The Worthy Physician Podcast
Reigniting your humanity and passion for medicine.
The Worthy Physician Podcast
Overcoming Physician Burnout: The Power of Self-Advocacy and Collaboration with Dr. Todd Otten
Why do so many physicians struggle to prioritize their well-being or even consider leaving the profession despite severe burnout? Dr. Otten shines a light on the cultural and systemic hurdles, from financial worries to family impacts, that keep many healthcare providers trapped in a cycle of self-sacrifice. He shares personal anecdotes and insights from his collaborative book "The Ripple of Change," co-authored with patient Joshua Judy, revealing how their dialogue evolved into a broader call for action within the healthcare system. Their unique partnership offers a fresh perspective on rebuilding trust and combating learned helplessness in an often dysfunctional system.
Imagine the extraordinary outcomes that can emerge from simple equations like one plus one. In our final discussion, Dr. Otten explores the incredible synergies that arise from collaboration. Reflecting on his journey of co-authoring a transformative book with Joshua, he emphasizes the profound impact of working together towards a common goal. His optimistic view encourages us all to recognize our potential and the powerful results that collective efforts can achieve. This episode is not just about surviving burnout; it's about thriving through resilience, self-advocacy, and the magic of partnership and collaboration for a solution.
Connect with Dr. Otten:
https://www.ourquadrupleaim.com/
Though I am a physician, this is not medical advice. This is only a tool that physicians can use to get ideas on how to deal with burnout and/or know they are not alone. If you are in need of medical assistance talk to your physician.
Learn more about female physicians' journey through burnout to thriving!
https://www.theworthyphysician.com/books
Let's connect for speaking opportunities!
https://www.theworthyphysician.com/dr-shahhaque-md-as-a-speaker
Check out the free resources from The Worthy Physician:
https://www.theworthyphysician.com/freebie-downloads
Battle of the Boxes
21 Day Self Focus Journal
Welcome to another episode of the Worthy Physician. What does it mean to be a ripple of change? Today we're going to dive into and discuss that with Dr Todd Otten, who also has his own podcast in addition to his book. Todd, can you share with the audience a little bit about your journey through being a physician and the multiple hats you've worn?
Dr. Otten:I often will start with. Right out of medical school I did a year of general surgery and I loved it. I loved operating, but the culture, the training culture, wasn't quite for me. At times I just it's almost seemed sadistic a little bit in terms of the morbidity and mortality conferences and one individual getting grilled on a stage by 100 people. I just was like, wow, this is what this is about. Maybe this isn't for me and actually it was during that time I had some inkling of maybe some minor burnout, if you will, crying at the end of the day, not sleeping well, things of that nature.
Dr. Otten:Fortunately, I was in the US Navy and I had the opportunity to train as a flight surgeon, which is a total misnomer. It's really primary care for the pilot and the air crew and that kind of thing, and I loved it. It was a blast. I'd go to get a cup of coffee and I don't have to mess and it would take an hour because I would get interrupted with 35 questions along the way and I'm like my office is right down the hall, you can just hop in anytime. So after that I came back to Michigan, did my residency in family medicine and then I joined a critical access hospital just southwest of Lansing and most of it was amazing. I really love seeing patients. I really do, and that was never the issue. It was all these other things that I had added to my plate.
Dr. Otten:And so, at the peak of my busyness, or overextending myself, I wore several hats, as you alluded to. I was chief of staff, I was an ATO medical director and I was seeing like 6,000 visits a year, which is quite a few. And then that kind of imploded when I had some pay withheld because I had two open charts literally two and I freaking lost it. I resigned a whole bunch of things. I was ready to quit, I was ready to walk away from the job that I loved.
Dr. Otten:Fortunately, I had some time off and it was during that time off you can call it a sabbatical or what have you. I did some counseling, which was super helpful, and learned the things that maybe I could work on to do a little bit better, to be a little bit more resilient than perhaps I was. But when I came back I vowed I would never get burned out again. I was like I'm not going down this path, I'm going to set some boundaries I'm going to be able to get better at saying no, and so I took over a clinic and in the book here I'll show the book here.
