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We bring together three passionate advocates for physician wellness: Michael Foti, an internal medicine physician; Tushar Bhagat, a research assistant professor; and Kim Downey, a physical therapist. Join us as they share their deeply personal journeys and professional insights on tackling burnout and promoting mental health in health care. From Michael’s story of overcoming personal loss and panic disorder to Tushar’s experience using mindfulness-based practices to support medical trainees, and Kim’s perspective on physical wellness, our guests discuss the urgent need to prioritize the well-being of health care professionals.
Michael Foti is an internal medicine physician. Tushar Bhagat is a research assistant professor. Kim Downey is a physical therapist.
They discuss the KevinMD article, “How to support physician wellness during the toughest times.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Kim Downey. She’s a physician advocate, and she brings together Michael Foti, internal medicine physician, and Tushar Bhagat, a research assistant professor. We’re going to talk about the KevinMD article, “How to Support Physician Wellness During the Toughest Times.”
Kim, Michael, and Tushar: Thank you.
Kevin Pho: Perfect. Kim, you’re on many times, and thank you so much for bringing these guests together. So, what brought you and led you to Michael and Tushar?
Kim Downey: Oh, sure. So, last spring, Michael and Tushar each reached out to me. Michael shared that we’re both advocates for physician wellness. And Tushar said he found me on one of Dr. Jonathan Fisher’s posts and that we both care about physician well-being. He commented on my cancer journey, sharing that he’s in a cancer research career. I Zoomed with Tushar and then Michael the very next week, and I thought that they should meet. So, I had them on my YouTube channel together.
Kevin Pho: Excellent. So, Michael, you’re an internal medicine physician. Just briefly share your story and journey.
Michael Foti: Yeah, definitely. So yes, I’m an internal medicine physician. I trained during the COVID-19 pandemic. It was actually that first wave of COVID that arrived during my intern year—kind of the back end of my intern year, which is the first year of residency. It was, suffice to say, a very chaotic time. Many, many patients suffering and dying, many of whom were quite young. And on top of it, around the same time, my mother passed away quite suddenly due to complications of stage four lung cancer. So, it was a very difficult time for me. And once I graduated from my residency program is when my personal journey with mental illness began. I developed quite severe anxiety and depression due to just unprocessed grief and emotions.
I went on for months, and I suffered in silence for quite a long time—a large part due to the state of mental health—and I was afraid to really speak up and get help and even accept what was going on. Eventually, though, I did get help, started on an antidepressant medication, and began seeing a psychologist. I took a medical leave to take care of me, finally. And honestly, it was the best thing I could have done, and I’m in a much better place for it. And because of those experiences, I’ve become very much a passionate advocate for mental health awareness, and especially physician wellness, particularly for those training to become physicians as well.
Kevin Pho: All right, Michael, we’re going to touch upon that story, and I have a few questions about that in a bit. But before we do, Tushar, can you introduce yourself, and tell us a little bit about your story and journey?
Tushar Bhagat: Yeah, sure. I’m happy to be here again with Michael and with you, Kevin. So, I’m primarily a cancer researcher, a translational researcher where we do lab research. Plus, we have clinical trials that have led to some therapies in the clinic now that they’ve been used. But while doing this, I got a chance to interact with patients and medical students for a decade while I was teaching students and bringing in mindfulness during respiratory system lectures when they found out I’m teaching meditation.
When I was teaching mindfulness to the cancer patients who are on our clinical trials, it hit me. They said, “Thank you for keeping us alive through your research and the treatments you come up with. We’d love to learn how to live.” That’s why they came to the mindfulness program. From there, I saw what meaning, purpose, and joy we got from being aware and developing awareness. So, that’s basically my work. But besides doing meditation, I wanted to bring some more understanding through the lens of science. So, I got trained at Brown University in the most validated, scientifically, and clinically tested meditation program called Mindfulness-Based Stress Reduction, for which I am a facilitator and a teacher trainer.
For the ESR organization, but because I would be in the medical field and medical research field, medical education field, I had this desire to bring this to, let’s say, my tribe, if you will. Because I’m able to relate with them more so, but to the understanding of neuroscience, understanding trust and validity, and therefore the willingness of tough scientists and physicians with pride to their own benefit. I’ve been seeing those for a number of years now and am happy to continue doing this work with advocates like Kim, Michael, and yourself.
