The Lane County Medical Society started offering counseling and mental health care to their doctor members nearly 10 years ago. Those services have been increasingly needed over the last two grueling years. Doctors Benjamin Vasquez, Kevin Modeste, and Priya Carden join us to talk about what they’re hearing from fellow physicians, and what they see looking forward for people working in the medical field.
The following transcript was created by a computer and edited by a volunteer:
Dave Miller: This is Think Out Loud on OPB, I’m Dave miller. The Lane County Medical Society started offering counseling and mental health care to their members about a decade ago, but doctors need more help than ever these days. The relentless pandemic has been a time of high stress and burnout. We wanted to hear more about what doctors are going through, and what help is available for them. I’m joined now by three Lane County physicians who are all members of the Medical Society’s leadership. Dermatologist Benjamin Vasquez is the vice president, primary care doctor Priya Carden is the secretary, and surgeon Kevin Modeste is the president of the Lane County Medical Society. It’s good to have all three of you on Think Out Loud.
Benjamin Vasquez: Thanks for having us.
Priya Carden: Thanks for having us.
Kevin Modeste: Thanks for having us.
Miller: Benjamin Vasquez first, I’m curious broadly what you’ve been hearing from fellow physicians in terms of mental health just over the last two years.
Vasquez: Well I think on the national stage, one of the things that we’ve heard of in all of our communities are the high rates of physicians suicide and burnout, physicians actually taking their own lives, particularly those providers in the ER or in the ICU, but then also physicians just choosing not to practice medicine anymore, I think in all stages of their careers. Some of the people that may be getting close to retirement retired early, there was quite a large number of people in 2020 who did. And I think that left a lot of patients sort of stranded. I had a lot of patients struggling to find a primary care provider during that time, and I think that still is true. But then also physicians earlier in their career, physicians that would normally have probably another 10-15 years in practice, choosing to leave medicine at least temporarily, if not permanently. I think that’s continued to be an issue.
Miller: Priya Carden, you’re a primary care physician. Have you seen an increase in the need for primary care, even regionally around Lane County, because people have left the profession?
Carden: It’s hard to answer. There’s honestly always a primary care shortage, even before the pandemic. That’s a chronic threat, not being able to find a primary care doctor. What I have heard is definitely exactly what Benjamin said, so many primary care providers and physicians as a whole retired early or took a leave because of the stress during the pandemic. Even if they tried working through it, just the stress of working through the pandemic was too much to hold.
Miller: Can you give us a sense for what those particular stressors were for physicians? The variety of them?
Carden: Well, the sheer volume of patients and patient needs is a big component. Another is the uncertainty. We are practicing medicine in a way that some things we have answers to, and other things we know we don’t have answers to. But there were no clear answers to anything when it started. So the pure uncertainty of it, and yet at the same time being to provide answers to our patients is a juxtaposition that’s really hard to stand in, and maintain a sense of clarity. What are we doing, what’s going on?
There’s also the divide among the patients and physicians and healthcare providers in the work environments of what stance do you hold with vaccines? What stance do you hold with masks? What stance do you hold in policy? And that’s a division and a stressor. And there’s also the stress of distrust. Your patients that are asking you your opinion on what you feel is something that you don’t believe in at all. And yet they’re trying to convince you of the opposite of what is healthy for them, and what is not. Having to be their primary care provider is hard when they’re coming to you with questions that you can’t answer, and that you can but they don’t wanna believe the answers.
Miler: Kevin Modeste. I know that you’re a surgeon, how much have the issues that Dr. Cardin was just talking about cropped up in your own professional work, as opposed to conversations you had with physician colleagues?
Modeste: Well in the professional setting, I was lucky to be working in the hospital where they had pretty strict requirements. They would have one or two naysayers, mainly about the masks. A lot of the physicians were on the vaccines, they were okay with getting vaccinated. Patient population was variable.
We also did a lot of acute surgery during the pandemic, we still had to be available to cover acute emergencies. A lot of physicians were a little bit afraid to go down to these acute emergencies. I remember I went down to the trauma. In trauma, you can’t do much, you have to see all these people. And everybody who came into trauma was positive for COVID. So it was a little bit of a stress for some of the physicians.
Miller: Did you have a particular sigh of relief when the vaccine was available to you, given that you had been on the front lines and had no choice but to be around people who were positive for COVID pre-vaccine?