Dr. Otten:Here's the book, since we do have a video for those of you on audio. I'm holding up the book. But in Ripple of Change I called it the office utopia because we lived the quadruple aim. And yeah, that was the first stage of my journey, if you will and I don't want to just keep throwing it out because it definitely accelerates at one point from there for sure so yeah, so, through all this, you're wearing multiple hats and, by the way, thank you for your service.
Dr. Otten:Oh yeah, for sure it was a blessing and I would do it again. You're welcome.
Dr. Shah-Haque:That's awesome. And what happened with the two open charts? You're seeing 6,000 patient visits. You have 6,000 patient visits at 6 6 000 charts because you chart on each visit, but you had two open what was the most amazing part of that is I was involved in writing the contract the physician contract and I knew exactly what the intent of that was.
Dr. Otten:The intent of that was. The intent of that was to address habitual offenders of chart, incomplete charts rather, or delays in the charting. I was not that guy at all. Routinely I would have my charts done at the end of the day, every day, no matter what, and the reconciliation was like every six months. So once every six months you would get a snapshot of open charts. And so you had some of my colleagues who struggled to keep up the night before doing all these charting, and I'm like I should be good, I keep up, no big deal whatever.
Dr. Otten:And as it stood there were two open charts and literally I couldn't close them. It didn't matter what I did, and Emma had to go in and check a button. I think it took all of 60 seconds to close the two charts, but it created this whirlwind effect, that sort of was like the straw that broke the camel's back. At that point I'm like this is insane and actually, ironically enough, that led to, I think, the first two F-bombs that were in the book, as I told off some administrator as a result of it, because I appealed the decision. I'm like this is insane. This is not what we're supposed to be doing and they stood firm.
Dr. Shah-Haque:And you know I don't want to play spoiler, but yes, I let loose after that one a little bit to a couple of key administrators. The reason why I'm circling back to that is because I think it's a pain point for most physicians After everything that you've done, you get a little slap on the wrist for something that is nonsensical, particularly with a number of two charts, and it just, it's almost a really bad kid.
Dr. Otten:It evokes that emotion from you, yeah, and I think, oh boy, you're spot on. That should not have happened, yeah. But I think the really interesting part of that whole situation is it led to a change in me, yeah, and for a couple of years it was very painful. It took a couple of years for me to really get back to the person I was. But after that period I was different. I wasn't going to take the garbage, I was going to stand up for myself. I was going to stand up for myself, I was going to stand up for my colleagues.
Dr. Otten:And ultimately, when a similar type of situation came up again three years later, that was really the evolution to where I'm at now and maybe to give a little bit of backstory to that because I think it's important, so probably two years after going through burnout, I had wrote a poem called Medicine is the World of Gray, and it was a dark poem, really, a catharsis maybe of what it's like to be a primary care physician, with all the clerical burdens and the struggles. And then I wrote a chapter called Anatomy of Burnout, which really walks the reader through that period that I was just describing. And then it was during this is when Joshua got involved, my co-author. And then it was during this is when Joshua got involved, my co-author. He had been having his own struggles related to a medicine that I wrote from of all things that created horrible side effects, and then the administration has this brilliant idea that they're going to save some money on rent and move our office rather back to the town. I got burned out with no warning and this was going to happen in about three months and one of the VPs told the CEO and the other VP that were describing this to me that are like you probably should tell him this, because he's been talking about maybe going part-time or retiring, because I was trying to be very transparent to the administration, to get work on a succession plan and what have you. So this is presented to me and I was pissed. I was so upset in the meeting I could barely talk. I restrained my emotion not to create a problem, but I went home and told my wife and she started balling and I'm like that's it, that's it, I'm done, I I resigned the next morning and I had been there for almost 13 years at that point.