Kevin Pho: Perfect. So, Tushar, let me follow up on that. You talk about Mindfulness-Based Stress Reduction. Just for those who aren’t familiar with that, tell us exactly what it is and how it can specifically benefit physicians today.
Tushar Bhagat: Definitely. So, Mindfulness-Based Stress Reduction is a program that began at the University of Massachusetts Medical Center by an MIT-trained molecular biologist, Jon Kabat-Zinn. It has three basic elements. It has formal meditation practice, where you sit and meditate quietly; informal meditation practices, where you integrate movement with meditation and your regular day work; and integrative mindfulness, where you’re actually applying the principles of mindfulness to your day-to-day life to see whether it works and how it helps you.
So, this has been around since 1979, but there are 40 to 45 years of primary research articles and clinical trials published in JAMA and similar journals to show the evidence that it may be practiced in the medical setting. It’s very relevant to, let’s say, our people, if you will. Besides this research and clinical trials, I’ve met people such as Kim. It’s different when we meet a person in real time and see what this program is doing to them. So, that’s basically what MBSR is. The research continues to go on. Clinical trials continue to go on. They are not only to reduce, let’s say, the fines incurred through medical malpractice due to burnout, which is what institutions are interested in, but I care more about the person itself.
While they are taking care of people, somebody needs to take care of them in all possible ways. This is one of the ways that is very well validated and tested. While the system changes, we can still do this.
Kevin Pho: All right. Michael, when you were telling your story, you mentioned a difficult time, especially during COVID, and then you had a lot of personal tragedies that affected you as well—all while doing residency, right? So, give us a sense of what it was like during that time, during those days while you were on the hospital wards with all those stresses around you. Give us a sense of what it was like during those days.
Michael Foti: Yeah, thank you, Kevin. It was extremely chaotic, to say the least. To kind of give some context to that, I was part of the RRT team, or rapid response team, which responded to emergencies in the hospital. Pre-COVID, our hospital maybe got one or two RRT calls a day, right? But at the height of the first wave of the COVID-19 pandemic, you’re talking about one or more an hour. Almost always, the case was one of our patients’ oxygen levels dropping. So, there was no stopping. It was constantly in and out of patient rooms, trying to stabilize patients, and more often than not, having to then transport our patients to the ICU. What made this even more devastating was that most of these patients were young—in their 30s and 40s for the most part. Oftentimes, we had families admitted at the same time in the hospital in different rooms who couldn’t even see each other.
I even had a patient whose wife was in another room, and she got discharged, and a week later he passed away. They never got to see each other again. These were the types of things that were happening. So, yes, it wasn’t personally happening to us, but as someone very involved in the care team, it was devastating to witness and really had a mental toll on all of us. Again, it was very much akin to a war zone because something devastating like that happened, but you couldn’t stop for a moment to even process it. Then, you had to jump to the next emergency. It was emergency after emergency, and it was just a very difficult time.
Kevin Pho: And Michael, in terms of that stress and that journey, it eventually led you to a place of burnout and seeking help, right? Because a lot of physicians, when dealing with behavioral health stresses, often don’t seek help. So, what was it in your case that led you to seek help and kind of make that turn in your path?
Michael Foti: Yeah, definitely. Thank you for that question. So, it was kind of like my body made that decision for me. I had probably the worst panic attack up until that point. I had been having nightly panic attacks for months when it all started, where I would have very intense chest pain—akin really to a heart attack. My arm felt like someone was squeezing my left arm off. But there was one night, particularly in December of 2022, where I had the worst panic attack. I thought, well, maybe this is my heart. So, I had my wife bring me to the emergency room. They did all the testing imaginable, and everything was fine. Finally, I requested to see a psychiatrist because, as a physician, I knew this had to be—if it’s not my heart—something else.
