We’re Burnt Out on Burnout Training | Dr. Jillian Horton
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Hello, welcome to Knock Knock High with the Glockenfleckens. Over here we have Krista Flannery, also known as Lady Glockenflecken. And you are Will Flannery, also known as Dr. Glockenflecken. Thank you for joining us. We have a special guest. Yes. A very, very...

Very high powered. Yes. Very accomplished. Accomplished. Articulate. What are the words? What are some other A words? You're better with words, I think, than I am. We are talking to Dr. Jillian Horton. She's a specialist, internal medicine trained physician, and associate professor of the University of Manitoba in Winnipeg, Canada. She is an author, an award-winning medical educator, writer,

writer, musician, and we didn't even get into the musician. And, um, very multifaceted. Absolutely. And, uh, she has done a ton of work on, um, on, on wellness. And we talk about what,

what wellness really means because I mentioned at the beginning that people feel like starting to roll their eyes a bit at the term wellness because it's just thrown around. But she has a fantastic perspective about it and how we can actually make morale better in healthcare. Yeah.

which we all need to be working toward because we want people to stick around in healthcare. Yes. And she takes more of an evidence-based approach rather than a pizza-based approach. I like that. Yeah. Less of the pizza-based approach. That's good. And she's written a wonderful book, We Are Perfectly Fine, which is a memoir of love, medicine, and healing. Very informative and lots of great stories as well. Yeah. And I love how she relates. Treasure trove.

She relates stories to and evidence. Like she blends all of this together and very compelling speaker. And I just, I could have listened to her for hours. Yeah, me too. So anything else? Oh, she's done, she does a lot of speaking and she's got a second book she's working on. So just so busy doing all the things. So let's get into it, shall we? Let's do it. All right. Here we go. Dr. Jillian Horton.

So, Will. Yeah. You're always teaching me things about demodex mites, your little friends there. Yeah. Let's switch things up a bit. Okay. How about I ask you a couple questions to see how much you really know? Go for it. Okay. Let's do it. What are the only two main species of demodex mites found in humans? Oh.

Type 1 and type 2. Hmm, got you on that one. Demodex follicularum, which are found in the eyelash follicles, and demodex brevis, which are found in the meibomian glands. Impressive. All right, next question. Why do people with demodex blepharitis often feel itchy eyelids first thing in the morning? I know this because I use it to gross you out. Demodex mites avoid light and they come out mostly at night to mate.

and move between your eyelash follicles. So many people will wake up with that itchy, irritated feeling along their eyelids. So gross.

I'm surprised you even brought that up. I know. I know. I'm just trying to get used to these mites since demodex blepharitis is such a common disease and we keep talking about it. Well, that's a big step. And we know there's a prescription eye drop available to treat demodex blepharitis. To learn more about these mites and demodex blepharitis, visit miteslovelids.com for more information. Again, that's M-I-T-E-S-L-O-V-E-R-I-T-E-S.

L-O-V-E-L-I-D-S.com to learn more. This ad is brought to you by Tarsus Pharmaceuticals.

Alright, we are here with Dr. Jillian Horton. Jillian, thank you so much for joining us. It is an absolute pleasure. I'm so happy to be here with both of you. Can I just throw something out to start here? Because we're going to talk a lot about the whole idea around wellness. We're going to talk about humor and maybe some advocacy. Just all the things that warm my heart and Kristen's heart. But real quick, hear me out on this. Medical Comedy Fellowship.

What do you think? Yeah. What do you think? Good? Well, it's going to be intense. We got courses on costume procurement. We got a little session, sessions on stereotypes. I don't know. It's just an idea. Yeah.

I think it's really good. You don't have to lie to me. That's okay. No, I do. And I think, you know, think of how good we get at dealing with rejection and fellowship already. So the level of being able to deal with, you know, jokes falling flat, the audience walking out on you. I mean, people are going to have to have a blast.

Pretty thick skin for this fellowship. I'm excited to work on it with you both. As an internal medicine trained physician, I think there are probably a lot of internists who could use a little resiliency training around having their jokes fall flat. Yeah.

No, it is devastating. I mean, let's be honest. Especially on rounds, you know. We've all been there. A joke falls flat on rounds and then you have to just sit there with it for like another six hours until rounds end. You are doing the walk of shame to the nursing station and it's following you.

All right. So if there's anybody we should be talking about wellness with, it's probably you. With your experience, it's phenomenal. All the education that you've done. I mean, you've written a book around this idea and a lot to do with this. And lived experience. Exactly. It's also its own education. But can I just, here's where I'd like to really start is, and it may sound silly to just ask this, but

What exactly is wellness? And the reason I ask this is because I feel like this gets thrown around a lot. It's become a buzzword. It's a buzzword. And I think to a lot of people, they're starting to roll their eyes a bit. Like, oh, okay, wellness. Totally. So it's almost like

We're so aware of the idea of wellness that it's starting to lose its meaning. So can you just help people like put this into perspective for people? Yeah. Why is it so important for health care?

Yeah. You make me think of, you know, just other buzzwords, right? And how neatly they fit into this model. We're burnt out on burnout. We need psychological safety from psychological safety. And now, you know, we need... Resiliency is another one. Resiliency. Yeah, resiliency. The dirty, horrible R word that is so overexposed, right? But, you know, it's interesting.

