The Gold Connection: A Gold Humanism Honor Society Podcast
In Episode 5, join us for a special episode of the Gold Connection in recognition of National Suicide Prevention Month, which is every September.
We are honored to welcome Dr. Steven Wengel and Dr. Kenneth Zoucha for a wide-ranging and intimate conversation about physician wellness, the particular risk factors often built into the physician culture, and how we can help colleagues and each other in fostering wellness.
Both Dr. Wengel and Dr. Zoucha are physicians at University of Nebraska Medical Center, and Dr. Wengel is a member of the Gold Humanism Honor Society Wellness Committee.
Dr. Steven Wengel
Dr. Wengel is originally from Omaha and received his bachelor’s degree from UNL and his MD from UNMC. He completed his psychiatry residency and geriatric psychiatry fellowship training at Creighton University and UNMC. He has been practicing geriatric psychiatry since 1991. He sees patients in his office and at several local long-term care facilities in and around Omaha. He is an active and enthusiastic teacher of students and residents.
Dr. Wengel has also served UNMC in several administrative roles, including clerkship director and department chair. In 2018 he became UNMC and UNO’s first Assistant Vice Chancellor for Campus Wellness, and in this role he is developing strategies to reduce stress and burnout in students, staff, faculty and healthcare professionals. His vision is to improve the physical, psychological, and social wellbeing of all who work and learn in the health care world, the academic environment, and the community at large.
Dr. Kenneth Zoucha
Dr. Kenneth Zoucha is a recognized leader in addiction medicine for the State of Nebraska and serves as Director of Addiction Medicine for the Department of Psychiatry at UNMC. Board certified in Pediatrics and Addiction Medicine, Dr. Zoucha has extensive experience that includes his almost 20 year career as a general pediatrician in Hastings, Nebraska and now specializes in the treatment of Substance Use Disorders in adolescents. He has also served as medical director for several adolescent secure care placement facilities throughout the state, serving youth with a broad array of experiences, backgrounds and trauma.
Dr. Zoucha is a clinical educator of medical students, residents, and other health care providers. Responding to the escalating national need, he championed the establishment of an Addiction Medicine fellowship at UNMC. He also led the development of an innovative executive addiction fellowship, featuring one-month immersive experiences for residents and providers already in practice. Through this work, he enjoys lifting up learners to become the best clinicians, educators, and advocates that they can be.
Dr. Zoucha’s awards include Reba Benschoter UNMC Department of Psychiatry Inspirational Leadership Award, Volunteer Faculty Clerkship Teaching Award from the UNMC Department of Pediatrics, Commitment to Excellence in Leadership from the Nebraska Juvenile Justice Association and the Deborah Munson Barger Pediatric Resident Award.
In addition to his expertise in treatment of adolescents and young adults, he also has a special interest in the treatment of pregnant women with substance use disorders, babies with neonatal abstinence syndrome and their families.
Show Notes
National Suicide Prevention Lifeline 1-800-273-8255
Twitter: @drkenzoucha @drstevewengel
LifeBridge Nebraska – Nebraska’s Physician Wellness Program from the Nebraska Medical Association
COVID Coach – Mobile app to support wellness and mental health during the pandemic, created by the Veterans Association.
For Health Care Professionals, Music is the Best Medicine –An article about the Nebraska Medical Orchestra by the Omaha World-Herald newspaper.
National Association of Medical Orchestras (NAMO) – A new national organization for medical orchestras, led by Dr. Matthew Brooks, Founding Music Director and Conductor of the Nebraska Medical Orchestra.
National Organization for Arts in Health
Nebraska poet Steve Langan, who started a Medical Humanities major and who has worked with physicians on expressive writing projects, including the Seven Doctors Project.
Credits
Music by Luca Fraula, “Follow that dream”
Host and audio editor: Dr. Hellen Ransom
Producers: Louisa Tvito and Brianne Alcala
Transcript proofing: Isabella Kovacs
Website support: Jill Levenhagen
Transcript
[00:00:01.820] – Dr. Hellen Ransom
Hello, everyone, and welcome to another episode of the Gold Connection, where we share stories of humanism and health care as well as tools and lessons for students, clinicians, and leaders. The Gold Connection is produced by the Gold Humanism Honor Society, a program of The Arnold P. Gold Foundation. My name is Hellen, and I’m your host. Today, as a part of our recognition of National Suicide Prevention Month, we have a special episode for you on wellness and connection. As our Gold community knows, health care professionals are at much higher risk for burnout, depression and suicide than the general population.
This episode features two experts from the University of Nebraska Medical Center, or UNMC. Dr. Ken Zoucha is a pediatrician and addiction medicine physician and Dr. Steven Wengel, who is a geriatric psychiatrist and Assistant Vice Chancellor for Wellness at UNMC and the University of Nebraska at Omaha. Dr. Wengel is also a member of the Gold Humanism Honor Society Wellness Committee. In the conversation today, Doctors Wengel and Zoucha share their personal stories, tips to foster connection and wellness and resources to help prevent burnout, depression and suicide.
We are grateful that they have shared their insights.
