319: From Cardiologist to Wellness Advocate: A Trailblazing Stand Against Healthcare Burnout through Lifestyle Medicine | Dr. Svetlana Chamoun

00:00:00 Dr. Chamoun: The bottom line is that we have to take control over things that we can control and we should not worry now about things that we have no control over. So the goals when we think conceptually about carbon burnout, conceptually, we need to lower the drain and improve our ability to reach charge. Right now we're talking about the human being, about you and me, experience and potential burnout. So how do we curb it, lower the drain of energy and improve our ability to recharge? 

00:00:39 Maya: This is the Healthy Lifestyle Solutions Podcast and I'm your host, Maya Acosta. If you're willing to go with me, together we can discover how simple lifestyle choices can help improve our quality of life. Let's get started. 

00:00:53 Maya: So friends today, welcome back to another episode of the podcast. Today we are speaking about provider burnout and we have the right person to speak to us about this program that she's developed to really support her colleagues and people in general who need these tools. So today my guest is Dr. Svetlana Chamoun. She is a double board certified cardiologist, the founder and the creator of the CardioSeeds Podcast, and a member of the American Society of Preventive Cardiology and the American Medical Women's Association. She's a Diplomat of the American College of Lifestyle Medicine and a certified health and wellness coach by the nationally and internationally recognized American Fitness Professionals and associates. Dr. Chamoun also serves as a co-chair of the Cardiology Group at the American College of Lifestyle Medicine, where she works to build collaborations with other organizations and to advance the field of lifestyle medicine. She has more than 20 years of combined expertise in clinical and academic cardiology, lifestyle medicine, cardiac imaging and cardiac safety industry. There is so much more that will impress you about Dr. Chamoun. So you'll have to go to the website to read the full bio. That's healthylifestylesolutions.org, but I just can't wait to get started. So welcome, Dr. Chamuon. 

00:02:19 Dr. Chamoun: Thank you so much, Maya, for having me today. I'm delighted to be here with you. Thank you.         

00:02:24 Maya: And I'm really impressed about all that you have done and how you have now taken your background as a cardiologist and what you have yourself experienced to now develop a program that's going to support your colleagues. And it always seems to be that way, that when a physician learns about lifestyle medicine and begins to implement, bring those lifestyle medicine pillars into their own lifestyle, they have this sense of a transformation that kind of directs their path towards a new mission and reviving really, the healer in you. So I'd love for our listeners to learn about you. Can you share with us what inspired you to pursue cardiology and how has lifestyle medicine helped shape your work today? 

00:03:11 Dr. Chamoun: Of course, that's a wonderful question. For me, the first thing was cardiology, actually, and lifestyle medicine came much later. In fact, I was a resident at one of the University of Virginia Internal Medicine programs. Back in the '90s, lifestyle medicine was not even a separate specialty. It did not even exist. But during my residence in Virginia, I got fascinated with cardiology and interestingly, with specifically interventional cardiology. For whatever reason, I love the difference that we made in the cat lab between life and death. So I was so drawn to this interventional cardiology that I was accepted to one of the cardiology fellowships here in Philadelphia and strongly was thinking about becoming an interventional cardiologist. In retrospect, though, I should say maybe. Fortunately, I had very good teachers and mentors who appreciated my interest and talents in other aspects of cardiology and invited me to transfer to the newly opened Cardiovascular Imaging Fellowship at the Temple University Hospital, which I actually did. And I loved it. And as a result, I graduated as a specialist in cardiovascular imaging. And over the next several years, I worked in both the clinical setting and the cardiac safety industry, as you mentioned. And then during my work, I saw COVID-19 decimate medical community and I realized that preventive medicine and preventive cardiology would truly address the root cause of chronic disease who were underutilized and underfunded in America. So I was thinking to keep the United States healthcare system from collapsing during our next, possibly next pandemic, right? Many things needed to change in medicine. Many things needed to change in cardiology.    

00:05:13 Dr. Chamoun: And one day, my husband, who was a practicing cardiologist, handed me a brochure and he said this may actually interest you. And it was a flyer to the annual meeting of the American College of Lifestyle Medicine. I attended it. Then I became board certified in lifestyle medicine as a lifestyle medicine physician and then as a health and wellness coach. And it changed my life forever. I changed my own work life balance. I started practicing lifestyle medicine pillars to take care of my own mental and physical health first. Then I learned that change in healthy lifestyles can prevent, treat and reverse up to 85% of all chronic disease in the Western world, including cardiometabolic problems, cancers, inflammatory conditions, even burnout, right? That affected at that point, more than 70% of the healthcare workforce. So I left at that point, my corporate job and I started my own company, which I called Cardio Seeds. Cardio from cardiology and seeds, as if you saw seeds of health and wellness, right? So to put seeds to grow something, some fruits of your labor. And I did it in order to provide lifestyle medicine interventions and behavioral coaching for cardiovascular risk reduction and burnout mitigation. So this is how it all started.         

00:06:40 Maya: Well, this is beautiful. A simple flyer changed your life. Destiny, you probably would have found out about Life Summit isn't at some point, but I'm interested in knowing just for the listener who might not understand what a preventative cardiologist is, could you tell us a little bit about what that looks like compared to the cardiologist that we mainly hear about. 