Dr. Otten:But they crossed the line. They crossed the line and I was being a chess piece and I'm like you know what. I'm in a position to stand up for myself, I'm in a position to stand up for my colleagues, and I didn't know where it was going to go. I didn't really have a plan at that point and so, yeah, I stayed on for about five months and did the best I could to transition my patients and even then I had my quality paper that year withheld because I was an employee the following year. How crazy is that? That's how the contract is written. Isn't that a beautiful thing? Get those dollars any way you can. The reality is it led to finishing the book, and that book has I've described it as a key that's opened doors and, I think, in a lot of good ways. So 2023 is this kind of amazing journey of publishing the book but then really starting to get into networking and advocacy and building towards more activating type thing, and so I think everything happens for a reason, and here we are.
Dr. Shah-Haque:So, going back to the original kind of scenario that you described and then fast forward a couple of years past, that there has been a ripple of change, from losing your shit to getting back to yourself, but maybe a stronger version In the sense that now you have boundaries, now you're willing to stand up for yourself and advocate for your coworkers. That's huge. That is huge. Why do you think it takes physicians so long to really hit that wall and say either I'm done with this or now is the time for me to stand up? Why do we need so much permission or so much havoc?
Dr. Otten:Oh yeah, I think there's probably many layers to that question. I think for some it's the fear, and it could be financial, it could be how it could affect their family, those golden handcuffs, if you will. I think that's part of it for many and they're afraid they can't step away or make that change. For some, I think, it's risk tolerance Not everybody's, like me, who has a very high risk tolerance and is willing to rock the boat at times despite some of the consequences. But I think some of it is at least historically related to our training.
Dr. Otten:I know for me I was taught to be autonomous and put the patient first and suck it up and just keep going. And I can give you a couple examples of just the lunacy of that whole mindset, if you will. I remember when I was a surgical intern I had pneumonia and I was like half sleep, deprived and malnourished and probably borderline depressed, and I was so dehydrated I had a nurse put in an IV as I'm charting and one of the senior residents comes and I was just going to keep working. One of the senior residents comes around and says Todd, what the hell are you doing? And I'm like writing a soap note what am I supposed to be doing 6 am. It's like why do you have an IV in your arm? I'm like because I haven't peed in 12 hours, I think.
Dr. Otten:And then fast forward when I had bouts of cluster headaches in between patients, I would literally have an oxygen mask on my face to try and get some pain relief because nothing worked, and I don't wish those on my worst enemy. But I think that speaks to some of that mindset and that culture and that training that you just keep going and you put the patient first and oftentimes at the expense of your own health, well-being, finances, marriage and unfortunately for some it leads to suicide and yeah. So there's a lot to that. I think a lot that goes into that. But fortunately I think we're starting to see some of that change. Advocating yourself, self-compassion, taking time out, saying no, all those things are so important.
Dr. Shah-Haque:Advocating yourself self-compassion, taking time out saying no. All those things are so important. Now let's dive into what we were discussing at the beginning, this ripple of change. So we've seen it in your life and in how you practice and how you advocate. Now tell us about your book, the Ripple of Change, and your podcast. Yeah, wow.
Dr. Otten:So when I first started with the book the Ripple of Change and your podcast, yeah, wow. So when I first started with the book, it was probably more catharsis for myself and I didn't really know where it was going to go. You never know how all these things are going to evolve, but I enjoyed it and, frankly, it made me feel better. It was a great way to get some of these things off my chest, if you will. At the time I was debating okay, is this a project to bridge the gap between clinicians, or physicians and administrators was where it started when Joshua got involved. It was an amazing evolution of a much, much bigger audience, because you then have that patient voice involved of saying oh my gosh, todd, this is what was going on with you when I had that horrible appointment and it was like your mind was in another place and then we would talk about it and then we'd write about it and it became this back and forth. So the target audience became everybody and instead of trying to bridge that gap between the clinicians and the administration, it became more of a call to action for all of us to do something, anything, write a thank you note to your physician, to really try and turn around the mess that we exist in. And so that was the evolution of who the target audience was to where it is now.
