Interview with Dr. Simon Maltais
This week's guest explains why you must put yourself first in order to overcome burnout and “Healthcare Disease.” He is a successful academic cardiac surgeon who fell victim to both of those conditions. However, he overcame them and wrote a book to assist others to do the same.
Dr. Simon Maltais recently released “Healthcare Anonymous: Put Yourself First to Avoid Anxiety, Addiction and Burnout.” It addresses the root causes of burnout and other dysfunctional aspects of our health system in which most of us have worked.
Simon is an active cardiac surgeon in one of the world’s largest healthcare services institutions. He is an internationally recognized leader in the field of heart failure and alternative cardiac interventions. He is also a keynote speaker, author of more than 160 articles, and book contributor.
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Healthcare Anonymous: Put Yourself First to Avoid Anxiety, Addiction, and Burnout
Dr. Simon Maltais started writing through journaling. And he held conversations with dozens of experts on the issues leading so many healthcare workers to stress, anxiety, burnout, depression, and addiction. In turn, this system leads to devastating personal and professional consequences for healthcare workers, patients, and society.
This book offers a guide for healthcare workers to understand these challenges and start a process of healing and recovery. It is intended as a way to start a movement to address these challenges. It is available through all of the usual channels. And it can be purchased directly from Dr. Maltais's website here.
Highlights from the Book
- Characteristics and personality traits. Ego, perfectionism, self-discipline, and other traits often found in healthcare workers, and that are nurtured further during training, set us up for healthcare disease.
- The influence of the environment and the system. Long hours, little time to rest and recover, and prolonged self-sacrifice in the name of the patient, keep us from identifying early signs of stress and burnout. and more. There are also unrealistic expectations by the public.
- The way we interact with the system. Healthcare workers cope in ways that further interfere with balance in our lives.
Dr. Simon describes the development of healthcare disease as a process, that develops similarly to other diseases. It involves the agent, the host, and the environment.
Simon's Advice
“For physicians, especially certain types of physicians and especially the heart surgeon, being honest about having a problem, being honest about being at the end of the rope is hard. And taking a pause is even harder because taking a pause from what?…
“But I give tricks and pitfalls there on what I did in terms of removing some of the extra stuff that didn't align with where I was with my values. Basically, what you do there is you start creating time for yourself to think about those things.
“It's creating this extra space and then you have to let things go, and control your schedule.
“Once you get into that recovery, start analyzing every day, because it's like you're diabetic and you work in a chocolate factory, or you're an alcoholic and you work in a liquor store… You've got to find a way to protect yourself.”
Summary
The pain that physicians, nurses, and others in healthcare have been enduring is an epidemic and it is destroying careers and hurting patients. Healthcare workers are leaving their work in droves. Patients are unhappy because the system doesn't work for them either.
Dr. Simon's book starts another conversation intended to open our eyes to the problem, and help push for solutions.
NOTE: Look below for a transcript of today's episode.
Links for Today's Episode:
- HealthcareAnonymous.com
- Breakthrough Points
- Simon Maltais, MD, PhD, LinkedIn Page
- Root Causes of Physician Burnout – Interview with Dr. Dike Drummond – 028
- Burnout and Career Transition – Interview with Dr. Kernan Manion – 007
- NewScr!pt
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Transcription PNC Podcast Episode 243
Why You Must Put Yourself First to Avoid "Healthcare Disease"
- Interview with Dr. Simon Maltais
John: I feel it is my duty to promote books written by physicians, especially when the book itself addresses burnout or some of the dysfunctional aspects of our health system in which most of us either currently or in the past have worked. That's why I'm thrilled to bring on today's guest. He just released the book called "Healthcare Anonymous: Put Yourself First to Avoid Anxiety, Addiction, and Burnout." Hello, Dr. Simon Maltais.
Dr. Simon Maltais: Hi, John. Thank you for having me on the show.
John: This is going to be really great. I love to talk to physicians that have written books, and again, particularly when they are so applicable to my audience, many of whom have gone through burnout or doing different jobs or side gigs or things to avoid it. This is going to be great. Why don't you tell us a little bit about your background, your training, your education, what kind of work you've been doing, and then what actually led you to writing the book?
Dr. Simon Maltais: Yeah. Well, thank you first and foremost for having me on the show. I'm very thankful for the opportunity, and really this has meant to really open a platform for conversation. I'm originally from Montreal, so I'm French Canadian. Sometimes if my accent comes out, it's more of a background thing than anything else.
I did my cardiac surgery turning over there. I did a PhD in biomedical engineering. I did a fellowship in heart failure, heart transplantation, mechanical heart at Mayo Clinic in Minnesota, to then start my career in Nashville in the south of the United States, at Vanderbilt University. I helped build a program there and then went back to be staff at the Mayo Clinic in Rochester for almost four or five years.Focusing my practices again on heart transplantation, mechanical heart, and then less invasive surgery and robotic heart surgery. So, pretty busy clinical practice. A fair amount of research as well. I have an interest for research and education in that field specifically, clinical outcomes mostly.
And over the past two, three years, I have had some personal and some professional challenges myself that were not all of abrupt, but were progressively affecting my practice and my overall life. It really started by journaling. It's interesting because journaling is kind of special with this book called Greenlight, where he basically reports journaling and how journaling has brought him a lot of positivity in his life.
