Transcript: You Can't Pour From An Empty Cup: Wellness in ENT

with Dr. Ashley Agan

Dr. Ashley Agan and Dr. Gopi Shah talk wellness in life and practice! You can read the full transcript here or listen to this episode on BackTable.com.

Transcript: You Can't Pour From An Empty Cup: Wellness in ENT

Table of Contents

(1) What is Wellness and Why is it Important?

(2) Take Care of Yourself before Taking Care of Others

(3) Incorporating Wellness into Medicine and Work-Life

(4) Being a Physician by Being Yourself

(5) COVID-19 and its Effects on Wellness

(6) Wellness for Students, Residents, and Trainees

(7) Ways to Reflect and Keep in Touch with Yourself

Introduction

[Ashley Agan MD]
This week on The BackTable Podcast.

[Gopi Shah MD]
And I think, especially as physicians, we are very service-oriented. That's our constitution, is to want to serve and to help people get better and make people happy. But it can wear on you if through that you're sacrificing your own happiness and your own well-being.

[Ashley Agan MD]
Because it eventually affects patient care too.

[Gopi Shah MD]
That's true. Yeah, absolutely. You can't pour from an empty cup. So yeah, you have to take care of yourself before you can take care of others. You got to put on your oxygen mask before you-

[Ashley Agan MD]
Right, exactly. Put on your own mask first. Welcome to the BackTable ENT podcast. We are doing something very special today. This is our first podcast that will be a spinoff from your usual BackTable podcast listening. BackTable ENT will be all things ENT and more, and it will be hosted by myself, Ashley Agan, and my partner in crime, Gopi Shah.

[Gopi Shah MD]
You knows it.

[Ashley Agan MD]
We will be coming to you regularly with all things ENT. Today, we are going to dive into wellness and beyond. Thanks for listening. Let's get started.

[Gopi Shah MD]
All right. So this is a bit of 180 degrees. The last time we were on BackTable, we did an epistaxis podcast with myself, you, Ashley, as well as Sabeen down in IR. So today we're doing a bit of 180 and talking about wellness. Just quickly, I'm a pediatric ENT at Dallas Children's at UT Southwestern.

[Ashley Agan MD]
And I am a general otolaryngologist. I'm also at UT Southwestern here in Dallas. Gopi and I met maybe five years ago.

[Gopi Shah MD]
Six, seven years ago.

[Ashley Agan MD]
Oh.

[Gopi Shah MD]
Yeah.

[Ashley Agan MD]
It's six or seven years.

[Gopi Shah MD]
It's been a while.

[Ashley Agan MD]
Gopi was my fellow. She was the peds fellow when I was a resident still. And we have become great friends and partners in otolaryngology, partners in crime, partners in wellness. We've had some good times in that-

[Gopi Shah MD]
For sure.

[Ashley Agan MD]
... we've been able to be well because of it.

(1) What is Wellness and Why is it Important?

[Gopi Shah MD]
So I wanted to first started out with you, Ash, and ask you, how did you get into wellness?

[Ashley Agan MD]
So that's a great question. I would say my interest in wellness stemmed from a experience of burnout when I was a resident. I guess I should just take us all the way back because for as long as I can remember, I have been burning the candle from both ends and saying yes to everything and spreading myself too thin and feeling like if I'm not being productive, that I'm being lazy. And so there was just this constant push to just be going, going, going, going, going, going. And it worked for a long time. And I did that when I was in grade school. I did that in college. I did that in medical school. And then I got into residency, and I was still going. And then my chief year in residency, it just all finally hit me. I was just burnt out. I was physically and emotionally exhausted, very depleted, just in a dark place. And I think having been through that, I didn't know it was a burnout back then. I just was like-

[Gopi Shah MD]
It's a buzzword, but it's hard to know exactly what it means.