00:07:06 S: Well, look, when I started my career as a cardiologist in America some 20 years ago, I did not plan to become a business owner, right? A board certified lifestyle medicine physician, a wellness podcaster or blogger, social media content creator. But I became all of the above. Why? I worked as a cardiologist for almost 18 years, taking care of the sick, prescribing pills, prescribing, doing procedures, working at the world's largest innovation technology company for clinical trials without giving this lifestyle medicine much of a thought, right? And it wasn't until several years ago when I had a couple of rude awakening. One was COVID when I realized that the US healthcare system could have been much better if we did not have this much of a burden of chronic disease that could have prevented so much death and suffering of people who had this COVID because it was disproportionately affecting people who had chronic disease, diabetes, hypertension, congestive heart failure, et cetera, et cetera. And then also the cost, unsustainable healthcare cost, was becoming prohibitive for many people. And I also saw that, and I also began to heal the inadequacies of the system. When I became a patient myself, it was hard to get an appointment, impossible to find a doctor who had time to listen to me or my relatives, for that matter. So it was inconceivable to end up without a handful of new prescriptions. When you left the hospital, doctor's office copays increased dramatically. Lousy but expensive health insurance tied me to my job like a chain. So something was obviously wrong, right? So, as a doctor and patient, I started thinking and reading.         

00:09:04 Dr. Chamoun: So our country spends the highest amount of money in the world on treating chronic diseases, like diabetes, high blood pressure, and the consequences of obesity, right? Americans spend an enormous amount of money on diet, supplements, vitamins, gym memberships. So, logically speaking, Maya, we should be getting healthier, right, as a society, but we aren't. In fact, the US has the lowest life expectancy among developed nations. So what's our problem? What's the problem with healthcare? The problem is that despite all the spending, one crucial aspect of healthcare here in the United States was or is, for a long time, almost completely left out. It's what is called prevention, right? Prevention.         

00:09:53 Dr. Chamoun: So when we don't do enough to prevent disease, treating it in the advanced stages may be too little, too late, if you think about it. And this is exactly what the disease oriented United States medical system has been doing. It receives patients when they are really sick. It patches them up and releases them back into the same society they came from. And sometimes they're too sick to benefit from treatment, so the time is lost. Somehow, for decades, the system has been ignoring the fact that almost 85% of all chronic cardiometabolic disease is entirely preventable with healthy lifestyle choices. Meanwhile, if preventative care in the United States were as strong as its therapeutics, it would be entirely possible to improve the overall health of several generations of Americans, our dads, our moms, our grandmothers, right? And ourselves, including preventing deaths, as I mentioned, related to COVID-19 because it disproportionately affects patients with chronic illnesses. After all, look, regular exercise, healthy diet and other lifestyle interventions have been scientifically proven to be protective against heart disease and diabetes.         

00:11:16 Dr. Chamoun: Of course, to achieve noticeable results on a national level, systematic cardiovascular prevention must reach individuals and communities and must become a widespread medical practice. And physician burnout is widespread in some categories, reaching almost 80% or maybe even more. And the main root cause is lack of autonomy of physicians, lack of respect, and misalignment of physicians' values with the values of those who manage transitional health care. And so leading a healthy lifestyle, however, becomes universal in carbon burnout and restoring one's best health, no matter whether you're a provider or you are a patient. So it can be applicable to all of us, right, whether we are providers, physicians, or we are patients.         

00:12:09 Dr. Chamoun: This is why when I started CardioSeeds, I started focusing on lifestyle interventions and their role in preventing physician burnout. So when I started CardioSeeds, our mission was to lead the way to value based, burnout free health care and to contribute to population health. So, all of the above, because we provide lifestyle interventions and behavioral coaching and burnout mitigation services and solutions to both patients and healthcare providers and administrators, we don't discriminate. We have them all. So we also launched CardioSeed podcast and we volunteer our time to educate both patients and families and healthcare providers about living and practicing pillars of lifestyle medicine. And we work closely with professional societies like American College of Lifestyle Medicine that you mentioned to advocate for an improvement in the present health care system. 

00:13:01 Maya: Yes. I hope I answered your question. It was kind of a long answer. You've touched on a lot of important reasons why you're doing the work that you're doing now. This sick care model, this kind of Western model that we have in medicine for treating patients, doesn't work for the patients or for the providers. Basically, what you've highlighted is what many people in the field of medicine have seen during COVID which was more people getting sick, more people dying from conditions that could have been prevented had they had access to this information of lifestyle medicine and preventing these diseases. And on the other hand, our providers were not really being supported during COVID Either they were overworked during that time or they were just dealing with a lot of personal stress that comes along with being in this field of Western medicine. So it's a sick care model that is no longer working. And what you're doing is you're advocating through your podcast and now your program, CardioSeeds, to say, hey, there's got to be a change in both. What you're proposing is a change in how we support our providers, but also how we support our patients and...

00:14:26 Dr. Chamoun: No, I think it's been brewing for a long time. COVID just brought it all to the surface. COVID just showed us shortcomings. So much so that it became so obvious on multiple levels. Not only physicians, our nurses, our PAs physician assistants, our nurse practitioners, everyone, even medical students, is screaming, something has to change, something gotta give. Because otherwise during, God forbid, the next pandemic comes, it will all just crumble down, right? Something doesn't change. 

00:15:02 Maya: I absolutely agree with you. And we had this opportunity, Dr. Chamoun, for this awakening to happen among the general population, at least. 

00:15:09 Dr. Chamoun: Good thing that came out of it. 