[00:01:47.310] – Dr. Steve Wengel
Hello, so, Steve Wengel, I’m a geriatric psychiatrist at the University of Nebraska Medical Center and delighted to be here with a friend and colleague, Doctor Ken Zoucha. So Ken, you want to say hello to our listening audience?
[00:02:03.090] – Dr. Ken Zoucha
Hi, Steve. Ken Zoucha. I’m a pediatrician but also board-certified in addiction medicine and work at the University of Nebraska Medical Center, running an addiction medicine fellowship and get the opportunity to teach, which I’m really grateful for.
[00:02:20.460] – Dr. Steve Wengel
It is great, isn’t it, that we get to influence the next generation? We hope that we’re doing a really good job of teaching them what we’ve learned over many years. I won’t ask you to volunteer how many years, but 30 years for me, practicing and still practicing. I would say I am still trying to get it right. But it’s a great thing. It’s a great career to be in and to be able to help people and to try to help the next generation learn from us.
[00:02:47.840] – Dr. Ken Zoucha
So true. I got that opportunity to make a career change from a clinical life into academic medicine three years ago. So, it’s been a really big right for me, too. So, I’m just really grateful to be here.
[00:03:02.220] – Dr. Steve Wengel
That’s a really good point, because not too many pediatricians work in an academic psychiatry department, right?
[00:03:07.660] – Dr. Ken Zoucha
Right.
[00:03:08.230] – Dr. Steve Wengel
We are so lucky to have you. And you’ve done just great things for our institution here at the University of Nebraska.
I’ve gotten to know you over those last three years. And just for the listening audience, we’re work buddies. We set up a buddy system in our department during the pandemic, and I’m privileged and really enjoy our weekly get together, kind of check in on one another, make sure we’re doing okay. So, I’ve gotten to know you over this last couple of years with that, which is great. But tell us your story if you don’t mind. Ken, how did a pediatrician wind up in a psychiatry department? You’ve got a really, I think, compelling story, and I know our listeners are going to really be riveted to hear your story.
[00:03:55.540] – Dr. Ken Zoucha
Yeah, well, Steve, that’s interesting. I’m setting up to do a quick, brief kind of thing in just a day, and so I thought I would just run through that and give me a chance to kind of talk about this and see how it flows.
So just kind of looking back, I really know that alcohol affected me differently than my friends. They stopped and I didn’t. And then I had a severe back injury in high school, introduced me to the power of opioids to alleviate my pain and anxiety and just made me feel better than I thought was possible.
College and medical schools were perfect backdrops for drinking for me. Studies show that 90% of college or medical students drink and a third of them binge drink. And that was just a perfect backdrop for me to kind of normalize my drinking for me. But I’ll say I started living a double life around the time after I got into clinical practice. My wife became ill with cancer and she died two months later. And alcohol and opioids helped me deal with the grief and the anger and the fear of how I’m going to raise four kids and continue to work.
Really, I spent all my time trying to look super human during the daytime and make sure I had enough alcohol and opioids to sustain this unsustainable life, when I really should have been spending all my energy caring for my kids. I rationalized really, that if I was using these substances to treat my pain, both emotional and physical, it was okay. But I also feared that if anyone found out what I was doing, that I’d be devastated. Years of competition caused me to think of reputation and knowledge and prestigious deities, and so it was really a difficult kind of time. Thinking about also my family, my family’s just riddled with alcoholism.
My parents escaped the alcoholism part, but they unintentionally taught me that people who couldn’t control their drinking were stupid and foolish and bad. The thought that I might embody that really fueled my drive to hide that from my family and just made it so that I just couldn’t reach out for help. I would say that stigmatizing attitude was amplified in medical schools as I watched an attending I admire admonish a peer who had been caught using opioids and stating that that physician should never work again as a physician.
[00:06:20.310] – Dr. Ken Zoucha
And subsequently, when this happened, I feared the worse. I feared that the physicians in my community and in my hospital would think of me as less than for my disease. Stigma led to shame, and that told me that I was a mistake rather than a person who had a disease in making a mistake. And so, I kind of lived in those shadows for a long time. I initially found recovery when a cataclysmic pivot event happened. I got caught writing fraudulent prescriptions by pharmacy staff, and so I went to treatment reluctantly. I thought I was too important to be gone for very long.
I had my kids in my practice. But I will say that that cataclysmic pivot event that leads to a physician’s diagnosis with substance use disorder and hitting bottom is the rule. The exception is that we reach out for help before something bad happens. And I think that fear of just not being good enough of and being that weak, stupid person that I learned about from my parents and from other folks, kept me from reaching out. But my partner accepted me back into my practice after I went to treatment and I held it together. Unfortunately, 15 years later I thought I was better and I stopped treating my disease and the cycle of relapse happened. I ended up going back to opioids and adding stimulants, writing prescriptions in my kid’s names and signing my partner’s name to the pad.
And this time the consequences were severe. And so, after my treatment, my license to practice was suspended and placed on probation. The DA felt I was unsafe with a prescription pad in my practice and very gently informed me that maybe I should think about another profession. The hospital in my community really confirmed my fears with a letter that stated that I was just permanently barred from privileges. And so, it was a thing where I really felt I deserve those consequences and so much more. So, then I was stuck with this realization that I might never work as a physician again.
