S01E12 – Reducing the Stigma of Mental Health Issues with Kyle Bradford-Jones

Physician Kyle Bradford-Jones discusses the stigma around mental health issues for healthcare professionals and how medical training could be adjusted.

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Transcript

Jan:

Welcome to this next episode of our podcast. And it’s a really great pleasure for me today to welcome Kyle Bradford Jones and this is for many reasons. Kyle Bradford is an Associate Professor of the Department of Family and Preventive Medicine at the University of Utah. And Kyle is not only a physician but he is actually also an author. He is an author of a book and he’s just written a book called Fallible. A memoir of a young physician’s struggle with mental illness. And I had the chance to read the book and I was really touched by it. And I felt that you’re really raising such an important topic. And I would just like you to introduce us to the topic, maybe by telling us how did you come to write a book about being fallible and what the importance is? What got you to write that book?

Dr. Kyle Bradford Jones:

Sure. You know, that’s tough because obviously to write a book about all of your failings and many of your inner most thoughts was a bit daunting. A little bit of background, I have struggled with clinical anxiety and depression for many years and those were significantly worsened during my time of medical training. And a lot of the way that we treat our trainees, our students and residents and each other and both the physical and mental and emotional grind really brought out some of the worst of that mental illness in me. And so in about 2014, I was blogging for the American Academy of Family Physicians and I had a little bit been talking to a couple of other physicians about mental illness and severe burnout and those types of issues and realized how much more common my experience was then I initially thought.

Dr. Kyle Bradford Jones:

And there were so many other physicians and students going through that but we felt like we weren’t allowed to talk about it. And so, that gave me the idea and the courage to start writing about it. So I wrote about it in this blog, I wrote about it in a couple of other venues and my wife and I did an interview on a podcast where we talked about it from the family’s perspective of how it affected my wife and my kids. And afterwards the podcast hosts said, “You know what? You guys should write a book.” And my wife, wasn’t interested in writing. And so, that gave me the thought and I started exploring it and worked on it for about three years and here it is. So, sometimes it’s difficult to … When I realized some of the things that I included and how personal those are.

Dr. Kyle Bradford Jones:

But I think it’s really important. I think it’s important for healthcare professionals and physicians, especially to be willing to admit some of the things that we struggle with because it’s not only us, it’s those around us and our colleagues. I think it also helps us understand our patients a little bit better. And also we know that if you have a clinically diagnosed mental illness that you are not properly treating, you’re more likely to cause medical errors and cause mistakes and hurt your patients. And so, all of these things together, I really wanted the book to help propel the conversation a little bit and hopefully decrease some of that stigma.

Jan:

Yeah, wow. I couldn’t agree more. This is such an important topic and there’s this, yeah, with the idea that as a physician we are here to help others. And as a physician, we’re here to be the heroes and we are the carriers of the solution while the patients are carrying the problem. So how can you have a problem, right? You’ve got to be the doctor, you’ve got to be the savior or the hero or the super brain. And we’re tuning ourselves into this, not consciously, it’s not a conscious process but it’s very easy. I think every professional knows how easy it is to go down this track and to identify as the one who knows and to identify ourselves as the one who helps others and is kind of the stronger part in the relation of somebody else suffering. And this is so important. So I was wondering, what actually happens during our training, right? What happens? How do we build this image? How do we get down this track, even?

Dr. Kyle Bradford Jones:

I think there’s a few things that contribute to it and part of it is that frankly, medicine is really hard. Even if everything else is going perfectly, it’s hard to be a physician and a nurse because you are dealing with suffering and with life and death and all of these things. And we’re not really taught, at least I wasn’t taught as a medical student, how to deal with that. And so once I started seeing it and experiencing it more and more, I didn’t quite know how to process that. But I remember an instance as a medical student, where it was the middle of the night, I was on the OB rotation and it was a quiet night. So I was in the call room getting a little bit of sleep and I was paged to come down to a delivery.

Dr. Kyle Bradford Jones:

So I came down and turns out I missed the delivery. And they said, “We paged you 20 minutes ago. Where were you?” But there wasn’t a page on my pager. And so, I felt attacked that I had missed this, even though there was no indication they actually paged me. But first of all, the physician, as he’s sewing up the mother, starts yelling at me in the room in front of the mother. And this was her first child, she’s exhausted and exhilarated and all of the emotions you have with a new baby and he’s yelling at me. And so, finally I just excused myself and left. When he was done, he came out of the room and said, “Okay, where were you? What were you doing?” And I said, “Well, I was laying down in the call room.”