And it's really started by journaling, writing what went wrong, what was positive, what was negative. And then all of a sudden, it started to make a lot of books and writings. And so, I thought, well, maybe I should think about maybe telling my story. And then that opened up to more conversation with people, and led to more stories that people wanted to share. I'm really fortunate to be the person that was able to bring these people together, to express what we're all feeling into a nonfiction book. And so, this is all that came together.
John: Awesome. That's very interesting. And I think you probably experienced some of the things that many, many physicians have experienced, obviously, that's I think what you're writing in the book.
Just to kick things off, I know a couple of terminology or a couple of terms I should say that I notice in the book. Just the title for example says healthcare anonymous and then healthcare disease as sort of the condition. Maybe you can start by defining those. I didn't catch the healthcare anonymously until like the third or fourth time. And I'm like, wait a second. It sounds like something else anonymous.
Dr. Simon Maltais: Well, yeah. Healthcare anonymous, it's a bit of a wing to alcoholic anonymous. It really depicts the structure of the book. I know at a certain point in my life I had to read that book. And the way the book is built, it really gives you the shades of what alcoholism can look like. It's not always when you see someone on the street and lose everything. Most people are just functional. They have jobs and things like that.
And so, the book is really about depicting those shades of burnout or anxiety or telling stories. And that's how this book is built, telling stories about people's life stories that depict some of the variations of what we can go through, through our career or through a career in healthcare. Healthcare disease, it's also sort of a term that, of course, I created. But I was trying to put together everything. The stories, what went on beforehand and when the anxiety or the burnout comes over and the recovery.
And as I was talking about building the book, it came to me pretty easy as a format to say, "Well, it's really like a disease where you have the susceptibility phase, the med school, the personality traits, the influences. Then you get into the preclinical phase where you're exposed to some of these environment changes, the constraints of a healthcare system. Then you get the disease manifestation and that's all burned out anxiety at different stories and then the recovery." That's how we just decided to build the term. To say it's a chronic adaptation problem that people develop within the system, that has both influences from the person that's in it, the environment and the way that people interact with it.
John: Yeah. Excellent. Well, I'm glad you kind of mentioned that. The way that you broke it down, because I want to ask some specific questions about each of those sections, and maybe we can highlight just to get as much as we can. Obviously, there is a lot in the book. I think it's 10 chapters and there's just a lot of background and detail, but I think the highlights will be very useful as we walk through it and give some of the listeners things to think about.
You alluded to what sets us up as healthcare workers that might be susceptible to this healthcare disease. A couple of questions. Can you go into a little more detail and also, does it affect everyone on the healthcare team? Is it the same for the nurses, for the therapists, and so forth? Does it affect doctors worse? What would you think?
Dr. Simon Maltais: Yeah, I think from that second part of the question, it's meant to be really a healthcare book. And so, while there's some doctors in the book, there's stories about different specialties, there's a technician, there are nurses talking in the book. And so, it's really expanding to healthcare workers.
The principles are the same, whether you're a doctor. Of course, there's references to medical training and what that entails and things like that. But altogether, I think a lot of the constraints that the nurses or others evolving in the healthcare systems go through are applicable to all the systems.
We really got to describe the disease manifestation as a process. That fits within a triangle. The example I give is any disease, you have to have a certain host. The person that contracts the disease. You have to have an environment. For example, E. coli, you have to have a warm environment, anything like that. And you have the agent, the bacteria.
I go through the same stuff within the book. I describe for example, what are the characteristics, what are the traits of personality that people in healthcare have in common. As a host that could put people at risk of developing the disease. And when I say disease, it is to make people realize that when it comes to the burnout or the anxiety or the addiction, that's the end result of suction, that's when the disease becomes apparent. We go into detail into ego, perfectionism, the positive and the negative stuff, the self-discipline, and the internal traits or characteristics that people have to develop or that are forced on them during medical training without necessarily the emotional maturity of being able to process them. That's the first part of the book.
Then we go and talk about the environment and we really expand that to changes in the system. Just what it looks like to work in healthcare. The long hours, having difficulties eating good food, the self-sacrifice in the name of the patient, and expanding that to the environment as a whole. The perception of healthcare from the public and how it affects us. What is represented in healthcare in those TV shows, how should it look? How does that influence people in training, people in practice? Because oftentimes you see these burnout doctors, you see people that just take on too much that have broken relationships that make out in the room, and are angry at work. And so, that's the influence that we're looking at.
Then I get into the agent and that's a bit of more of a concept, but it's the way you start interacting with the system. It's the mechanism that you develop to balance your life, to act a certain way in the system. Then the disease happens when all these three things become maladaptive together or become this regulated. That's how the book is sort of constructed around.
John: Okay. Yeah, that makes perfect sense. We'll get into, I guess the last section, which is about what we can do about it. Let me see if I have any other questions about the rest of it though. Do you think there are things that can be done even as early as med school, or even before med school to maybe pick those that aren't as susceptible to this healthcare disease?