The psychiatrist, she was wonderful. She sat with me for hours, and we just spoke about the experiences I’m telling you now and everything that I dealt with. She looked me right in the eyes and said, “I’m not surprised. This isn’t just stress from work. You have a lot of unprocessed grief—the loss of your patients, the loss of your mother.” And this manifested as quite a severe panic disorder and depression. It was hard to hear, but I said to myself, if not for me, but for my son and my wife, I needed to get help. That’s when I finally decided to stop taking care of others—meaning my patients—and take a medical leave and take care of myself.
Kevin Pho: So, Kim, when you’re hearing Tushar’s work with mindfulness-based stress reduction, and you’re hearing Michael’s story about how he overcame behavioral health issues and now he’s openly sharing his story, tell me the connective tissue between both of those stories. What made you bring them together here? What are some similarities between what Tushar does and Michael’s story?
Kim Downey: Yeah, sure. So, when I spoke with Tushar first, he was just so kind. When I was hearing him speak about how he taught in medical school and witnessed the stressors of medical students, and how it progressed to residents, and then now that he supports medical professionals in teaching mindfulness. And then the very next week, when I spoke with Michael and saw he’s working hard to end mental health stigma in medicine by sharing his story, I was thinking, “Oh my gosh, they should meet.” And geographically, they aren’t so far from each other. We had connections—Michael’s only about 45 minutes from me, and Tushar’s at Albert Einstein, and I did some work there as a PT student. He has a friend who lives here in Connecticut, so it just felt like we were all connected.
Kevin Pho: All right, so Tushar, let’s get back to mindfulness-based stress reduction. Give us a story or an example where a physician or medical student instituted some of these techniques and that really helped them reduce some of their stress and potential path to burnout. Tell us a case study or a story.
Tushar Bhagat: Yeah, this is when it comes alive. Thank you, Kevin. So, without naming the physician, I had several physicians in this course. One of them was somewhere on the northeastern coast in his residency at the time and taking this course. Michael did a great job describing his life, actually. Whatever Michael just said, everything was happening to this resident. Long work hours, having physical symptoms that were unmanageable for him, that led to more difficult interactions between his juniors or his senior attendings, and that led to more complications that we had to deal with—more physiological reactions, panic attacks, anxiety. And in that, not being able to be present for the patient. He outright said that, “I don’t feel anything about anybody. There’s someone dead, and I don’t feel anything.” So, their ability to be empathic got lost. Apathy set in.
But then when they sat down to think about this, they found some meaninglessness in life. They were doing more harm to themselves and others. But now, having done this program for nine weeks—eight to nine weeks—daily practices, weekly two-and-a-half-hour sessions, and three different ways of practicing it, slowly, what really transformed in them was they developed this space of awareness just before the reactivity.
If I were to talk in neuroscience terms, their amygdala started reacting less—the reactive part of the brain—and the prefrontal cortex, which makes logical decisions, kind of set in and activated in that space when they were able to think even for two seconds or a minute before they acted. That had a huge impact on the consequences they had in personal relationships with their patients. People saw transformation in them in a way where they said, “I don’t recognize this person anymore, in a good way. They’re not getting upset, angry, mad, or running away from conversations like they used to—whether on email or in person.” So, there’s a snippet of that, and this is a person who really worked very hard. They followed the practice to the tee and then saw the outcomes that have been tested for a long time. It’s only seen when the rubber hits the road, when people do it, just like any prescription.
To use a medical analogy here, Michael might prescribe something, but until people open and take those prescriptions just as guided, they would not see the effect. So, it’s similar in mindfulness.
Kevin Pho: And Tushar, if someone was interested in learning more about these techniques and your program, where can they find more information?
Tushar Bhagat: They can find information through me on LinkedIn, or they can find information on the Brown University website, the University of California, San Diego, and then several other institutions like Mindful Northwest, where I’m associated with and which are actually leading the MBSR program in the country.
Kevin Pho: Michael, so getting back to your story, what was your ultimate goal in terms of sharing it? What do you hope to accomplish and change by sharing your story, being on this podcast, and talking about what happened to you?
