In today's podcast, Dr. Shelly Bhowmik describes how her training in preventive medicine and lifestyle medicine enhances patient care.

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Preventive Medicine and Lifestyle Medicine

Dr. Bhowmik explains that stress is the foundation of burnout. However, she also views depression and suicidal thoughts as part of this process. It's crucial to identify these signs and symptoms quickly so appropriate action can be taken.

And she believes that her training in preventive medicine and lifestyle medicine together enable her to approach the problem more effectively.

On her site, she offers both private and group coaching. She developed a three-step framework for her platform that she calls ReST: Revive, Strive, and Thrive. And this framework supports managing stress, overcoming burnout, and regaining resilience and vitality.

A free masterclass offered by Dr. Bhwomik delves deeply into the entire framework. Here are the nine steps:

1. Detect distress
2. Secure space
3. Seek support
4. Restore routine
5. Tackle triggers
6. Master mindset
7. Ease efforts
8. Hone habits
9. Cultivate connections

Corporate Workplace Solutions

Organizational burnout management requires a more methodical, systems-level approach, combined with individualized coaching.

Dr. Bhowmik identifies organizational culture as the key factor at play Being able to work with businesses and assist them in developing psychologically safe settings is important because it will make employees feel more at ease seeking assistance when they do. 

Dr. Bhowmik's Advice on Burnout

…mindset is medicine. The beliefs that we have, what we tell ourselves, it is so powerful. And if we have dysfunctional thoughts, dysfunctional beliefs that are fueling the burnout, that's where a lot of this work is. You have to be able to identify what those limiting beliefs are and then be able to replace them with more empowering ones that can help you and lift you out of the burnout.

Summary

You can access a free Masterclass that teaches the 9-step coaching method to help you detect distress, restore routine, ease efforts, and more by going to www.shellybhowmik.com/masterclass

NOTE: Look below for a transcript of today's episode.

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Links for Today's Episode:

• Dr. Shelly Bhowmik's Website
• Dr. Shelly Bhowmik's Free Masterclass
• Can Lifestyle Medicine Help Me and My Patients? – 185
• NewScr!pt

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Today's PNC Podcast Transcript

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Transcription PNC Podcast Episode 257

Why Preventive Medicine and Lifestyle Medicine Make for a Great Career

John: I'm really interested in learning about the specialty of and the training for preventive medicine and public health. And I'll explain why later. That's why I'm so excited to be able to speak today with today's guest. Welcome and hello, Dr. Shelly Bhowmik.

Dr. Shelly Bhowmik: Hello, thank you for having me today.

John: This is going to be fun and I will put a plug in for Sylvie Stacy. She actually is the one that introduced us and the listeners know her very well if they listened to previous episodes, because she's been on a couple of times. She's got a background in preventive medicine, and now I have you, but you have some other interesting additions to the preventive medicine. I guess with that, why don't we just get into telling us about your education and training and kind of the start of your career?

Dr. Shelly Bhowmik: Yeah. Yeah. And by the way, Sylvie is amazing. I'm fortunate that we were in the same residency program together. But yeah, I'll start with my college education, because I think that's where a lot of my inspiration came from. I went to Johns Hopkins and I actually majored in public health as an undergrad.

At the time I think Hopkins was the only institution that allowed for undergraduates to major in public health. I felt fortunate in that way because I was introduced to the idea of disease prevention over disease treatment or health promotion very early on in my education and training.

The second thing that happened for me in college was that my mom actually passed away from cancer. And that was a really important experience to have, especially at that time in my life because she really was my first patient. I learned so much from that experience. And in particular I realized just how holistic health and wellbeing really is. It's not just about your physical health, it's your psychological, your social, your spiritual health, all of that contributes to wellbeing.

I went into medical school with this mindset of, "Okay, I am here to improve the quality of life of patients." And I had a really hard time in medical school. I really struggled because I felt like an oddball. I was really focused on the health, the wellbeing, and the quality of life for patients. And I wasn't like my peers in terms of being fascinated by the pathology or wanting to know the latest surgical treatment or drug. My heart wasn't in that. And so, I really felt like an oddball.

