Key Takeaways
- Burnout often stems from imbalance across physical, mental, and emotional domains
- Early signs include irritability, cynicism, and loss of control
- Administrative burden (EHRs, documentation) is a major contributor
- Mentorship and team-based care reduce isolation and improve resilience
- Small daily habits (reflection, quiet time) can significantly improve mindset and longevity in practice
Transcript
Please note: This content is a direct transcript, capturing the authentic conversation without edits. Some language may reflect the flow of live discussion rather than polished text.
Jayesh Shah, MD:
Hello and welcome to Wound Conversations, the podcast where we share actionable insights from leaders in wound healing. I'm Dr. Jay Shah, and today we are stepping slightly outside the exam room, putting to a topic that directly impacts how we care for patients every day. This episode focuses on something we don't talk about enough in wound care, burnout, balance, and caring for ourselves as clinicians. I am pleased to welcome Dr. Desmond Bell. Among his many roles in wound care, Dr. Bell is the founder and the President Emeritus of the Save A Leg and Save A Life Foundation. President of Wound Scribe AI and a Chief Medical Officer of Capsicure, a clinical research organization. In 2020, he joined MD Coaches as an executive physician coach to serve as a peer-to-peer mentor and host the program Inside the Doctor's Lounge. He's also well known to us in HMP Global, having served as faculty for the Amputation Prevention Symposium, WoundCon, and SAWC.
Throughout his career, he has become a passionate advocate for limb preservation and interdisciplinary care, and more recently for wellbeing of the clinicians delivering that care. Welcome, Dr. Bell.
Desmond Bell, DPM:
Thank you, Dr. Shah. It's really wonderful to be with you, and I'm really, truly looking forward to our conversation.
Jayesh Shah, MD:
WoundConversations is brought to you by WoundSource, the trusted resource for wound care professionals, and WoundCon, your connection to global virtual education in wound management. So let's get started. Listen today and apply tomorrow.
Dr. Bell, I have known you for a long time. I even was a part of your Save the Life and Save the Leg Foundation event in San Antonio. And you have really done a great job with coaching and your podcast yourself, and you have talked about burnout in the past. But before we define that burnout in clinical terms, I would love to ask, was there a moment in your career when you personally realized that caring for the caregiver is just as important as caring for the patient?
Desmond Bell, DPM:
Jay, I wish I could say that there was one particular moment, but I think it's really been more a series of moments over the course of my career. And even going back prior to starting in medicine, I mean, going back to the time in school and then residency, if you look around at your colleagues and observe some of the things that their behaviors, let's say, you can a lot of times get some insight maybe even into what's going on in your life too. We all go through a lot of the same type things. So I guess really at the one point though, if I really had to narrow it down, this is going to sound kind of crazy. So I initially started out as a solo practitioner and had a free standing wound care center in Jacksonville, Florida, where I practiced. And one of my colleagues loved to play basketball, as did I.
I was always athletic. Well, one day I ran into him in the mall and he's in a wheelchair and I'm looking at him like, "What happened to you? " So I tore my Achilles tendon. And at that point I said to him, it kind of hit me. It's like, I’ve got to really watch now. I'm not just taking care of myself, but I'm taking care of my family, my practice, my employees, and even my patients. And if I'm able to function at my full capacity, then there's a real problem there. So in a kind of crazy way, that was one of those defining moments. But like I said, you look back to other things along the way and it just kind of all ties together. And so when I say look around too and see what others, how they attack or approach problems and how they go through their life too.
You can learn a lot. Just a lot of times it's also maybe what not to do. At that point, I made a decision. I'm not playing anymore basketball, not competitively anyway. That was that. So again, kind of leading it, you've got to take care of yourself physically and mentally, which we'll get into.
Jayesh Shah, MD:
I have seen so many physicians going through this journey where they don't know what to do and they just goes in this cycle of burnout and they feel they just are going to work, but they're just not happy. And if you don't have a physician or a doctor or a nurse practitioner or a PA or any wound care person who already is dealing with such a difficult patients who have difficult in the sense of being complex patients, where they have to deal with so many things to get them better. And if they are not at their top level, then you're not going to provide the best service. And our patients deserve the best. I like that saying when you are flying that, put a mask on yourself before you save someone else. And it's so true for all the clinicians, they need to be able to function at the top level and take care of themselves so they can help someone else.
Now, when we hear the word burnout, often it can mean different things to different people, Dr. Bell. So how do you define burnout in context of healthcare professionals?