Dr. Simon Maltais: Sorry to interrupt, but I think there's a lot of things that could be done in med school. And I remember med school or any sort of time where you get accepted into these healthcare trainings. A lot of it comes from identifying big problems, people with major issues functioning in groups. They don't really know how to select people, necessarily. Although they're getting better, some of the schools rely only on grades which is oftentimes a bad reflection of how good of a doctor you could be. I think a lot of my friends that are much more balanced emotionally stable could be better fit for medicine and for this patient sort of empathy you need to have.
That question, it could be better. I think it could be better about analyzing what are the specific characteristics or traits of character that people have that could make them a better provider or not. From that standpoint, I go over some of them. Perhaps for me, competition, perfectionism was really strong. And so, there's absolutely nothing else I would've done than heart surgery because it was cool, because it was an ego sort of boosting.
Now, thinking back now through recovery and still maintaining recovery, I realize that I'm good at different things. I pay attention to some other areas of medicine, maybe that I could have been a better use of my knowledge. And so, I think early on perhaps, helping people being influenced by people that are similar, have similar characteristics. Helping with mentors that are associated with what you want to do and identifying some of these things to sort of tone down some of these characteristics of people throughout training.
John: I think that's a great insight and I look forward to reading more about it in the book. If you ask most physicians, what they'll tell you is when they've gotten to a point where they've recognized it or in the middle of it, or have even overcome it, they will say, it's not because I'm not resilient enough, it's not because there's something wrong with me. It's because the system is completely out of whack. It's dysfunctional, expects things that it shouldn't expect, and there's no way to break out of it other than just quit. You go to get help and there's not a lot of people listening. Number one, is that true? Number two, has that changed? And have you ever seen an organization that's been really good at recognizing and addressing it?
Dr. Simon Maltais: Yeah, I think to that point, I'd say, I partially disagree. I think we have to own a part of the responsibility. Because it's always easy to say, yes, it's always easy to do more. It's always easy to put your family second. It's always easier to talk about medicine all the time, be at work and have this piece of the pie that is 90% work and 10% other stuff.
So that's on us in some ways. But it's also the way we were brought up. To put the patient first, to always do the work. I'd say I agree partially because the system is what it is. You can change it. You can swear about it. You can try to change things, but the system will change just because it's just powerful. It's this sort of machine that has to evolve over time to adapt to patients, to the economy, and things. It's the way you start interacting with it that I think is clear.
To your point, I think sometimes the only solution can be to leave it behind. I tend to be a bit more half full. I mean, for some people that will be it. And in the book, we have stories of people that have done it. We have stories of people, unfortunately, that are too late. By the time they realized they needed to do something. We have one very particular story where the wife is speaking about her husband that's now passed, from just being sick and depressed in healthcare.
But I think the better avenue is to really take a pause and maybe assess how you really interact with the system. And that's easier said than done because even yesterday I was having frustrating conversations and frustrating things at work. And I have to really reset myself because it's easy to get caught up in the vortex, I call it in the book.
But yeah, I think it does require an adjustment, how you interact with it, how you put your limits, how you scan yourself every day to see if you've done too much, not enough. That is active work. It's like realizing you're sick that you have a chronic disease to deal with, because if you get burned out, it's a chronic problem that finally manifests itself.
But then going back to the exact same place. Sometimes it's got to change. And hospitals are pretty good about pointing out when it's not well. When you come to work, you're drunk, where you sort of make mistakes, when you're angry, they point at you. And they're pretty good about that. The prevention of it, not so much.
Then the treatment of it, not so much. They'll send you the charm school. They'll check a HR box and they'll bring you right back. That part, I'm not entirely sure. And I do see some changes. Especially with COVID I think people realize that's a significant issue. And by the way, whether I do surgery through a hole like this, or a big hole like that, whether I do it with or without the pump, I don't think that's what's going to be the end of my specialty. It's how we treat ourselves and how we manage stress moving forward after all this stress over the last two years.
John: Interesting. Well, I will say to your point about maybe we need to really make better decisions about certain things. People that I talk to, physicians, who are trying to make a change, a lot of times they haven't even approached their boss, their partners with the problem, like, "Well, they're not going to care. They're not going to do anything." And in reality, when you do that and have a conversation, that's a real conversation, half the time, they'll say, "Okay, you want to cut your hours back? Okay. You want to do a job share?" There's not a lot of that, but most of us don't even think to ask about it. We just keep plugging along until it's too late.
Dr. Simon Maltais: It's too late. I think if there's some specialties that have been sort of, and I talk about historically built into that kind of mentality, where if you say "no" it's not good. Do the right thing. We used to say that. You're tired, you can't drive home because you haven't slept for 24 hours. That extra phone call, the word was DTRT - Do the Right Thing. That's how we were trained. And so, you just keep piling it on. And as I said, at some point, it's just too much.
John: Now at the end of the book, again, not having read it, which I should have gotten that Kindle version and read it before our interview here, but I've got the hard copy on order. But you come up with some suggestions, some job observations, some advice for the readers. And I didn't know if you could maybe just pick a few of those and give us some things to think about in terms of what we might do differently.