[00:08:16.510] – Dr. Ken Zoucha
Depression was a constant companion during that time. However, also during that treatment is when the solution started to happen. So, I learned about humility and grace during that time. So, humility became manifest for me and the ability to ask for help, mostly due to the depths of despair I was feeling. Grace entered in the realization that there’s a resourcefulness not in being the smartest and knowing at all, but of knowing who to ask for help and the courage to do so.
And so I was in that space that I launched what I thought was going to be my second career counseling. But as I was going to school to learn that very noble profession, the plans aligned. I got hired as a medical director for a series of treatment centers for adolescence. It allowed me to become board certified in addiction medicine, and six years later I’m at the Med Center with the honor of being able to be the program director for an addiction medicine fellowship. I will say, though, that none of that would have been possible without my wife and my family, and now this daily treatment that’s an integral part of my life.
And today I realized that if I had reached out for help sooner, I wouldn’t have had to go through so much pain, and experience so many sanctions. And so, we’re going to talk today about Life Bridge. It’s a program in Nebraska designed for physicians who have mental health and substance use disorders, as a way to reach out without having the fear of something bad happening. We’re really lucky to have that, because they see these conditions is really no different than physicians who have other health conditions.
[00:09:47.820] – Dr. Ken Zoucha
So, with that program in mind, I now use my journey to teach medical students and residents and fellows at our university about stigma in substance use disorder and healthcare professionals. And with all the support that I’ve gotten here and I now know is available, there’s really no reason that reaching out for help can’t become the rule, rather than the exception. This cataclysmic pivot event doesn’t have to happen for help to be found. And it’s in this space that I really, understand now that reaching out for help not only is the courageous thing to do, but it’s the only option, and that’s what I try to get across when I teach folks.
And so that’s kind of my story in a nutshell.
[00:10:31.760] – Dr. Steve Wengel
That is a courageous story indeed. And I’ve heard much, but not all of that before. And every time I hear it, I just am always inspired, Ken. I know you’ve been teaching, you mentioned medical students, and you sit down literally with a group of a dozen or a dozen and a half medical students every six weeks when they come to our clerkship and you tell them very forthright the same story. And I think oftentimes that maybe the first time, other than I know you get in front of them, even as first year students, too, and tell them your story.
[00:11:02.170] – Dr. Steve Wengel
But I think that may be the only time a medical student can go through medical school and hear something so refreshingly honest about dealing with substance use, mental health issues, all those sorts of things. We keep this stuff to ourselves, right? As you were talking, this reminded me of you mentioned sometimes again, I don’t want put words in your mouth, but about feeling not good enough, and things like that, which made me think of imposter syndrome, where the impostor phenomenon, which I think most of us probably have.
[00:11:34.180] – Dr. Steve Wengel
I certainly have it. I’ve experienced this many times in my career in medical school and beyond, and even up until now. All that sense that you’re not as smart as other people around you, you’re not as good, you’re not as conscientious or whatever it is. Right. So, I think it’s really rampant in the helping professionals, not just medicine but the helping professions, and it really can drive treatment underground, like either not get treatment at all, or I’ve heard tales of physicians that if they finally do decide to get treatment for mental health problem or substance problem, that they’ll go to another city. They’ll drive to another city where nobody knows them.
[00:12:13.770] – Dr. Steve Wengel
They’ll use a fake name, they’ll pay cash. So, we go to these great lengths to avoid the guilt and shame. You mentioned guilt and shame earlier, too. And I think we’re really prone to that.
[00:12:27.050] – Dr. Ken Zoucha
Absolutely, Steve. I would think, one of the things that you’ve taught me kind of as this wellness person is that one of the things, we really need to do is battle the stigma surrounding all these things. That imposter syndrome. I think now, just if I forget to do something I was supposed to do, just how much I can still beat myself up about something simple as that, just being a human being. We kind of think that we’re supposed to be more than human beings. It’s that super human kind of thing that I talked about in that story.
And that’s impossible. There’s no way to sustain that. And so eventually something cracks. And I think that’s probably the first thing that I try to work on or talk with students about it. It is that whole stigma piece and talk about the culture that sort of says that you can’t make a mistake or you can’t have a weakness or your patient care and your family come way above your own health when it actually has to be the opposite.
[00:13:39.680] – Dr. Steve Wengel
Yeah boy, so well said. It kind of, reminds me of the saying, I guess in the performing arts, “The show must go on.” So, you’re a Broadway performer, but your favorite uncle just died. But you still got a show. You got the 02:00 matinee so the show must go on, right? That’s true here in medicine I think that, the show must go on. We’ve got people needing our help, and we work when we’re hurt. It’s kind of like athlete playing when they’re hurt. But we work when we’re hurt and we put our game face on.
And there’s always this story about two physicians meeting in the hallway on a busy day in the hospital. How are you doing? Fine. How are you doing? Fine. And we keep moving. Sometimes we’re not so fine, I think, right.
[00:14:23.050] – Dr. Ken Zoucha
Well, one of the other things I think about with just the things we talked about with students a little bit is, I’d be interested to hear what you remember from medical school about substance use disorder in physicians. I remember a 1-hour video about this doc with alcoholism who ends up losing his family and getting run out of town because of his alcoholism. And I took an elective my fourth year that sort of focused on it a little bit. But that was pretty much it.