Dr. Kyle Bradford Jones:

He said, “No, that is abandoning your patient. You need to forget about sleep, about exercise, about sex, about having relationships with other people and friends. It’s all about the patient. And so, if you are not there for them, you have abandoned them and you are not a good physician.” And so it perpetuated both. I think that that idea of, “Hey, we’re the only ones that can save you. It’s me, I’m the hero.” But then also brought up the notion that we as healthcare workers, don’t really matter, that our needs are not important. It’s only what the patient needs. And so it perpetuated this unspoken rule, I think, and impression that I was getting.

Jan:

So that is very reminiscent of several teachers that I had, it’s really reminiscent. And the idea of boasting about not taking care of ourselves, the idea about one pointedness in availability for the patient to the point that you’re actually misbehaving with the patient, which is what this colleague has actually done, right? So yelling at you in front of the patient has probably not helped the patient at this moment. So he actually forgot his … He didn’t take his own medicine. And probably one of the reasons is that, he didn’t take care of himself, right?

Dr. Kyle Bradford Jones:

Yeah, exactly.

Jan:

Yeah. And I mean, this story that you’re telling in principles of this kind of mechanism, I guess everybody has seen this and I have seen this in myself. I mean, I don’t know about you but certainly I’ve seen this. I’ve been overworked, haven’t slept enough. I was irritable, living off the vending machine and coffee for way too long and this is not unusual.

Dr. Kyle Bradford Jones:

Yeah, yeah. And well, it’s hard too, because so many of us go into this profession to help our patients and to have those relationships. And so, in some ways, we think we’re doing them and ourselves this great service but if we are ignoring our own wellness, in the end, it hurts our patients. Like you said, the physician was yelling at me in front of the patient and we’re not getting enough sleep or proper nutrition. We can’t be expected to give our best to the patient to help them.

Jan:

It’s amazing that this is not natural, right? It’s amazing that here are two senior health care professionals talking to each other in 2020 and why do we actually have this conversation after … Tell me when you want to start the history of medicine. But if we look at our history now, of the last 200 years of very scientific, biological, particular matter focused Cartesian worldview framework for our learnings, for what we’ve learned in doctor’s school, it’s amazing that we need to have this conversation. That basically, it is not required of us to be in a space of health and healing, to be in a same space, so that we can invite others into it. But rather we’re yelling at our colleagues in front of our patients, right?

Dr. Kyle Bradford Jones:

Absolutely. Well, and it’s interesting because even though I had numerous experiences like that, of being berated and demeaned and humiliated in front of colleagues and other professionals and patients, it’s interesting because I’ve often thought, well, I’m sure part of that was because the other physicians are going through the exact same and they don’t know how to deal with it. And so, like you say, with that physician, delivering the baby and how he wasn’t taking his own medicine. And so, then he was much more likely to snap at me and maybe what he was trying to, in his mind, teach me and prepare me for were some of his own struggles and inadequacies. And so to avoid that, avoid caring for ourselves, I mean, it just makes such huge waves across multiple people’s lives in a negative way.

Jan:

So true. And you talked about the safety effects but that’s the really far end, is when it comes to medical harm. When it comes to really patient safety questions, where you’re experiencing and where you’re having an adverse experience because of the doctor not being in an adequate state of being. Not just an inadequate state of mind but body, mind and soul to be actually coherent as a human being.

Dr. Kyle Bradford Jones:

Yeah, absolutely.

Jan:

But not only is it a safety issue, it’s also a quality. And I think this is really a point you make in your book. Is that, the patients are not getting what they’re deserving. So we’re learning in training that it’s great to act like a martyr, is to actually not take care of ourselves. And this is encouraged and there’s a heroic clamor to sleep less and not look after yourself. And that actually is a disservice to our patients. So you’re really pointing out a weakness. And I really love it in your book that you’re not finger pointing at your colleagues but you’re saying, “Look, this behavior of these very esteemed colleagues is a system failure anyway.”