00:15:12 Maya: Yeah. Many of us had hoped that this realization of, "Oh, the reason I'm getting sick from COVID and I'm having more advanced complications is because of something that I could have done in my life to prevent that," or but instead it became very political and polarized with other topics taken over that hijacked the important conversation that we could have had. But I'd like to come back to something that you're very passionate about as a result of all of this, the physician burnout aspect. Can you tell us about those common signs and symptoms that we see in our health professionals now? And by the way, how does this affect patients? Because if I'm in the same office with a physician who I'm his 30th patient, or probably not.         

00:16:02 Dr. Chamoun: Yeah, Maya, this is such a deep and multifaceted question, and the answer is not easy, but let me just try to answer to my best ability. So burnout, it's a definition. Finally, it's included into ICD-11 as a syndrome, thanks to the work of Christina Mass, like Susan Jackson and all multiple other people who really pushed this to be qualified and classified as a syndrome, just not just as nothing. It's in your head. Right. So this is a disease syndrome that is caused by chronic work related stress that has not been sufficiently addressed. Let's put it this way. And symptoms can be not only psychological, physical, they can be all kinds of consequences of it. But the classic triad of symptoms, which Christina Massachusetts and Susan Jackson of UFC Berkeley standardized in their math-like burnout inventory, became the gold standard of burnout evaluation. This is the classic triad, is emotional exhaustion, depersonalization, and lack of personal accomplishment, or feeling of lack of personal accomplishment. It's not like we are not accomplished. We are very accomplished, but we don't feel it.         

00:17:37 Dr. Chamoun: So if somebody wonders what depersonalization feels like, it's almost like feeling like outside of your body, you feel like you're absorbing everything around you from the outside. And it's interesting that there is a difference in those symptoms between the female doctors and males. So there is a female pattern that's been described in the male pattern, and the female pattern has those three classic triad patterns. Stage one is emotional exhaustion. Stage two depersonalization and cynicism. And stage three is reduced accomplishment, feeling of reduced accomplishment. But males do not have three stages. They only have two stages. They start with depersonalization and cynicism which actually serves as a coping mechanism, which is followed by stage two, emotional exhaustion.         

00:18:41 Dr. Chamoun: And stage three does not exist. So cynical and exhausted male physicians keep going. They keep going despite burnout, despite how they feel and they feel they are still good doctors. And it's only coworkers and only patients who witness their exhaustion and cynicism on the job and only coworkers and patients may 1 notice that these doctors must be worn out or may be burned out. Okay? So this is the difference between men and women physicians. And as far as physical symptoms go, they're multiple, multiple. But as a cardiologist, I have to mention a few. There is this term that came out of Japan and it says it's called Karoshi.         

00:19:33 Dr. Chamoun: Karoshi means death by overwork in Japanese, mainly from mi and stroke. So this term comes back from when in Japan, there was an oil crisis when people were working 100 plus hour, week, and they started just dropping dead from overwork and Karoshi. Right then, sudden cardiac death, coronary artery disease, obesity because of the change of... in appetite, hyperlipidemia or high cholesterol, type two diabetes, high blood pressure, naturally. And then karojisatsu also Japanese term, which means suicide due to mental stress, early death before age of 45, depression, substance abuse, many, many other things that happen. And you ask a very important question: what are the negative consequences of this on patients?         

00:20:39 Dr. Chamoun: Oh boy. First of all, patients sense this. As I said, they see cynicism, they see depression, they see changes that creep up on physicians that they are not the same, they don't have the same memory, they don't have the same attention span, they miss things. And they also notice that the time spent with patients is shrinking very rapidly. That physicians log into computer and spend the 15 minutes that they're given to them.         

Instead of looking patients in the eye, instead of holding their hands, they spend time on their computers, right? They barely look them in the eye. So it leads to poor patient engagement and high patient satisfaction. Patients become alienated, it alienates whole families. They leave hospitals, they leave their physicians, they give them bad reviews and it also leads to a negative impact on other staff members. It creates a high rate of turnover. Of course, I'm not even talking about inadequacies in standards of patient care. Substance abuse leads to medical errors, to absenteeism, low productivity and all of those things. So low quality of care and patient dissatisfaction is a major thing because we are ultimately in this profession to serve our patients to our best ability and to make sure that our patients are receiving the best medical care possible, and we aren't harming anybody whatsoever, and we are giving them the best possible medical care, right? 

00:22:31 Dr. Chamoun: The other thing is the cost of physician burnout. So think about this. To replace one physician, a medical system or a hospital will need half a million dollars to replace one single physician. So if a healthcare provider employs, let's say, 450 physicians, it will lose $16 million a year per year to replace physicians at a turnover rate, average rate 7.5%, which is an average rate now. So the national task force calculated that at this moment, the overall cost of physician turnover in the United States is about whopping, $17 billion per year. And alienating patient costs is upward $1 million per year. So all of those things are consequences of physician burnout. 

00:23:33 Maya: Oh, that's so unfortunate to hear. I want to go back to patient care first before I ask my next question. But I want to say, Dr. Chamoun, that part of the reason why I like having the podcast and having physicians come on and talk about disease and various health topics is because I want to help the patients out there. Regular people like myself feel a little more empowered when they step into the doctor's office. And so that's sort of what I want to pick up on when a patient comes into the doctor's office and there is that cynicism that happens. I was wondering if you can kind of give us an example of what that cynicism looks like. What does this sound like from a physician to a patient? But also I want to mention that we know, for example, that female patients tend to be gaslighted in many ways or dismissed with symptoms and other things. And I wonder if that's part of the physician feeling burnout, maybe being distracted, maybe not having enough time to say, well, let's order this exam or this test for you and let's check for these kinds of things. So that's one and then it's all part of the same question. But the idea that when we even speak about weight issues, for example, that patients feel judged by their physicians again. I wonder if all of those things make a patient sort of shut down and not ask enough questions when they're with their doctor, if it's all related to maybe a patient feeling restricted or maybe the physician is not as open or doesn't have enough time for them. But in general, if you can address that. And what does cynicism sound like when the interaction is happening between a patient and a physician?         