[00:15:01.260] – Dr. Ken Zoucha
And so not that that would have changed the tread directory, but maybe it would have for me if I had a little bit more education. You have a disease. And that’s the way it is. And so, I don’t know, what was your experience in medical school and how do you think it’s different now?
[00:15:19.860] – Dr. Steve Wengel
Yeah, that’s a great question. I’m thinking back. So, I went to medical school back in the early ’80s. I remember a single lecture. I do remember we had a fairly senior and very highly respected faculty member that did talk about his own struggles with alcohol use disorder, as we now call it back then, it was called alcoholism, I guess. But alcohol use disorder. And again, somebody that had he not told us, we wouldn’t have known that because he was a highly respected person, probably in his late 50s, that was a full professor and all that sort of thing.
[00:15:52.890] – Dr. Steve Wengel
But short of that, I don’t really remember getting a lot of education, certainly not about other mental health conditions, about physician suicide, any of that sort of thing. I think things are changing or things have changed quite a bit. We’ve got a way to go. But I think back then it was like you do not talk about these things in public. It’s kind of part of the physician culture is you keep that sort of thing under wraps.
You don’t talk about it.
[00:16:22.730] – Dr. Ken Zoucha
Well, there’s actually been some studies, looking at physicians’ self-disclosure of mental health issues, your psychiatric diagnosis and treatment, and that shows that students have a different attitude about that less stigmatizing attitude and more open about talking about it if they have a professor or an attending or faculty member who discloses their own issues. And I have to believe that that probably is true for substance use disorders as well. That would open up some stuff and change student thoughts and beliefs about that. And I think that’s really important.
I think, to show, just like you said, that physicians can have mental health or substance use disorders and seek treatment and continue to treat their chronic condition and do well. And I think it’s important to show that.
[00:17:27.590] – Dr. Steve Wengel
I think that’s right. There is hope, right. These are not terminal conditions, so to speak, right? But I think as physicians, we tend to have this sense that if I’m out either because of a mental health condition or anything else, even sometimes it seems like we have this sense that we’re one step away from losing our license, whether it’s again because of mental health problem, substance problem, accidentally making an error. Like you said, we’re always so worried about making errors because we’re conscientious we don’t want to hurt anyone.
[00:18:02.180] – Dr. Steve Wengel
I think we oftentimes struggle. I know I have that sense like, boy, this career, this marvelous career that I have could disappear tomorrow. But for that one thing.
[00:18:15.550] – Dr. Ken Zoucha
Well, I’m sorry to cut in on you, but as I think about your career and being vice chair of wellness for our campuses here. I’d like to hear a little bit about kind of how you got into the role you’re at right now because you do that so well. The wellness piece is such a blessing for our campus and just kind of how you got there.
[00:18:37.960] – Dr. Steve Wengel
Well, thank you for saying that. It’s an interesting trajectory. We all have our own trajectories. And in all honesty, one of the reasons why I got into kind of more prevention and stress management resilience, building things like meditation and mindfulness was quite selfishly to treat some of my own stress and anxiety. And I remember being an undergraduate many, many years ago, I guess in the late 70s, late 80s. So going to college, doing the usual premed thing. I enjoyed college a lot, but I was quite anxious.
[00:19:12.420] – Dr. Steve Wengel
I don’t know that I would have put a diagnostic term on it because I wasn’t that sophisticated back then, even though I was a psychology major. But I was pretty anxious and I don’t know that I even knew that college counseling existed. If I did know it, I probably just felt like, well, that’s not for me. For some reason, I probably could have really benefited from it. So instead, though, I stumbled upon a book on meditation written by a cardiologist named Herbert Benson, who was actually at Harvard.
He was at Harvard. He studied meditation in his patients with high blood pressure, and he found that if people had meditated for 10 or 20 minutes a day, oftentimes it could bring their systolic blood pressure down and keep them down because they would manage their stress better. And he was doing this mind you back in the 70s, when this was not — nowadays, mindfulness and meditation are kind of household words, but back then they really weren’t, especially, I think, on the East Coast, on the Ivy League campuses — but he kind of fought the tide.
[00:20:08.400] – Dr. Steve Wengel
His mentors told him not to do that, not to do that kind of research because it was sort of out there, so to speak. But he kept doing it. So anyway, I stumbled on his book and I read about it, and he talked about the science of cortisol and stress and the autonomic nervous system and the fight or flights and all that stuff which was all new to me and then, he had an antidote. So, do this very simple breathing exercise for about 10-20 minutes a day. So, I started doing it back then, and I found it really worked.
It didn’t make it all go away and didn’t make me completely not anxious. But it made things a lot better. And so, I’ve kind of been doing that for many years, off and on. And then when I became a psychiatrist, I started using some of these techniques with my patients and kind of coaching them a little bit, in addition to prescribing medication and all. And because of I guess, my interest in this, the University three years ago, about the time you came, our campus said: Gosh, we really like to have a point person that can help us come up with some strategies because recognizing burnout rates are high, rates of depression and anxiety are high in health care and always have been.