There's so many different ways that people look at this, as we know. We can look at wellness as it's more than the absence of disease. It's more than the absence of pathology. It's more than just escaping environments that make us unwell or taking great vacations. We know there's this definition of resilience that we sometimes talk about, bouncing back or moving through things at the...

having difficult experiences at the lowest psychological cost. But when I think of wellness, I guess one of the things that when I talk to health care worker groups about it, where I usually end up is talking about fulfillment. Because, you know, wellness, I think it's a really actually powerful

surprisingly complex question. What does it mean to be well? It's not a fixed state. You know, we have lots of times during the day we do a biopsy of the moment. How are you? Actually, right now, I suck. It's awful. A couple hours later, it's pretty good. But, you know, I love instead looking more at what is the experience that

So much of our wellness dialogue tries to capture when we're talking about, you know, our identities as physicians. And I often land on fulfillment. And I didn't come up with that, of course. The Stanford Professional Fulfillment Model is the model that really focuses on the idea of fulfillment as being a marker of, you know...

sense of well-being, a sense of contentment, a sense of purpose and meaning being present in our life. So that's almost where I start because I think when we talk in professional circles about wellness, well then we get into a lot of other things that yes, they apply to everybody, nutrition and sleep and all these other things that you know, maybe our approach is more general there like other people's, but I think that fulfillment

We can really understand that from the point of view of our experience as physicians and healthcare workers and start to look at what is required in order to experience a fulfilling life in this work. That is really interesting, too, because.

That might be part of the problem, right, is because what fulfills someone is different from individual to individual. And that's very different from a medical diagnosis, which you guys are all trained in and taught to think that way of, you know, there's these five symptoms and there's a checklist. Yes, yes, yes. No, then. OK, it's this.

And individual fulfillment will be different for everybody. And I think that is why we end up on these general things, because you're trying to make it this prescriptive thing of, well, if you just get enough sleep and enough good nutrition, then you should be fine. I don't know. It's on you, I guess. I don't know. Yeah. And by the way, come in on Saturday and we'll learn about this. Exactly. For five mandatory hours.

Yeah. Yeah. You know, I've been thinking about this and, you know, and, and right before, you know, we, I started prepping for, for this interview with you. I went to a, a conference, an ophthalmology conference, and I go to a lot of conferences and all these specialty organizations, they all seem to be worried about the same thing. And that's young members like being engaged in the profession.

And I can't help but try to connect what we're talking about with fulfillment and with having people want to move, young people in particular, want to move medicine forward and make it better and grow the profession as opposed to just, you know,

really just considering it as a job, which it is, it's a job, medicine's a job, but, but also, uh, we, sometimes it does need to be a little bit more than that, uh, to try to fix the things that we need to fix in healthcare. So I'd like to talk a bit about the young folks, right? The residents, the med students and what kind of work you've done around like medical education, uh,

regarding fulfillment. Yeah. I love that question. And to go back to something you said, Kristen, you know, sort of thinking about the complexity of looking at these issues, the desire that we have to provide simplistic frameworks, cookie cutter kind of ways of checklists, red, light, green, how are you doing? And that not even beginning to capture, you know, what we all know is the

The

very complex to nuance nature of our experiences. So you just made me think of something. I was speaking at the International Conference on Physician Health in October, and a resident came up to me afterwards, and she said something so interesting. She said, you know, she had read my book, and she shared with me that she'd really identified strongly with it. But she said, you know, I sometimes wonder, I go to these conferences, and we have conversations about kind of the state of the union in healthcare, and

And I feel like so much of what we talk about is so negative. It's all negative. It's all burnout. It's all, you know, hearing the horror stories. And, you know, rightly, I mean, the experiences, the dark side of what we do needs a lot more airtime and sunlight than it's ever had before. But that was sort of

one thing I found myself thinking about, you know, the negativity bias in how we are so often talking, including in medical education, about our experiences these days. But you also made me think of something else, Will, that I often talk to residents about is

Adam Grant, years ago before he was kind of a household name, talked about, and I think he was one of the first people to frame it this way. Forgive me if somebody did this before him. But he talked about, you know, three models for work. And one is exactly what you talked about. You know, model one is work as a job. Work is a means to an end. It's a paycheck that allows us to, you know, pay for the things that we need just to

to live. Model two is it's a career. And in model two, that career model is a trajectory. It moves. We see the hope of an upward movement. And the third model is it's a calling. It's something that aligns deeply with us. Just as you said, you know, there's a sense of who I am, what my deepest values are, are aligned with this thing that I'm doing. And

And I think one of my favorite messages to impart to medical students and residents and also to faculty who are grappling, especially early faculty, with that is that all there is kind of feeling. You know, I think sometimes...

this mismatch of our expectations. We think it's a calling. It's going to feel like a calling every moment of the day. Or we think it's a career. I'm always going to be psyched about my career. I often tell medical students, if I look at every single day, I can find an hour where I say, this is a job. This filling out paperwork. Yes, I can, you know, connect it to my mission and my personal fulfillment. But this is a job hour.

And then I have other hours that are career hours. I see where I'm going. I see what I'm trying to build. But then we have these moments as well. These hours, hopefully they're more than just fleeting moments, where it is a calling. It's so that sense of, again, I am here because of this. This moment, I am here to meet. Everything in my life kind of prepared me to be the person, to be with this other person at this moment. And I think sometimes I often like will...

Use the analogy of, you know, kind of the idea that we're going to have everything. Sometimes I think one of the problems we have is we want to have everything all at once. And it's like going to a really amazing restaurant and putting all four delicious courses into the Vitamix and then saying, this is disgusting. You know, why doesn't this taste better? Maybe because we're just not.

Dealing with what we've got in the right order, separating it, handling it in the right way. If only that were the only problem. It's clearly not. But again, thinking about what we can do, what we can control, how our perceptions influence things. To me, that's part of those solutions. I love that framing of...

job versus career versus calling and how fluid it can be. I've never really thought about it in that way, but that's absolutely true. When you're sitting there as a med student trying to...

you know, just, just throw your first suture or you're being asked as a resident, I was, you know, asked, I would be asked to just like suture up this incision. You're sitting there for like an hour doing it like that. And it just feels like a job that's, but then when you're having like a difficult, you're telling a patient they have cancer or, or they're, you're, you're, you're sharing an intimate moment with a patient like that. It does change. It no longer is just a job. This is a very important moment in your life and in the patient's life. And it's,

What really bothers me that I see on social media is almost like weaponizing the idea of medicine as a calling in order to make people feel like if they don't feel that way, it's not professional. Yeah.

