Episode 25 - You Are More Than an Empty Vessel with Dr. Kevin MailoAug 15, 2023
Dr. Wing Lim interviews Physician Empowerment co-founder and frequent co-host Dr. Kevin Mailo on the subject of burnout. Kevin addresses how the language we use for recovering from burnout makes us sound like a drained battery and reminds us we are not simply vessels that are either full or empty. He discusses building daily wellness and resiliency.
Dr. Mailo resists the language that makes us sound like fuel tanks and instead shares his vision of each of us being a great oak tree that can withstand storms, drought, and pesticides without breaking. That is the image he uses when he teaches wellness: the notion of us as growing living beings, needing daily nourishment, not just a refuel when we are empty.
In this episode, Dr. Wing Lim and Dr. Kevin Mailo talk about the very real stresses of physician’s careers and how frequent burnout truly is. They address the need to be honest about our needs, about needing time off, or cutting back on hours. Kevin reveals the three selves that need to be nourished in balance: the personal, professional, and financial selves. He has some ideas on how to both do more to achieve constant growth and self-care, and also how to do less in order to rest. This episode is vital for understanding the importance of cultivating resiliency and healthy boundaries.
About Dr. Kevin Mailo:
Kevin is an emergency physician based out of Edmonton, Alberta. He is known for his highly engaging teaching style that breaks down complex topics into memorable experiences.
Kevin cares deeply about the long-term wellness of the medical profession and wants to see physicians and their families succeed personally and financially.
Resources Discussed in this Episode:
- “YOU as the most important investment” mini-course by Dr. Kevin Mailo
Dr. Kevin Mailo: [00:00:01] Hi, I'm Dr. Kevin Mailo, one of the co-hosts of the Physician Empowerment podcast. At Physician Empowerment, we're dedicated to improving the lives of Canadian physicians personally, professionally, and financially. If you're loving what you're listening to, let us know. We always want to hear your feedback. Connect with us. If you want to go further, we've got outstanding programming both in-person and online. So look us up. But regardless, we hope you really enjoy this episode.
Dr. Wing Lim: [00:00:34] Okay. Welcome everyone, to our episode of Physician Empowerment. I am Dr. Wing Lim. I'm a family physician, one of the co-founders of Physician Empowerment, and we're really glad to interview my partner and co-founder, Dr. Kevin Mailo, emerged out of Sherwood Park as well. And today we're going to talk about a topic that he presented in Mexico. This is back in 2021, 22. We brought in the New Year at that time, Kevin, right? So we had a lot of fun. And this topic that you presented was very well received and there was a lot of echoing from the depth of people's souls. So we'd like to bring this up. And the topic is you're more than an empty vessel. So Kevin, tell us why you had that name as a topic.
Dr. Kevin Mailo: [00:01:19] So if you want to get down to sort of what we're going to be covering in brief today, this is not by any means the comprehensive discussion that I had during our time in Mexico. Thankfully, we're not going to spend that much time. But it's the notion of burnout. Right? And one of the first things that I came to realize in the current model of physician wellness, and occupational wellness in general, is this idea of burnout being that you are some kind of empty vessel, right? Like how many times do we hear that imagery kicked around in wellness circles of you are some kind of fuel tank that runs out of fuel or you are a battery that runs out of power. And somehow in the current model, when we get close to empty, we're supposed to do something dramatic or not so dramatic to refuel the tank to get better.
Dr. Wing Lim: [00:02:18] Of course, that was not just our phone, even our car. It's got to be plugged in overnight. A zoom, two, three, four, five, six hours later, you're good as new.
Dr. Kevin Mailo: [00:02:25] Exactly, right? But like, we're people. We're not electric cars. I'm not a Tesla. Okay? And frankly, that model is exhausted because when we think about the length of our careers, it has to be better than a pendulum or a yo-yo where you oscillate between being okay, you know, relatively full and empty. So that's why I titled the talk 'You are more than an empty vessel'. And so this is a Physician Empowerment concept in the notion of personal growth and resiliency. And in my opinion, it's a far more optimistic model of looking at physician wellness because burnout is only half the discussion. Yes. Is it a very real fact of life? You bet it is. We work extremely stressful jobs. We have one of the most stressful jobs in society. We deal with people's lives. And more than that, we make decisions that are, frankly, life and death. And it doesn't matter what kind of specialty you're in. As a psychiatrist, you're constantly assessing your patients for risk of self-harm or suicidality. As a pathologist, how good are the margins on that sample you looked at? As a radiologist, is it a benign nodule or is it cancer that needs to be followed up aggressively with a repeat CT. Right? So we're constantly faced with this and we're very highly trained. So we don't necessarily consciously have an awareness of this. But the burnout is a very, very real fact.