We’re not immune from that here. And so, they asked me to take on that role. So, I spent half my time doing geriatric psychiatry, the other half doing kind of wellness things for our campus. And it’s been really an interesting job, I would say, and I’m really privileged to be able to do it. But it takes a team, and I don’t do it by myself. I’ve got a couple of really good psychologists that, you know, Dr. Courts, and Dr. Delisa,, they’re really good. But I think the best part of my job is I get to work with other, really conscientious, empathic people like you and like people in some of the other colleges, the nursing school, the pharmacy school and so forth, because there’s a lot of people interested in this topic nowadays.
[00:21:56.760] – Dr. Steve Wengel
I think the pandemic maybe has brought out the interest because I think we’re all kind of more stressed than usual because of the pandemic. So, it’s allowed us to talk more freely, I think about stress and anxiety. And so, part of my job, though, anyway, is to kind of round up the people that are already interested in this and supporting them any way I can, giving them some tools that can help them in their work. I can’t do it all and wouldn’t even try to.
But if nothing else, I get to work with a lot of other really good people that are already in the trenches and doing a lot of this work and do my best to try to support them a little bit.
[00:22:30.100] – Dr. Ken Zoucha
Yeah, that’s just really amazing. It’s pretty cool stuff. And I know I’ve been a couple of trainings that you have been part of, and they’ve just been really good, and really helpful for me. So yeah, that’s really great.
[00:22:46.340] – Dr. Steve Wengel
Well, I can say it’s a fun thing. And quite honestly, I try to employ these techniques myself, and if nothing else, I can kind of share with people my own experiences. So, I try to be transparent and sharing and talk about impostor syndrome that I have and stress that I have just like you do. I mean, you are the King when it comes to really just kind of being out there and being really courageous enough to share your story. I’ve learned so much from you, and I think I’m trying to do more and more of that myself, and I think it really helps.
[00:23:17.640] – Dr. Steve Wengel
I think when people realize they’re not alone. I’m not the only one that struggles with, fill the blank- a substance problem, worries about my license, worries about getting treatment and losing my license, whatever it may be- we all struggle with various variations on that theme. I think to hear you’re not alone. I think that’s really powerful. I think it’s really, really super powerful.
[00:23:41.370] – Dr. Ken Zoucha
Yeah, absolutely. Stigma, I think, is an interesting topic, but it’s such a big part of all of this, I think. The couple of components to that are: First, that somehow you cause what’s happening, especially for substance use disorders. You’re the one that chose to start drinking. You’re the one that started taking opioids, and then, on the other hand, that you can control it. So, we’ve got just say, no kind of deal or the scare straight. You can scare yourself out of your disease or whatever.
[00:24:16.680] – Dr. Ken Zoucha
And so, when we’re struggling with something that we have this kind of deal, well, this is something that my patients have, but not me. And this is something that I should be able to control because my willpower and my brain got me through school and residency, and so I should be able to handle this. And so not being able to handle that, I think is such an important I think lesson. And so, when we look at stigma and kind of like, okay, how do we reduce stigma?
How do we help with that? One of the strategies we know works is exposing people to folks that are in recovery from the stigmatizing condition. So, when you can expose folks to people in longer term recovery, from substance use disorder or somebody who’s struggled with depression in the past and is doing well now, just over time. Our students’ and residents’ exposure to substance use disorder a lot of times, is just in the emergency room or on the wards where they get to see and treat those patients who have the most severe disease..
[00:25:32.810] – Dr. Ken Zoucha
Just like anything else, substance use disorders are people who have severe disease. And so, they come away from that thinking that people with substance use disorders don’t get better. In fact, they do. And so, if we can expose, I think students, too, again, people that are in recovery over a long term, I think that’s really a benefit to help reducing that stigma. And I think probably is one of the main reasons why I tell my story to students is. to help reduce that stigma and bring down those kinds of difficult thoughts they might have about people who have substance use disorders again, and being that weaker, bad person that I thought about when I hit medical school.
And so, my hope is that, you know, realization that a physician can have this disease and find recovery and then continue to treat the disease and work, I think, is a really important lesson and helps reduce the stigma a lot.
[00:26:43.320] – Dr. Steve Wengel
Boy, I think I think you nailed it because you’re right. We don’t always see the success stories, right? We see people when they’re kind of at their worst, at that low ebb sometimes. But again, I just can’t thank you enough for being willing to share your story here. A number of things you said reminded me of this. A number of years ago, I read about an article written by Glen Gabbard. Glen Gabbard is a well-known academic psychiatrist. I think he’s a psychoanalyst, and he treats a lot of physicians in his practice.
And he wrote a paper a number of years ago talking about the compulsive triad. So, he said, most physicians have this triad of characteristics, a lot of guilt, a lot of self-doubt and an exaggerated sense of responsibility. Let me say that again, just because I think it really resonates with me, a lot of guilt, a lot of self-doubt and an exaggerated sense of responsibility. When I mentioned that to other physicians, you almost always get a lot of head nods, saying, yeah, sounds like me.