[Ashley Agan MD]
I didn't know what wellness was. I knew it burnt out was. I just was like, ugh. And so now after having joined the faculty here at UT Southwestern and knowing everything we know about wellness, wellness is everywhere now, I just feel passionate about making sure that here at our residency program that we are doing everything we can to promote wellness and to make sure residents know what burnout is and what it looks like so that if they are headed that direction, they can recognize it and maybe reach out and get help and try to pull themselves out of it before it's as deep and dark as it was when I was there.

[Gopi Shah MD]
No, I think I had a very similar. So I had a little bit of time between residency and fellowships, where I think that kind of helped me breathe a little bit between that next stage in my life. And probably about four years into being staff is when I hit my burnout in the sense of every box is instantly being checked, you're starting to continue to one more notch under the belt or one more title, one more this or one more that. And at a certain point, that external stuff is not gratifying. It's exhausting. And you have to figure out who you are again and start choosing what you want to do and no more shoulds, no more external anything because, like you said, it's not sustainable.

So I think for me, it definitely became a priority when I was feeling that way in order for me to maintain a happy relationship with my family, myself, my patients, my friends. I needed to make some changes. So I think that's when wellness became important for me too. Wellness is, same thing, buzzword as the burnout. What do you think it really means? We say wellness, but what does that mean?

[Ashley Agan MD]
Yeah. What is wellness? I think wellness looks different for different people. And when I think about it, I think about just thriving, really being able to wake up every day and go spend your energy on something that you are truly passionate about. And we all enter medical school saying we're passionate about patient care. And then we get through medical school and residency and there are so many things that aren't patient care that just really can break you down. You spend so much time on other things, and sometimes you do have to do things that you're not passionate about. I think everybody has to do a little bit.

[Gopi Shah MD]
There's some peer-to-peer conversations for insurance approval you're just going to have to do.

[Ashley Agan MD]
But if you can be waking up every day and spending the majority of your time really doing something that lights you up and that you're excited about and feeling like you are looking forward to what you're doing, if you can organize your work and your life in such a way that allows you to have that, that's what I aspire to. And certainly, I have not figured it out yet, but that's what I'm working towards that. That's what I feel like wellness looks like and what I am hoping to do or trying to do every day.

[Gopi Shah MD]
Yeah. No, I think I like the thriving, that growth. I think there's a lot of introspection that comes along with trying to be well, which means taking some time to pause, breathe, think, get into yourself, but also get out of your head. And it's little baby steps and theory. It sounds very idealistic, but it's hard to sometimes make behavior changes to go along with what you feel you need to do about being well. I think, like you said, we're so used to burning the light at both ends when a lot of times that just is saying a lot of yeses to everything, and that's what gets drilled in terms of how to be successful in your training. Or what are the three A's right, accessibility, all that stuff, affability. Accessibility you're always available and on. But somebody very special had told me it's okay to say no to the things that you don't want to do so that you can actually say yes to the things that you do want to do. And so sometimes it's also-

[Ashley Agan MD]
I think that's great.

[Gopi Shah MD]
... behavior changes and making those things of saying it's okay to say no to that because it's okay that you don't want to do something because there are other things once you figure out what you are passionate about and take the time to enjoy. Every other little action will be a little bit more meaningful. But it is little steps, I think, day to day.

[Ashley Agan MD]
For sure. And it can change.

[Gopi Shah MD]
And it can change. What you think you want and what your goals are and what looks like thriving can change over time, and you can pivot.

[Ashley Agan MD]
And that's okay.

[Gopi Shah MD]
Yeah.

[Ashley Agan MD]
And that is totally fine.

[Gopi Shah MD]
I agree.

(2) Take Care of Yourself before Taking Care of Others

[Ashley Agan MD]
It's hard. I think it's very easy to find yourself pigeon-holed into your title, what you have professed that you are. You've put your stake in the ground, that you are the whatever person, and if at some point you wake up one day and that's not who you want to be, it can be hard to turn around and tell everybody that suddenly you're not the person to send all of that thing too. But you're right. Yeah. You have to be true to yourself. You have to be able to really be happy, make yourself happy and worry less about making everybody else happy. For me, that is something that I struggle with very regularly, every day, is putting other people's happiness before my own and wanting to make sure that everybody else is happy, patients, their families, my colleagues, my bosses.