Dr. Kyle Bradford Jones:

Yeah. And the system gets the outcomes that it’s designed to get. And so when you’re part of a broken system, of course, you’re going to have broken physicians, so to speak.

Jan:

Isn’t that crazy. So we’re entertaining our own misery, if you like.

Dr. Kyle Bradford Jones:

Yeah, yeah.

Jan:

And we’re actually not helping ourselves to show up in the best version of ourselves then. And how different did we get into medical school? What were the intentions initially and what was our state of mind and heart? And initially, why did we choose this profession? So what happens on the way in terms of, where’s that snap point, I guess? Where you’re coming in with a fairly subjective worldview and then you learning about the benefits of objectivity and you’re learning about the benefits of disconnecting but then we don’t find back home, right? So we’re going off on a journey and we never come home. So we don’t get to integrate our skills that we have learned. The skills of signs and objectivity but bring them back home into our hearts.

Dr. Kyle Bradford Jones:

Yeah.

Jan:

So what happens there? Why is that?

Dr. Kyle Bradford Jones:

You know, and I think that’s a good way of putting it, where so many of us start out very optimistic and altruistic, and we want to help patients and we want to help people. And there’ve been numerous studies that are very clear that, right in the middle of medical school, that’s gone. We have, as a whole, of course each individual can be a little different but as a whole, our level of empathy and our level level of altruism has decreased significantly. I personally do think it has to do with, we’re not really prepared for how hard medicine is on an emotional level.

Dr. Kyle Bradford Jones:

Obviously we study hard, we learn all of these great and important things but we’re not really trained how to deal with death or how to deal with a patient that continually suffers. And what things we can do to take care of ourselves, if we have a really long shift and aren’t able to sleep for 30 hours. And so, I feel like once you start entering that clinical realm in the middle of medical school, you start seeing all of these things and you have no idea how to process it. And so, it just builds in you. I kind of explore it in the book where, throughout medical school and residency, I worried that I had lost my humanity, so to speak.

Dr. Kyle Bradford Jones:

That I no longer cared about patients. I no longer felt like I was there to help them or that I could do anything or that I was able to do that. And I’ve had a lot of people ask me just recently, since the book came out and said, “Do you feel like you’ve gained it back?” And I do, to a certain extent. I don’t think it was to the same level as it was before medical school. But I do feel as if I’m in a very fulfilled position right now, emotionally and with my family and professionally and all of those things. But that was a legitimate concern of mine, that maybe I’ve lost my soul a bit and I’m not going to get it back.

Jan:

What a journey, what a journey. Where we’re learning, too. Obviously we’re learning that we need to take care of patients and it’s our responsibility and first do no harm. And in a way, the sentence, first do no harm, is very quickly the next one is, so therefore, first of all, don’t make mistakes, right?

Dr. Kyle Bradford Jones:

Yeah.

Jan:

That’s kind of the second sentence. So that’s just one way to do no harm, is to not make mistakes. And that’s where a lot of the pressure is coming from, that if we make a mistake, if we’re fallible, the consequences are dramatic. So how can you be a human being, heart open, vulnerable, while being in an environment where messy mistakes are completely not acceptable and where objectivity is king?

Dr. Kyle Bradford Jones:

You know, some of the studies that have been done, at least here in the United States, have shown that the more open you are with patients and the more honest you are with some of the things that you want to accomplish in their care or that maybe you’ve made a mistake with, they’re much more forgiving and they understand a lot more. And when we have the sense that I’m the hero and the savior and I come in and I take care of you and fix everything, that is the exact opposite of what we need to be thinking about. And so, we are going to make mistakes, that’s going to happen no matter how good of a physician or nurse or whatever we are. And so being open about it, both with ourselves but then also with our patients and in the majority of cases, they respond well to that because they recognize that we’re human, if we act human, so to speak. If we’re focusing on that relationship with them, they’re much more forgiving.

Jan:

So, is that amazing? Yeah. So, what is it for you when you realize that, wow, I actually do make mistakes. I’m actually a human being. And I actually have doubts about the way of being professional in the way that I’m trained in and it doesn’t feel authentic. So at that point, where you know you still have your job, you’re still going and you’re starting to now struggle with … Am I actually authentic? Am I really worth the profession? Am I really worth doing that job? Can I really give? What happens at this point? What happened to you at this point?