Dr. Otten:Where it is now, and, honestly, joshua and I talk about who came up with the title and neither one of us can actually remember which I think is a kind of amazing little fact, because I was really stuck on the whole concept of the quadruple aim, or quadruple aim, and Josh was like, todd, no one's going to know what you're talking about when you talk about the quadruple aim, and I'm like, yeah, but that's a big part of the book. And but he dug his heels in and he and Megan, his wife, were adamant that we needed to go in another direction. And then one day it hit us and then it was like we were just being guided. At that point it was like almost like we were being guided by a higher power to create this story for everybody to create this story for everybody.
Dr. Shah-Haque:That's awesome. That's awesome Especially since you wrote it with a patient and that's an unusual dynamic.
Dr. Otten:It is, and for sure we had our moments right. We would agree to disagree, but it also led to great conversation, sure, and that trust and that transparency and I consider Joshua a brother now, like I love the guy when I ultimately going back on, like the podcast, as you mentioned, that was his idea to do the podcast, but over time he didn't have the bandwidth. He's got two little kids and he works full time and so that led to my crossroads to where we have a guest co-host and then another guest and we just have these fun, organic conversations about people doing positive things in our system, trying to move the needle, and we just need an overabundance of that I couldn't agree more and what I love that you're doing is you're bridging that gap.
Dr. Shah-Haque:Like you said before, it's about creating relationships and also generating those ideas, like those conversations is where are where ideas get generated or validated, and not that we always have to have external validation. But it's nice to say, okay, I'm not the only one feeling this or thinking this or feeling a call to have this type of action to move the needle in a positive way. And, like you're talking about the networking and there are a lot of positive things that are happening in medicine. I wish it had happened 10, 15, 20 years ago, but I don't think the need was as much then as it is now. Because again, going back to the conversation, we tend to hit a wall and then say, wow, things really need to change, and I just see that amping up a lot. So what is a piece of advice that you would give to Dr Otten, his intern year? That maybe you feel that, with what you know now yourself, back in your intern day, what would you wish you would have known?
Dr. Otten:Oh, so many things.
Dr. Otten:I could probably create a massive list as a result of that.
Dr. Otten:I think some of the things that I would feel more empowered to do now I don't know that I would have been in a place to do back then being more vocal about things that weren't appropriate and that kind of thing In particular, in the military, the culture is even a little bit more different with the hierarchy and that kind of thing.
Dr. Otten:But I do think one of the things that I very much could have benefited from and actually considering doing now, to be honest with you, is getting a coach, somebody to help talk through that, or so. I think coaching is a very valuable asset that is underutilized, and I think the other thing that I really could have benefited from would be counseling just to have somebody to talk through some of the things that I was going through and how I felt, as opposed to internalizing it all. I think those would be two things that would have been very valuable back during that time frame. Those would be two things that would have been very valuable back during that time frame. I don't know that I would have been capable of blowing up silos back then. That might have created more problems for myself, but yeah.
Dr. Shah-Haque:But no, those are two great tools that you have mentioned, particularly when we when statistics have shown that physician coaching, particularly one physician coaching another helps to reduce the signs and symptoms of burnout. I think because of the problem solving aspect, really getting to know your blind sides, and then also, nobody's going to understand a physician better than another physician absolutely, yeah, absolutely.
Dr. Otten:I agree with that, and I think there's some interesting corollaries too to maybe some of the work that you're aware of with medicine forward and the healthcare reinvention collaborative. I talk about those two entities quite a bit and involved with both of them building towards this notion of an impact network or a network of networks, which I think is fascinating, as it's a real opportunity to continue to connect these wonderful entities around the country that are doing amazing things. And I think one of the things that I'm really starting to realize with this is a lot of us have our ideas of how things could be or should be, and oftentimes I'll see what's got to be this way, or this is how we're going to fix it, or what have you, and that's all well and good, but we've got to learn that give and take right. We've got to learn you know what. That is a really good idea.