[Gopi Shah MD]
My six-year-old and eight-year-old.

[Ashley Agan MD]
Yeah. Yeah. I hear you.

[Gopi Shah MD]
It's an easy trap to fall into. And I think, especially as physicians, we are very service-oriented. That's our constitution, is to want to serve and to help people get better and make people happy. But it can wear on you if through that you're sacrificing your own happiness and your own well-being.

[Ashley Agan MD]
Because it eventually affects patient care too.

[Gopi Shah MD]
That's true. Yeah. Absolutely. You can't pour from an empty cup. So yeah, you have to take care of yourself before you can take care of others. You got to put on your oxygen mask before you-

[Ashley Agan MD]
Right, exactly. Put on your own mask first. So speaking of which, how do you feel that you can incorporate wellness into the workplace or on your day-to-day to help with the goal of bringing the whole team up?

(3) Incorporating Wellness into Medicine and Work-Life

[Gopi Shah MD]
Yeah. That's a great question. There's lots of these different wellness tools that you hear about these days, things like mindfulness and breathing and meditation and yoga, the things that help with the stressors because I think a lot of people are just constantly in that fight or flight mode. And just breathing sometimes is something that I do every day where I just remind myself to really breathe and take a beat when I feel it coming up in me. And then trying to be present and not be thinking about what the next thing I have to do is because my Outlook calendar is so full of things. I literally live by it. If it's not in my calendar, it's not going to happen because I don't know about it.

You're so scheduled, but I think I have to very consciously be like, "Okay, I'm doing this right now." And so if I'm teaching, if I'm with a patient, I'm with the patient. And it's very easy, especially when you're running behind and you're like, "Okay, I'm 40 minutes behind schedule, but this patient really needs to talk to me right now. And so I'm going to just stop thinking about the other patients that are waiting, and I'm going to just give them everything right now." I think in addition to the things that we do medically, sometimes a lot of patients just need us to hold a space for them to talk.

[Ashley Agan MD]
Well, and also, when you do that and you're with them, it doesn't mean, okay, here's another hour that's going to go by. Sometimes all they really need is your being with them present for that 10 minutes.

[Gopi Shah MD]
Yeah, for sure.

[Ashley Agan MD]
And it's the same or even less time, but it's more efficient. You're there. And what they need get actually gets addressed. When my mind is half there and I'm thinking about the other 10 patients I need to see, I just get more and more behind because then I'm just like, "Oh, I need to sit here even longer because they waited longer," and the focus changes.

[Gopi Shah MD]
And a lot of the other patients, they'll be okay. When I'm running late, I say I'm sorry, and they say it's okay. And then we move on. Every now and then someone is really upset, but a lot of times, patients will forgive you. Once it's their turn, then they have all of me at that time too. I think that contributes to my wellness too by trying to just bring myself down and not be rushing all the time.

[Ashley Agan MD]
Yeah. I think I didn't really get comfortable with this until a couple of years in the practice. But just really being myself with my patients and families in the sense of we'll talk about obviously why they're there, school's about to start soon, so asking them what they're doing with, how their kids are doing for school, or there's stuff or jokes or something. And so I think in terms of sense of self, it's important for them to know who you are as a person too. And they appreciate that.

[Gopi Shah MD]
What do you think the barrier was to doing that in the past? Do you think you're just more comfortable now?

[Ashley Agan MD]
Yeah. I think in my mind, maybe I had just a certain idea of what a doctor or an ENT is supposed to be and how you're supposed to be with your patients and have all the answers or have all the scientific data. And sometimes, yeah, that's all great, but many times for routine things or just even sometimes for something really serious, sometimes families to see who you are on the inside-

[Gopi Shah MD]
Yeah, 100%.

