So this is Dr. Ajay Kekne, who really doesn't need an introduction, but he's the director of Columbia Interventional Cardiology, playing the guitar, actually, and he and Dr. Stefan are at a meeting. Thanks so much for having me be part of this, and I think that the title of my talk is really talking about work and life separation, and personal separation from work, and whether that's possible, whether it's desirable, how do we do it. And so I figured we'd start with two votes. So the first vote is going to be, and just so you can do this to yourself, think about it, is personal and professional life separation important? And I would dare say that pretty much everybody would look at that question and say, yes, it's obviously important to separate our personal lives from our professional lives. But the second vote is, is personal and professional life separation possible as a practicing, busy clinician, interventionalist? Is it something that we can ever even try to accomplish? And I think this discordance between these answers, because the first one, everybody would say, yes, it's important, the second one, say, no, we can't really do this, is the crux of what can get to a lot of what we've heard the prior speakers talking about is burnout. And hopefully, through this talk, you'll sort of hear my philosophy on a way of combating it. I don't think I have a solution or anything like that, but just some observations about myself, about our careers, and what it is as an interventionalist. I think most people know this guy, Jeff Hartzler. It's interesting, many trainees coming out, when you show pictures of Grunzig, Hartzler, et cetera, they may have heard the names, but they don't really know who they were, what they stood for, what they were like. But really, first, primary angioplasty and acute myocardial infarction is what he's known for. But the other thing that most people don't know that he was known for was that he really was, at the time when balloon angioplasty came out, the sort of best operator, in a sense, for these types of cases. So basically, everyone's failed cases got sent to Jeff Hartzler, and he would have to do them. He'd have to line up and do them. And remember, there's no stents, so abrupt closure's happening, all kinds of stuff is happening. And what people don't really know about him, and I only learned this because Marty Leon told me, was that he had an untimely demise, it was tragic, but this wasn't related to that. But at the end of his career, when he was getting all these films, he basically couldn't look at the films in advance of the day he was going to do the cases. Because if he looked at the films, he would think about all the bad stuff that was going to happen. And to Peter's point about these high-risk cases and the stress level and all that, it just was something he couldn't do. And as a result, he just shut it out from his own life, because otherwise it would have ruined his own personal life. And so I think what we do as clinicians is not, we shouldn't be doing that to that extreme, and certainly we want to avoid those situations that Peter talked about. But one of the things that we do pretty well, and we're kind of trained to do without formal training, is to compartmentalize. So we kind of see some horrible thing happen or bad news or a really busy day, and we kind of deal with that at work, and we're really good at shutting that out and then going about our way with the rest of the things we have to do. And I think I remember this vividly from being a med student, and nobody ever told me that this is what we should do. It just seemed like the obvious way to deal with bad stuff going on, because how the heck else could I confront it? And so we're often just do this by observation, and we're kind of taught how to tell patients about bad news, but we're not taught about how to react to it ourselves very frequently. And so we kind of learn this behavior from observing those around us. And the question is, does that mean that we do it right? Is this the right way to do it? And certainly, is this the best way to train trainees and to sort of just say, just watch what I do, and you figure it out whether that's good or bad for you, isn't it all? So I think it takes a lot of self-reflection to kind of think about, is it good for us and does it work for me personally? And I kind of learned this serendipitously in the pandemic. We heard Dawn talk about a little bit how the pandemic left some time for reflection, etc. But one of the funny stories that happened to me in the pandemic is that I still remember that first day where I converted my entire clinic to telehealth. And so I did it at home. My two kids are teenagers, they're in high school, they're at home. My wife is home. And I went upstairs and I did my whole telehealth, I have like a standing desk with a treadmill underneath it. I wasn't on a treadmill, but I did my telehealth. And you know, I was tired because I'd never done this before, like 20-something patients in telehealth. And I come downstairs and at the bottom of the stairs, like as I'm coming down, I vividly remember my wife, my daughter and my son, and they're all looking at me with their mouth like wide open. I'm