Yes, they're deficient. And to exploit them, right? It's the same. We see this in education as well, right? You can pay teachers almost nothing because it's a calling. And look at this work that you're doing that is so important, right? It's like a, it's a distraction to say. Exactly. It's okay if you don't have great working conditions. Yeah. Residents, because this is a calling. Because it's a calling, it doesn't mean you don't need to be treated well. Right. Right.

Exactly. It's just it's a total exploitation in many cases of that altruistic quality that brings so many people into our midst, our nursing colleagues, our allied health care colleagues, our fellow physicians. You know, we've seen, and I love how you frame that, that altruism, that good instinct weaponized against people.

and sort of your best quality becoming your greatest weakness because it means that sometimes organizations know, health systems know, these people will never walk away. Except we are seeing, of course, since the pandemic, that's shifted to a more transactional quality. So many people, I think, have hit that final threshold where they say, I have seen that

I don't feel aligned with this organization. I don't feel valued by the people around me, the organization that I'm working for. And so what happens? People become transactional and they shift. And I think it's caught a lot of people by shock because I don't think we've by surprise, pardon me, because I don't think we've seen this in our lifetimes in medical practice, the way that people are kind of going, you know what, I'm just.

That's it. This is just that job to me now because you push me to the point where I had to pull that lever in order to save myself. And that's that's heartbreaking. And when it becomes a job, that's now you're looking at it's just reminding me of the same patterns that we're seeing in the workforce in general. Right. Which is people used to stay in one career for their entire lives, one job even for their entire lives. And they get a pension at the end of it. And, you know.

And now, like with millennials and even more so, I think with Gen Z, it's not like that. It's more like I have standards for how I want my life to be. And if this job doesn't allow me to have those standards, then I'm going to go find a different job that does. And so I think that problem is only or at least that pattern is only going to continue as these younger people move up into the ranks of medicine.

I completely agree with you. And it kind of makes me think of your question a few minutes ago, Will, you know, communicating and helping our learners and our early career colleagues navigate that challenge because this is now their reality. This is how a lot of people around them are making decisions. And we all know there are some good things about it. I think we're all glad to see people finally starting to

creates some healthy boundaries as long as it, you know, anything can be taken to the extreme, of course, as we know. But we want people making this job as sustainable as possible within the confines of the complexity of what the job actually is. And so I think one of the ways that we can temper some of that

is really, and again, this sort of traces back to literature and what we know about healthcare worker burnout, you know, really hacking meaning. So people, again, are in a bit more of a transactional state, thinking about boundaries. But what we can do to enhance their experience is really help them

Help teach them, help create opportunities, really sophisticated opportunities. And also, you know, for organizations to really be focused.

living their values. So, you know, what's the thing that's going to keep me coming back to a job if all things are equal? It's going to be, as we said, that sense of mission alignment. This place represents the things that I believe in. What I see around here is my heart in action. You know, it's my deepest values. I see them reflected everywhere. That is a much harder thing for us to walk away from when we've had a taste of it. And I think we're

Again, we're just seeing that loss of mission alignment for all kinds of reasons. So many of the reasons that the two of you speak out about so critically in terms of, you know, the incredible pressures that American physicians in particular deal with when it comes to dealing with the insurance piece and the health care system. Yeah. I don't like that.

Putting so much pressure on the individual to fix their own burnout. Right. Totally. That's just another task. And that's the last thing someone who's on the verge of quitting medicine needs is another task to try to like... Well, and it's putting someone in a burning room and you're telling them, just cool yourself down. Yeah. Just cool yourself down. Don't burn. Yeah.

Like, let's get him out of the room. Yeah. Have you tried? Here's some pizza. Yeah, exactly. And so, yeah, trying to like address it on the organizational level and like set the standard for working conditions and how the interaction between physicians and patients should be and just making that happen.

a possibility. Totally. But man, it's so hard for that to happen, at least in the U.S. It is so hard. Lots of places. And I love that you said that because I often think of that as like one of the critical disclaimers. So, you know, my book is, you know, I mean, a lot of it is about my own experiences with mindfulness and how mindfulness has made a huge difference to me personally, both as a clinician and as a human being. And so often when I go to speak,

And I'm very fortunate. I have the opportunity to work with all kinds of different groups now. You know, people I think are sometimes, especially if they've never heard me talk before, they don't know anything about my work. They think I'm going to come and give that exact message that people so often give that you said, Kristen, you know, if you just take control of your life and breathe more deeply and accept what you can't control. Like, honestly, no.

You wear a series of crystals around your neck. Yeah. Oh, I can't see them now because they're all off screen, but I'm big into the crystals. But it's one of the most important disclaimers, I think, is to anticipate change.

What you both said, what people are used to hearing and what are our learners and so many of our colleagues and us, what are we used to hearing? You need to be more resilient. That's not what the literature says. That's not correct. Literature tells us we are more resilient than age match controls. Literature tells us, as you know, that when medical students...

Right.

buy it. And so the disclaimer number one is exactly what you said. The literature tells us unequivocally organizational and system factors are the primary drivers of burnout, not our lack of mindfulness, not our lack of, you know, engaging deeply with our sense of meaning and doing a gratitude journal and like, hell no. I mean, these are, I

These are things that we have to separate them out, put them in a different basket and say, if we're going to talk about mindfulness, for example, if we're going to talk about thinking.

Things that we know actually do have some impact on our quality of life, they cannot be part of the organization saying, well, have you tried mindfulness to deal with your burnout? Like the organization, that's I think where we so often run into trouble. You know, cookie cutter solutions, as Tate Shanafelt, one of the world experts on physician health often says, cookie cutter solutions don't work.