(4) Being a Physician by Being Yourself

[Ashley Agan MD]
... like your humor. And I like that because then they loosen up. We're not trying to be friends. There's obviously still a very patient-physician relationship, but there's a lot more honesty and trust and compassion, which from both ends. There's forgiveness and room to breathe on both ends. So I think that's important too.

[Gopi Shah MD]
I completely agree. I think patients do feel more of a... They do want to be more connected and know their doctor more than this rigid just white coat.

[Ashley Agan MD]
Yeah. Yeah, yeah, yeah. For sure. Or now with the mask and the shield.

[Gopi Shah MD]
Right. Yeah. I know. Yeah.

[Ashley Agan MD]
I can't even see you.

[Gopi Shah MD]
Speaking of, I had a clinic day recently where two, maybe three patients, I walked in and I hadn't seen him in a while. And they were like, "You're not my doctor." I was like, "Yes, it's me."

[Ashley Agan MD]
Yeah.

[Gopi Shah MD]
I showed them my badge with my picture. And I was like, "It's me," because I had my mask and eye protection and everything on. And I guess they hadn't seen me in a while. But yeah, they didn't recognize me. We've lost a little bit of that human connection with being able to see faces recently with COVID and everything.

(5) COVID-19 and its Effects on Wellness

[Ashley Agan MD]
Well, yeah, with COVID going on, how do you think wellness has changed? Or what have you felt like you've had to do differently in your day-to-day in terms of wellness? And is wellness different now? What it means to be well now is different than what it was six months ago.

[Gopi Shah MD]
Yeah. I think it's definitely had an impact. So many people just either know people who are sick or who have passed, knowing people who have lost their jobs and don't know how they're going to pay for their rent, groceries, et cetera. For me personally, it has been just trying to figure out how I can use my skillset to help and to help out and do things to make things better. I am not good when I'm idle. All that energy is just there, and I need to be doing things. So when we had to close down clinics back in March, or I guess it was March or April, that was a hard time.

And in addition, not being able to be with people. So I think community is a huge part of wellness. And not being able to gather has contributed to some sadness, for lack of a better word. I think it's rough to not be able to get together with people. And Zoom is great, and phone calls are great and FaceTime, but it's not the same.

[Ashley Agan MD]
That feedback, that facial expression.

[Gopi Shah MD]
And people's energies being in the same place with a big group of people who you love and enjoy being with, there's nothing like that. So I think that it's had a huge impact. But we'll get through it. We will.

[Ashley Agan MD]
I appreciate that at least at our institution there has been a big push towards wellness and mental health.

[Gopi Shah MD]
Yes.

[Ashley Agan MD]
And there's been a ton of support for people who are on the front lines in the COVID unit every day, for people who've either had family members they've lost or had family members who are sick. There's just been a big outpouring of resources, whether it be counselors or group sessions. I have noticed and appreciated that there has been a lot available depending on how it has affected you, which is great to see.

[Gopi Shah MD]
Yeah, I think as an otolaryngology community, I think that we just as our academy to staying in touch with other people, other otolaryngologists across the country, friends, colleagues, partners, just that we're very fortunate to be a part of a close-knit group of professionals. I think having the academy upfront early on about testing and protection, I think, was very helpful just to have that sort of guideline support backup in terms of what our needs would be in the workplace. So I think, like you said, community is very important, and I feel lucky to be part of our otolaryngology one. And like Ash said, I love that UT Southwestern ENT community as well. I think overall it's a very happy place and we all respect each other for who we are.

The other thing I think with COVID, I think more than ever it's, like they say, you can never predict things in life, but I think in the last couple of months, it's even more you just can't predict stuff. And just being okay with that when having to learn to go with the flow even more and whatever plans, all that, it's okay that they're not there or that things change within the next day, whether in terms of your day-to-day. And so that flexibility, I think, has been important. So just be able to pivot and not be reactionary towards it. But just proactive and, "Okay, what do I need to do next? Or what can I do, or how do we do it differently?"