Dr. Simon Maltais: It wasn't easy to break it down because I try to build on my own experience, but I try to discern also what was common among the 20 plus stories I've had in the book. These stories are categorized into different clinical manifestations of the disease, whether it's physical, psychological, behavioral, and others, divorce and all that stuff. Which I think also is a sign of not taking care of your family and for many reasons it could lead to that. When I talk about recovery, I start from that, and then try to discern five steps that at least have helped me throughout the process. And it's not rocket science, but the first step is really to be honest and take a pause.
For physicians, especially certain types of physicians and especially the heart surgeon, being honest about having a problem, being honest about being at the end of the rope is hard. And taking a pause is even harder, because taking a pause from what? Just leave it. But I give tricks and pitfalls there on what I did in terms of removing some of the extra stuff that didn't align with where I was with my values. Basically, what you do there is you start creating time for yourself to think about those things. I'm reading this book. It talks about this space as a unicorn space. I think about it the same way. It's a bit different from what she talks about in the book, but it's creating this extra space and then you have to let things go, control your schedule. And I give tricks about that.
I think that's applicable for a lot of things in medicine. It's realizing that you are not God. And that doesn't really relate necessarily to the individual thinking he's better than everybody else. It's realizing that you are part of a process, that you are trained a certain way. Whether you're a nurse, you're a doctor, you can't control the outcome. You're just another bozo on the bus. So, you're not driving the bus, you're not following the bus. You're just another guy on the bus or a woman on the bus.
I think that when you start realizing that everybody has a role to play, first, it gives you a perspective. And it allows you to forgive yourself and to say, well, if I've done everything right, and the outcome is not good. I don't have to be angry. That's what we do. And sometimes there's an external force that's just stronger, it can take patients away or have them have complications.
I don't want to go through all of them, but I think the third most important one, I call virus scanning yourself. And it's to find time for yourself during the day, during the morning to do things that will allow you to reset time within a busy environment. And I think that's important for anything. Whether you're an athlete, whether you're a CEO, a lot of the coaching tips and pitfalls are to find a time to say, "Am I stressed today? Well, how do I feel? Where do I feel it? Is it in the back of my neck? How can I change things to feel differently?"
I think it's important steps. Once you get into that recovery, start analyzing every day, because it's like you're diabetic and you work in the chocolate factory or you're alcoholic and you work in the liquor store and you have a disease. You interact not so well with an environment and you put yourself right back into it. So, you got to find a way to sort of protect yourself. That's another big step I think that we try to identify or we try to give people insight into.
John: Yeah. And there's a whole lot more as you allude to, but I want to spend the last few minutes actually talking about the book and how to get the book and what's going on with the book. Why don't we just hit that? For the listeners, when this is being recorded, it has not been released yet, but it will have been released by the time I publish this. And I think the release date is April 5th, so it's a few days ago in the future. Where's the best place you can find the book, number one?
Dr. Simon Maltais: Well, you'll be able to find the book at most of the major stuff. It'll be distributed in all the Barnes & Nobles and the regular venues. You can have it on Amazon, Books-A-Million, and all the online things. You also can go to healthcareanonymous.com, which is a website we've created to have easy access to ordering the book. You can have order bundles, which comes with a certain work around it, where we can go to your workplace to do what's called the SWOT analysis of your workplace to try to help your team and people be better in the environment. Sometimes it's little things. It doesn't take much to make people happier and decrease turnover and certainly, it's valuable to do that.
But more importantly, I want to mention, for those of you that I think want to pass a message or start a company, I was just listening to the TED talk from Simon Sinek who wrote the book, "Start with Why." I always come back to, "Why am I doing this?" And it's not to sell books. It's not to formalize a therapy for Simon. It's to really start a movement because I do think that that's going to be the challenge for the next 10 to 20 years for healthcare, to manage the people within the system, to take care of their workers that can then overly take care of to foster.
There's not a week now, for those of you that are in the system that will resonate. There is not a week now that I hear another partner, yet another person that either leaves medicine or healthcare in general. A nurse that transfers to something for better hours, or leaves medicine altogether. A surgeon that has left another hospital for "issues."
That is the real threat I think to healthcare. There were thousands of nurses missing to take care of patients. They're out there. They just are going through something real. The real "why" on this is to raise the movement and try to have people understand that that's a real threat. We provide even more help through a site called breakthroughpoints.com where I've aligned myself with other doctors from around the country and professional athletes to raise even a bigger, because I think a lot of the themes are common, whether you're in healthcare, you're an athlete, you're a CEO, a lot of the themes are common and we're proposing a system there to help people get through this and have a better life.
John: Excellent. Yeah, that is great. I recommend people go to healthcareanonymous.com. It's a cool site and there's some testimonials and you explain a little bit about again, why you wrote the book and all that. Plus, it has the opportunity to buy boxes of copies of the book. Maybe if you're part of a team, you want to share it with other people. That would be a good starting point. I appreciate that. And I'll put the links to that and to breakthroughpoints.com in the show notes. Maybe we'll reach out to you again in a year or so and see if things are getting any better.
Dr. Simon Maltais: Yeah, this is the hope. I've gotten really good feedback and I've got a lot of opportunities now to speak and meet people and that's been great. Just spread a message of hope. One of the guys tends to summarize it pretty well. He says, we were called heroes. And now that the system has to recover from all this, there's only one word difference between "hero" and "zero". Unfortunately, that's what we're seeing. We're seeing people closing, getting fired, because they have to recuperate money somewhere from all those two years of COVID. So, it has a significant impact on everybody. I hope that your listeners will not only just get the book, but spread the message.