00:25:21 Dr. Chamoun: Oh, Maya. I'm so sorry that you even asked this question because as a physician, I feel hurt when a patient asks me this question. I feel hurt when you say, I feel marginalized as a patient. I feel like I'm underserved when I come, they brush me. They brush my symptoms off or they underestimate my symptoms, or they undervalue my complaints and stuff like that. So in my opinion, it should never happen. We know, as cardiologists will learn, that women in cardiology have different symptoms. There is no question about it. They have microvascular angina that presents differently from obstructive coronary artery disease, typical anginal, chest pain, et cetera, et cetera. So we have objectively different symptoms that can present and our symptoms should not be underestimated. And it's notorious historic that we are underrepresented in clinical trials till most recently.         

00:26:41 Dr. Chamoun: We are under represented or underrepresented on the tables of ORS for coronary bypass surgeries in the past when it was at its height. So for percutaneous, coronary angioplasty, et cetera, et cetera, because it was always all in your head or it's all maybe you pull your back or whatever. So it's unpleasant to hear. I want to say that when physicians have burned out, it probably shows first when they start really making less and less eye contact with patients and spending less and less time with patients face to face. So they try to be in and out just to do the minimum amount of work that needs to be done.                      

00:27:36 Dr. Chamoun: It's hard for me to tell because it's hard for me to generalize and speak for all. But I would imagine that physicians probably, who burnout just hanging there by thread, just trying to be professional. And it shows in small things like maybe slightly inappropriate jokes or insinuations and stuff like that. Or just trying to get in and out of the room as fast as they can. So those are the first signs that physicians don't really enjoy what they're doing and there is so much behind it blaming the victim. And I mean in this case that when there is a problem of a group of people and I mean the group of people are physicians we're talking about, it's never a problem of an individual, it's always a system problem. So blaming that particular physician for burnout, for overwork, for over schedule link, or for being ignored by the administration or being not brought to the table for discussion or not being heard or been marginalized in terms of assistance for mental health care, this is sad, but this is not that physician's specific problem. This is a problem of a society, of medical culture, of system culture that needs to be changed. And when there is a toxic workplace, it actually manifests in burnout of its workers, of its workforce, in high turnover. And usually when there's a high turnover or burnout, it's a red flag for the administration that this is a toxic workplace.         

00:29:48 Maya: Okay. And speaking of female patients, we already touched on that. I think in general, medicine used to be profession, predominantly male dominated profession. Women, of course, are taking a great place now in medicine, especially primary care. Primary care is still marginalized because there is a totem pole in medicine, in medical profession, neurosurgery, orthopedic surgery, dermatology, plastic surgery is on top. Primary care is at the bottom. Even though they're taking care of bread and butter of medicine, they're underfunded. They don't have time. They don't have physician extenders to help them. They really don't have time even to see patients face to face. They have to take work home, they work on weekends, they spend enormous time over electronic medical records. They work nights to finish their paperwork. So those primary physicians are mostly women. And when they have to deal with their home, their kids on top of that, some homework, they come back from work and they have to deal with their house chores, kids and everything else that sometimes they have to take care of elderly parents, it all piles up.  And this is why females in medical professions, their burnout is higher than their male counterparts. 

00:31:40 Maya: Yes, it seems like we as women in general tend to be more of the caregivers, on top of also having a profession or a business, whatever that may be, are expected to do at all. You likely already touched on some of the significant factors that contribute to this physician burnout, if you'd like to mention any more of those factors. But also, what are those effective strategies for healthcare providers to prevent burnout and maintain their well being?         

00:32:12 Dr. Chamoun: Sure. Well, let's talk a little bit more about the causes because if we don't address the causes, the burnout will never be addressed. So, there are many factors that go into physician burnout. And I would like to emphasize that when a group experiences a problem, it's not a problem of an individual, it's a system problem. So the world expert on physician burnout, Dr. Christine Sinsky, who is a vice president of Professional Satisfaction at the American Medical Association, she says that when you have to fix group experience, you have to fix the environment and systems such as teams, technologies, administration, administrative burden and workloads. And when we talk about burnout in physicians, we need to make clear about one thing that it's not related to the lack of physician resilience. So when workplaces start introducing physician resilience programs to reduce burnout specifically, it's almost an insult, Maya. In fact, one after another, studies that came from major centers like Stanford, Mayo Clinic showed that physicians are and remain some of the most resilient people in the world. They are much more resilient than the general population. Also, health care is not transactional, should not be transactional, I should say. 

00:33:50 Dr. Chamoun: The nature of healthcare is relational, right? It became transactional with time. It will improve outcomes only when it supports relations between doctors and patients and doctors with one another and with other staff. So think, let's think back. The rise of electronic health records or EMR, HR, whatever you call it. It gradually made doctors take on tasks that used to be done by clerks or scribes. So physicians working as transcriptionists is not a good use of their highly valued skills. Not only physicians cannot physically take on more responsibilities and continue to deliver the same quality of care in the same amount of time. But they also spend their days performing transactional activities like filling out forms, calling insurance companies to get authorizations that leaves them with only a few minutes to see each patient, okay? And sometimes the schedule is filled with 30-35 patients per day and they have no control over that.         