There were several times that I felt like, "Okay, maybe I should drop out. Maybe I'm not supposed to be a doctor." It wasn't until a friend, a classmate of mine told me about preventive medicine as a residency. I'm so thankful for that because once I found out about the residency, the fact that pre preventive medicine is all about public health. I really felt like I was going back home. I felt like I found my people again. That's how I got into the specialty of preventive medicine.

John: Maybe I can stop there then, because this kind of ties in with my interest or at least it piqued my interest initially, although you've got a lot of other interesting things to say today. But I've talked to med students who told me a story either they were already burned out or in retrospect, they never went to a residency because they didn't really either feel comfortable. They didn't really want to take on individual patients.

But they weren't aware of preventive medicine. They weren't aware of public health. And I think that this would be a specialty and training because you're going to describe in a minute what it actually entails, but would maybe offer some skills and training for physicians to practice in a different way. And if they maybe opt out of direct individual patient care, although they can do that as well. That's why my interest was peak. So go ahead and explain then what happened as you went through your training and what it really means to be board certified and preventive medicine and working in public health.

Dr. Shelly Bhowmik: Yeah. It's really a shame that more medical students don't know about the specialty, about the field. And it's understandable. You go into medical school. You have this big debt. You look towards those specialties that are going to provide salaries that really can address that debt. And public health is not known for being extremely lucrative. And I will say though, preventive medicine as a specialty, the beauty of preventive medicine as a specialty is that you can make with it whatever you want. If you want to continue seeing patients, you can do that. If you want to go into health policy, you can do that. If you want to be a business consultant, that's an option. Going into media, producing television shows, all of this is available to you as a preventive medicine physician.

You can really make with it whatever you really want to be doing in the field of medicine and healthcare. And for folks who don't know preventive medicine, the specialty itself, it was born out of the polio era. And I used COVID, the pandemic as a really good example of this. Back when we were dealing with polio people quickly realized that we needed experts who not only understood the clinical aspect of what was going on of the infection of the disease. We needed experts who understood the clinical piece, but then also the population piece. Given what we know clinically, how are we now going to put together programs and implement strategies for an entire population?

And so, that's what preventive medicine is. We are at that intersection of medicine and public health. We deal with population health. How are we going to elevate the health and wellbeing of many people at the same time? That is the specialty. And in terms of the specifics for training, there's actually two ways that folks go into preventive medicine. One is going directly from medical school or from a transitional year into inter preventive medicine and that's two years. So, it's three years total of residency. Or a lot of folks end up doing preventive medicine as a fellowship. So, they'll do internal medicine or family medicine. And then they'll do the extra two years of preventive medicine as a fellowship training. So that's another really great way to get into the field.

And typically getting an MPH is part of your residency training. The first of the two years is doing the MPH. And then in the second year we do what's called practicum rotations. So, you can consider these as they're like short term consulting assignments in a variety of industries, again, anywhere medicine and public health intersect.

So, for me, for example, I did rotations in state government. I was at a global pharmaceutical company doing corporate wellness. I was at a health startup. I was at an innovation hub within a hospital. I really got to taste different sectors, different industries and find the place that suited me best.

John: No, that's very interesting, because as you're recounting these rotations or these experiences that you had, again, they didn't really, for the most part at all involve direct one on one patient care but working in a system and organization and learning how to interact and add value in a different way. I'm assuming there's a lot of epidemiology and statistics in there. I have an MPH that I did after I was in practice. And so, those things are industrial hygiene, blah, blah, blah, there's all these things you can study. And I found it all very interesting and it just seems like, "Wow, you're learning ways to practice nonclinically right from the get go." That's why I thought it was pretty interesting.

Dr. Shelly Bhowmik: Yeah. And I will point out too, depending on which residency, where you are for residency for preventive medicine, that will impact the types of rotations you do. Again, I was back at Johns Hopkins. We're lucky because Baltimore is so close to Washington DC. So, we have access to a lot of these larger corporations, these government bodies, where folks can do rotations with the FDA, with the department of health, et cetera. So, the Hopkins program in particular has that focus. Whereas I know of some other programs that are on the west coast that the clinical component of preventive medicine is quite strong. And so, again, you can find something that is suited to your needs and to your interests.

John: Okay. Listeners pay attention to that. And if you know a medical student who hasn't quite decided what they want to do, or someone who's maybe even just approaching, they're going to do a rotating internship or whatever, throw this out there as an option, particularly if they're reticent about going into some intensive type of clinical specialty. But we have a lot more to learn from you, Shelly. Now I'm curious what happened after that, because you took that and then you moved into another area after a while. So, let's hear the rest of that story.