John: Your point is well taken. I don't think that the people in charge, whoever that is, realize the pain that physicians, nurses, others in healthcare have been enduring and the fact that they are leaving in droves and they're not being replaced effectively. And patients are already unhappy. Every patient I used to see was unhappy because I was rushed. I couldn't spend time with them. The system didn't work for them. Accidents happen, mistakes are made. Man, hopefully, something like this will be recognized and followed like you said, to fix it.
Dr. Simon Maltais: I was just reading this Harvard business review. The companies have adapted better, the tech companies. When you come in, you propose hybrid work and that kind of stuff. It's better received than our culture where there's more history where you have to wear the white coat, you had to be there in your office all day waiting. Actually, I've proposed now. I'm very fortunate. During COVID I've been proposing that model to a hospital. And actually, my three partners have the same. We're here, we work hard. We have this hybrid ability to take time off. And I think a lot of systems would benefit to have rested people and allow some of that flexibility.
John: And I think some of those big, massive companies are actually creating their own health systems like within their borders in a way, the Googles and that. Maybe that'll be an option down the road. All right. Well, Simon, I will let you get back to work. I thank you very much for talking about your book today and we'll keep an eye out to see how things progress over the coming years with this problem, not just with the sale of the book, obviously with this problem.
Dr. Simon Maltais: Well, thank you again for the invite, John. I'm very fortunate and I thank you for the invitation.
John: All right. You take care. Bye-bye.
Dr. Simon Maltais: Thank you.
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Transcription PNC Podcast Episode 243
Why You Must Put Yourself First to Avoid "Healthcare Disease"
- Interview with Dr. Simon Maltais
John: I feel it is my duty to promote books written by physicians, especially when the book itself addresses burnout or some of the dysfunctional aspects of our health system in which most of us either currently or in the past have worked. That's why I'm thrilled to bring on today's guest. He just released the book called "Healthcare Anonymous: Put Yourself First to Avoid Anxiety, Addiction, and Burnout." Hello, Dr. Simon Maltais.
Dr. Simon Maltais: Hi, John. Thank you for having me on the show.
John: This is going to be really great. I love to talk to physicians that have written books, and again, particularly when they are so applicable to my audience, many of whom have gone through burnout or doing different jobs or side gigs or things to avoid it. This is going to be great. Why don't you tell us a little bit about your background, your training, your education, what kind of work you've been doing, and then what actually led you to writing the book?
Dr. Simon Maltais: Yeah. Well, thank you first and foremost for having me on the show. I'm very thankful for the opportunity, and really this has meant to really open a platform for conversation. I'm originally from Montreal, so I'm French Canadian. Sometimes if my accent comes out, it's more of a background thing than anything else.
I did my cardiac surgery turning over there. I did a PhD in biomedical engineering. I did a fellowship in heart failure, heart transplantation, mechanical heart at Mayo Clinic in Minnesota, to then start my career in Nashville in the south of the United States, at Vanderbilt University. I helped build a program there and then went back to be staff at the Mayo Clinic in Rochester for almost four or five years.Focusing my practices again on heart transplantation, mechanical heart, and then less invasive surgery and robotic heart surgery. So, pretty busy clinical practice. A fair amount of research as well. I have an interest for research and education in that field specifically, clinical outcomes mostly.
And over the past two, three years, I have had some personal and some professional challenges myself that were not all of abrupt, but were progressively affecting my practice and my overall life. It really started by journaling. It's interesting because journaling is kind of special with this book called Greenlight, where he basically reports journaling and how journaling has brought him a lot of positivity in his life.
And it's really started by journaling, writing what went wrong, what was positive, what was negative. And then all of a sudden, it started to make a lot of books and writings. And so, I thought, well, maybe I should think about maybe telling my story. And then that opened up to more conversation with people, and led to more stories that people wanted to share. I'm really fortunate to be the person that was able to bring these people together, to express what we're all feeling into a nonfiction book. And so, this is all that came together.
John: Awesome. That's very interesting. And I think you probably experienced some of the things that many, many physicians have experienced, obviously, that's I think what you're writing in the book.
Just to kick things off, I know a couple of terminology or a couple of terms I should say that I notice in the book. Just the title for example says healthcare anonymous and then healthcare disease as sort of the condition. Maybe you can start by defining those. I didn't catch the healthcare anonymously until like the third or fourth time. And I'm like, wait a second. It sounds like something else anonymous.
Dr. Simon Maltais: Well, yeah. Healthcare anonymous, it's a bit of a wing to alcoholic anonymous. It really depicts the structure of the book. I know at a certain point in my life I had to read that book. And the way the book is built, it really gives you the shades of what alcoholism can look like. It's not always when you see someone on the street and lose everything. Most people are just functional. They have jobs and things like that.
And so, the book is really about depicting those shades of burnout or anxiety or telling stories. And that's how this book is built, telling stories about people's life stories that depict some of the variations of what we can go through, through our career or through a career in healthcare. Healthcare disease, it's also sort of a term that, of course, I created. But I was trying to put together everything. The stories, what went on beforehand and when the anxiety or the burnout comes over and the recovery.