00:35:02 Dr. Chamoun: So they must take charts home to fill them out during nights and weekends. This clerical work, Maya, which statistically takes twice more time during every physician's day than actually seeing patients, degrades them as professionals. It devalues their precious time, takes away their time from actual healing, and when compared to their own professional values becomes a deep rooted cause of burnout. Because physicians know that if their opinion was valued by administrators and this work could be done as a fraction of time and cost by clerks freeing time for physicians to do what they're trained to do, diagnose and heal patients. And there was the survey by the Medscape National Physician burnout and suicide.   There was a report in 2022 by Medscape and they came up with the whole list of factors that contributed to physician burnout the most. And on top of the list, of course, there were bureaucratic tasks like charting paperwork, lack of respect from administrators and colleagues and too many hours at work and lack of control and autonomy, right? So all of those things.

00:36:28 Dr. Chamoun: And of course, let's just mention that physicians' culture, all this archaic culture that comes from centuries ago of perfectionism, that we are beating ourselves for mistakes. We ruminate, we have this reverse perception of happiness, that if we work hard and long, then happiness will come. It's exactly the opposite from what positive psychology teaches us, that if we're not happy at the baseline, we will not be happy no matter how hard and how long we work, right, and how much we win. So we as physicians have this psychology of iron dock or iron dock culture. So medical training encouraged self deprivation, toughness, suppression of emotion, because everyone who is weak perceived that they're out, they should not be treated as equal. And this culture of iron duck should also be stigma. The stigma about mental health. Look, not like the majority of people. If you ask the majority of physicians would say they will not even dare to seek help for provider burnout, even not even consider seeking help.         

00:37:49 Dr. Chamoun: Why? Because the majority of states have this when you renew a license, the state board will ask you to pry into your past medical and mental history. And if people answer yes on one of those questions about past medical history or psychiatric history, god forbid anybody had illness related to even postpartum depression, even 30 years ago. Some states ask about that. Have you ever had any history of mental illness? Can you believe that? And if a person answers yes, they will ask. To provide every single name of a provider that treated you and they will contact those providers, they will start digging into those things and may delay or deny people getting license or renewing license. So those things should be changed because not only this is in my opinion not only in my opinion violation of HIPAA rights, but also it becomes almost an occupational hazard for physicians because people delay their mental health treatment because of this, because of fear of their own medical boards. And it was even determined that this may be one of the detrimental things to increase physicians suicide.         

00:39:24 Maya: Oh, my. This is just so much that you've covered that makes sense why physicians and really health professionals feel burned out, something that you touched on previously when it comes to substance abuse. Also, same thing. What is a safe place for a health professional to go to without being outed exposed or having that risk of losing their license? That's one that you touched on. And also just mental health, same thing. How can you feel safe without somebody exposing something that should be very private and you should have the right to ask for this help without having consequences. 

00:40:03 Dr. Chamoun: Let me just answer about the effective strategies in preventing and mitigating burnout because it would be also answering your next question if we still have time, because it will cover all of our questions and answers for our listeners how to deal with it. The most important thing is how to deal with it.         

00:40:31 Maya: That's right. And I want to say that before you proceed, Dr. Chamoun, in defense of our health professionals, we're having this conversation to raise awareness of what our professionals are going through, our health professionals. So we're having this conversation without pointing fingers. I think it's clear that it's a systemic problem and that change has to happen. But we're not here to criticize or attack our physicians. Simply what you're doing is you're going to provide these excellent resources and strategies and ways that you support your colleagues and I think it'll hopefully start to change how we as patients interact with our health professionals as well.

00:41:16 Dr. Chamoun: Maya, absolutely. On the contrary, I am here to provide every bit of support I can for my fellow physicians because I think that the problem is widespread. People are suffering and this is a real problem. Actually, our own US surgeon General Vivek Murthy said it and there is a written statement about it. He said the health of the nation depends on the health of the workforce, health workforce. And we have to do something about it. Something needs to be done. We must take action. That's exactly coordinating his words. And the American Medical Association actually issued a whole bunch of toolkits, and manuals on how to deal with physician and other provider burnout. So it's not a secret for anybody that we have to work on it together collectively. And mental health has to be destigmatized in our medical society. And research on relationship between high sense of control and ability to handle high workload in industrial psychology shows the relationship between the sense of control and ability to handle high workload is direct, meaning that even if people have very high workload but they're in control, they tend to handle those workloads relatively well, or rather well. So if physicians are at the table and have a place at the discussion and place in their environment where they can be heard, their voice can be heard, they're not just told what to do, right? The administrators just are not directing them, do this, do that. But they're brought to the discussion table and they have a voice. Or there is the Institute of Chief Wellness Officer that is very much advocated for now, who advocates for physicians and brings them to the discussion table. So physicians participate in making their everyday life better. It really matters.       

00:43:54 Dr. Chamoun: So there are so many players in fixing providers and physician burnout starting from communities and healthcare technology companies and federal, state and local governments and health insurers and academic bodies and accreditation, et cetera. But the main focus that we have control and can address now are workplaces, physicians and trainees, us, ourselves and our family members actually. So the bottom line is that we have to take control over things that we can control and we should not worry now about things that we have no control over. So the goals when we think conceptually about carbon burnout, conceptually, we need to lower the drain and improve our ability to recharge. Now, we're talking about the human being, about you and me, experience and potential burnout. So how do we curb it, lower the drain of energy and improve our ability to recharge. So our mental health is a continuum. So we should avoid languishing and spiraling down in terms of our energy.         