like, what's going on? Why are you staring at me that way? And they're like, you're so nice. Because they had never heard me be that way when I'm talking about the hospital, because I'm always on the phone, like, you know, grumbling about something, this, that, and the other. The other part, so when we started talking about that a little bit at home, because I started laughing, was that I realized is that this is me in the cath lab, this is during a live case. And this is kind of standard interventional position, we're all sort of standing around. Nobody's making eye contact with anybody else. And we're kind of just like barking out orders, like, I'll have a 2-5 this, I'll have a rotoblader, call for the this, call for that, but nobody ever, ever in the cath lab makes eye contact. And when I was talking about this other thing about the clinic with my wife, she said, like, while we're at it, like, you do realize that, like, when you're home, you just kind of like shout stuff into the air, asking people to get you stuff or whatever, and you never really ever look at us. And I'm like, you know, that makes sense, because that's what I do every day in the cath lab. So you start learning by thinking, and then we start realizing that these are completely like maladaptive behaviors for interpersonal interaction. And so we got to get better at that. Now, what's interesting is that there have been calls by various, not just societies, but people in our field as a way of combating burnout, that what we need to do is change how we think about professionalism. So this was a paper in JAMA about 10 years ago, where they talked about to make the transition from a pejorative, nostalgic, to a new type of professionalism, because nostalgic professionalism is not good. We have to adopt something, especially in residency training or otherwise, where the team-based model is used, where there's no ownership of any patient individually, but it's shared among a group of team members. And they use examples of the airline industry, the police force, where people are on shifts, and then they're off. They're on, and then they're off. And they actually used in this paper examples like going home and checking labs as not good behavior because it just leads to burnout. But the thing that's crazy is, is that really possible? The whole definition of caring for somebody is you actually care. So when somebody goes home, when I go home and I'm looking for some lab value, I can't just shut that off. I have to think about it. And to sort of subvert that to some other person and me not even think about it, I actually think becomes even worse in some respects. So I don't think that that's actually possible to do. It's just how do we manage it so it doesn't overcome our daily life? So that was my gestalt. I didn't know if I was right or wrong. So I decided to do what my patients do, and I went to Dr. Google, and I asked, separating work and professional life. And so here are the first two topics that came up. So this was an article here that said, there are real benefits to separating our work and personal lives. The next one, finding enough time in the week to both carve out meaningful home experiences and complete work assignments seems to leave both depleted. And keeping work and life separate is actually more trouble than it's worth. So like anything, conflicting, 180 degrees conflicting advice on Google. So I started reading some of these articles, and what resonated with me was this. And that is that if you really try to separate things entirely and do this transition between your cognitive roles, that actually can cause more stress. Because you want, originally, you think in an idealistic way, I want to create boundaries. But if I do that, it's actually those transitions. When I'm with my family and I get a phone call, that's the worst possible thing. I get more stressed out unless I sort of accept the fact that as a physician, I'm going to be on call and patients are going to be calling me for things when they're sick, or my family members are going to be calling me instead of resenting my family members for calling me for medical problems because they don't have anyone else to call. And so the idea here was instead of leaving work at the office and home at the door, if there's a way to integrate both of those in a healthy way, not in a way where it takes over your life, that might be a better strategy. And so for me, this has involved actually leaning into the things that matter to me. So this is my daughter, she's giving a graduation speech. This is my son, he's still in college, he's playing the drums. This is my wife and my dog. And yeah, my dog can't necessarily know what I do at work, but I talk to my kids and my wife about the calls I'm getting. If I get a phone call from the office or from somebody afterwards, I don't just hang up the phone and go back to doing what I'm doing. I actually explain to them what the call was about. And the same way is at work, I actually talk about my wife, my kids and my dog to my colleagues. And the reason I do that is to try to minimize the separation between the two, because I'm the same person wherever I am, and these are part of me. This is my life. And so if I