Dr. Kevin Mailo: [00:03:50] And the other thing that I came across is the CMA data. And if you have not looked at this data, I would strongly encourage you to look at this data. It was published in 2017, 2018, somewhere around there. And I know the post-pandemic data is even worse. But to summarize in very broad strokes, I'm not going to get into the numbers or the figures, is that at any given point, six out of ten physicians are experiencing some kind of burnout. And at any given point, three out of ten of us are screening positive for depression. So, and that doesn't mean that we're not performing well in our jobs. It doesn't mean that we aren't great doctors, but it means that we're barely treading water. For many of us, we are just surviving in our careers and our personal lives. And frankly, life has to be better than that. We need to be thriving. And that's really my mission. One of the reasons why I started Physician Empowerment is to see physicians truly thriving, truly happy in their lives, happy in their careers, healthy, doing the things we should be doing to be our best selves.
Dr. Wing Lim: [00:04:57] So let's yes, let me just have a point of reflection. Right? So I think we know, I've been around 30 years, so we went from hush-hush with ten feet tall, bulletproof. Nobody's stupid. Nobody's weak. Everybody's Superman. Right? There's no Kryptonite, right? Everybody's strong. To a point that now we realize that, oh, gosh, people are burning out, but we still hiding. Right? But then suddenly I've heard some colleagues, the department now have these forcible sessions of wellness.
Dr. Kevin Mailo: [00:05:25] Oh, forced wellness modules.
Dr. Wing Lim: [00:05:27] Yeah. Forced modules. Suddenly you're supposed to be well, now. Okay.
Dr. Kevin Mailo: [00:05:31] You're supposed to be well, you did a module, Wing, and the organization got to check the box.
Dr. Wing Lim: [00:05:37] So how do you manufacture wellness?
Dr. Kevin Mailo: [00:05:41] Yeah. So let's agree that, you know, you're probably not a battery. I'm not a battery. I'm not a fuel tank. You're not a fuel tank. Um, the image that I have, and this is actually the image that I teach with, so I had one slide in Mexico when I taught this. There was only one slide. And that was a picture of a big, beautiful tree standing on a hilltop with the sun. And that, you know, when you think about a plant, it's a living thing like us. And you don't wait until the plant withers and begins to shrivel before you water it, sun it or weed it. But at the same time, the plant itself has an intrinsic resilience, an intrinsic drive to grow and to become stronger. To reach greater heights. And that's the way I look at it when we talk about ourselves and our lives personally, professionally and financially. So when it comes to wellness, I have this vision of a tree, a great big oak or something along the lines of that, a tree that withstands droughts, hail, attempts to cut it down, pesticides, storms, lightning and the tree lives for hundreds of years and encounters those things. And it does not break. It continues to grow. And that's the vision that I try to have for myself as I go through the ups and downs of life and career. Where despite whatever struggles I face, I continually invest in myself, continually grow. And that's really how I've been teaching it for a few years now. This notion that we are growing living beings, very three dimensional, that we need to nourish ourselves every day, physically, emotionally, and spiritually. The other thing that I would challenge you on, and again, I brought this forward to our attendees in Mexico, challenge you on if you were your own patient, what would you say to yourself? You'd probably say work less, sleep more, strengthen your personal relationships, strengthen your relationship with yourself. Set boundaries. You would do all of those things, or at least you would tell your patient to do all of those things.
Dr. Wing Lim: [00:08:00] Isn't that ironic? It is ironic, right? We tell people this and there's a very high degree of hypocrisy about ourselves.
Dr. Kevin Mailo: [00:08:08] Yeah.
Dr. Wing Lim: [00:08:09] Right? Do we exercise enough when you go to these pharmaceutically sponsored meals, people just gorge themselves, but then, you know, they prescribe it. Do they actually exercise and eat well? Right?
Dr. Kevin Mailo: [00:08:21] And it's not about being a model of perfection because that itself can actually be a source of burnout. Right? I am not saying, you know, we all have to be, you know, exemplary. I'm hardly that when you watch me hit the McDonald's drive-through. If I'm having a busy day with the kids or whatever and work, right? There has to be lots of room for self-forgiveness. There has to be lots of room for, you know, being the humans that we are, not robots but imperfect beings. But we should be striving not to be someone else, but to be the best version of ourselves, right? And so again, it comes back to that challenge of if you were your own patient, what would you be telling you to do? And we rarely take time to reflect on that. So I want to, you know, share two sides of the coin here. Number one is the notion that there's burnout and that's the negative aspect of high-stress jobs like health care. And then there's resiliency, which is the beauty, you know, within. Right? It's our ability to overcome. It's our ability to grow despite challenges and setbacks. And so let's explore burnout first, very briefly. And again, this isn't going to be a definitive exploration. This, actually we do have this full talk on the website, so we'll show you how to, how to link to it, or if you have questions, just reach out to me because I think it's worth, I really think it's worth watching. Honestly. It's one of my best. It's one of the things I'm most proud of in this journey.