And if you don’t have those characteristics, when you enter medical school, we will inculcate those in you right. We kind of never miss the diagnosis, never miss that rare thing, that tumor, that whatever, never make a mistake. And certainly, we strive to be conscientious and to be the best we can be. But you said it earlier. We’re not perfect. This is an imperfect science, and you can’t be perfect. But when you hold yourself to this impossible standard, and you also have this sense that other people are achieving that standard, but I am not because you have imposter syndrome.
That’s a setup for a lot of stress, for sure.
[00:28:34.460] – Dr. Ken Zoucha
One of the important things that I learned that really helped me kind of in the treatment process is sort of the difference between guilt and shame. Shame again says that you’re a mistake, inherently you’re wrong, your bad because of the behavior that you wish you wouldn’t have done, and you feel bad about it. And there’s a tremendous difference because one is your bad, the other is your behavior could be different. And I think, you know, when you talk about the guilt, that’s the first thing that came to my mind is, do we feel guilty?
And I think a lot of people do. A lot of people have a good, strong sense of themselves. And I think that’s an amazing characteristic to have, for sure. But also, there’s some folks and I was one of those, that it wasn’t what I did was wrong, but that I was wrong. And that is part of my upbringing from my grandmother constantly saying, “Shame on you.” But there’s a lot that goes into understanding that and I think recognizing that the mistake doesn’t mean you’re bad or forgetting to do something or whatever, it just means you made a mistake.
And welcome to the human race, you know.
[00:29:57.570] – Dr. Steve Wengel
I love the way you said that. That is great. I think that is an amazing thing you said there, guilt versus shame. The shame is kind of intrinsic. It’s like, yeah, I’m bad. I’m defective in some way versus guilt being something that’s kind of an active thing. It’s a good thing. Like if you do make a mistake, it teaches you from it. So, you can maybe try not to make the same mistake. That’s a great distinction.
[00:30:22.290] – Dr. Ken Zoucha
Absolutely. As I think about – and maybe I think this is a good topic to talk about – as I think about just talking with medical students, I mean, one of the first questions when I started to do this that I got from students was so how do I approach my friends, a friend who has something going on. How do I talk with somebody? Because I say that one out of ten, one out of twelve physicians is going to struggle with substance use at some point over their career, which means that you’re probably going to be in contact with somebody, if not yourself, somebody else.
And so, I think it’s really important maybe to spend some time on that, because, again, just thinking about a physician who has a substance use disorder going on at the time, they’re worried to death, that they’re going to be found out, worried that they’re going to lose their license and their livelihood and their career. And, so just constantly paranoid and on the defensive that if somebody approaches them and says, you know, we think you’re drinking, what do you think somebody’s going to do? They’re going to automate. So, what I tell students – there’s a little bit of data to support this – is really talking more about behaviors from an empathetic standpoint.
And some of the stuff is objective or subjective. You’re not doing well as a physician. Okay, that’s subjective. But to say that, You know Ken, you used to be right on time every morning in the nursery and right on time in the office to start seeing patients, and we’ve noticed lately that you’ve been late. And you’re always dressed nice and your hair was combed, and we’ve noticed that you’ve been dressing is a little bit different. And you know, you’re always such a nice guy, and we noticed that this time when the staff person asked you about your schedule, you liked, snap back at them and that was so out of character. So, having specific behaviors and then just saying, You know what, I’m just really worried about you. Is there something going on or is there something that I can help you with?
And when you approach somebody about their objective behaviors that maybe they can argue with, but that have a specific kind of time, a specific sort of thing with it and you’re approaching it or not, as I think you’re drinking or I think you’re doing this, but I’m just really worried about you. Is there something that I can do to help you out? You just seem really stressed. Is there something you want to talk about or something that I can do to help?
I think approaching folks, and there’s much more to it than that, obviously, but I think approaching folks in that way and giving people a way to kind of think about very specific behaviors and objective type of information, I think that somebody’s going to be much more likely to be open and maybe respond to the question.
[00:33:39.140] – Dr. Ken Zoucha
And initially it might be, nope fine. Just like you said, two physicians crossing the hallway. Both of them have been awake for 48 hours. And how are you?
Fine.
How are you?
Fine.
Well, you’re not because you’ve been awake. But it might open up to a conversation later on down the road. And I’ve been impressed with the number of students who have come to me about a friend or a family member or whatever after telling my story and then talking about physician substance use disorder and talking about how do you approach somebody. So, I just think it’s really important to kind of think about that and think about how you might because it’s a difficult conversation, right? You’re worried that the person can get mad at you and then create a difficult relationship.
And what if I’m wrong? What if it’s nothing really? All that stuff that keeps people, I think, from asking that question or bringing it up. I think we have to give people the courage and the knowledge about how do you approach somebody. And I spend time, every six weeks when we’ve got students rotating through the psychiatry department talking about some of those things. So, I think it’s important.
[00:35:05.510] – Dr. Steve Wengel
Boy, no kidding, and I think you are saving lives by giving them those tools. I’ve gotten a lot out of this because of what you just said. So, kind of just to recap. I’ve been keeping some notes here. So, think about specific behavioral observations. You mentioned already, maybe their grooming has changed, maybe they’re late when they used to be really punctual, just specific behavior observations with no judgment. I’ve noticed over the last few weeks some changes in you and approach it from an empathic point of view or perspective.