Dr. Otten:Let's utilize this little piece of what you're doing and maybe marry it up with this group who's doing this thing, and let's get this other group involved, and if we can figure that out how to work together despite maybe some of our subtle differences, then it's going to get very interesting and we're going to hear a lot of noise and it's going to be very hard to ignore If we have not just hundreds or thousands of people mouthing off. If you will, maybe that's something. How do I say that Politely, disagreeing with, maybe, some of the current infrastructure, but if we get millions of people behind a movement like that's going to be very powerful and lead to, hopefully, big systemic changes that desperately need to happen in our country.
Dr. Shah-Haque:Absolutely. This is grassroots and time after time it shows that grassroots movements are very powerful, because you're not only getting to the source or asking the source and but you can also momentum because of that ripple of change, because we're all affected by it. And physicians, by proxy, are problem solvers. Look how many problems we solve as a team or with patients, or in a day, every appointment if you will.
Dr. Shah-Haque:For lack of better terms, it's not a meeting, but let's put it in business terms, that's a meeting we just did several solutions in one meeting, depending on how many acute issues or chronic issues that need to be addressed within reason that a patient brings on top of the questions that we answer when we come out of the room, and then the emails that we have to go through, etc. So we're coming up with solutions all day. So it's not a lack of brain power or the lack of critical thinking. I think we have all those pieces for sure.
Dr. Otten:But I think trust is an important thing too. We're oftentimes, as physicians, we're so used to trying to do everything and problem solve and we have to learn to trust our colleagues and offload some of those things and trust other organizations that are trying to move in the right direction. That's important as well. Joshua talks about it. Joshua Judy, my co-author, talks about reestablishing trust. All the time, In fact, I don't normally do this, but his quote on the back of the book. He says my quest is that ripple of change blazes, a path to rebuild trust in healthcare, firmly placing you in the driver's seat on your own wellness journey, and together we achieve a healthcare system that cares about you and you about it. To me that's profound and obviously I'm biased because I was involved in writing the book. But Joshua, once he got further along into this process, just some brilliant perspective from the patient side of the same coin, Just good stuff.
Dr. Shah-Haque:That is very profound. We need to go back to that relationship where it's again. Even if it's with an entity or an organization, it's a two-way relationship, not just one, especially with today's society and the distrust that has been brought on to the medical community, not really by any means of our own, but by social media and bad representation, so that's big.
Dr. Otten:For sure.
Dr. Otten:I think there are so many areas that we need to work on, and that's part of it.
Dr. Otten:A lot of people get into this learned helplessness where they feel like we've got such a massive level of dysfunction within our healthcare system at large that what can they do? And I think it's part of our job is to encourage and inspire our colleagues that they can do something, and maybe that's self-care. Maybe they need to reach out or to get a coach or counseling so that they can be in a better place to have the capacity to set those boundaries so that they don't get burned out, or to get a coach or counseling so that they can be in a better place to have the capacity to set those boundaries so that they don't get burned out or realize that they don't have to work 80 hours a week. Maybe they'll be fine cutting that in half and can still provide care. So there's lots of ways to put your positive spin on our system, but doesn't have to be being super loud and vocal, as some of us may are. Maybe it's more focused in internally.
Dr. Shah-Haque:Yeah, and that's not for the listener. That's not to say that physicians are the problem. No, we've mentioned that the healthcare system needs to change and that physicians are being more vocal about it, and we're encouraging collaboration on how to fix that. But what we are saying is, hey, or at least what I'm saying is we are in this system whether we like it or not. It needs to change. We're working on the change, but in the meantime, how can you be a physician in that system and make it sustainable?
Dr. Shah-Haque:And two of those possible techniques would be physician life coach or even counseling. And it's not to say that there's a lack of resilience. But going back to physicians type A personalities with our training et cetera we're not very good at all about saying no or drawing boundaries, so it's good to have a coach, just like in baseball or basketball, to help with shooting or to help with batting. It's great to have a coach to help draw boundaries, to help say no, to help understand what your needs are, to get that back into you and to have your decisions thus reflected accordingly. And not only do you have the book and the podcast, but you also have an interesting way of having listeners listen to your book. They're available by chapters.