Dr. Kevin Mailo: [00:09:57] But number one is burnout. These so-called lows, they can be prevented. They're not all preventable. But over the course of a 30-year career, maybe you have fewer of them. And maybe the lows aren't so low, right? So maybe the lows don't have to be as low as they get. Again, when you consider this kind of yo-yo back and forth between, you know, struggle and success is one of the first things they want to highlight. Okay. And I've got a few strategies that I'll go over, but only very briefly, because again, we don't have a lot of time for that. Okay.
Dr. Wing Lim: [00:10:35] Okay. Sure.
Dr. Kevin Mailo: [00:10:36] So again, it starts with self-care and the notion that suffering in our professional and personal and financial lives is inevitable. You know, it's like saying I'm going to be a diagnostician, so I'm going to be a physician, you know, who works on the front lines and primary care, internal medicine, emerge, whatever, you're going to have a certain miss rate. Or being a surgeon and saying, well, I'm never going to have surgical complications. Of course you are going to have surgical complications. This is an inevitability, right? So accepting some of those inevitabilities in our practice lives can be very powerful because when they arise, we can put them in context. And rather than flogging ourselves, we can look at them as a point of deep reflection and improvement in our practices. And I'm not just talking about technical improvement, but saying what is the context? How much was I working? How much call was I doing that week? Whatever it is--
Dr. Wing Lim: [00:11:31] Can we just stop right there, please? Because I think this is huge, right? So we don't even allow ourselves to park there because a) is there's a lot of shame.
Dr. Kevin Mailo: [00:11:41] Yes.
Dr. Wing Lim: [00:11:42] And b) there is a lot of consequence. Right? So there will be a lot of cover-up and denial. And actually people ended up with malpractice complaints and lawsuits are the ones that either a) denied or b) over embracing and apologize when it's not their fault. Right? Because we are our own worst enemies, right?
Dr. Kevin Mailo: [00:11:59] Oh, without question. Without question, Wing. And that can become a kind of a, you know, a negative, self-feeding cycle where we get down on ourselves and it begins to rock our confidence. And so it's really important that we address that. And there's lots of formal supports and informal supports. There's lots of reading that can be done around it. But even spending time with, you know, in counselling or some other formal support like that can be extremely, extremely powerful. But just recognizing the inevitability of complications and setbacks in our career can be a very powerful source of resiliency for us because we're not alone. We're not the first and we're not the worst, to borrow the words of one of my mentors, when we go through our struggles. The other thing that I try to highlight is that there are three selves, and this is another Physician Empowerment concept. And one day I'll go on a big deep exploration on the podcast or something like that. But there's a personal self, a professional self - so the MD - and there's a financial self, and those all have to be in harmony. Right? And they all affect one another differently. So if you are struggling in your personal life immensely, it will inevitably at some point bubble up in your professional life. Likewise, if you have financial struggles, they will at some point impact you professionally or personally. Right? So these things are all tied to one another. But resiliency. Resiliency is about having margin. So resiliency is when the system is putting pressure on us and the work environment becomes too stressful, having the ability to set boundaries and step back and work fewer hours when we need to, is a huge source of personal professional renewal. Right? And the way we do that is by having that constant awareness of self in our professional lives going, Wow, you know what? Call has been really busy on the wards these days, and I think I'm getting a little tapped out. Maybe I should be working less.
Dr. Wing Lim: [00:14:07] Yeah, that's a really good patch there, Kevin. So let's dwell a little bit on it. Number one in response to that, a) we're taught and we bred and we're still expected to be so professional that we don't let anything come through, right? And when we do, we fail, right? But, you're right, the personal and financial side does affect the professional side. So. And then when you say, okay, let's just cut back some calls. Well, I think you and I lived through it, the shame, the guilt, the hate that we get from our colleagues, you know?