[00:35:38.960] – Dr. Steve Wengel
I’m just worried about you and try to avoid jumping to conclusions or judging them. Oh, I think you’re drinking or are you drinking, just really just kind of opening the door. And I think you said this before, but let me just ask you this: As you say, sometimes people will not be quite ready to share that, if there is something going on in their life. But the fact that you’ve opened the door, don’t you think that makes it easier for them to maybe be willing to approach or come back a week from now, a month from now and say, I’ve been truly trying to do this, motor through this on my own, but since you asked me, and boom, then they maybe can tell you? Then they can open up a little bit.
[00:36:21.050] – Dr. Ken Zoucha
Yeah, I definitely think that that is true. And I can think of situations myself or I’ve seen that that happened for sure. When I’ve approached folks that way, it’s just so important to just not be judgmental and always just to remember that we’re dealing with people who have a neurobiological disease. Once they’ve gotten to the spot that an addiction is playing out, those behaviors now are symptoms. They’re not choices, their symptoms and to recognize that. Now there are behaviors that we don’t like or that are not socially acceptable, maybe in some situations, but they are as a result of the obvious changes we know about with the neurobiology that happens with substance use disorders as well as mental health disorders.
[00:37:14.360] – Dr. Steve Wengel
Boy, thank you for making that point. That is a great point. Much like major depression, I think now people accept the fact that other mental health conditions like schizophrenia, bipolar disorder are not disorders of the will. They’re not caused by moral weakness or whatever, like we might have thought generations ago. But these are a biochemical or neurobiological, maybe the term you used, and are absolutely true for substance use disorders, too. These are not moral failings. Well, again, you said it really well before. These are physical conditions, but there is a neurology to this.
[00:37:51.720] – Dr. Ken Zoucha
Well, and the second part to that is maybe having a solution ready to go or plan, ready to go. That’s right up your alley, Steve. What do we have available at Nebraska Medicine in our facility, that could be helpful for folks. So, you see it. You approach somebody, they say, Yes, this is what I have, then what? I think, of course, as Vice Chair of Wellness, you have an incredible handle on these resources. So, I’d like to hear your thoughts about that.
[00:38:29.700] – Dr. Steve Wengel
That’s probably a good thing, a good segue for our last segment here before we close. Right. What are some of those resources? We’ve got some local ones here, which can help people locally, which I’ll describe just briefly, just to give people sort of an example. So, for example, and I take no credit for most of these. These are things other people already have been doing, so I don’t want to take anybody else’s glory, but we have, like, a dedicated nurse who actually works within our house officer program because residency is stressful, when you were a resident, when I was many years ago, but certainly continues to be.
[00:39:09.020] – Dr. Steve Wengel
Our graduate medical education program here has a great program where 24/7 a resident that wants to talk can talk to our house officer’s assistance program person. Our medical students have a parallel thing that we started again, I take no credit for it. I think it’s a great program and I support it, but I can’t take the credit for starting it, our dean did a number of years ago. We have a student wellness advocate so medical students can drop in and talk to a senior faculty member just very confidentially.
She’s not a therapist, but she’s just a friendly approachable person. They can text her after hours if they’re going through a tough time. But we also have a counseling program that we have been working hard to improve access for students. And of course, with telehealth now with the pandemic, now students can talk to a counselor through telehealth, or even come into the office if they’d rather do it in person. But trying to make it easier for people to get the help they need, try to reduce barriers are really important.
Our employees get to use an employee assistance program, which is really good, and we stay in contact with them to kind of make sure that our employees can get in quickly with a really good therapist. But physicians are a different breed, though I would have to say, because of the stigma and the fear of license loss and all that that you mentioned. And so, our local medical society here in Omaha, a number of years ago got a grant, and so they actually have, like physicians in Omaha that can get online telecounseling or telepsychiatry services for free.
So that way it reduces some of those barriers, like they don’t have to tell their insurance company that they’re getting help, for example. But you mentioned Life Bridge earlier, and I know you’re connected with that. That’s a great statewide program here in Nebraska, among other things. They set up a peer support program, super helpful, and they also worked really hard to change the licensing laws. So now if you’re getting a physician’s license, if you’re applying for a physician’s license in Nebraska, you no longer have to answer questions about past treatment for substance problems or depression or whatever that you used to.
You used to have to do that, but thankfully, we eliminated those questions. So now you don’t have to worry about that. You won’t lose your license in Nebraska or you won’t have trouble getting your license in Nebraska if you’ve been treated for depression, substance abuse problem, whatever. And I think then again, it’s happening all over the country. Thankfully, we’re getting rid of some of those arcane licensing problems that really got in the way of treatment.
[00:41:45.770] – Dr. Ken Zoucha
Yes, I definitely was the person who had to fill all those things out, and write paragraph after paragraph about what happened and how that happened. And they were somewhat demoralizing, I will say. And now not have those questions, I think is really good. One of the things that our country has for physicians is physician health programs, and each state is responsible for their own program. It’s mostly for substance use disorders, and Nebraska has been one of those states that didn’t have a robust program in the past.
And now we have Life Bridge, and it’s unique in that it’s a little more robust because we have substance use disorders. But we’ve also added mental health disorders into that as well.