Dr. Shelly Bhowmik: Yeah. In the interest of time, I feel like I need to fast forward a little bit. I did human centered design work and that's the part that I'm going to fast forward through. If we have time, we can come back to it. But I ended up back in corporate wellness. I was working for an executive health firm. At that firm, we would do wellness screenings for executives and employees of large companies. And much of the work that we did was lifestyle coaching. We would talk to these individuals about nutrition, physical activities, sleep, et cetera. And so, it made sense for me at that point to get the board certification in lifestyle medicine.

Again, in terms of just really quick history of lifestyle medicine, it started off as an interest group within the college of preventive medicine, but because it became so big, it's now its own college. It has its own board exam. There's a lot of really interesting work happening in that field. And so, that was the reason for getting that second board certification.

John: Okay. But you had something in mind. I assume when you did that, you were looking forward to taking this impacting people's risk factors and their lifestyle. So, where did that take you?

Dr. Shelly Bhowmik: Yeah, yeah. And this is going to circle back a little bit to my personal story. And actually, to what I had mentioned earlier in terms of losing my mom. For me, stress, mental health issues, it's something that I've dealt with on and off over the years. Really ever since my mom passed from cancer.

And what happened was that in the beginning of 2020, before COVID really hit the US, February of 2020, I found myself personally in a pretty bad place. And the scary part was that I didn't realize it. So, I didn't realize how bad things were until literally a Friday evening rush hour standing at the edge of the subway platform, wondering if I should push myself over that edge. And so, to step away from that edge, literally figuratively, it was a process to say the least. I tell folks I was one of those individuals who was so thankful to go into lockdown at the start of COVID because I literally needed that time and that space in order to heal.

And it was during that process, during that recovery that I came to realize how powerful your mindset is when it comes to health and wellbeing. I like to say that mindset is medicine because that's what really helped me get to the other side. And as a physician, I feel like it's my duty, it's my responsibility to make sure that other people don't end up at that same extreme, at that same edge. And so that's why I decided to start my own practice platform wellness, and to be able to help individuals in particular when we talk about lifestyle, the stress management, the burnout prevention piece. That is where I'm focusing all my efforts right now.

John: Okay. From what I understand, you're focusing on both in helping individuals, as well as I think a corporate approach where institutions sometimes recognize, oh, they have a problem with let's say physician or clinician wellness and break burnout and all kinds of things. So maybe just take us where you want to explain those two sides of that coin.

Dr. Shelly Bhowmik: Yeah. Yeah. A lot of this work in stress management, burnout prevention, a lot of it is individual. It's personalized. A lot of it is one-on-one coaching or group coaching. But a big part of it too, has to do with organizational culture. And this is where the corporate wellness piece comes in. So, being able to work with companies, being able to help them create what we call psychologically safe environments so that their employees feel comfortable getting help when they do need help, because that's a really big part of this. You can throw whatever meditation app subscription you want at them, free therapy sessions.

You can have all those HR benefits, and those are great benefits, but if you don't have that culture where people feel safe and okay to access those resources, then you have a problem. You need to create that culture first. Being able to deal with burnout on an organizational level, it takes that individual personalized approach, as well as this more systematic approach, the systems level approach. And tying this all back to preventive medicine. This is where my preventive medicine hat comes in because as a preventive medicine physician, we are taught to take a step back. We are taught to look at things from a systems perspective. That's what our training enables us to do.

John: I might be putting you on the spot here, but I'll be honest that I've talked to coaches and consultants in the past who have been trying to enable and assist organizations like usually a health system or a hospital to address wellness in their providers or medical providers or burnout and so forth. There's a lot of backward movement. I don't know, have you had some really interesting, or good successes that you could share, even just an example of maybe an organization? Not by name, but just the kind of things that happen when they address this.