And as I was talking about building the book, it came to me pretty easy as a format to say, "Well, it's really like a disease where you have the susceptibility phase, the med school, the personality traits, the influences. Then you get into the preclinical phase where you're exposed to some of these environment changes, the constraints of a healthcare system. Then you get the disease manifestation and that's all burned out anxiety at different stories and then the recovery." That's how we just decided to build the term. To say it's a chronic adaptation problem that people develop within the system, that has both influences from the person that's in it, the environment and the way that people interact with it.
John: Yeah. Excellent. Well, I'm glad you kind of mentioned that. The way that you broke it down, because I want to ask some specific questions about each of those sections, and maybe we can highlight just to get as much as we can. Obviously, there is a lot in the book. I think it's 10 chapters and there's just a lot of background and detail, but I think the highlights will be very useful as we walk through it and give some of the listeners things to think about.
You alluded to what sets us up as healthcare workers that might be susceptible to this healthcare disease. A couple of questions. Can you go into a little more detail and also, does it affect everyone on the healthcare team? Is it the same for the nurses, for the therapists, and so forth? Does it affect doctors worse? What would you think?
Dr. Simon Maltais: Yeah, I think from that second part of the question, it's meant to be really a healthcare book. And so, while there's some doctors in the book, there's stories about different specialties, there's a technician, there are nurses talking in the book. And so, it's really expanding to healthcare workers.
The principles are the same, whether you're a doctor. Of course, there's references to medical training and what that entails and things like that. But altogether, I think a lot of the constraints that the nurses or others evolving in the healthcare systems go through are applicable to all the systems.
We really got to describe the disease manifestation as a process. That fits within a triangle. The example I give is any disease, you have to have a certain host. The person that contracts the disease. You have to have an environment. For example, E. coli, you have to have a warm environment, anything like that. And you have the agent, the bacteria.
I go through the same stuff within the book. I describe for example, what are the characteristics, what are the traits of personality that people in healthcare have in common. As a host that could put people at risk of developing the disease. And when I say disease, it is to make people realize that when it comes to the burnout or the anxiety or the addiction, that's the end result of suction, that's when the disease becomes apparent. We go into detail into ego, perfectionism, the positive and the negative stuff, the self-discipline, and the internal traits or characteristics that people have to develop or that are forced on them during medical training without necessarily the emotional maturity of being able to process them. That's the first part of the book.
Then we go and talk about the environment and we really expand that to changes in the system. Just what it looks like to work in healthcare. The long hours, having difficulties eating good food, the self-sacrifice in the name of the patient, and expanding that to the environment as a whole. The perception of healthcare from the public and how it affects us. What is represented in healthcare in those TV shows, how should it look? How does that influence people in training, people in practice? Because oftentimes you see these burnout doctors, you see people that just take on too much that have broken relationships that make out in the room, and are angry at work. And so, that's the influence that we're looking at.
Then I get into the agent and that's a bit of more of a concept, but it's the way you start interacting with the system. It's the mechanism that you develop to balance your life, to act a certain way in the system. Then the disease happens when all these three things become maladaptive together or become this regulated. That's how the book is sort of constructed around.
John: Okay. Yeah, that makes perfect sense. We'll get into, I guess the last section, which is about what we can do about it. Let me see if I have any other questions about the rest of it though. Do you think there are things that can be done even as early as med school, or even before med school to maybe pick those that aren't as susceptible to this healthcare disease?
Dr. Simon Maltais: Sorry to interrupt, but I think there's a lot of things that could be done in med school. And I remember med school or any sort of time where you get accepted into these healthcare trainings. A lot of it comes from identifying big problems, people with major issues functioning in groups. They don't really know how to select people, necessarily. Although they're getting better, some of the schools rely only on grades which is oftentimes a bad reflection of how good of a doctor you could be. I think a lot of my friends that are much more balanced emotionally stable could be better fit for medicine and for this patient sort of empathy you need to have.
That question, it could be better. I think it could be better about analyzing what are the specific characteristics or traits of character that people have that could make them a better provider or not. From that standpoint, I go over some of them. Perhaps for me, competition, perfectionism was really strong. And so, there's absolutely nothing else I would've done than heart surgery because it was cool, because it was an ego sort of boosting.
Now, thinking back now through recovery and still maintaining recovery, I realize that I'm good at different things. I pay attention to some other areas of medicine, maybe that I could have been a better use of my knowledge. And so, I think early on perhaps, helping people being influenced by people that are similar, have similar characteristics. Helping with mentors that are associated with what you want to do and identifying some of these things to sort of tone down some of these characteristics of people throughout training.
John: I think that's a great insight and I look forward to reading more about it in the book. If you ask most physicians, what they'll tell you is when they've gotten to a point where they've recognized it or in the middle of it, or have even overcome it, they will say, it's not because I'm not resilient enough, it's not because there's something wrong with me. It's because the system is completely out of whack. It's dysfunctional, expects things that it shouldn't expect, and there's no way to break out of it other than just quit. You go to get help and there's not a lot of people listening. Number one, is that true? Number two, has that changed? And have you ever seen an organization that's been really good at recognizing and addressing it?