Dr. Kyle Bradford Jones:

That’s hard because in the United States medical culture, making a mistake and being sued for malpractice is the same thing but it’s usually not. So about a year after finishing residency, I was involved in a malpractice claim but there wasn’t a mistake. It was just an unfortunate outcome and the individual lost some hearing but it wasn’t that we missed anything. It wasn’t that we should have done something different, it was just an unfortunate circumstance. And yet, that experience was incredibly difficult for me to feel that even though I didn’t make a mistake by all accounts, obviously we have multiple physicians weigh in and courts and whatnot and everyone agreed, we did not make a mistake. It’s still just eats at you. And I’m much more self-aware now of making mistakes but probably not in a good way.

Dr. Kyle Bradford Jones:

You know, at least in the American system, one of the results of suing doctors so much is that now we order more tests, we do more things just to cover ourselves, so we can justify and say, “Hey, I looked into everything. You know, I didn’t find anything, so this isn’t my fault.” And so obviously that causes other problems, both with patient care, with financial issues, et cetera, et cetera. And so, it’s so much more present in my mind, those things about potential mistakes but more in a fearful way. And I’ve really tried. That’s something I’ve explored with my therapist before.

Dr. Kyle Bradford Jones:

I’ve done different things to try to decrease the influence that it has over my decision making as a physician. And in many ways it has, it has helped but I wish I could say I’ve completely gotten over it. But it’s still there in the back of my mind of, “Yeah, boy, what if I do something wrong or I miss something?” And with this malpractice claim, this poor woman, I felt awful for her that she did have something bad happen to her but it just wasn’t anybody’s fault. It was just life. And so, even that still eats at you because it was a negative outcome, even if I did everything right.

Jan:

Yes. Yes, it’s amazing. And it reminds me sometimes at this emotional level, it reminds me of a child, like if there’s actually something you do wrong. Okay, so we know both situations. We know situations where somebody claims that we did something wrong. While actually, we did the best possible that we could to the best of the current state of ignorance. And then sometimes we actually do make mistakes. And for example, because we’re not really coherent and we shouldn’t actually be working. So yes, we do make mistakes. And so, it reminds me a little bit of the situation where it’s [inaudible 00:24:15], it reminds me where you’re … Let’s say you really make a mistake, like a child, okay? Let’s say you drop a glass, okay? Or you break something, okay?

Jan:

You have a ball and you kick it into the window and that shock, I think everybody knows. Everyone knows this moment, where you, as a child, you really fucked up and you made a mistake and you have this visceral experience of, “Oh my God, I didn’t want.”

Dr. Kyle Bradford Jones:

Yeah, yeah.

Jan:

Next thing that happens, if you’re unfortunate, is that you get blamed on top of that, right?

Dr. Kyle Bradford Jones:

Yeah.

Jan:

So actually in a change of culture, if we were to change paradigm, in a way it should be the other way around, right? It should be like, “Wow, I’m so sorry for you, that this happened to you,” right?

Dr. Kyle Bradford Jones:

Yeah, yeah.

Jan:

So obviously it’s difficult to hear the patient, I can understand that. I’m the patient and it’s easier for me to blame you rather than to actually recognize that you’re a human, too. And to say I recognize that you tried your best but I also recognize that you screwed up but now I have the consequences, okay?

Dr. Kyle Bradford Jones:

Yeah

Jan:

So how do you see … I mean, is there a way out? What does the paradigm change in other words that we’d need?

Dr. Kyle Bradford Jones:

Yeah. I think you have to address it from multiple angles, that dealing with the potential of the mistake or being sued, whether it’s a mistake or not, that you commit, et cetera. I think that does go back to needing better training in medical school of how do you deal with this because it will happen. And I also think I’ve heard people recommend that every medical student and resident have a therapist and I totally agree with that. That to be able to and even if it’s not a therapist, to have someone you can talk to and be open about it. And I think that’s part of the next step, is being able to recognize this in ourselves as a profession, that this is something that everyone is going to struggle with and that’s okay. It’s okay to struggle with it, as long as we’re supporting one another.

Dr. Kyle Bradford Jones:

I think, and this is different in different places across the world but it seems that there’s much more encroachment by others on how we practice medicine. So whether that’s payers or governmental regulations or whatever it is, we have less and less autonomy. And obviously, when you are used to having a certain amount of autonomy to do what you and the patient together feel is best and then you have this big roadblock, that frustration that happens over and over and over again can be so debilitating.