Dr. Shelly Bhowmik: Yeah. Yeah. And it's not just healthcare institutions. Because I'm based in New York City, there's quite a few financial institutions that I've worked with. National organizations. There was a national sports organization involved there too. But I will say being able to align with organizations that truly are mission driven, organizations that recognize there's a problem and are willing to invest the resources that are needed to address the problem. That's where a lot of the work goes in. It's in that discovery phase of "Does it make sense to partner with this organization?" Because some of them aren't ready or some of them are just wanting to check off the wellness box. Tick off a box for the year that says, "Yes. Okay. We address it. We fulfilled that requirement. Onto the next." Yeah, being able to really partner with the right organizations, that's a big part of this.

John: It's interesting. That just triggered something in my mind. I listened to a presentation one time by an ex-athlete and the issue of burnout came up. And he said that it was quite a parallel that there's a lot of burnouts in professional athletes because they have that same intensity, it's like residency and fellowship and practicing. And so, it's interesting that you would say that.

Dr. Shelly Bhowmik: Yeah. Burnout is affecting everyone, every industry. It shows up in different ways, depending on what industry you're in. I was just talking to somebody who's in media and journalism, and they were talking about how for employees in that field, they have to deal with looking at the news every moment of the day. And after a while, it's a lot, it can be a lot. And so, knowing how to deal with that is part of their profession. So yeah.

John: Before we get closer to the end, I like to interject the website because some people don't listen to the very end. Listeners, you better listen. But anyway, shellybhowmik.com is the website, right?

Dr. Shelly Bhowmik: Yes, shellybhomik.com.

John: Okay. So, we get that right. And that will be in the show notes. Tell me more about what if some of our listeners end up needing some kind of coaching, would your coaching be appropriate for them and what would be your ideal let's say one-on-one client?

Dr. Shelly Bhowmik: Yeah. Yeah. I'll talk a little bit about the framework that I use with other patients and coaching clients, because I think that'll be helpful for the listeners. So, I created a three-step framework that I call ReST. ReST stands for Revive Strive and thrive. It is a three-part framework to really help individuals overcome burnout, to handle stress and to restore resilience and energy.

In that process, I take the individual through nine steps in particular. The very first step is to detect distress. If you don't know that there's a problem that needs to be fixed or addressed, or you have to know that first in order to address it. So, being able to recognize when you are dealing with burnout is one of the very first steps to take in order to get to a place where you are better and well.

John: No, that's important because it's sort of like the boiling of frog, right? It's so gradual that we can be completely burnt out and miserable and we haven't really even identified it. It's like, "Well, that's just the way life is." And it's no, that isn't the way life is supposed to be. But we don't always recognize it.

Dr. Shelly Bhowmik: Yeah. And going back to just what I experienced personally, that's exactly what happened. It starts off as stress. It progresses to burnout. For me, as an individual, it was depression, it was suicidal ideation. It just kept going. It's worth being able to recognize the signs and symptoms early on so you can intervene.

John: So, then you're going to go through the other steps quickly?

Dr. Shelly Bhowmik: I'll tell you about the steps. And then, I think we'll put this in the show notes, but I have a free masterclass that actually does a deep dive into the entire framework. So, listeners can learn more about each individual step. But the nine steps are, number one, detect distress. Secure space, seek support, restore routine, tackle triggers, master mindset, ease efforts, hone habits and cultivate connections. Those are the nine steps. I don't know if we have time to go through everything.

John: No, we don't. But how do we go through those steps? Is that something that's done individually with you? Are there videos? How does one actually go through that process?

Dr. Shelly Bhowmik: Yeah. At the moment it is through coaching, individual and group coaching. I have plans to create a course around this framework, but that'll be sometime in the future when I have an extra set of hands. But until then, yes, it's really about coaching folks through the nine steps.

John: Okay. That sounds very interesting. And I like that there's structure. For someone like me, I need to kind of know what process I'm going to go through and that there is going to be progress and that maybe I'm going to have some homework to do and take some steps to make things better.

Dr. Shelly Bhowmik: Yeah. Knowing that there is an endpoint, there is a goal, a light at the end of the tunnel, whatever you want to call it, knowing that that's something that you're working towards. I think that's what keeps somebody going and is able to carry them through and lift them from the burnout that they might be experiencing. So, yeah, definitely part of the process.

John: All right. I'm going to throw you another curve now. In working with these people and in trying to resolve this, these clients, if you were to be talking to, let's say, a medical student or a resident, is there any advice you would give them in terms of how to recognize this is happening and how to maybe stop it in the process or take measures to prevent it?