They're often what are deployed by HR because they're easy, they're cheap, and then people feel that they're doing something, but they're radically ineffective because individually tailored things, just like you said at the beginning, Kristen, that's another saying that Tate Shanafelt has. If you've seen one unit, you've seen one unit. So in every single context, every healthcare system, there are going to be general principles that apply, but the solutions in each place are going to be different.

totally different. So starting from that place of saying, hey, the organization has to constantly be reflecting back to people anytime it's doing any work around burnout and healthcare worker well-being,

This is what the literature tells us. We know it's not you. We're working on these components of the organizational problems. And then if we want to venture into those, the things that we, you know, call physician-directed or individually-directed initiatives, that has to be of our own volition. I think that's the key. And the reason I do believe there's a lot of merit in those things, you know, actually, I see a strong parallel between...

For example, me pursuing mindfulness or me writing mainstream media op-eds and the work that the two of you do. This is individually directed wellness. I know you know it, but I know it too. I mean, what you're doing, it restores a locus of control. You kind of go, I am powerless to change A, B, C, D directly, but I can also influence it. I can find ways. And even though it doesn't change the system that we work in, it restores a sense of,

I don't have zero agency. There are things that I can control. There are some things I can influence. And then there are some things about which I can do absolutely nothing. But that influence and control piece, you know, really, this is where I think physicians, we often forget how much influence.

Yeah. Do you find organizations are receptive to that message? That says it all right there. Yeah.

I did my body language to say something different in my mouth. Because I can totally see, I mean, maybe some are, but I could totally see how you're asking organizations to hospital systems to change their way of thinking about this. They would love nothing more than to just put this on the individual to make themselves better. And so, honestly, how do you...

How do you deal with that pushback? You know? Yeah. Oh, well, you know, I would start by saying for sure, um,

There are some organizations, some spaces, probably just like the two of you that I'm invited into places where I go and speak or do workshops or talks or things with leadership where I say, wow, this organization has is going to make progress in the next 10 years. I think I don't know what it's going to look like, but their leadership gets it. There's buy in. There's a structure to really look at serious change. And people are really literate.

And I think that's one of the keys that I'm certainly not the first person to observe this, but it's a message that I internalized years ago from a Canadian colleague, an amazing internist and researcher into physician burnout long before it was like on the tip of all our tongues. Her name is Jane Lemaire. And one of the things that Dr. Lemaire taught me years ago is build literacy.

I have really become convinced. I think that's one of the best pieces of advice anyone has ever given me. Because so often we go to these organizations, and you've had this experience too, people start by saying, well, you know, well, in question, the problem is these young people and blah, blah, blah. And it's also this, and it's also this. And, you know, beginning with...

I always think about how do we learn everything else? If you wanted to invite me to give grand rounds in ophthalmology, which would basically consist of there's a right and a left eye, that would be my level of expertise. I'm impressed. Yeah, it's not bad. Throw out a little ODLS. Not in everything. Yeah, absolutely. I don't know if it's the same south of the equator, but I never thought about it. But, you know,

The level of literacy is low. And one of the things I think we know, physicians don't like to look foolish. That's something that as type A++ people, we really struggle with. We always ask questions that we only know the answers to of our learners. And that kind of perpetuates into a way of life for many people. And so I think the right touch is...

When we're going to go in and speak and work with groups, beginning – and again, it's why I like going back to the Stanford professional fulfillment model. That's become the way that I occupy this kind of really cool, neat, privileged, fun space in this world now of being a knowledge translator, figuring out how do I go in with a group that doesn't have high literacy, doesn't want to admit it, doesn't necessarily know that they don't have high literacy, and

And make them feel, you know, not inferior, not talked down to them. Spend an hour or a day with them so that they leave with a whole new understanding of even like just a framework. You know, I always see an example of when we see a patient with abnormal kidney function and an elevated creatinine, you know, we are...

drilled into us from week one of medical school, there's a way to think about this pre-renal post. So you've got that high creatinine, which one of these things is it? And then you start, you know, finessing from there. But one of the interesting things is I think

when it comes to healthcare worker well-being, many people have no such model. Now, there are many people who really have extremely sophisticated knowledge in this area and are leading the charge. But just as often, many of the people tasked with running systems and leadership actually don't

They don't have any kind of pre-renal post model when it comes to physician health. And so that's why I think sometimes they end up doing what exactly both of you have said. They're like, I don't know what to do about the system stuff. I don't even know how to describe it. But here's a yoga class, so nobody can accuse me of doing nothing. So they actually, I find...

there's a small percentage of people for whom I would say, about whom I would say they're not receptive to this. A percentage of people who are just going to lecture us and say, you know what, this is just about you people not accepting how hard medicine is and I had instruments thrown at me and it made me better. You don't actually know that. It's quite equally possible that it just maimed you severely, screwed you up because you'll never know the alternate version of yourself. So let's talk about your reasoning there as well. But most people I find with that

that kind of the touch that allows them to be a little bit vulnerable and say, I don't actually understand this. I could use a better framework. Teach me. Hey, I get that. I can build on that. I can take that away, reinforce it, kind of spiral curriculum eyes it. I think there's an openness to that. And I think that's one place where we have a real opportunity to,

To kind of impart knowledge in a way that we can think about how it's strategic. What is strategic for me to impart to a leader who wants to learn more, but just kind of feels like they don't know where to start. That I always feel like that's my challenge. And I love that challenge of moving into that space. I love that. Let's take a break. We'll come right back.

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Offer valid May 15th through June 4th. U.S. only. See store or online for details. All right, we're back with Dr. Jillian Horton.

So you have mentioned, we're talking about the organizations and, you know, kind of things on the system level. And you're right, there's no cookie cutter approach to this issue. But are there maybe some general guiding principles for organizations to use to move away from the, you know, put the blame on the individual and suggest yoga and resilience? Are there some...