Dr. Kevin Mailo: [00:14:43] But in my opinion, that's not a marker of weakness. That's a marker of strength. Strength says I'm aware of my limitations. Strength says I'm powerful enough to be vulnerable with my colleagues and say I need to work less. And financial strength says I can afford to do it. Right? But again, we struggle with that culture in medicine of like being the quiet warrior and you just go in, no matter how much it negatively impacts your personal health or your relationships, and just work more and more. But resiliency in our personal lives also affects our professional life, right? So when we have lots of, you know, margin in terms of sleep, exercise, diet, you know, healthy relationships with people that build us up and support us, healthy time for self where we're not consumed with work, those things, again, can be an enormous strength of resiliency and an enormous strength of happiness in our lives that let us keep going and go back to that stressful ward where we're struggling with high volumes and patients laying in stretchers in the hallway, which, let's be honest, we're increasingly facing.
Dr. Kevin Mailo: [00:16:01] The other thing that I want to talk about, and this underpins wellness both personally and professionally, is money. Financial resiliency. A lot of people, you know, will ask, you know, why at Physician Empowerment do you guys talk about money or teach financial literacy like you do? I'm not here as an educator in finance to help, if I can be blunt, to help doctors buy nicer cars, homes, boats, vacation properties or whatever. That's not my goal. That's not my dream at all. And I'll be very blunt about it. The power of financial security and why I teach it is that it allows us to step back from the stresses of the profession when we need to. Right? That we're not worried about paying the bills. That we have a, that we work in an efficient practice where if we need to take a week off for a personal or family matter or a health issue, that we can do it. And we're not worried. We're not dragging ourselves in. So we're doing better medicine when we are financially secure.
Dr. Wing Lim: [00:17:08] Or, may I add too, the guts to stand up and speak against authorities that could affect your livelihood.
Dr. Kevin Mailo: [00:17:14] Exactly. So one of my mentors who spoke up very boldly at a lot of meetings, one time I sort of walked up to him and said, like, how do you do that? And he goes, I have money. I don't care. They can fire me. And I thought that was very powerful. Like, if you want to change the system, you need to be able to do it from a place of personal, but also financial strength. So you're not worried about any retributive behavior. The other other side to this is, you know, when we talk about financial resiliency is, you know, being able to do those wellness things that matter. Right? Like so when your wellness module is online, take you to you should do more yoga and meditate and exercise and go on a nice vacation. Well, all of that costs money, whether it's a direct expenditure, or whether you're giving up clinic time to do it. So again, when I teach this to residents - and I do a lot of teaching to residents about money, not through Physician Empowerment, but as, you know, an academic doctor that I am - I say that money is not the cake, but it's one of the ingredients. And so, you know, again, financial resiliency is so key. It's about financial security. It's about peace of mind. It's about when things are getting rough in the hospital or you start having physical ailments or there's a loved one that needs you, you can cut back on your clinical hours without worrying about money, because in those situations, that's the last thing you should be worrying about.
Dr. Wing Lim: [00:18:44] Well, let's face it, wellness has a price tag, right? A colleague of mine just had a minor surgery, and they said that, well, I can't afford not to come back within two weeks. Right? So just saying. It's so real. It's so real.
Dr. Kevin Mailo: [00:18:58] It is so real. We all face it. And it's not necessarily that it's going to go away, but we can do a lot to make it better. And so let me talk about resiliency more practically. And then we're going to wrap up here because I know this is already going on and I can keep going on and on. So resiliency, when I think about it, this constant investment, growing the tree of our lives, is a daily activity. That it's something we set out daily to do. It should be consciously and mindfully undertaken and shared with those closest with us, like so our colleagues, our spouse or our partner, even our children. Setting a positive example. Resiliency should go across the three selves - personal, professional, and financial - and it should occur regardless of our mood. So the people that are, you know, training, let's say for a marathon, that person gets out there and runs, whether it's a good day or a bad day, whether they feel like it or not, good weather or bad weather, they're out there training. Okay. And resiliency can be big things like saying, okay, you know what, I've got a very powerful goal to be retired within ten years and I'm going to take the steps to get there. Or it can be something small, which is like, I'm going to go for a walk every single day. Right? And, you know, resiliency needs to be built into our dreams, our aspirations, and our goals, and not just our own personal individual dreams, but the shared ones with our spouse, family, or even our colleagues.