Modeste: You know, there were some people who were afraid, they were like, oh my gosh it’s experimental. I was like in the first line. I basically ran into the room and was like, give me my shot. Because that’s what we do as physicians, our job is to protect the public. Sometimes you have to protect them from themselves. If you look at the history of medicine, physicians have experimented a lot on people, and I’m okay with being an experiment to help people. A lot of us were gung ho, we had a very high vaccination rate, at least the physicians. Some of the ancillary staff, it still took a little while to get them convinced. But I was very proud to watch the amount of physicians running to get their vaccinations.
Miller: Just to be clear, in case people are wondering about what role they played in this, my understanding is that when you were getting your vaccine, this was no longer an experiment. This was when it had gotten emergency approval and had gotten through clinical trials, and people all over the world were getting it.
Modeste: But for a lot of people they were still being considered experimental. When you talk about medicine, we look at 5 or 10 year trials. So even as a physician, it’s something that’s kind of novel. But again, at that point we weren’t sure what was going to happen with this vaccine or what’s gonna happen with the virus. It was already tested and proven, but we were on the forefront. And I was really happy to see a lot of the physicians saying we can do this, we’re gonna be there to show the public that it’s safe. It can be done.
Miller: Benjamin Vasquez, I noted that the Lane County Medical Society has been offering counseling and mental health care to their members for a while now. On your website, there’s a list of a handful of mental health care providers who have some kind of a specialty in helping people who themselves work in health care. Are there enough resources for all the local or regional doctors or other health care professionals who may themselves want help?
Vasquez: That was one of our big agenda items, especially during the 2021 year. We did add two more providers, and tried to expand our services to all of our members. And we actually, for a while, did expand those services to other practitioners, not just physicians, but also to physician assistants and nurse practitioners, just trying to make sure that we were able to reach all those people who may have been struggling in healthcare during the pandemic. So that was a big push that we had last year, trying to offer not only more providers to be available for physicians and other healthcare staff, but also add breadth of services they can offer, as far as if they have a particular focus within mental health, or addiction services, or figuring out careers, especially during this time when maybe people are rethinking whether or not they want to continue in healthcare, maybe they want to branch out.
Miller: Priya Carden, you noted that one of the challenges has been not always, especially early on, having answers to questions when patients were used to actually getting answers from people in your position. It seems like a corollary to that, the idea that people become physicians because they want to help, and that sometimes it may be hard for them to seek help of various kinds themselves. Is that an issue that you run into? That doctors, even those who are struggling, are just not used to reaching out?
Carden: Definitely, yes. Doctors, as a general whole, are not used to reaching out, and kind of tuck issues underneath the carpet, specifically about themselves, and try to work through, push through, and just keep going. I feel like sometimes getting over involved in the work is kind of covering up for dealing with their own emotions and mental health struggles.
Miller: Even if the work is causing some of those struggles?
Carden: Even if the work is causing the struggles. It’s a somewhat universal defense mechanism to pour yourself into the work more when you’re stressed. It’s an interesting battle.
Miller: How do you deal with that?
Carden: Well, a lot of what Benjamin said is checking in with colleagues, both for your own benefit, but also theirs. Sometimes stepping in, taking on their work so that they can get a break. Being able to offload your work. But the main thing is checking in with colleagues, other physicians, who know exactly what shoes you’re wearing right now, and what you’re having to deal with. There’s no need to explain the emotions. It’s just a kind of a warm handoff, which is what we say in some clinics.
Miller: Dr Modeste, we’ve been focusing on the pandemic, but there was also the racial justice uprising after the murder of George Floyd in the summer of 2020. I’m curious how that affected you?
Modeste: Well, that was a difficult question, but it did add, it compounded. I consider myself a physician of color, and I think Priya as well. We felt it added insult to injury. For me, to be honest with you and everybody else on the show, I did have severe depression. As Priya said, you try to reach out to your community, and in this situation, the community that you thought was going to be there wasn’t there. It was hard, the year and a half, two years of that.
Miller: When you say that you reached out to your community and you didn’t feel like the community was there, do you mind explaining further what exactly you mean?
Modeste: Well in the medical community, I had like two members, Priya and myself, we were kind of texting. The last president of LCMS, she’s an ER Physician, and she texted me after seeing the George Floyd uprisings, and she was one of the only people to ask me how I was doing. Which is really kind of harsh. In our community here and it could have been, everybody was caught up with their lives with the pandemic. But it would have been nice to see more, like, “hey what’s going on, you okay” approach.