Is there any kind of checklist anywhere since that's sort of where people are coming from? Can we meet them there somehow? Yeah, yeah. Love that question. So there were some really great resources as, you know, whether it's people thinking about future leadership roles, people who have some kind of wellness role or people who are in leadership roles who just, you know, want to figure out what

is there out there that can tell us where to begin this work and that the evidence kind of points us in the direction of what is the best investment of our time. The American Medical Association has, as you probably know, these amazing steps forward modules, including amazing modules for organizations looking at what do I do? Where do I start? Where do I begin? And that's like one resource that people can look at. But if I think of

you know, how do I approach this? Just sort of what is my, I was going to call it a cookie cutter approach, but that was maybe not quite what I meant. It's definitely not a cookie cutter. It's an artisanal cake. But, you know, where do you start? And I think, again, the way where I've landed, taking people through that Stanford professional fulfillment model, what do we need if that end goal is fulfillment, not happiness, but fulfillment, not wellness, fulfillment?

We know that we need three big clusters of things in order as physicians to experience professional fulfillment. One of them is we need a culture of wellness. And people often think, oh, that's like the paint of rock day or that's like free hot chocolate, pizza Friday or free muffins. I've written about this term that I call muffin rage, you know. So those are not.

culture of wellness things at all. Those are usually symbols that if that's where people start, actually what they're often telling you is they don't understand anything about the problem. So within culture of wellness, we know that leadership matters.

matters more than almost anything else. Is leadership emotionally intelligent? Do leaders listen? Are they good listeners? Do leaders understand, if we're talking about in smaller cohorts, you know, the principle of putting their staff, aligning their staff with the work that their staff find necessary?

the most meaningful and making sure there's sort of the number that the literature tells us to aim for. There is about 20% also old work by Tate Shanafelt and colleagues. But, you know, so that piece, the, you know, it's funny because a lot of what we talk about when we talk about pizza and muffins are tokens of appreciation, but that's

That's just what an organization is thinking we might like is appreciation as opposed to going out and saying, hey, well, hey, Kristen, what does appreciation feel like to you? What does it look like to you? I've even there are some organizations that kind of crowdsource that.

But as a leader, you can't know that from people if you're not asking that question and listening to the response. And there are little things that have been shown to be surprisingly impactful. Thank you note programs, you know, the opportunity to formally thank colleagues. Hey, will you help me? I had that patient who was enucleated and I felt I didn't know what to do. And you came and you saved his eye and you made me look good. And, you know, thank you. Like those, that deeply relational component of the work

that has been another casualty of all of our electronic medical record use and communication by electronic device, et cetera, et cetera. So those are some of the highlights in the culture piece. The piece that everyone is always floored by is the second piece of professional fulfillment, the efficiency of practice.

Because when you look at changing how we use an electronic medical record or rolling out big things, we know these are some of the most costly things that organizations can do. They're the most daunting, the most complex. But again, looking at, so many organizations are

in the process of making changes there, but even other things like prioritizing, um, you know, FaceTime and relationships. So if we're, um, you know, if I'm a rheumatologist and you are an ophthalmologist and we're caring for some, uh, patients with overlapping illness, we want to make sure that our practices, that we're going to have the opportunity to physically see each other, to talk to each other, not just to be sending each other, um, increasingly impersonal notes, um,

And so those are some of the things within efficiency of practice. Organizations can still do things to promote personal resilience, but that's where I think the messaging is so often just butchered. So if you are, for example, going to support as a university, you want to

bring in Jill Horton or some of her colleagues who teach an evidence-based JAMA-published program on mindful practice, and you want to make that available to your staff. Embedded in that offering, you've got to say, this is

only one piece. This is the smallest piece. We know that you are not the problem. We also want to communicate to you we're working on these other changes. Again, that's where leadership and communication comes in. So many missed opportunities. The feeling that there's nobody in the cockpit. What do you know about the person at the helm of your organization? What do you know about their values? What do we know about what the plan is in plain language in terms of what the

what the next

priorities are for the next year as opposed to some strategic plan that looks like this. So I guess to summarize all of that, the criticality of leadership, there's nothing that can correct for leadership that doesn't believe that these things are problems, that isn't highly personable, leaders who aren't good listeners, leaders who are not empathetic and also actually have the skills to do these things. But those are some of the other pieces and places where people can start.

Well, I want to thank you for using the term enucleation. Very, I love it. That's good. I hope that you're going to reciprocate. I haven't heard that from a non-ophthalmologist, I think ever. So fantastic.

I used to think it was just about nuclear arms, you know. Then I learned more about homology. So I've learned a little bit about you. And I notice in all the strategies we've talked about, one thing that you haven't mentioned is pranking each other in the hospital. What, me? Yeah. Well, I don't know about that. I've heard a few things. I heard some stories. Yeah.

And, and I, but it does speak to just having fun in general. Like it's okay to have fun. I'm a big, obviously a big fan of humor. And so tell us about the pager incident, please. Yeah.

Well, actually, you know, I've found myself even thinking further back to my origin story. When I was in grade eight, we have a Festival de Voyageurs in Manitoba. It's a big, like, French festival celebrating the huge aspect of our French culture. And I still remember, because this is, my friends still talk about this, there was like a big mural that had

One of my really talented friends had painted of all the voyager in a canoe. And I snuck into the classroom and in the back of the canoe, I painted sitting a giraffe at the back. And then the teacher came in and she's like, she was so mad. She's like, what the... She's in French. She's like, what the hell is this? And then she waves her finger and she goes, I know who did this. She's like, this...

has Gillian Horton written all over it. Awesome. Love it. I think that was... And I told her it was a voyeur giraffe, actually. I thought it was kind of a... I can't believe historically. The native giraffes of Canada. Totally. The native Canadian giraffes. Completely. The pager, though, is...