00:45:27 Maya: So changing that physician culture that I was talking about takes time. It will take time. It needs to be triggered, it needs a couple of generations maybe to get rid of the Iron Duck culture. But I see that lifestyle medicine interest groups within medical schools and lifestyle medicine groups within medical schools and curriculum, they're already engaging, they're already doing that. They are aware that something needs to be done. But what we can do immediately is to change the work environment. We can take some immediate steps and we can change some personal mindset and behaviors and we can change some home environments that need to take immediate steps. So in order to change workplaces, it's important to voice, as I said, your concerns. A physician should voice their concerns, try to do everything possible to destigmatize mental health at their own workplace, okay? And it usually starts with leadership. Leadership should lead the way to the stigmatization of mental health so that it will make changes to that immediate mile and work environment.         

00:46:46 Dr. Chamoun: But also physicians need to have a voice to change workloads in their schedules, okay, that will change the work environment in a better way for them, so the administrators know that workload is not amenable for them, the schedule needs to be worked, that they can tweak their schedule. They have control. Remember, the lack of control is the main reason they have burnout. So they need some control over their schedule, so that bringing them to the discussion table is important. And also what's important is to measure and follow burnout metrics. You know how hospitals follow metrics there, how many surgeries they do per year, what's patient satisfaction? If every institution measures and follows burnout metrics and does something accordingly, then it will improve the situation and stress the importance of dialogue and importance of physicians being in leading roles of the organizations like the Chief Wellness Officer. 

00:47:58 Dr. Chamoun: But as far as the personal techniques, et cetera, the current research on burnout prevention management emphasizes practicing creative hobbies. Creative hobbies? Not just any hobbies, like art music, playing band music with somebody, creating poetry, journaling, practicing mindfulness meditation, positive psychology, and just frankly, finding joy without purpose and using multiple senses daily, like your eyes, your ears, listening to birds, looking at flowers, smelling some pleasant smells, tasting variety of pleasant foods, et cetera. And as far as physician culture changes, to be a physician is still a privilege. But however, medicine is a team, work is not individualistic. And physicians have to remember that. And they don't have to bestow suffering, and they are highly creative by nature, but they can use those traits to improve teamwork and leadership. So they don't have to say that, don't tell me anything, I know the best.         

00:49:18 Dr. Chamoun: And they can eliminate those biases of medical training to thrive. And for those teams, the teams that surround them, to thrive, so they can say, I'm not better than everybody, I'm a part of this amazing team. I can listen to the opinions of my team members and I can step down if I am tired or become unfit, right? And I welcome suggestions from my team. So, medicine should promote and reward creativity.         

00:49:49 Maya: I hope a lot of people hear this content. And I'm so glad to know that you're lecturing and educating at a broader level, because these strategies that you just have given us make sense in terms of how we can support our health professionals. Having a voice, being in a place where they have more of a say so, like you said, like chief officer of different things, changing that home environment, being able to recharge through creative ways as well, like playing the guitar or dancing. I know yoga does wonders for my husband. So all these strategies are such wonderful solutions to help harness that energy that our physicians are kind of feeling depleted of in many ways. What can we as patients do to support our physicians?        

00:50:47 Dr. Chamoun: Oh, boy, it's such a wonderful, such a wonderful question. I was a guest on another podcast recently, and the podcast host said, it never occurred to me to be nice to my doctor until I told her about the degree and the reasons behind physician burnout. So it was eye opening for her to learn how much silent suffering so many physicians and other healthcare providers go through while staying actually fully committed to their patients and their profession. And the Hippocratic oath.         

00:51:25 Dr. Chamoun: I was at this conference on physician burnout by the American Medical Association most recently. Actually, it was not even a conference. It was like a webinar. And the Surgeon General of the United States, Dr. Vivek Murthy, said, after all, can you think how many professions out there can say that they would readily cancel every single plan if their client needs something now? And the doctor always does that. We can't cancel dinners. We cancel going out, theater performances, vacations, children, graduations, birthdays, sometimes our babies birth men, of course, cancel being with their wives and all of that because utter dedication to one thing care to our patients. And when a system, a government, a country puts in consistent jeopardy fails, a workforce that essentially throws itself to battle pandemics, the workforce that overworks contracts, diseases, even dies, and does it over and over again without giving these people any recognition, it's kind of disheartening, right? I think that patients should be nice to their doctors and other medical professionals, remembering that behind every doctor is a human, is a human being.         

00:52:58 Dr. Chamoun: The doctors are human. They have hearts and feelings as simple as that. And they also get tired, right? And exhausted. And they have families and dying moms and wives and husbands with cancers, God forbid. But they never leave their patients. They never leave before they finish everything that they have to finish, because of who they are, because of what we signed up for and what we went to medical school for. And a simple, "Hi, doc, how are you doing?" Just look in the eye and how is your family? How's your wife? And bring a simple Christmas card. Thank them for their efforts. Can go a long, long way.         

00:53:49 Maya: This is beautiful. I already have ideas of how I can enter a physician's office and be different just with this mindset of considering even from the moment I see a receptionist, right, until I sit down at the doctor's office, I can have a different perspective on how I interact with everyone there. 