share that with everybody, then I think that that's a more adaptive way of doing things. The other reason I do it deliberately is because as the section head of interventional cardiology, there's this hesitancy on the part of junior faculty fellows and others to talk about their own lives, because we just don't do that in medicine, do we? We just work. And by me sharing these things, that encourages them to think that this is okay. It also encourages them to talk about their own lives, and as a result, we're all far richer because we actually experience everybody in every different way. It's also made me a better doctor. I think that this is a slide I like to show when we talk about, as physicians, what we do when we prescribe medicines or talk about procedures. As a physician, we pretty frequently write a prescription and say, hey, just take these medicines and it's going to be great, because I know how to treat your hypertension. But most physicians don't recognize the fact that when we write a prescription, only two out of three patients fill that prescription. And of those that fill it, only two out of three of those take it as prescribed. So that's a 50% hit rate. And the reason is, is because we just write the prescription and we say, hey, you're going to listen, it's fine, and we don't realize that from the patient's perspective, this is what they're thinking. Do I really need to take another pill for life or something that I don't even feel? And we have to bridge that gap, and the way we bridge that gap is by being human with our patients and connecting with them in ways that don't necessarily involve medicine, even. You just talk to people like they're people, and by being more human that way, that's also how you get back to that anti-burnout sort of tonic, which is the humanistic parts of medicine as a whole. Don't just take my word for it. These are other doctors who are actually well-known to Sky and others. Just quotes that we had from our complications course in Seattle, Alex Truesdell, we're always on. Jared Feazell, home makes me a better doctor, because I bring that to home. And then this is a text message from one of my colleagues, Megha Prasad, who had an unfortunate death in her family, and I asked her about a work-life balance talk, and she said, my two cents are choosing the right people to work with, which goes a long way. My support, Margaret McIntyre, who's our cath lab director of support, as she heard the news yesterday, and in general, as I navigate family life with work, makes all the difference. The environment you all have created has made work also enjoyable and fulfilling, so it's integrated into life. I didn't tell her to write this. She wrote this. So I think working with and for the right people is a critical way to achieve balance that there is one. Thank you. For me, this is a clip of my family. This is my wife, my son, me, my daughter, my brother, my cousin, we're playing music at a wedding. This is the type of stuff I like to do. I share it with folks at work, maybe too much, so I'm not going to play you the clip, because you already saw a clip before, but this is us. We're an Indian American family. We are dressed in full Indian garb for a wedding, and we're playing a Frankie Valli song. That's who I am. I don't want to talk about my Indian American heritage in the hospital, instead of, when I was a kid, basically being totally embarrassed of my mom wearing a sari because I was just an American kid, but then I realized I'm actually brown, I'm actually Indian. We should lean into these things, and so for me, it's totally profiting that we're dressed like this and yet playing American show tunes. So some final musings of this talk, remember, you're physicians or clinicians, you're not a provider. To me, the word provider is complete BS, and maybe I'm seeming old by saying that, because I know many people have adopted it, but I don't provide a service. I actually care for patients, and it's a true privilege to do what we do, and if I lose that feeling that it's a privilege, then I need to actually do what Don talked about, is find some other way to get back to being a clinician and someone who actually cares for patients. There's no question, as Peter said, that when you're doing a case, you don't want to be distracted with the humane element of the patient in front of you, because it's going to make you freeze. So we're more efficient, focused, and present when we separate and compartmentalize activities, either professional or personal. We can just get the job done that way, and distraction is going to be an enemy, but we need to come out of that so as to realize our humanity, and it's virtually impossible to separate our professional entity as physicians from our personal life, and in the case of a physician, vice versa. I just say, in closing, it's far easier fulfilling and human to be consistent across all of our various roles. I'll share this with you. This is by Arthur Brooks. He is sort of a self-help-ish guru of a sense, and there's five acts you can do each day to make yourself feel better. Help other people out by serving them tea, smiling at yourself in the mirror, changing your places with somebody who you might not