You know, when I think of, like, all of us getting through internship year, you know, worst year of many of our lives in so many ways. And I had this friend, an amazing friend from the United Arab Emirates, and we would just always try to outdo each other with jokes.

you know, one day I had, I'd gotten him. I thought it was so good. I'd paged him to the hospital gift shop and he gets some very nice older lady there. I'm just like, hello. And you know, my friend is like, I was just paged to this number. And she's like, this is the gift shop here. And he was so confused. And so he's like, I'm going to get you. So then about a week later, uh,

I get a page, so four-digit page to my number, and the page is 9911, and it's, you know, 8 p.m. So I answer it unthinkingly, and somebody answers, and they're like, emergency services. And I'm like, yeah, this is Jillian Horton. I was paged to this number. And they're like, ah, sorry.

I was like, I was paged to this number. You're like fighting with the 911 operator. Oh, yeah. What could be, you know, what's a better use of time than tying up the 911? But I was amazed at how easy it was for him to slip that in. But your comment about humor, you know what it makes me think of?

Unless jokes are malicious, which we're not interested in that kind of humor. I think, you know, when it comes to like with patience, with each other, with teams, with friends, with colleagues.

Humor is like a safety signal, isn't it? Like you don't joke with somebody that you don't like. You don't joke with somebody that you don't care about. It signals, you know, that we're, there's a bond here, a connection. I think it's one of the reasons I love the work that both of you do so much. It's just, it's part of that collective, you know, it really, I don't think it's possible to,

state its importance when it comes to building that sense of community and also, you know, just carefully crafted humor that makes people feel seen. It's, um, it's also like resistance in the, in the best possible way. I have one point to say about that. Uh, but real quick, my, um, the hospital next to one of my offices in the gift shop, there is like a seven foot tall stuffed giraffe. Will you, will you send it to me? It's been there. Yeah.

I've worked at this office and been going to that hospital for eight years now. And it's, it's been there all eight years. So no one has purchased the eight foot tall. Well, I'm waiting, we're waiting, we're waiting for the right Canadian to come by and just grab it. Um, I, we couldn't afford the tariffs now. Oh man. But the, um, you know, I've, I, over the years I've, I've,

thought to myself and Chris and I have talked about this is like what exactly with my content like what about it you know like what is it that because I'm making fun of all these specialties and I sometimes I'm surprised by how little

I like anger the specialties because people always ask me that. I was like, has anybody like, you know, do you receive like hate mail from the, and I'm like, no, I don't. And, and it's, and I'm just as surprised as you are. I know. Like, wow. Like, no, the orthopedic surgeons, they love it. And, and I've, you know, maybe I, you know,

I took some cheap shots early on just because I was just trying to figure out my voice and how to do medical comedy correctly. But then over the years, I've realized that if you, if you frame it in a way, like you said, that you're, that people are,

are being heard by someone that's especially someone who is outside their, their area of expertise. Um, and, and it's so, so they're feeling heard, even though you're making fun of them, they, they see the truth in it. They, they see that, okay, this guy really does like get the conflict with, between cardiology and nephrology. Um, it's, it's when you cross a line into, um,

Yes. Yes. Yes. Yes.

Yeah. And I just thinking about that as you as you say it, it's it's exploding the idiosyncrasies as opposed to, like you said, the value or the worth or the contribution. And so often I think it's it's it's just a relief to people, actually, because when we think about the real life tensions that we often experience, that's.

They can be malicious. They can be devaluing. They can be, you know, coming from if we just think of a day in the war at a snapshot when we see, you know, times when relationships are fraught and people are, you know, talking trash about each other. They it's it's often it's.

infused in that, it's not joking about the idiosyncrasies. Embedded in it is, I work harder than you. I'm more important than you. And of course, I think what you give the window to is, with both of your work, is just...

a very holistic perspective and everybody gets a turn to be, you know, examined under that microscope. Everybody's idiosyncrasies, um, except for OBGYN. They keep telling me I don't have enough OBGYN content. I need to do better there. So there's a few blind spots I have. He's afraid of them. That's really why. I try to, I try to,

I try to be an equal opportunity ridiculer of the medical profession. Totally. But what I love about your collective work is also how it's evolved. So again, it really to me embodies that idea that, and by

I know we feel this viscerally, and I think your audience feels this so viscerally, that humor is about so much more than just making people laugh. It's an opportunity for us to say things that sometimes in medicine, and again, this is just what I love about the 20s,

tonally your work, you know, people are actually, we have a lot of aversion and fear about speaking out, criticizing. There are a lot of reasons in our profession, as we know, you know, we're kind of conditioned to just be good little soldiers. And, you know, we talked about that in terms of altruism, but it's also in terms of compliance and, oh, yes, yes, I won't challenge this. I won't step out of line. I won't, you know, my mentor, again, back to that, threw something at me. Well, that's just...

part of the indoctrination. But there's also this social piece, you know, and for us as type A plus plus plus people, one of the things that I think is pretty universal in medicine, we say we love feedback, but we hate criticism.

Yeah, like we're such perfectionists that, you know, then if I'm going to make a video and it's going to move into political territory and somebody's going to say, oh, this is wrong. A doctor shouldn't be political. A doctor shouldn't do this. You know, some people that has a big chilling effect and they never go there again. So I do think it's what's so

powerful about the very unique space that you're both working in. It allows for a lot of, you know, very healthy interrogation of what is my role? What is our role as physicians? You know, we have a lot of privilege. Our voices carry a lot of weight. How can we

how could it be true that we can't weigh in? You know, I always use that example of the New England Journal. The first time in 208 years that they weighed in on a presidential election was eight years ago. And many people going, wow, that's so amazing. And to me, the amazing thing was how

could that have taken 208 years? You know, how could there have never been a time, you know, when our profession said, hey, we might have different views about certain things, but there are certain things that we stand for that we're supposed to be advocating for. How can it be true that we can't move into this space? And again, we all have

in Canada, charter rights for freedom of speech and freedom of ideas. But there surely must be things that we've been sheltering ourselves from saying. And that's, again, the work that the two of you were doing moving into the space, talking about the insurance system and training and everything else. How can we, how can it not be incumbent on us at this moment to use the power and the platforms that we have to say those things that, yes, sometimes they're uncomfortable, but