00:54:15 Dr. Chamoun: Thank you, Maya. Thank you.         

00:54:15 Maya: I get used to the lifestyle that I have with a surgeon that I've never realized just became the norm. Dr. Chamoun, you're also married to a cardiologist. You're married to another practitioner as well. So in the sense you're aware of this lifestyle, and then as someone that is not in medicine like myself, but married to someone who is, I see these things. I can't tell you how many times in the last two weeks I've gotten a call from a tech in the surgery room saying Dr. Bukari won't be home for dinner. No wonder it's 07:00 p.m. And I haven't heard from him. Sometimes I am a little worried, but how demanding physicians jobs can be. No matter what field you're in, it can be that demanding and stressful and I agree. I remember being at the opera and the husband saying I'm not going to be able to make it, go ahead with the girls. So there are a lot of missed opportunities, a lot of traveling that we can't do as a result of the obligations. And never once do either one of us complain about it, it's...

00:55:27 Dr. Chamoun: It's all worth it. It's all worth it. 

00:55:30 Maya: Why he's here. And so I'm glad that lifestyle medicine has been able to do something to sort of change that conversation and the journey that the health professional is experiencing. We touched a little bit about female physicians, Dr. Chamoun. Some of those challenges that they experience with burnout and mental health I'm just thinking of again, we talked about the tremendous burden that women in general have. Is there anything else we'd like to touch on in terms of female physicians?         

00:56:08 Dr. Chamoun: It's all the same. Female physicians have more percentage of self reported burnout than males and more percentage of suicidal thoughts Maya than their male counterparts, especially in their early to mid career. It kind of evens out later on, but early to mid, yeah, we are more vulnerable for whatever reason it is. There are theories why that's the case, but most of us who work in this field agree that most likely it reflects a multifactorial problem with women in medicine in general. So women physicians traditionally experience gender gaps in pain career advancement. No matter at what stage of their career, they're underrepresented in leadership roles. That takes away a platform to express their concerns and work more effectively in solving problems at work and not infrequently. Females are subject to sexual or gender discrimination in all forms and kinds. And women physicians frankly have to carry on with their house and family responsibilities outside work, as we mentioned already, and often our caretakers of their kids as well as parents. That also places an enormous stress burden on them.         

00:57:37 Dr. Chamoun: On the other hand, the good thing is female physicians statistically are more willing to seek and get help for mental health problems and more willing to vent their problems with their colleagues and male counterparts. So that's a good thing. And as far as lifestyle medicine goes, lifestyle medicine is very simple. It actually kind of takes you all the way back to the basics and it's absolutely grounded in science and very rooted in science. So it's essentially pillars of lifestyle medicine meaning just plant based nutrition as medicine, not instead, maybe in addition to if people need pills or procedures, nobody's going to take it away from them, obviously. But if it can be substituted for nutrition and at some point, blood pressure normalizes and some of the pills can be deprecated. It's most welcome to do that or for instance, weight drops. And some of the medications, even for weight loss like Ozampic, can go at some point. It's most welcome. Or now, there are scientific statements that the College of Lifestyle Medicine issued last year, for instance, together with American Diabetic Association and the College of Endocrinology on reversal of diabetes with nutrition only.         

00:59:19 Dr. Chamoun: In the past, we only thought of diabetes and nutrition as prevention, preventive measure. Now they prove that diabetes can be type two diabetes I'm talking about can be reversed with nutrition, with diet alone, without any other medications or procedures. So imagine all those millions of patients we're dealing with on a daily basis who take these piles of medications, how much they can benefit from proper nutrition from exercise, from stress reduction, from sleep, from social connectedness, and all of those simple but effective measures or pillars of lifestyle. Minnesota, they actually really take care of almost 85% of chronic diseases, if you think about it, prevention, treatment and reversal.  And they work for burnout as well, because they help you to reach your personal best health. And what is not ideal. It's not more ideal in burnout reduction than reaching one's personal best health and open horizons, than stopping drinking, for instance, or using alcohol or some other medications at home for self medicating stress at work and instead learning how to do all of this mindfulness and meditation instead. And the increase in social connectedness and joining clubs and doing sports. Right, right.        

01:01:05 Maya: Absolutely. I mean, this is wonderful. The alternative is just the quality of life improves, your longevity improves. You have this revived sense of what you're doing when it comes to working with patients and also the other physicians taking care of themselves, patients taking care of themselves and being more compliant when they see that the pillars of lifestyle medicine are really effective and better. 

01:01:35 Dr. Chamoun: Completely universal. Maya. Lifestyle medicine is completely universal whether you practice it or you apply it in your own life. And in fact, multiple studies show that physicians who practice it and use pillars in their own life are very happy and much less stressed out at work and life in general. And their patients are very happy and their patients are engaged and happy and healthy and stay out of the hospital and don't get readmitted, et cetera, et cetera. Use a minimal amount of medications. 

01:02:07 M: Yeah, that's the new model in the future, like you say, it might take a couple of generations, but the new model is pricing.

01:02:15 Dr. Chamoun: I hope not. I hope it will happen.       And, you know, there are some initiatives. Now the American College of Lifestyle Medicine partnered with New York City, the city of New York, actually, because Mayor Eric Adams is very enthusiastic about this and he asked every practitioner in the city of New York to get educated on basics of lifestyle medicine. And now they're getting every single practitioner, not only physician, nurses, MPs, PAs, et cetera, et cetera, and human health insurance company, the same thing, every single practitioner within human health. So we hope this is just the start of a big, big movement to save health, save money, save the population, save America.         