like so as to understand where they're coming from, and then let things go. If you're interested in more stuff like that, there's a ton of information out there, books you can read and beyond, and this is just a plug for him going to be at TCT, and he'll be speaking about these types of things, and we deliberately picked this type of topic for a keynote address, for instance, as opposed to other meetings where you may get politicians and other people like that, because I think this is a really important thing to talk about, how we can get back to the humanness of what we do, irrespective of our profession. I hope that was helpful, and happy to take any questions at this time. That's awesome. Thanks a lot, Ajay. I'm going to ask Islam, who is on the wellness committee at SC&I, a little bit about the data that was sent out to SC&I members on cath lab-related injuries and the wellness aspects that people follow. Maybe you can quickly share in a minute or two the highlights of that data. I just wanted people to know that there is that aspect to the cath lab as well. Of course. So the biggest findings we found on this survey was that it actually is very similar to the 2004 and 2014 survey, 2013 survey, sorry, 14. And then the 2023 survey essentially emphasized that we haven't really made any progress in terms of the amount of stress that physicians are under. So for example, the orthopedic injury rates are, if anything, slightly higher, not statistically higher, but they are significantly higher than the general population. So you have cervical spine, lumbar, knee, and hip. And they're very destructive to us as an interventional cardiologist. No other career, no other job allows people to be in such risk of injury as interventional cardiology that I could find. And I've actually, we've looked up the data. So other specialties such as orthopedics and interventional radiology have similar rates, but ours tend to be really considerably higher in some aspects. By the way, that includes the full spectrum of injury, cataracts, malignancy, skin injury, renal injury, and so on. So we tend to minimize this. I think Dr. Lombardi's talk in the most recent Sky meeting in March really emphasized that. We tend to be very motivated as a specialty. We are, I wouldn't say aggressive, but we certainly tend to, at the cost of our own selves and wellbeing, tend to push ourselves. And there's a cost to that. We are human. I know some of us deny it, but we are. So what the survey also described is that we're doing more cases now. Going back to Don's talk, we do more cases now. We are actually busier than we've ever been. The structural rates have gone up. The coronary rates have gone up. The only thing that's really gone down somewhat has been the peripheral interventions. Having said that, we do more cases, but we don't have better protection. The rates of adoption to radiation protection equipment, orthopedic mitigation equipment, and so on, has not improved hardly at all. In fact, not at all. And that is also telling. So there's a lot we can do for ourselves, but we also will need the help from each other, from the society. I hope that answers the question. That's great. I'll also ask Dr. Subha Iqbal, from a female interventional cardiologist and being a wonderful operator and just a sky leader as well, just to, you know, whatever take, what's your take on Dr. Ketanai's talk? Anything that you want to stress on and just kind of share with us? You're muted. You're muted. Some of my thoughts that came from everyone's talk. One thing that's highlighted throughout this that I just, we don't have a lot of time, so I'll just say, I was taught very early on, we're happiest when we can focus on one thing at a time. So that's probably why we all love interventional and cath, because when we're in there, you can't think about the administrator, the in-basket, you know, I wish our patients could fall asleep a little bit more because they're actually and so they're asking me what I'm doing at every step, which I would love to stop. But other than that, happiness is when we can focus on one thing at a time. I think that's just something to think about. As you juggle, we have to juggle, like you said, as a woman, you know, female, we have home and family, which I think everyone is still, is really incorporating in their life. I have, you know, administrative and leadership responsibilities, but when I'm in the cath lab, I try to focus on the work that I'm doing. But when I'm in the cath lab, I try to focus just in the cath lab. And when I realize that I'm unhappy that I'm in the cath lab, it's usually because I have a hundred things on my to-do list. So, you know, all the things that we talked about, you have to enjoy when you're in the cath lab and then figure out boundaries around the side. And yeah, I'm all about being human and enjoying the little things and talking about it. You know, I got to stay with my daughter for breakfast and make her lunch this morning. And everyone heard that today because I had a meeting canceled in the morning. And I think that's what we need to do is relish those moments, talk about them, make it part of who we are. Awesome. I know this topic is extremely important. We