But it always goes better than you think, right? Like what you said about hate mail is super interesting. Yeah, yeah. There's definitely ways to do it. And it's just this cohort of people, the healthcare workers, it's just such a unique job. And sometimes you got to treat it delicately, but also...

we all need to be free to express ourselves, you know, and, and fortunately a lot of people don't feel they have that ability. Yeah. Like you said, just based on work environment, um, leadership and, and how they're, uh, you know, thinking about all of this that we've been talking about. So, but as storytelling is so, I mean, that's, that's all I do on social media, right? All my skits, it's all storytelling. Yeah. And, um, and that's, that's so incredibly important with advocacy, um,

with humor, with just, just creating bonds with people. Um, and your book, um, you know, so, uh, won't,

you know, I want to definitely, you know, mention your fantastic book. We are all perfectly fine. A memoir of love, medicine and healing. And so, and you have a lot of storytelling in there, obviously your own personal story. And, um, and I'm always, we're always talking, we're telling our story. We have a very interesting story all the time. You sure do. It has a way of reaching people. And, um, and so I definitely encourage people to check out, check

check out that book. We are all perfectly fine. And you're working on a second book. Is that right? I am. Yes. I've, I'm devastated to discover that writing a second book is no easier than writing a first book. You know, it's probably kind of like doing a second fellowship. Yeah. It's excruciating actually, but I am, I am moving forward in that. Yeah. That storytelling piece for us. It,

It's interesting, right? Because as you say, it's our most powerful mechanism for connection. It's sort of on one level what we trade in on our best days all day long. But so often there's this, you know, and I also love how you framed it. I mean, not everybody has the same level of safety, of ability to speak out. As we get older, that gets a little easier, I think, for all of us.

I think you just stop caring as much. You do stop caring. You go, what's the worst thing that could happen? You're going to fire me? That would be fabulous. Then I can open that coffee shop I've always dreamed about. A little more at stake when you're a resident. Yeah, that's right. Totally. But it's that...

conflict, too, between this idea. It's another thing I'd love to talk about going back to, you know, supporting learners and shaping culture, this idea of professionalism. There are for sure people who would say the kind of stories that I tell, the kind of videos that, you know, you make, they would say, that's not professional. They, we have adhered

for bizarre reasons, frankly, to this crazy rigid definition of professionalism that many people have rightly interpreted as, "I have to check who I am at the door." I was teaching a class, I was teaching mindful practice for three weeks actually to an amazing group of Med 4 students for the last three weeks. It's one of the highlights of my year.

And one student shared a story because I asked them to talk about a time when their basic human instincts came into conflict with what they had been taught was a definition of professionalism. And the story that she shared was a patient who...

I had a craving for some fresh fruit instead of the whatever food-like substance it is that we serve in the hospital. And so she'd heard this for a couple days in a row, and she had an apple in her lunch. And then she was like, I'm going to give him my apple. And she took him the apple. And then for the rest of the afternoon, she described worrying that maybe she'd done something that could get her in trouble, that was unprofessional, that would be reprimanded. And, you know, the three of us would love to say, like,

That could never happen. But it could happen. There is somebody somewhere who could say, what are you doing giving that 30-cent apple? That's a gift. Not appropriate. That's crossing a boundary. Yeah. It's a gift. Yeah. This is one of these, like, it's a kind of crazy making that we've done, I think, right, that's then resulted in people saying, well, gee, if I can't do that, can I write an op-ed? Yeah.

saying that our current policy towards people living with addiction is horrible. Can I share a professional, a personal story about my disabled sister in my case or in your case, you know, giving CPR and how transformative that was or your personal story of your own health challenges? Like, it's really created this kind of uncertainty that

I think it's actually made us far less interesting as people on the other side of clinical encounters has made us, you know, then wonder why we're lonely. It's like if you have a neighbor that you find out everything about your neighbor, but then the neighbor's like, and how are you doing? It's like, oh, I can't tell you anything about myself. Like we all recognize that'd be weird. That's not a healthy bidirectional balance thing.

And so it's as if we've suggested that the calibration for these things should be based on, you know, the maybe two to four percent people who actually do have boundary issues and not the best judgment and are going to have problems with these kinds of things. We've taken those people and.

inflated, you know, the teaching for everyone else so that what the end result is, we have amazing, caring young people who are afraid to do the most basic human things at the bedside, lest they be accused of this horrible, you know, scary thing, unprofessionalism for completely absurd reasons. I think it's another thing that we're really needing to, that your work addresses, in my view as well. It shows that this is a

Another way that you can be yourself in a public. It's OK to be human and a doctor. Yeah, we don't we don't need anything. And we're as Kristen knows, like ophthalmologists in particular are the most interesting people on Earth.

I've heard yet. Yeah. That's evidence-based. Absolutely. We should be able to show that. I don't have time to give the citation right now. But anyway. It'll be in the show notes. Well, Jillian, we want to just thank you so much for joining us. And tell us, you guys, so we mentioned the second book. What else do you have going on? Let the people know. Oh, well, the cool thing is,

The coolest thing right now, actually, is the We Are All Perfectly Fine has been optioned as a television series and is in development. Yes, that is so cool. That's awesome. Yes. It's crazy amazing. And so in a little while, we'll be able to say more about that and where and with who. But that's another –

Another thing I never thought I'd be doing, but it makes me think of your work. It's an opportunity to knowledge translate our experiences in a way that I hope will make people not only make other health care workers feel more seen, but also help the public understand the ways in which our well-being is affected.

interdependent. And yeah, that's, that's my next. Well, good luck with that. That's an awesome project. I look forward to seeing that. Thank you. And reading your next book. Thank you. And people can find, find you on, you know, Twitter, Blue Sky, Insta, Jillian Horton, MD.