And sometimes that’s how you feel as a physician of color. Most of the physicians tend to be white. You feel kind of like an outsider. But to be honest with you, when it comes to friends, you have to count the ones that you have, not the ones you wish you had. So I was glad that I had people like Priya, Alice, Mark Mueller, he was a former president. My wife, she’s a physician as well. That small circle of people was able to listen, at least to me. And I think the George Floyd incident and all the other incidents were eye opening for people who are white to realize that we need to improve. I’ve already seen a lot of improvements in our medical community towards making it more uniform.
Miller: Priya Carden, I want to go back to something that you mentioned at the beginning, the mistrust or the distrust that you have felt and other physicians have felt in your offices, or coming to you from patients. At the beginning of the year, your medical society had an event focused on medical misinformation, specifically how to diagnose and treat it, meaning treating misinformation. How much has that been an issue in your practice?
Carden: That’s been a huge issue, but especially with COVID. Obviously before that, there was always the Google doctors, and we learned to navigate that. But COVID and the misinformation out there. And then, I don’t know the term, but people can get into a web hole, when they’re looking at certain articles, those same articles keep getting fed to them, and they really believe these things.
I’ve had the opportunity of working as a primary care doctor in two different clinics. I worked both at White Bird and also in my private practice. And being able to see the differences between the patients, and what it means to trust your doctor versus not know the person at all. But because in my private practice I have a strong relationship with each of my patients, the way they were asking the questions, or even the ability to ask me these questions about all the conspiracy theories, was an opportunity for me to be able to educate them. But it also meant that I had to read everything, all these conspiracy theories, and learn the ins and outs of them so that I could answer their questions.
In the other clinic, in White Bird where they don’t know me as well because they don’t see me as often, they didn’t even ask me the questions. They didn’t want to engage in the conversation. And I also felt ill equipped to engage in the conversation with them, because I didn’t know them as individuals like I do in my private practice. So a lot of the distrust comes from that, from not having the ability to ask the questions to your doctor because you don’t know them.
Miller: Dr Vasquez, do you think that the mistrust of public health professionals, or public health messaging about things like masks or vaccines or ivermectin, things that were purely COVID related, I’m wondering if you think that’s spreading to other parts of medical care? Has it opened up a crack, so that now patients would be more likely to say to you, why should I trust you as a dermatologist about this melanoma?
Vasquez: Oh yeah, certainly. I’m not in primary care, like Priya is. Priya definitely faces a much bigger challenge dealing with the COVID misinformation, luckily or unluckily. I don’t have to engage with those conversations. But even before the pandemic, as Priya pointed out, we’ve always had Google doctors or individuals who may not be very Western medicine inclined or not necessarily trust Western medicine. Those conversations definitely came out prior to the pandemic, but it’s definitely exploded, especially in 2020. We didn’t see as many patients, but you could start seeing that narrative pop up, conversations about certain rashes that people get that are pretty standard, we have pretty standard treatment protocols, but people just trusting us less and less, declining certain treatments that are pretty standard, wanting to go their own way.
But I think since the beginning of 2021, it’s becoming a bigger problem. Just this week, I had to have a very challenging conversation with a patient about her melanoma, which I diagnosed and it’s invasive and potentially life threatening. But she didn’t trust what was telling her. She didn’t quite trust the diagnosis, she didn’t trust the gravity of the situation, despite all the data we have and all the published data regarding it. She wants to be able to do her own research. And what she will find is perhaps, as Priya pointed, this niche web conversation that’s going to lean into this idea that she doesn’t have to treat it.
That’s an extreme case, but there’s a lot of smaller examples on a day to day basis. And I know in our clinic, the providers and I often talk about how it’s almost a daily occurrence now, where we have that conversation, patients just not trusting us, and wanting to seek alternative opinions for things that are pretty standard, and in a lot of cases curable.
Contact “Think Out Loud®”
If you’d like to comment on any of the topics in this show, or suggest a topic of your own, please get in touch with us on Facebook or Twitter, send an email to thinkoutloud@opb.org, or you can leave a voicemail for us at 503-293-1983. The call-in phone number during the noon hour is 888-665-5865.