have at least, we have close to 300 members watching this live on social media. It's great to see you all and hopefully I'll see you all soon in person and we'll celebrate Dr. Naidu's birthday. But in the interest of time, we'll have one last comment from each one of you. Just share what keeps you well, what keeps you active, what keeps you going. And, you know, a quick suggestion for the fellows and early carriers to be successful in their careers like everyone here is. So we can start with Islam, you're first on my screen. Thank you. So I just wanted to say that I definitely resonated with both Peter's and Dawn's talk. The trouble we have is that we tend to not know how to say no and surrounding yourself with good people really mitigates the risk of burnout. At one point I was building programs, teaching, publishing and involved in leadership in excess of 60, 70 hours a week and then work on nights and weekends, two or three weeks in a row to the point where I couldn't say no. I just didn't know how to say no. So unbeknownst to me, my administrator would actually intercept my emails and email back nos, a lot of them. And I wouldn't even know about it till much later. So I'm very grateful for people like that. Surrounding yourself with people like that, surrounding yourself with colleagues that you can talk to, especially after a complication, especially after an incident is invaluable. And we tend to have the unfortunate tendency of diluting ourselves into a zone of dilution, as Peter mentioned, so that sleep deprivation and hard work becomes almost the rule. Sleep deprivation is not much different than working under the influence. And if it's not okay to drive under the influence or certainly do anything important under the influence, it's not okay to practice medicine in that fashion. So it's not only damaging to us, it certainly is, it's damaging to the people around us. So thank you for putting this together. Sano? I think one of the things that drives me the most is I look at my daughter, who's five, and I ask myself, if she were me and I was my mother, what are the things I would say to her? What's the kind of life I would like her to live? And I try to emulate that and kind of be that role model for her. I want her to be happy, I want her to be successful, but I also want her to be satisfied with all the things and continue to be curious and adventurous. And if that's what I want her to have and do, I have to model that behavior. So that really drives me a lot in my day-to-day decisions about life, work, and wellness. That's great. Hadi? Yeah, so I think, honestly- Oh, sorry, Hadi, shut up. Oh, sorry. Whoa, sorry, Hadi, go ahead. That's right. So I think, honestly, obviously, we're all got to this point in our lives because we're, in some way, perfectionists and we really wanna please people, we're compassionate, and we really wanna make everybody happy, but obviously something is gonna have to give. And the light at the end of the tunnel is that there is hope in our profession and there's a way to do it. It just takes five to 10% of cutting out in terms of our volume, in terms of procedures, in terms of organization, scene, days worked, that makes all the difference. If you cut out 10% of your work, you're still gonna have the same lifestyle, your family's gonna enjoy you more. And, of course, you won't make the administrator super happy about that target RVU, but there is a fine balance before you get there. And secondly, I think our job is like a fighter jet job we have to be super alert at all times. We have lives in our hands and we're expected to perform absolutely amazing all the time, even if we don't sleep. After a STEMI call, you get a 30 patient clinic day and we're supposed to function normally. So I found that in today's administrative environment, it's hard to kind of really navigate this and find a balance. The only way I thought was gonna be very helpful is all or none technique, meaning taking more days off, pulling yourself out of work as much as you can. And being out of work just doesn't expose you to those questions where you have to say no. And by taking more vacation, even if it's unpaid vacation, I think you can buy yourself your happiness and you're still gonna live the same lifestyle. Awesome, Suha. I'm gonna say two quick things. One is we have all been taught how to be really good at what we do. I think what we need to learn and what I learned later in my career is where we're gonna thrive, what kind of environment we're gonna thrive in. So not just focus on being the best interventionist, but where the cardiologist or whoever you are, but where are you gonna thrive? And the second thing, thinking about complications, is we really need to learn how to forgive ourselves. I had a complication in the cath lab recently and I literally in my head said, I forgive myself. And it was the most refreshing thing I've ever felt. And I would love for everyone to get to that point that you could do that because we're all good intentions and we're trying to do our best. That's a great point. We have a great talk at Bill's course, complications course every year. Peter? I just wanna comment on the concept of saying no, because that's one of the