Dr. Shelly Bhowmik: Yeah. Let me go through the definition for burnout, the WHO definition, and then I'll kind of give my own spin on it. Burnout in particular is defined as an occupational syndrome. Due to workplace stress that's not chronic workplace stress, that's not well managed. And in particular, there are three main characteristics. The first is energy depletion, which I think all medical students and residents feel. So, the energy depletion.

The second one is feelings of negativism or cynicism related to your work. So that might be one potential flag for folks to keep an eye on. And then the third is decreased professional efficacy or performance. If you're noticing that you're not hitting that bar that you typically are used to hitting, that's another indication that you can use.

And my own spin in terms of the definition, for me, burnout is when you're going through your day-to-day actions without intention. A big part of this is being able to respond instead of react to different situations and triggers. And so, when you do that, it's because you are intentional about how you're showing up. When we are starting to go on autopilot and just do things because we're used to doing them and we get caught up in this cycle, that's when you start to head down a slippery slope. Being able to act with intention is the goal.

John: When you were describing the features or the symptoms of burnout, I've mentioned the one that I had in the past. Can you tell me if this fits it? I started to hate my patients. Is that not a good sign?

Dr. Shelly Bhowmik: I think that would go great with the feelings of negativism or cynicism related to work. Yeah.

John: Oh, my goodness. But I can relate. That's one of the reasons why I started the podcast later in life is to help people think about, recognize and do something that maybe brings them more joy and fulfillment. Okay. Let's go over how to get ahold of you because we're going to have questions and we might want to access some of your services. Again, tell us what your website is.

Dr. Shelly Bhowmik: Yes. The website is shellybhowmik.com. And in particular we were going to point listeners to the free masterclass that I have on the website. Folks are interested in learning more about the ReST framework. That coaching methodology. That masterclass goes into detail on each of those nine steps. So, it's a great place to start and learn more.

John: It sounds like it. It's very easy. It's at the top of the webpage there. I think it's a link right at the top. So, if you're interested listeners, of course, look around for everything else too, while you're there. We're getting towards the end here. Other than the question I already asked you about recognizing burnout and so forth, would you have any other advice for physicians and other clinicians really who are maybe early in their career and they just feel like something isn't right?

Dr. Shelly Bhowmik: Yeah. I'll go back to something I said at the beginning, and that is, mindset is medicine. The beliefs that we have, what we tell ourselves, it is so powerful. And if we have dysfunctional thoughts, dysfunctional beliefs that are fueling the burnout, that's where a lot of this work is. You have to be able to identify what those limiting beliefs are and then be able to replace them with more empowering ones that can help you and lift you out of the burnout. So, mindset is medicine. That's the biggest one.

John: Yeah. And two things that I would also add to that. One is what you mentioned as far as burnout, that is a workplace situation. That's a workplace thing. I know we can all learn to be more resilient, but when the workplace is broken and causing these problems, it doesn't mean we shouldn't take steps ourselves to help us, but maybe someone needs to look at the workplace, which is what you're doing with the other side of your consulting business is trying to make those workplaces a better place.

And the other thing is, I think as physicians or clinicians, we should enjoy our jobs. If you're not, there's something's wrong. There's no reason why highly educated and really dedicated and committed people should be miserable. It doesn't make any sense really when you step back and look at it. So, I appreciate all the comments that you've made and suggestions you've made for recognizing that and then addressing it.

Dr. Shelly Bhowmik: Yeah. Thank you so much for having me. I think this is such an important topic. And especially with those who are listening to this podcast, I hope it's helpful.

John: Oh, I'm sure it will be helpful. And I'm going to tease something. Maybe I'll get you to come back and tell us about that mid-career thing you did that you mentioned. That sounded like it'd be very interesting to hear about, but we're going to put that on the side for now. How about that?

Dr. Shelly Bhowmik: Part two, part two.

John: Yes. Okay. Shelly, thank you very much. It's been very interesting and enlightening and I think we'll help everyone from med students to physicians who are well into their practice and burnt out. So, with that, I guess I'll just say goodbye.

Dr. Shelly Bhowmik: Thank you. Thank you again.

John: My pleasure. Bye-bye.

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The post Why Preventive Medicine and Lifestyle Medicine Make for a Great Career – 257 appeared first on NonClinical Physicians.