[Ashley Agan MD]
Absolutely. Yeah. Absolutely. Being flexible is huge.

[Gopi Shah MD]
It's huge, yeah.

[Ashley Agan MD]
I think hanging onto the way things are supposed to be is a recipe for probably getting burned out.

(6) Wellness for Students, Residents, and Trainees

[Gopi Shah MD]
For sure. For sure. So Ashley does a lot with the medical students at UT Southwestern with our ENT electives. We both are involved in resident education, and I'm the pediatric fellowship director for pediatric ENT at UT. What do you think are ways to incorporate wellness for medical students, residents, trainees? Again, it's a buzz word, and people have curriculums. But what have you found to work?

[Ashley Agan MD]
I think for our residents, we have slowly been incorporating different types of wellness-themed activities into kind of a "wellness curriculum," so to speak. We do a wellness journal club where we review articles that are related to wellness. We do a lot of activities together. That's been something that has really taken a hit with COVID, is all of. Originally, we had a group, Women in Oto, WOTO, and then the last couple of years we changed it to Wellness in Oto. So it was still WOTO, but it was wellness.

[Gopi Shah MD]
We're trying to be inclusive.

[Ashley Agan MD]
We're trying to be inclusive. Okay, guys.

[Gopi Shah MD]
Everybody should be well.

[Ashley Agan MD]
Because that's what it really was a great wellness community outing. Usually we would go out to eat or go to somebody's house and just hang out. Yeah, yeah. Yeah, we made some little succulent terrariums one time. We've done all kinds of good stuff. So that's been hard in the time of COVID, but that's something that we've been really good at instituting at our program. And about a year or maybe a year and a half ago, we started having formal mentoring, which has been good. Historically, we would have just organic informal mentoring where people would just hope that people match up and find a good mentor for them. Now just out of the gate, the interns will be assigned a mentor. And then after that first year, once they have their feet under them a little bit and know a little bit more, they can choose to switch mentors if they want to work with somebody in a particular sub-specialty, et cetera. But we do send out quarterly reminders to meet up. We send out recommendations for what to talk about and just try to help keep people on pace to get done what they want to get done during residency. Five years does go by faster than you realize.

[Gopi Shah MD]
I know. It does.

[Ashley Agan MD]
But I think in addition to talking about what papers they're trying to get published, they also just have an opportunity to check in with someone. And if they need to talk about struggling with the inservice or struggling on call or whatever there is going on, or maybe they just want to celebrate and talk about good time, whatever, just having someone that is assigned to them that they know they're going to be talking to quarterly, I think it's nice. And I think on the faculty side, it might give us an opportunity to pick up on somebody that might be headed towards burnout before they get there or try to detect that maybe. I don't know.

[Gopi Shah MD]
Yeah. No. I think, like you said, and the same thing on the fellowship side, it's trying to stay in touch and communicate and whether it's about research job opportunities, life in general, I think it's just, like you said, community connections and having that human contact relationship is very important. And I think that's probably how mentoring contributes to wellness. And I think it is if you feel residency is a very busy time, fellowship's a busy time, that tenure life, there's a lot going on. And so if you have to have somebody that is there or knows what's going on or somebody you feel like you can reach out to is very important.

[Ashley Agan MD]
Yeah, for sure.

[Gopi Shah MD]
And then overall connecting with yourself, staying true to you, making sure that you're number one in that sense.

(7) Ways to Reflect and Keep in Touch with Yourself

[Ashley Agan MD]
Do you do anything in particular to try to stay true to yourself or tap into yourself, a journal?

[Gopi Shah MD]
So yeah. No. I-

[Ashley Agan MD]
What would you recommend?

[Gopi Shah MD]
I don't know. It's my husband... No, I'm just kidding. I do journal. Definitely journal sometimes. I wish I was a little more consistent or regular with it.

[Ashley Agan MD]
Do you find that you journal when you're upset?