Michael Foti: Yeah, my initial reason for sharing my story was that I knew I wasn’t alone in my story. I knew there were other stories very similar to mine. I knew that, whether it be a medical student, a resident, an attending physician, or really anyone in the health care workforce, there were many who were suffering in silence. Because I knew what that felt like, I knew that if I could share my story and potentially resonate with someone else, it could empower them to get the help they need and not feel alone. Not feel scared to get the help they need. My mission is to raise awareness about mental health, especially in the medical community, to get rid of the stigma that exists, and really create a safe space for everyone, everywhere dealing with mental health, but especially in the health care workforce, to feel safe and empowered to get help when dealing with this and hopefully change the culture of medicine for the better.
Kevin Pho: And Michael, can you share a story or a case study where someone heard what you went through, and it made a huge difference in their life and changed their path as well? Is there a story that you could share with us?
Michael Foti: Yeah, definitely. So, I’ve been speaking at many institutions and medical schools, and I had a student reach out who said, after hearing my story, they were afraid to speak up because they felt that they were going to need extra time for their board exam. Oftentimes, students are granted accommodations for whatever reason they need more time on their board examinations. This student was afraid to speak up about why they needed that extra time, and they didn’t want to feel isolated because they spoke up and, you know, obviously, the stigma. They were afraid, but after hearing my story, they immediately went and shared why they needed this extra time on their board examination and were granted that accommodation. Again, they felt empowered to do so after hearing my story.
Kevin Pho: We’re talking to Michael Foti, Tushar Bhagat, and Kim Downey. Michael is an internal medicine physician. Tushar is a research assistant professor, and Kim is a physician advocate. The KevinMD article is “How to Support Physician Wellness During the Toughest Times.” Now I’m going to ask each of you just to share some take-home messages for my clinician audience. We’ll start with Tushar, then Michael, and end with Kim. So, Tushar, why don’t we start with you?
Tushar Bhagat: I would say, speaking of, like I heard Michael use the word “empower.” So, I’m going to go with that. I would say that physicians can still be empowered with the tools that they have within them—within their brain and body—until the system changes through more advocacy. And what I mean by that is they can still do a lot of these validated mindfulness practices that might not take away too much time from their life but might have a huge impact on their well-being. So, they should trust the science, learn about it, and then try it for themselves. Then come back and see what they want to do—continue or shift, change.
Kevin Pho: Michael, what are some of your take-home messages?
Michael Foti: One of my biggest ones is that healing starts with self-compassion, right? To love oneself is to take care of oneself no matter what. I want everyone dealing with mental health, whether you’re in the health care workforce or not, to know that you’re not alone. And know that it’s not a weakness to be suffering from any form of mental illness. In fact, the strongest thing that you can do is to get the help that you need. You cannot be a healer if you do not first heal yourself. You can’t be your best self for whatever profession and for your loved ones if you’re not your best self. So please, take care of yourselves and just be kind to yourself. It’s OK to not be OK.
Kevin Pho: And Kim, we’ll end with you. Leave us with your take-home messages.
Kim Downey: Sure. One is, we didn’t get to touch on Café Foti, and I’m hoping that you’ll all reach out to Michael so he can tell you a little more about it. Basically, he has an hour a week at least where medical students can come in any time and get a drink and a snack. He has an hour where he’s just there for them. I think that is so beautiful and wonderful, and I hope it could be replicated in many ways around the world. So, reach out to Michael and find out more about Café Foti. The other thing is, I was thinking about what I wanted to say, and it’s to reach out and touch someone. That was like a phone commercial in the eighties, but that was like 40 years ago, so Michael might not be aware of it. But it made me think of it, literally and metaphorically. My son’s first-grade teacher would always ask the kids every day, “Do you want a hug, a handshake, or a high five?” With my own doctors, mostly we’ve shared a hug, a handshake, or a fist bump, and I never do that without smiling. It just means a lot. Whenever I meet a doctor in person, we always share a big hug, and metaphorically connecting—Tushar and Michael reached out to me, or I reached out to other doctors—and then we had that conversation, and they wanted to keep the conversation going, which is why we’re doing this today. So, just reach out and touch someone.
Kevin Pho: Well, thank you all for sharing your stories, journeys, and perspectives. And thanks again for coming on the show.
Kim, Michael, and Tushar: Thank you, Kevin, for having us.