Dr. Kevin Mailo: [00:20:28] Okay. So let me just go with a brief overview of what we call quick wins and what we call long-term strategies. So when it comes to like quick, easy things you can do to feel better and to be more resilient rather than running out of the tank, try just some of these sorts of things. So the first category I have on quick wins is doing less. Actually let me go with doing more. I like doing more better to start with because doing less is funnier. So doing more. Spend a day laying in bed and sleeping. Watch a favorite movie. Go and exercise. Walk or go for a drive. Have a wonderful meal, like cook one, you know, go buy the ingredients, go real slow, take your time. Have some comfort food. Phone a mentor or a friend that you can confide in. Hug your spouse or partner, tell them how much you love them. Hug your kids or your pets, tell them how much you love them. Spend time with the people who aren't medical. Like get out of the health care space, you know, and hang out with non-medical friends or family, people in your, you know, religious or cultural community if you're affiliated with one. And again, those are just examples. I don't want to be prescriptive here. That's the whole point of this is not to give you a bunch of modules or a checklist, right? But to do, you know, but to share just some ideas of what you can do to invest in yourself on a day-to-day basis.
Dr. Kevin Mailo: [00:22:04] So when it comes to quick wins, though, there's actually a lot in the doing less space. And this is where I kind of have a little more fun with these. So draw up a clinic day. We already alluded to that. If you are feeling burnt out, then start cutting back, right? It's not only better for you, it is better for your patients, it is better for the system in the long term. Our patients deserve to have happy, healthy, resilient doctors who are taking their own advice. Here's another good one. Turn off the notifications on your phone. Or better yet, put it away for the day and just unplug. Don't check your email or your EMR. Stop. Set some boundaries. Don't go and spend more money that you don't have. Buying more consumer items that you know deep down are not going to make you happy. Right? Like, truthfully, and again, that's not why we started Physician Empowerment when we started talking about financial education. And then here's my favorite, skip another useless meeting. Honestly, do that for yourself. Do that for yourself. Another big one that I rely on is practicing gratitude, really trying to sit down and be thankful for what I have in my life and not just focusing on the problems.
Dr. Kevin Mailo: [00:23:25] Obviously, we can't be avoidant towards problems or try to distract ourselves. You know, we have to face our problems because that's the only way that life gets better. But at the same time that we face them, keep looking ahead at the beautiful things in our lives and remind ourselves of what's really important. And then in the long run, it's about like having very clear, personal, professional, and financial goals that you are working towards every day because those things keep you on your path. They help you set your priorities. More importantly, they help you set boundaries. They help you say no when you need to say no. Because there are system-level issues that are never going away. Health care is inherently stressful and it will only get more stressful and more complex. So you as one person in this giant, giant machine, need to care for yourself. Okay. And so I regularly check-in. I regularly write my dreams down. I regularly write down my goals. And I'll talk in another episode about the difference between dreams and goals. I think maybe last Zoom meeting we had, Wing, I was accidentally screen-sharing my dream panel. I had them written down. Maybe you didn't see it all, which is probably just fine. Um, but I've got a, it's probably my biggest note on my computer.
Dr. Wing Lim: [00:24:50] There's a name for that. It's called the power page.
Dr. Kevin Mailo: [00:24:52] Yeah. Ooh, I like that. Ooh, I like that a lot.
Dr. Wing Lim: [00:24:55] Yeah. The power page.
Dr. Kevin Mailo: [00:24:56] Okay. So again, at a future point, I'm going to talk about dreams. And I really want you to hold on to that concept because that's something that's very near and dear to me. And I really, really love talking about it because it's so important. So with that being said, I think we're going to wrap up and, again, check us out on the website. And if this resonated with you and you want to talk further, hear some of the things that I've done over the years to become more resilient. I'd love to connect. I am so, so passionate about this, so just reach out to us over email or you can text me. Thanks so much.
Dr. Wing Lim: [00:25:31] Yeah, thanks Kevin, for sharing. And yes, to recap, everybody knows about burnout. Everybody talks about it. Everybody knows seven out of ten of us and maybe us was just denying it. And we look around, nobody is owning it up and saying, I'm the one that burned out. Right? So this is a very toxic environment. And as you know, in Alberta and any other places, the working environment is getting so stressful post-pandemic. Well, we're not even post-pandemic yet. And then we cannot just manufacture wellness just based on a few wellness modules. And it's not something to plug a USB in the brain and then you download a wellness app and you're better, right? This is a lot of hands-on stuff and I hope we just creating an awareness and we're ready to walk through with our colleagues, east to west coast, right?
Dr. Kevin Mailo: [00:26:19] Absolutely. Absolutely.
Dr. Wing Lim: [00:26:20] Wonderful. Good. Well, so thank you, everyone, for joining us today, and we'll look forward to seeing you at the next event. Check our website. All right.
Dr. Kevin Mailo: [00:26:29] Thank you so much for listening to the Physician Empowerment podcast. If you're ready to take those next steps in transforming your practice, finances, or personal well-being, then come and join us at PhysEmpowerment.ca - P H Y S Empowerment dot ca - to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend. And head over to Apple Podcasts to give us a five-star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.