And also, you keep, are you still writing? You're still probably writing like op-eds and things. I am. I do. Yeah, I just this past year have done a little bit less writing of that kind as I've tried to get the work done on. Yeah, the other work that I do here, obviously, on my day job and get the book underway in the TV series. But yeah, I love writing for mainstream media. And I think the more of us who

do that kind of work as well, the better. And just before we end, I just want to say thank you so much to both of you, firstly, for having me with you. It's just a, when my publicist message that you'd reached out and she said, this sounds like it could be good. I wrote her back and I was like, you don't understand. They are medical royalty. Okay. They are. This is like the queen inviting me in our world. So this is, yeah, we're, but, but also, um,

I should be wearing a cape everywhere I go. Well, you were at the start. You had to take that off right before we hit record. That's right. You were just, and I really appreciated it. But I just also want to thank both of you for your work and your voice. It is so important. It's so humanizing to our profession. I think it's allowed so many people to see

you know, the urgency of being yourself in these jobs that it's, and that you can also forge unusual paths. Yeah, true. Every part of yourself, there's very unusual. You are the only two who kind of make my career path look not so unusual.

I think that I feel like deep alignment with you. But I think that's really important as well for people to see that those other pieces of themselves, that we can find a way to work them into who we are and actually do incredible things as opposed to the old idea of just parking them at the door. And this has to eat your life. And that's the end. We need this kind of work.

In medicine, it's knowledge translation. It's culture changing. And I just, it's been just a thrill to spend this time with you both. Well, thank you again so much for joining us. Keep up the great work. Oh, my pleasure. Thank you. You too.

Oh, that was fascinating. It was so fun. I could talk to her forever. Yeah, let us know what you thought. If you guys have any thoughts on burnout, whether or not you roll your eyes when you hear the word burnout. I'm glad we got into some of that stuff. That's always bothered me. Just how nobody really...

you know, doesn't take care around that word anymore. It just becomes meaningless. It's just a token, like she was saying. I like the fulfillment thing. That makes a lot of sense. You can email us, knockknockhigh at human-content.com. Visit us on our social media platforms. Hang out with us and the wonderful Human Content Podcast family on Instagram and TikTok at humancontentpods.

Thanks to all the listeners leaving feedback and reviews. Don't we love those reviews? We do. The good ones. Absolutely. Constructive feedback is welcome as well. If you subscribe and comment on your favorite podcasting app or on YouTube, we can give you a shout out. Like we have a review from Cats and Churros, Chris. Oh, I would like to know more. Says the podcast is informative and entertaining. I really enjoy. Knock, knock.

particularly the knock-knock eye episode. It's fascinating to learn about the eyes and hear Dr. Glockman-Flecken geek out about ophthalmology. I'm glad someone thinks so. His personality brings a lightness to even serious topics and makes it a fun listen. I have a lightness. You do, and I think that is accurate feedback and

you somehow make eyeballs interesting to people. That is a feat. It'll be a feat whenever Kristen actually listens to the Knock Knock Eye episodes. That's when you get enough eyeball. Have I not given enough to the eyeball community? I know.

Full video episodes are up every week on our YouTube channel at Glockenfleckens. We also have a newsletter. That's right. Yep. And we also have a Patreon. Lots of cool perks, bonus episodes, react to medical shows and movies, hang out with other members of the Knock Knock High community. We're there. Early ad-free episode access.com.

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Let's do this. All right. New member shout out, Henry H., David D., Marsha N., Nastaran S.,

If I'm saying that incorrectly, please send us an email because I want to make sure I get your name right. Thank you all for joining us on Patreon. Shout out to the Jonathans as usual. Patrick, Lacia C., Edward K., Marion W., Mr. Granddaddy, Caitlin C., Brianna L., MP Cole, Mary H., Keith G., Parker, Muhammad L., David H., Kaylee A., Gabe, Gary M., Eric B., Marlene S., Scott M., Kelsey M., Dr. Hoover, Sean M., Hawkeye M., TheBubblySalt, and...

Seanity. Hey, join me on let time. Random shout to someone on the emergency medicine tier. Ashley Kay. Thank you for being a patron. It's Ashley Kay. And thank you for listening. We're your hosts, Will and Kristen Planey. Also known as the Glock and Plekans. Special thanks to our guests today. Dr. Jillian Horton. Executive producers are Will Fenner, Kristen Planey, Aaron Cordy, Rob Goldman, and Shanti Brooke. Editor, engineers, and expertise. Our music is by Omer Bin Zvi.

To learn about Knock Knock High's program, disclaimer, ethics, policies, mission verification, licensing terms, and hip release terms, you can go to Glockenplankton.com or reach out to us, Knock Knock High, at human-content.com with questions, concerns, or fun medical puns. Knock Knock High is a human content production. Knock Knock, goodbye. Hey, Kristen, are you good at multitasking?

I mean, as good as you can be. I don't think it's ever like super effective. Yeah. And a lot of physicians are being asked to multitask. Yeah. All the time. It's true. You're on the computer. You're typing away. You're looking at labs. You're trying to listen to the patient. You're doing all these things. That's just, it's not effective. Yeah. But it can help though, you know? What?

Microsoft Dragon Copilot. That can help. Yes, absolutely. This is your AI assistant for workflow and documentation. It helps automate tasks. You can summarize notes and evidence, prep your orders. It can draft referral letters. That's pretty cool. Yeah. And with after-visit summaries as well. You get an after-visit summary. I do. I always read them too. Yeah. I'm a very good student.

Microsoft Dragon Copilot can help you make that. Yeah, that's pretty sweet. I wish I had one of these things for like my job. Yeah. That'd be really nice. Running glockenflecken. Yes. It's a lot of work to make it where you are, you know, presentable to the world. Absolutely. To learn more about Microsoft Dragon Copilot, visit aka.ms slash knock knock high. That's aka.ms slash knock knock high.

You've been caught.