Desmond Bell, DPM:
So great question, Jay. I think really from my perspective, it really speaks to a disruption in your life's balance. And I think that we all know better in a sense. We all know that we're supposed to eat right, get rest, don't work all the time, have a good balance. And this includes physical, mental, spiritual, all these things. And I think when there's an imbalance, that's the disruption. That's where burnout's really the manifestation, I should say, of that imbalance and that disruption. And unfortunately, sometimes it's too late before we recognize it because it kind of creeps in. It's insidious in how it all begins. You take a little more time at the office or you don't create boundaries between your professional life, your personal life. And it's easier said than done. I mean, I think we're all guilty of it too, but I think being able to recognize it and try and nip it in the bud or take corrected measure whenever possible, when you see it kind of happening is really one of the big challenges.
But again, again, we all are guilty of it at some point. I think we really start to feel it not only in school and residency training too, and you're just always putting everybody ahead of yourself in a sense. And that's because that's what's the expectation too. This is what you signed up for and then all of a sudden down the road, we're not immune. It catches up with you. And so this is what we're talking about tonight. I think figuring out strategies on how to recognize it, how to break that vicious cycle and knowing that it's okay to ask for help too. It's like they say, it's not a sign of weakness. It's really a strength.
Jayesh Shah, MD:
Exactly, exactly. Dr. Bell, if I give an example of if you have a car, you do everything possible to maintain it. You put a fuel to it, you check your entire pressures, you do the maintenance, but who takes time to take care of your body? And the real question is, who really take care of the clinicians who take care of the patients? And that really is a very important concept now. And if you look at now, we kind of also talk about burnout as a moral injury. What do you think about that terminology, moral injury?
Desmond Bell, DPM:
A moral injury. I don't know if there's a morality issue involved with this, but it does go back to what we were talking about earlier, even not just the physical, but even the spiritual part. And you don't have to be religious to be spiritual, but we all have our little belief set that helped guide us in a sense. I guess paying attention to all this is so critical. Like you say, you're just talking about the car analogy too and the physical part of what we do. Well, your point about the oxygen mask on an airplane dropping in, you put it on first, you take care of yourself first. It makes a lot of sense because if you're not in a good place, then everybody around you suffers and no one benefits. So it kind of goes back to that point that we want to discuss a little bit more about how we can start to recognize when that imbalance is kicking in and the little signs and symptoms in a sense that maybe start creeping up.
And whether you recognize it or others around, you may even recognize it. And it's an ongoing process too. This is not like you flip the switch and everything's all better. So it's learning how to work that process to maintain and to continue on a good path.
Jayesh Shah, MD:
I think you rightly said a lot of people call moral injury because they get tired with this prior authorization being on the EMR and doing things which are more clerical than what they really wanted to do when they went into medical school or when they went into nursing school. And that kind of is tripping them into moral injury. That's what we see day and out. But you could rightly point it out that many of our listeners early in their careers who are building practices and learning systems and managing expectation, they may sometimes not know, like you rightly pointed out, some of the science that they may be going through burnout. What will, in your opinion, are the early warning signs that sometimes maybe heading towards burnout so you can catch them early?
Desmond Bell, DPM:
Yeah. Well, you just touched on it. And Jay, maybe moral injury, maybe I would think of that in terms of even more like the phenomenon of learned helplessness. And it's something that we, like you say, we all slide through laborious administrative duties charting that. I mean, if anybody can get done with their charting between ... I typically was somewhere between two to four hours a day of that and the frustration that would build up with that and partly because for this very point, that's time away from your life. You could be seeing either more patients, do another surgery, you could be at home with your family, having a better balance in your life. And here you are just putting this information into a data repository that you're more than likely not going to get much out of it in return. So you just have to take it in a sense.
You can't do much about it except go with it. And it creates a negative mindset, irritability for sure. People become cynical, negative in their outlook on things, not looking forward to it. Jay, I used to love going into my clinic and really the happiest days of my clinical life were before introduction of EHRs and EMRs. Seriously. I used to just focus on seeing my patients. I couldn't wait to see what kind of progress we were making and getting them well. Why do we go into medicine in the first place? We want to be of service to others. We wanted to help. We wanted to make a difference in the way that we knew how. And all of a sudden this is being taken away from you for no reason that you didn't really even have a say in it, but there you are having to do this type of stuff.
So as EHRs, EMRs, all this more people selling their practices to big groups and then feeling like a number, it just, again, that feeling of not having any control of the situation. A loss of control is what breeds anxiety. And so this is another part of the whole vicious cycle. So it's how do we break this cycle? You just kind of name it, address it for what it is. And then you can, once you identify and name it, then you can start to attack it and fight back in a sense. But I know there are different people are working on solutions around some of the stuff that we just talked about, which is a simple example, but it's the other parts of it. We want to return to being providers, physicians, nurses, professional people who our patients look to us, they trust us. And we've had so much of our day, our time, but our way we go about our business being dictated to us.