Dr. Otten:Oh yeah, oh yeah. No, I'm glad you brought that up. It has been an interesting process.
Dr. Otten:Joshua and I realized that there's a good percentage of individuals that prefer audio books, and my wife's one of those. She loves to listen to books. In fact, we joke back and forth. She'll say, oh, I read this book and I'm like did you really read it or did you listen to it? And we have this ongoing banter about it in a good hearted manner.
Dr. Otten:But yeah, so Joshua and I talked about it for quite some time and we were back and forth do we get somebody to read it for us or do it ourselves? And almost to a person, everybody was like we would love to hear the two of you do it. And I'm like, okay, I guess that kind of cements that. Having said that, you got to realize that there's going to be some mistakes with me reading it or whoops, I got to go back and fix things. But I think that's part of the humanity of it.
Dr. Otten:But yeah, so what we did is we decided, instead of doing it en masse, we would read a chapter or two at a time and release those weekly or biweekly depending on the circumstances, and then through a low subscription model on Patreon. It's five bucks a month. You'll get those chapters released. So currently we're through chapter up to chapter. 22 has been completed out of 28.
Dr. Otten:So if somebody was to go on Patreon now and for five bucks you'd get the first three quarters of the book and I would anticipate probably end of May, early June it'll be completed and you'll be able to listen to the whole thing. But the really cool part of it is we've brought in other individuals, so it's not just myself and Joshua, but, like one of my former MAs read her part when I was going through burnout and that was powerful to have somebody external talk about what was happening to me and how heartbreaking it was to her to watch it happen. And my former CEO read his part in the book and he too played a big role in this. And then a friend of mine who's an architect compared our quadruple aim to architecture and just so you get these different voices going. It's been fun project and so far pretty well received.
Dr. Shah-Haque:So yeah, thank you thank you, and yeah, that's the creativity part that I love, because it's not just an automated voice or some voice actor reading a book.
Dr. Otten:You're actually bringing in real people and there's emotion behind what they're reading oh yeah, there's a couple times when I was reading it I it was difficult for me to go back and read it and and some of it was maybe how others were feeling when I was self-destructing or how I was feeling. There's a lot of raw emotions still when I think back on that time of getting burned out and how that affected not just me but other people.
Dr. Shah-Haque:Thank you for that. That shows a lot of vulnerability, a ripple of change, not only in your own life but to those around you and hopefully to those who read or listen to the book, because it is about Mahatma Gandhi. Be the change you want to see in the world. Be the positivity you want to see in the world. We can't save the world, but we can impact it. One person at a time, one action at a time, one word at a time. So if the listener wanted to reach out and connect with you or learn more about your work, where is the best place to find you?
Dr. Otten:For sure. So probably the best place to find me on social media is my LinkedIn post or not post, but my LinkedIn presence is the best way to find me. But our website is ourquadrupleaimcom and that's actually being revamped right now but it has links to all the podcasts, the capacity to buy the book, but the book's on Amazon and Barnes and Noble and these other places. So those are probably the top two. I'm on Instagram and Facebook, but that's probably few and far between. So LinkedIn or ourquadruruple aimcom is the best.
Dr. Shah-Haque:Thank you for that, and those will be in the show notes. And Todd, what's one last pearl of wisdom that you would love to leave our listeners.
Dr. Otten:Don't underestimate the power of one plus one. It can be so incredible in terms of the yield. I am a very optimistic person, but never in a million years would I have thought that I would have written a book with a patient that I believe has impacted thousands of people at this point. So don't underestimate yourself and how you can have synergy with one plus one.
Dr. Shah-Haque:Those are awesome words, so thank you so much for your time and subscribe, share with a friend, because we can all use camaraderie.