Dr. Simon Maltais: Yeah, I think to that point, I'd say, I partially disagree. I think we have to own a part of the responsibility. Because it's always easy to say, yes, it's always easy to do more. It's always easy to put your family second. It's always easier to talk about medicine all the time, be at work and have this piece of the pie that is 90% work and 10% other stuff.
So that's on us in some ways. But it's also the way we were brought up. To put the patient first, to always do the work. I'd say I agree partially because the system is what it is. You can change it. You can swear about it. You can try to change things, but the system will change just because it's just powerful. It's this sort of machine that has to evolve over time to adapt to patients, to the economy, and things. It's the way you start interacting with it that I think is clear.
To your point, I think sometimes the only solution can be to leave it behind. I tend to be a bit more half full. I mean, for some people that will be it. And in the book, we have stories of people that have done it. We have stories of people, unfortunately, that are too late. By the time they realized they needed to do something. We have one very particular story where the wife is speaking about her husband that's now passed, from just being sick and depressed in healthcare.
But I think the better avenue is to really take a pause and maybe assess how you really interact with the system. And that's easier said than done because even yesterday I was having frustrating conversations and frustrating things at work. And I have to really reset myself because it's easy to get caught up in the vortex, I call it in the book.
But yeah, I think it does require an adjustment, how you interact with it, how you put your limits, how you scan yourself every day to see if you've done too much, not enough. That is active work. It's like realizing you're sick that you have a chronic disease to deal with, because if you get burned out, it's a chronic problem that finally manifests itself.
But then going back to the exact same place. Sometimes it's got to change. And hospitals are pretty good about pointing out when it's not well. When you come to work, you're drunk, where you sort of make mistakes, when you're angry, they point at you. And they're pretty good about that. The prevention of it, not so much.
Then the treatment of it, not so much. They'll send you the charm school. They'll check a HR box and they'll bring you right back. That part, I'm not entirely sure. And I do see some changes. Especially with COVID I think people realize that's a significant issue. And by the way, whether I do surgery through a hole like this, or a big hole like that, whether I do it with or without the pump, I don't think that's what's going to be the end of my specialty. It's how we treat ourselves and how we manage stress moving forward after all this stress over the last two years.
John: Interesting. Well, I will say to your point about maybe we need to really make better decisions about certain things. People that I talk to, physicians, who are trying to make a change, a lot of times they haven't even approached their boss, their partners with the problem, like, "Well, they're not going to care. They're not going to do anything." And in reality, when you do that and have a conversation, that's a real conversation, half the time, they'll say, "Okay, you want to cut your hours back? Okay. You want to do a job share?" There's not a lot of that, but most of us don't even think to ask about it. We just keep plugging along until it's too late.
Dr. Simon Maltais: It's too late. I think if there's some specialties that have been sort of, and I talk about historically built into that kind of mentality, where if you say "no" it's not good. Do the right thing. We used to say that. You're tired, you can't drive home because you haven't slept for 24 hours. That extra phone call, the word was DTRT - Do the Right Thing. That's how we were trained. And so, you just keep piling it on. And as I said, at some point, it's just too much.
John: Now at the end of the book, again, not having read it, which I should have gotten that Kindle version and read it before our interview here, but I've got the hard copy on order. But you come up with some suggestions, some job observations, some advice for the readers. And I didn't know if you could maybe just pick a few of those and give us some things to think about in terms of what we might do differently.
Dr. Simon Maltais: It wasn't easy to break it down because I try to build on my own experience, but I try to discern also what was common among the 20 plus stories I've had in the book. These stories are categorized into different clinical manifestations of the disease, whether it's physical, psychological, behavioral, and others, divorce and all that stuff. Which I think also is a sign of not taking care of your family and for many reasons it could lead to that. When I talk about recovery, I start from that, and then try to discern five steps that at least have helped me throughout the process. And it's not rocket science, but the first step is really to be honest and take a pause.
For physicians, especially certain types of physicians and especially the heart surgeon, being honest about having a problem, being honest about being at the end of the rope is hard. And taking a pause is even harder, because taking a pause from what? Just leave it. But I give tricks and pitfalls there on what I did in terms of removing some of the extra stuff that didn't align with where I was with my values. Basically, what you do there is you start creating time for yourself to think about those things. I'm reading this book. It talks about this space as a unicorn space. I think about it the same way. It's a bit different from what she talks about in the book, but it's creating this extra space and then you have to let things go, control your schedule. And I give tricks about that.
I think that's applicable for a lot of things in medicine. It's realizing that you are not God. And that doesn't really relate necessarily to the individual thinking he's better than everybody else. It's realizing that you are part of a process, that you are trained a certain way. Whether you're a nurse, you're a doctor, you can't control the outcome. You're just another bozo on the bus. So, you're not driving the bus, you're not following the bus. You're just another guy on the bus or a woman on the bus.
I think that when you start realizing that everybody has a role to play, first, it gives you a perspective. And it allows you to forgive yourself and to say, well, if I've done everything right, and the outcome is not good. I don't have to be angry. That's what we do. And sometimes there's an external force that's just stronger, it can take patients away or have them have complications.