01:03:06 Maya: Yes. And we should add that all of this information, you touched on it earlier, but this information is becoming available in medical schools as well as more students are asking for this information nutrition, exercise and all of that. So ACLM is now supporting those medical students who want the education as well through the Hill Initiative and other programs. So I'm just excited for the future doctors that maybe can prevent burnout in their careers. 

01:03:39 Dr. Chamoun: Absolutely. Surely, slowly but surely, more and more programs add culinary curricula and lifestyle medicine curricula to their programs, medical schools and nursing schools, et cetera.         

01:03:54 Maya: And I didn't ask the details of your program because you said it's for health professionals, but it's open to the public. When do you plan on implementing the program? Is it in place already? What are the details of all of that? 

01:04:10 Dr. Chamoun: Look, CardioSeeds is a functional company. So we opened CardioSeeds almost a year ago. So CardioSeeds is a small company that's on the outskirts of Philadelphia. We are fully digital. We are online. We offer people lifestyle interventions programs and behavioral coaching for cardiovascular risk reduction and behavioral coaching for stress stress reduction, cardiovascular risk reduction. And now for burnout, whether they are patients, whether they are physicians or other healthcare providers. And I worked on putting together my own proprietary program. It's about to be trademarked pretty soon, within this week actually coming to the end fruits of my labor. It will be called reclaim CardioSeeds. Like reclaim your life and health kind of. And there will be different programs within one under the same umbrella. So why different programs? They will be using the same tools, but they will be tailored whether to the general population, the general population, or providers. So there will be slightly differently averse and use the same tools of lifestyle medicine intervention and behavioral coaching. And some advocacy also for when it comes to providers. It will be advocacy for them as well included into programs. And also there will be a different duration, of course. And we decided to make sure that nobody will be left out because we noticed that some of those programs are quite expensive out there. So we decided to make sure that people who don't make much, maybe their salaries are prohibitive from really entering a full program. They can get at least some introductory programs and maybe even free information.       

01:06:19 Maya: Yes. I just think that even sponsoring our physicians to go through a program like yours or your program in general would be a beautiful gift just because a lot of times our physicians don't have the time to research what is available to support them. 

01:06:44 Dr. Chamoun: We are also I don't want to spoil it. I am given lots of volunteering, lots of my time to give talks to the members of American College of Lifestyle Medicine on burnout. Also to the general public and as students, medical students, nursing students on both lifestyle interventions and burnout prevention. And also, I am actually going to launch a series of physical products that... I don't want to spoil things, but it's going to be a series of interactive things that will help us to learn lifestyle medicine and prevent burnout as well. So this ought to come next year, in 2024. 

01:07:40 Maya: Wow. I can't wait to hear what all you have in store. This is cool. 

01:07:40 Dr. Chamoun: I hope you will enjoy it. I will give it to you and your husband to plain give me good, honest feedback. 

01:07:54 Maya: Wonderful. Anything that we can do to help you in your mission--   

01:08:03 Dr. Chamoun: To help you. 

01:08:02 Maya: That's true. Is there anything else that we could have touched on? I know that we had lots of questions, but I want to respect your time as well. Is there anything else you'd like my listeners to know?

01:08:16 Dr. Chamoun: I think that to wrap it up, we probably have to mention that looking ahead, we have wonderful trends now the fact that physician and healthcare professional burnout in general is finally recognized on the highest level of the government and the US Surgeon General is talking about. It is just wonderful that all the professional medical and surgical association societies that talk about it are wonderful. And documents are published. So one should follow the American Medical Association recovery plan for Americans Physician burnout reduction. If one is interested. There are many dedicated people out there, including myself. But not only there are thought leaders in this industry, including Dr. Robert Pearl, Dr. Mardin McCarry, Christine Sinsky, Ted Shannofeld, John Fisher, whom I'm going to interview next week on my podcast, CardioSeeds Podcast is actually also there where we talk about burnout prevention a lot. And yeah, so if one feels very strong and one is a medical provider, we welcome everyone to join the American College of Lifestyle Medicine and join the movement of lifestyle medicine in the United States and around the world. The more people, the merrier. So we can use the tools in our everyday practice for our dear patients and for our own health and wellness as medical professionals. 

01:09:59 Maya: Yes, absolutely. Thank you so much for all of this.  And what is the best way for my listeners to learn more about you and your program, your podcast as well.       

01:10:10 Dr. Chamoun: Sure. So my website is www.cardioseeds.com. My podcast CardioSeeds is on every single platform that hosts podcasts. I am on LinkedIn under Svetlana Chamoun, MD. And I'm on Facebook. Also either Svetlana Chamoun or CardioSeeds. I have both pages and on Instagram under Cardioseeds.         

01:10:40 Maya: Wonderful. Yes. Well, Dr. Chamoun, this has been so significant and so important that you were here to share this information that's valuable to us and it's going to benefit a lot of our professionals. And so I just really want to thank you for putting together all this information and resources so that we can do the best that we can to support our doctors and again, all our health professionals. So I just want to thank you so much for your time. 

01:11:07 Dr. Chamoun: Maya, thank you so much for inviting me today. It was a pleasure.        

01:11:11 Maya: You've been listening to the Healthy Lifestyle Solutions Podcast with your host, Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave an honest review as well@ratethispodcast.com/HLS this helps us to spread our message. And as always, thank you for being a listener.