And when you stifle people's creativity, that breeds a certain negativity as well and that hopelessness that we're trying to work around.
Jayesh Shah, MD:
You've rightly pointed out, Dr. Bell, you're such an experienced clinician who's been doing this for a long time and probably observed a lot of other clinicians. Why do you think clinicians tend to ignore this warning signs that you talked about?
Desmond Bell, DPM:
It may go back to that whole idea that people are relying on us all the time and we have to put on this strong facade and we can't get sick. We have to always be accountable. We have to always be there. Maybe we don't see it coming too. Sometimes we're part of the problem in our own issues, but we don't see it because we're not acknowledging that there's a problem and we just sweep it aside and we keep going about, it's easier to just put it off. I'll get to it tomorrow or I'll start exercising tomorrow. I'll go for a walk starting tomorrow, but today let me just finish doing what I have to do. And then another day goes by and another day goes by. And that's why I said earlier, it's so insidious how this all creeps up. So yeah, it's complex in a sense, but I think the paradox is it's actually fairly simple in its root.
Jayesh Shah, MD:
And Dr. Bell, you rightly pointed out, you said that medicine has traditionally kind of rewarded endurance and self-sacrifice. How do we begin to sift the culture so that acknowledging mental and emotional challenges in clinical life isn't seen as a weakness?
Desmond Bell, DPM:
I think mentors provide such a great source of maybe taking some of that pressure off. It's somebody you can bounce ideas off, somebody you can have a conversation with who understands your situation, maybe has more experience in terms of years at it. And it reads this idea that you're not alone in all this, that you don't have to go it alone. It makes you realize that it's okay to ask for help. And again, there's a strength in that in wound care for years. We've always talked about the importance of the team approach. We know that our patients are really the sickest of the sick. They have multiple comorbidities. There's a reason they have chronic wounds. And for somebody to try and think that they can manage these patients alone individually, that's really foolish. And it's not going to help the patient in the long run.
It's not going to help you either. You only know what you know, but when we get together and we trust each other's judgment from amongst our specialties, which is one of the beautiful things of wound care too, we all come from different backgrounds, but we're all working towards the same goals here, then it all works. Then we can solve the problems together and we all learn in the process and it only makes all of us better. So having mentors, the friendships that you make from practicing that way too, it spills over into your personal life. I mean, you probably can attest to this, Jay. How many friends have you made in the community over the years who you would not hesitate to pick up the phone or ask for help, and we don't do it regularly, but you know that they would always be there for you.
And so this is part of the beautiful thing of what we do. And so whether it's in the clinical setting, whether it's on the personal, the psychological side to be there for each other, I think it's truly empowering and it's a shame. People that maybe would see each of us as rivals or something, that's the farthest thing from the truth. We are all working towards the same goals here.
Jayesh Shah, MD:
Oh, absolutely, Dr. Bell. I think you touched on a very right message. I felt that I was successful because I had mentors early on and I knew people when I had a difficult case and that networking built over time when I started going to wound care conferences like SAWC and WoundCon, they truly develop a wound care community. We are all together in this. And thank you for saying that. Well, as we wrap up, Dr. Bell, we always ask for a wound to the wise. If you could give one piece of advice to an early career wound care clinician who's feeling overwhelmed, but hesitant to say it out loud, what will it be?
Desmond Bell, DPM:
The one thing I would say is try and know thyself. Look at yourself first, okay? Try and understand what is important to you, where does your happiness come from? What motivates you? Take time out each day if you can, because this is really valuable, but I used to always like to sit quietly for five minutes, 10 minutes every day. Just sit quietly, mentally organize your day, say a prayer, meditate, whatever you need to do. And then you go from there. And I just found it so invaluable to do that. So in learning more from that type of exercise, it provides you those moments to have a little more self-introspection. So you don't just go out there and react or just do things haphazardly in a sense. And it's not a control thing, but it just puts you in a positive mindset too. And I think that's what you want to carry over in the course of your day and you do that with enough repetition and practice and then it becomes habit.
And then it's just something that it leads to ... I really believe it leads so more fulfilling life instead of finishing and saying, "Well, where did all that go? What happened? Why am I so unhappy?" So take time.
Jayesh Shah, MD:
Dr. Bell, thank you for helping us start this important conversation. Burnout doesn't mean you chose the wrong profession, but ignoring it can change how you show up in it. We are going to have Dr. Bell back for another episode where we will continue this discussion by talking about practical strategies for setting boundaries, building resilience, and sustaining a meaningful career in wound care. Stay tuned on woundcon.com, SoundCloud, Spotify, and Apple Podcasts. And as always, explore resources available on woundsource.com and through WoundCon. Thank you for joining us today. I hope you listen today and apply tomorrow.