Dr. Kyle Bradford Jones:

And so, I feel like you have to address all of these from different angles to give students and physicians better tools but then make a big culture shift so that we’re supporting each other and we’re open to talking about some of these struggles. And also to free up physicians and other healthcare workers to be able to do our job and what we’ve been trained to do.

Jan:

I couldn’t agree more. I love the idea that every student has like a coach, you know?

Dr. Kyle Bradford Jones:

Yeah, yeah.

Jan:

Has a mentor and it makes so much sense. I just talked to a mother in my pediatric practice today. And she looked at me, she just put her baby in a cradle and I was just holding it. And then she said, “You know, it’s amazing. This is my first child and I’ve been educated and I have a management position and I learned all these things at school. I feel so helpless as a mother, that I’ve never learned to be a mother.” And this in many ways applies to us, too, right? So, we go to school to learn all sorts of things that feed our brains but to actually go to school to learn how to open our hearts, how to deal with fear when it dominates our actions, when we’re actually acting fear driven rather than love driven and acting from a place of resonance and connectedness.

Dr. Kyle Bradford Jones:

Yeah.

Jan:

So it makes so much sense that there’s a training needed as much as we need to train our minds, there’s a training for our hearts needed. And this is not a communication class in how to ask open questions. Oh, what brings you to hospital today? Everybody knows this now but it’s not a communication skill to parent something.

Dr. Kyle Bradford Jones:

Right.

Jan:

But it’s actually to allow ourselves to sink into our hearts and to see what does it feel like here and what is the place for which I’m acting and it’s beautiful, how you’re describing that through your process that you went through and recognizing the issue and addressing it and taking responsibility that you now feel more, you’ll feel more complete. That you’ll feel more that that’s the family, you see your family again. So all the things that the surgeon told you not to do, you’re actually now doing and now you’re feeling more complete.

Dr. Kyle Bradford Jones:

Right, exactly.

Jan:

Wow. Did he read your book?

Dr. Kyle Bradford Jones:

I doubt it. I didn’t send it to him.

Jan:

Yeah. No, I mean, I can highly recommend it. I feel this is really a great … Very, very valuable contribution to our profession that you’re naming this and you’re describing it and you’re showing up so strong in your vulnerability. Really leading this recognition and guiding our way in this direction to be more humble and vulnerable.

Dr. Kyle Bradford Jones:

Yeah. And that’s okay. I still, like I mentioned earlier, I do feel fulfilled in my personal life, my professional life. I can still achieve the goals that I want to and be successful in the ways that I want to, even when I’ve been through the ringer, so to speak, as we all have.

Jan:

Wow, beautiful. What a beautiful journey that you’re sharing with us. And I’m just highly recommending everybody to read the book. We’ll put the link under the podcast and the video, so that everyone can have a look at it. And I just want to express my gratitude on behalf of our colleagues, I guess. I have not yet read the book, for really encouraging us to look at this and to change paradigm and to start shifting to a different way of projecting ourselves and to allow ourselves to show up more vulnerability. And by this, actually more authentically and more fulfilled. And at the end, isn’t that why we went to medical school?

Dr. Kyle Bradford Jones:

Yeah, absolutely.

Jan:

We wanted to do something meaningful and seek to do something that is actually deeply fulfilling. Not just mentally satisfying but actually deeply fulfilling.

Dr. Kyle Bradford Jones:

Yeah, absolutely. Well, thank you. I appreciate those kind words about the book.

Jan:

Beautiful. Well, thank you. And it’s a really great pleasure to have you and we will make this video available. And I hope that there’s a lot of, that this will start actually a conversation as heart based medicine is really a lot about actually now getting physicians together and starting the conversation about these topics and see what emerges from this. If we’re not teaching this as some new ology from some teaching place but we’re actually creating this together and see what evolves when we bring our heart intelligence to a different way of being physicians.

Dr. Kyle Bradford Jones:

Yeah. Well, that’s excellent. Thank you, Jan.

Jan:

Thank you. Thanks a lot for joining.

Dr. Kyle Bradford Jones:

My pleasure.

Jan:

Thank you. All the best.