[Gopi Shah MD]
Yes, more than when I'm well.

[Ashley Agan MD]
Me too. Me too.

[Gopi Shah MD]
I think writing things down is something that gets lost I feel like nowadays. We don't do it enough. And yet a lot of our communication is written via text, emails, tweets, whatever. But actually with paper and pen and a notebook can be very nice. It's just nice to get it out and that way.

[Ashley Agan MD]
Yeah. It helps you get it out and look at it from a little further away. I think you can get all your thoughts out, and then you can look back over it and digest it from a distance or something, if that makes sense. Yeah. But I don't know. I don't know. I have a hard time keeping things in too. I feel like professionally or unprofessionally, I feel like my residents, my trainees, they know what's going on with me in that sense. And if I'm stressed out about a patient, I like to discuss with them why and what my thought process is. And-

[Gopi Shah MD]
Which is good.

[Ashley Agan MD]
... that helps me vent a little bit.

[Gopi Shah MD]
It's good to bring that into the fold.

[Ashley Agan MD]
Yeah. I feel like in that sense it's an open notebook, a little bit probably too much. I think it's good to go talk to somebody sometimes. I've at that point where I felt pretty down, I definitely. And I still do talk to a therapist, probably not as often as I would like to. We go to the gym to exercise our bodies. I feel like I need to have that to really clear my head and help me bring it back and get centered sometimes.

[Gopi Shah MD]
Yeah. I agree.

[Ashley Agan MD]
I think I wish I would've seen a therapist a lot sooner than I did, especially thinking back to that time when I was really burned out. And I think there's just a lot more talk about wellness and being able to go talk to somebody, but I still remember feeling just it was a hurdle to finally talk to somebody. But then after I did, I was like, "Oh, wow, probably should have done that earlier."

[Gopi Shah MD]
Yeah. No, for sure. For sure.

[Ashley Agan MD]
It's super helpful. I enjoy it. And I always feel refreshed after. And then, I don't know, I feel like just try to get out and play more, literally play more. We have a six-year-old and a eight-year-old, and they are always ready to play. And straight up, whether it's Monopoly, to making a haunted house, to hiding, whatever it is. It's easy to forget how to do those things. And I like comedy.

[Gopi Shah MD]
Yeah.

[Ashley Agan MD]
But what about you?

[Gopi Shah MD]
We like to play. My husband and I like to travel. We're very active, so going to the wake park or skateboarding or doing stuff outside. I agree. I think that's a great way to be well.

[Ashley Agan MD]
Yeah. I think-

[Gopi Shah MD]
Moving your body makes you feel good.

[Ashley Agan MD]
Yeah. And I think the BackTable ENT podcast is going to be a way to be well because what's nice is we're going to be able to connect with people in our fields and discuss whether it's ENT topics to professional topics that affect ENT, just like wellness. It's a way to connect with our community, our guests, our listeners. I'm so open to suggestions, ideas and topics. So I'm very excited for what's to come.

[Gopi Shah MD]
Yeah. I think this is going to be great. For you listeners out there, we would love to know you. And please subscribe and rate and comment and email us with suggestions and thoughts. And maybe you want to come on and chat with us.

[Ashley Agan MD]
We're here. So you'll find us on BackTable and on iTunes, on Spotify, SoundCloud.

[Gopi Shah MD]
Wherever you listen to your podcasts. We are on Twitter. Our handle is @_backtableENT, so please follow us. And we'll see you, or I guess not see you, but I think we can still say see you soon.

[Ashley Agan MD]
All right. We'll see the next BackTable podcast. You knows it.

[Gopi Shah MD]
You knows it.

Podcast Participants

Dr. Ashley Agan

Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.

Dr. Gopi Shah

Host Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.

Cite This Podcast

BackTable, LLC (Producer). (2020, July 5). Ep. 01 – You Can't Pour From An Empty Cup: Wellness in ENT [Audio podcast]. Retrieved from https://www.backtable.com/podcasts

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