Its, I think unique in that way, not from every program, but unique in that way. And some of those programs can be onerous and difficult. But I think just a way for people to reach out for help without having to worry about the significant consequences, like some of the things that I went through, and be able to get the help that you need to treat this again, neurobiological disease that needs treatment. And so, without having to think about what the sanctions might be or think about the board being able, I don’t know, just the stuff like that.
So, I just think that we’re lucky to have that program.
[00:43:31.180] – Dr. Steve Wengel
Yeah, I completely agree. But yes, thank you for highlighting that.
Well, I know we’re closing in on our time. There’s maybe a couple of other resources I want to just sort of make sure we had a chance to tell folks about, since some of these I mentioned are kind of local for Omaha and Nebraska, and knowing most of our audience is not here in this great state of Nebraska that we love. But I know there’s people in 49 other states maybe listening to us. But one thing lately, when I’ve been giving talks, I like to highlight a national resource that I think we should all have in our phones as a contact.
The National Suicide Prevention Helpline. So, if you simply do a quick Google search on like, suicide prevention, it’ll take you to that website, and I personally put it in my phone just under suicide prevention. So now I don’t have to look it up. If I’ve got a colleague that I’m worried about and I want to give them the number, if should happen that someday I might need it personally, whatever, I don’t have to go looking it up.
It’s in my phone. The number is 800-273-TALK or 800 273-8255. But you can look it up. The National Suicide Prevention Helpline’s good for anybody, not just physicians. Interestingly, there’s another website that I really have been promoting a lot lately that the VA put out called COVID Coach, which is a free app. Again, it’s the VA, so it’s federally funded by grants and such, but it’s a really good set of stress management tools. It was originally designed to help people with pandemic stress, but any kind of stress, doesn’t matter.
You can take a confidential mood test, check your depression and anxiety scores, and it’ll plot them out. But a lot of stress management tools are on there. So COVID Coach. It’s available on your app store no matter what kind of smartphone you have. But then I’d also like to have people check out the Gold Humanism website, even if you are not a Gold Humanism Honor Society member, go to the website. They’ve got a lot of really good tools. They’ve got the suicide helpline number posted there, but they also have some really good humanities things.
I know there’s a poetry writing contest coming up and again, as I understand it, you don’t have to be a member of the Gold Humanism Society to submit something. I’m a big believer in the humanities and expressive arts, whether it’s writing poetry or writing our stories out or telling our stories, narrative things like that.
[00:46:01.800] – Dr. Ken Zoucha
Music.
[00:46:02.310] – Dr. Steve Wengel
Some people get into music. As you know, we started an orchestra here a few years ago, which is kind of fun. So, for some people that’s a good outlet, but I think we all need a creative outlet and we all need a little bit of hope. I think it all comes down to hope at the end of the day, doesn’t it, Ken? And you’ve given us a lot of hope here. You’ve just given us a lot of hope.
[00:46:19.120] – Dr. Ken Zoucha
Oh, thank you. Thanks very much. The understanding that we’re living in some stressful times. I mean, it’s always stressful, but some stressful times and what you point out, I think, is so important that prevention and caring for ourselves is a big part of just our wellness. And I think that that’s what you’re so good at teaching, is just the importance of wellness, of sleep, eating well and some exercise and time with our families and time with the things that we love to do. It can be so busy and so that we kind of think, okay, I don’t have time for that today or this week or this month or whatever, and I can profess that I might be guilty of that at times, but it’s just so important to make sure that we’re caring for ourselves, because if we’re not able to do that, then we’re not able to care for others either.
[00:47:22.190] – Dr. Steve Wengel
What a great note to end on, because it is easy, I think for people, especially in the helping professions. We’re so used to helping other people. But you’re right. We don’t always take the time to fill our own bucket. We’re always busy ladling out our bucket of compassion and empathy or whatever to other people. Sometimes forget again, I’m guilty of that, too, to fill your own bucket a little bit. So, it’s not selfish. Self-care is not selfish, right?
[00:47:47.580] – Dr. Ken Zoucha
It’s a good way of seeing it. I like that a lot.
[00:47:51.770] – Dr. Steve Wengel
Well, friend, I tell you, thank you so much again, for the courage and the wisdom to share your story. I think that it was super helpful. I always enjoy talking with you, and I’m sure our audience would say exactly the same thing. I’m sure they’ve got a lot out of this. I’ve enjoyed it. So, thank you again.
[00:48:11.680] – Dr. Ken Zoucha
You’re welcome. Thank you. I’ve enjoyed it tremendously as well. I filled my bucket for the day and I can go on for the rest of my day with a big smile on my face.
[00:48:19.980] – Dr. Steve Wengel
Now, me too. Thanks very much, Ken. Yeah. Alright. Take care. Cool.
[00:48:26.180] – Dr. Hellen Ransom
Thank you to Dr. Wengel and Dr. Zoucha for your candor and guidance in this important conversation. To anyone listening, who needs help or who knows someone in need of help, the National Suicide Prevention Lifeline is available 24 hours a day, seven days a week at 1-800-273-8255. We will share more resources mentioned in this podcast and the show notes on the Gold Foundation’s website. Thank you for listening.
Until next time, take care.
