's 24 hours. That's your bar. Your bar may be instantaneous. Not when I'm vacation, but otherwise you're very available. I'm available once a day and I will answer. But that's just for me. And it works.

[C]

How about you, Pam? Are you a vacation? You're on a nice vacation in the islands?

[E]

If I can have Internet access, I will still answer, but I don't have the same frontline staff. I still don't have an ma. Never had a PA that answers the call, but none of them have any medical knowledge.

[C]

How about you, Dick?

[D]

I kind of set it up with my partner that's there. We'll kind of watch the in basket, answer anything urgent. If there's something that comes up, I'll have them message me. I try not to get on and look at it, but occasionally I do.

[F]

Yeah.

[C]

But you know, it's another orth pot, right? Yeah. So, yeah. So somebody, obviously you can trust them is qualified. So, I mean, that's. Yeah, that's great. How about you?

[B]

I think that's a tougher question for me. I think I have excellent PAs and MA and athletic trainers. A lot of we have a big team because we have at the university. But the tough part for me is if you want to take care of, for example, athletes like Matt's mentors who he's worked with, and some people who have been my mentors. They've always been available to me whenever I needed their help. And so I try to help any of my colleagues. But also if they're athletic trainers and someone's had a bad injury, it's hard not to answer the call at that point.

[C]

Your partner kind of suspect that guy?

[B]

I'm very lucky to have excellent partners. But yeah, I think those are the type of cases that they're hard to.

[C]

Yeah.

[F]

On that note, I'm available to my partners 24 7. I've answered calls in Colombia. I'm on the plane, get a text. I've actually. My partners never know where I am. They never know I'm gone because I always answer like, there's a couple athletes while I'm here. We just manage. You get checked, you just. So that's different to me. I'll always be Available because these people are calling you when they need you and they're your colleagues.

[C]

I will concede that, yes, I will always answer a colleague's question when I'm on vacation. That's not a problem.

[F]

You know, I have a couple patients that I've adopted, you know, too close relationship with. So they'll call and I'll answer their question. But I think, you know, people don't. And I think, Matt, you're doing it right. You, you know, your family wants you because the problem is you're on. You answer a message. It's day two of your 10 day vacation and something bad has happened. And that happens to me every goddamn vacation. Bad's always happening. Now your mind's like taken away from what matters most. Your mental sanity, your kids, your family, whatever. I think if you can figure out how not to do it, you should.

[B]

Okay, so we're coming up to the end of this. Does anyone else have any last thoughts? I think this is great advice from Matt. I wish I would have gotten this advice at your stage in the career, especially with baby on the way. I think it's important to prioritize. And one thing I'll say is I wasn't perfect at this, but when I was home with my kids, I tried not to answer my cell phone. And if they texted, I would just say, I'll text you back at 4 o' clock or 5 o', clock, whatever time. I think people are pretty understanding of that.

[F]

I think the last thing is, I've said a lot, but I think I've seen a lot of things. And so my advice is, it's okay to be sick. As a surgeon, you can cancel patients. It's okay. It's okay to take time off. If your family is sick and you got to quit a half day, it's fine. Yes, it's inconvenient for the patients, but we're not heart surgeons or brain surgeons. What you do, and I'll tell this to everybody, is not that important. There are a lot of people that do what we do that are not as qualified, and people do fine. So what we do is not that big a deal. You're not that important, means your family and you come first. And so you can cancel clinics day before day. I mean, I try never to cancel anything, but if something's wrong, you cancel. Like, for years I told my wife, like, no, I can't. I have to. I have to now, like, we have a problem. Like, all right, fine, call the office, Cancel it is what it is. And it's okay. You have all. You're a human being. And I you. If you're sick, don't go to work. Right. If your neck hurts, take some damn time off. Fine. Right? I broke my mom. I took time off. Barely. I went back to work as fast as I could. I was operating with stitches in my arm, whatever it took. When I broke my shoulder at Michigan, I was in a sling, operating. It's just insane what we do. It's okay to be. It's okay to be a person. And nobody tells you it's not weak. I was making fun of Matt just a little bit. It's absolutely weak to not recognize that you're not invincible. This is a long run, and you can't want to quit 10 years into this job unless you make it in some sort of stock market or bitcoin thing. And you're not. And you know what? The other thing I'll tell you, mentally, stop looking at everybody else. Don't look up open payments. Stop it. If you have, throw it off your phone. Because all it is is our version of social media where all you're looking at are people that are better than making more money than you have, a different life than you. Everyone's got problems just hiding it from you. So. So just worry about yourself, your family. Everybody around you is going to be doing better than you, because that's what we all think. Just don't worry about anybody else except yourself.

[B]

Great. All right, so that's a great way to conclude this special session. We're recording on site in Vancouver. So it's great to see all of you and thank you for joining us for the AOFAS Ortho Podcast.

[A]

Thank you for listening to the AOFAS Ortho Podcast, a conveymed production. To learn more about joining our dynamic community of highly skilled orthopedic specialists, visit aofas.org.