I don't want to go through all of them, but I think the third most important one, I call virus scanning yourself. And it's to find time for yourself during the day, during the morning to do things that will allow you to reset time within a busy environment. And I think that's important for anything. Whether you're an athlete, whether you're a CEO, a lot of the coaching tips and pitfalls are to find a time to say, "Am I stressed today? Well, how do I feel? Where do I feel it? Is it in the back of my neck? How can I change things to feel differently?"
I think it's important steps. Once you get into that recovery, start analyzing every day, because it's like you're diabetic and you work in the chocolate factory or you're alcoholic and you work in the liquor store and you have a disease. You interact not so well with an environment and you put yourself right back into it. So, you got to find a way to sort of protect yourself. That's another big step I think that we try to identify or we try to give people insight into.
John: Yeah. And there's a whole lot more as you allude to, but I want to spend the last few minutes actually talking about the book and how to get the book and what's going on with the book. Why don't we just hit that? For the listeners, when this is being recorded, it has not been released yet, but it will have been released by the time I publish this. And I think the release date is April 5th, so it's a few days ago in the future. Where's the best place you can find the book, number one?
Dr. Simon Maltais: Well, you'll be able to find the book at most of the major stuff. It'll be distributed in all the Barnes & Nobles and the regular venues. You can have it on Amazon, Books-A-Million, and all the online things. You also can go to healthcareanonymous.com, which is a website we've created to have easy access to ordering the book. You can have order bundles, which comes with a certain work around it, where we can go to your workplace to do what's called the SWOT analysis of your workplace to try to help your team and people be better in the environment. Sometimes it's little things. It doesn't take much to make people happier and decrease turnover and certainly, it's valuable to do that.
But more importantly, I want to mention, for those of you that I think want to pass a message or start a company, I was just listening to the TED talk from Simon Sinek who wrote the book, "Start with Why." I always come back to, "Why am I doing this?" And it's not to sell books. It's not to formalize a therapy for Simon. It's to really start a movement because I do think that that's going to be the challenge for the next 10 to 20 years for healthcare, to manage the people within the system, to take care of their workers that can then overly take care of to foster.
There's not a week now, for those of you that are in the system that will resonate. There is not a week now that I hear another partner, yet another person that either leaves medicine or healthcare in general. A nurse that transfers to something for better hours, or leaves medicine altogether. A surgeon that has left another hospital for "issues."
That is the real threat I think to healthcare. There were thousands of nurses missing to take care of patients. They're out there. They just are going through something real. The real "why" on this is to raise the movement and try to have people understand that that's a real threat. We provide even more help through a site called breakthroughpoints.com where I've aligned myself with other doctors from around the country and professional athletes to raise even a bigger, because I think a lot of the themes are common, whether you're in healthcare, you're an athlete, you're a CEO, a lot of the themes are common and we're proposing a system there to help people get through this and have a better life.
John: Excellent. Yeah, that is great. I recommend people go to healthcareanonymous.com. It's a cool site and there's some testimonials and you explain a little bit about again, why you wrote the book and all that. Plus, it has the opportunity to buy boxes of copies of the book. Maybe if you're part of a team, you want to share it with other people. That would be a good starting point. I appreciate that. And I'll put the links to that and to breakthroughpoints.com in the show notes. Maybe we'll reach out to you again in a year or so and see if things are getting any better.
Dr. Simon Maltais: Yeah, this is the hope. I've gotten really good feedback and I've got a lot of opportunities now to speak and meet people and that's been great. Just spread a message of hope. One of the guys tends to summarize it pretty well. He says, we were called heroes. And now that the system has to recover from all this, there's only one word difference between "hero" and "zero". Unfortunately, that's what we're seeing. We're seeing people closing, getting fired, because they have to recuperate money somewhere from all those two years of COVID. So, it has a significant impact on everybody. I hope that your listeners will not only just get the book, but spread the message.
John: Your point is well taken. I don't think that the people in charge, whoever that is, realize the pain that physicians, nurses, others in healthcare have been enduring and the fact that they are leaving in droves and they're not being replaced effectively. And patients are already unhappy. Every patient I used to see was unhappy because I was rushed. I couldn't spend time with them. The system didn't work for them. Accidents happen, mistakes are made. Man, hopefully, something like this will be recognized and followed like you said, to fix it.
Dr. Simon Maltais: I was just reading this Harvard business review. The companies have adapted better, the tech companies. When you come in, you propose hybrid work and that kind of stuff. It's better received than our culture where there's more history where you have to wear the white coat, you had to be there in your office all day waiting. Actually, I've proposed now. I'm very fortunate. During COVID I've been proposing that model to a hospital. And actually, my three partners have the same. We're here, we work hard. We have this hybrid ability to take time off. And I think a lot of systems would benefit to have rested people and allow some of that flexibility.
John: And I think some of those big, massive companies are actually creating their own health systems like within their borders in a way, the Googles and that. Maybe that'll be an option down the road. All right. Well, Simon, I will let you get back to work. I thank you very much for talking about your book today and we'll keep an eye out to see how things progress over the coming years with this problem, not just with the sale of the book, obviously with this problem.
Dr. Simon Maltais: Well, thank you again for the invite, John. I'm very fortunate and I thank you for the invitation.
John: All right. You take care. Bye-bye.
Dr. Simon Maltais: Thank you.
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