things that became much more important for me over the past several years. And it used to be, you wanna say yes all the time because you felt like you weren't forward in your own career, you weren't being true to yourself, but you let somebody down that asked you to do something that you could do. Or the other side of it, and this is the ego part, is they need me. I mean, they can't do without me. I've gotta go do this. And really neither one of them is true. And I really did learn that. And it's important to keep that in mind. And I really appreciated the takeaway for me here is gonna be Ajay's talk on blending. Because normally we think of this late work-life balance and it's that seesaw diagram that we always see, the picture, one end or the other end. But really it does have to have a little Venn to it there. We have to mix those two somehow. And I really appreciate his thought there of bringing some of the work home, not just they see you doing it, but they understand what you're doing and relate that to the patient that you're taking care of and why you're doing that. And then the same thing at work there, sharing who you are as a person there, I think really builds teams and can give you a lot more job satisfaction and decrease the risk of burnout. So I appreciate this talk, thanks. Awesome, Ajay? Well, one thing, I mean, I guess I can cover that. We didn't really talk about too much and it's a big focus of Sky this year with Tim Hermiller as well, is making sure you take care of your body. And especially with the radiation risks and the orthopedic risks as well. I'm a very active person. I ski avidly, I run, I play tennis and I just had my second back surgery this year. So I think that it's something that we neglect. We think we're invincible. We don't even think about it. Make sure you have a doctor, make sure you're like getting your basic screening and stuff like that. Because that, if you don't have your health, you really deteriorate fast. And when my back was bothering me, I was a totally different person. I was just angry and irritable and all this other stuff. So just something else to think about as well. Dawn? What's that stains be? One of the things that I am learning is setting priorities and identifying what are most important to me. I guess my biggest priority is my faith. Spending that time, prayer, meditation and devotions is pretty important to me. And if I'm working 24 hours a day, I am not spending that time. And it's pretty important to do that because by spending that time, I'm a little bit more grounded and I can take what comes at me. So I can do more when I prioritize myself more. So we have to step back and look at our lives and identify that priority, identify what, where our grounding points are. And we can always go back to the superwoman stage, but you have to spend that time and prioritize. And Hadi. Yeah, I mean, this is a great webinar. There's a lot of take home points. I think people have covered. I think the last thing I'll say is that I think people burn out also, not just because of autonomy issues and support at work, but I think there's a sense that when you're at work, you're working for work and making sure that everybody's happy at work. When you're at home, you're working for your family, making sure everybody at your family's home. But who's making sure you're happy? And so I think there's actually a third bucket, which is how do you make sure that you stay the person that you were? We saw how Ajay does it. I do it by lots of different hobbies and things that were, if I do those things, my mind can disconnect and I can feel I'm who I am. That's why I made the tweet this morning. How do you stay you? So I would encourage people to find what really made them happy in childhood and as I grew up and things that they kind of gave away because there wasn't as much time, but bring some of those things back, like music for Ajay or whatnot. And because that way you feel very grounded in who you are and that's the person your family loved, right? And that's also the person that can share at work and make the environment better. So I do agree with having some personal life at work and having some work and personal life. And I agree with Ajay. I think I've evolved in the same way, which is to make sure everybody's aware of what that is. It's oftentimes hard in family, if they're not in medicine to understand fully, but even the fact that you're trying and they can get a little sense of it makes you feel a little less conflicted in each of those environments. This is great. Thank you all so much. It was wonderful having you all here on this webinar today. And I'll be a miss if I don't say thanks to Jim Vermeuler, Alison DuPont Islam and all Sky staff and members of the wellness committee who've put together these webinars. And so thank you all. And my just takeaway is feel your emotions because it's not wrong to be happy. It's not wrong to be sad or angry or whatever. And then you come back as a happy person at the end of the day. So thank you all. It was awesome. And have a good rest of the week.

work-life balance

burnout

self-care

interventional cardiology

professional fulfillment

personal relationships

holistic wellness