Physician Interrupted: Recent Episodes
Kernan Manion MD
Hey there! Heads up. We've moved the main podcast to www.physicianinterrupted.substack.com. The substack platform offered both blogging and podcasting and we decided to give it a try. We'll keep this Anchor site active for the time being and may explore cross-posting of podcasts. We're about critically relevant topics, real-life stories, and practical survival advice re physicians in the trenches negotiating the challenges of contemporary physicianhood. We focus on the burning issues facing physicians today and the challenges that they face in their careers as clinicians and healers. Support this podcast: https://anchor.fm/kernan-manion/support
This is the podcast of the article by the same name on Substack. The article may contain some additional material in the form of footnotes, links to other materials etc. Be sure to check it out.
In this podcast, we continue a series that began with a look at an emerging bevy of state laws proposing to create a sort of “mental health safe harbor” for physicians to get mental health care. We saw that while termed a “safe harbor,” it was anything but.
In this podcast, we explore the broader concept of confidentiality in mental health which serves as a backdrop to understanding the major intrusion on privacy and safety that Delaware’s law causes. And we look at why physicians in particular are in great danger should they be “reported” by a state-mandated confidentiality-breaching therapist.
You comments and sharing the podcast are especially welcome.
If you’ve not yet done so, consider subscribing (free!, no junk mail or sales pitches) to Physician Interrupted. It’s produced as both a newsletter “post” and - somewhat less regularly - as a podcast. The podcast pretty much mirrors the article but occasionally offers impromptu asides. The written form offers footnotes that can contain richer explanations, links to important articles, and even witty (sometimes maybe just snarky) commentary.
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This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
In this episode, we do a deeper dive into the significance of US DOJ’s Letter of Finding regarding its investigation of a nurse’s complaint regarding the Indiana Board of Nursing IN BON and its professional assistance/rehabilitation program “ISNAP” violation of the Americans with Disabilities Act. The violation specifically pertained to IN BON’s and ISNAP’s refusal to allow participation in the program – necessary for removal of licensure restrictions – of any nurse who had a diagnosis of an opioid use disorder and who was currently on a medication-assisted treatment for it.
As significant as the findings and proposed charges are, the fact of DOJ’s intent to levy not only civil (and perhaps criminal?) penalties and its decision to advocate on behalf of all of the nurses harmed by this policy in the form of holding them liable for compensatory damages (lost income as well as pain and suffering), is extraordinary.
But even beyond this opioid use disorder ADA-based case and other ADA cases regarding MAT (medication-assisted treatment) and ADA cases regarding impermissible questions on licensure, I suspect there are larger implications to the aggregate DOJ enforcement activity. Considering also the FTC v NC Dental Board case, what’s going on here is a multi-federal agency challenge to state agencies who have been acting with impunity in imperially ruling their licensing agencies in overt defiance of federal laws and the established rights of others.
You can view the article here; it’s essentially a transcript of this podcast.
Your comments and sharing are most welcome.
Thanks for listening to the Physician Interrupted podcast. Please do share it.
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
Welcome to the Physician Interrupted podcast.
Here’s the link to the transcript/post of this podcast. There’s a trove of footnotes and resources there.
And of course, I’d love to hear your comments and your sharing this podcast and article with others, especially those whose ADA rights to MAT and preservation of their career has been wrongfully obstructed.
Sharing helps a wider network of physicians and leaders become more informed of challenges to physicians’ rights so that they can take action to protect those rights.
If you’d like to learn more about CPR - The Center for Physician Rights, click here.
Thanks for listening to the Physician Interrupted podcast. This podcast and related posts are public so feel free to share them, esp with colleagues who urgently need to know their rights.
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This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
In this episode, we examine the array of causality of clinician burnout and why it’s so important to drill down. Like a bacterial infection, if you don’t know the bug that’s causing it, then all you’re left with is throwing non-targeted killer drugs at it, none of which might be the anti-bug you need.
And we also look at some overarching principles in approaching and remedying burnout.
I’d love to hear your thoughts and would be delighted if you’d take a moment to share the podcast.
And … if you haven’t subscribed yet, this is a fine time to do so. You’ll be the first to get the notice that a new podcast or article is posted. And you get first dibs at commenting ;)
Wanna bring me in to do a presentation, workshop, or retreat? Yes, even virtually. Let’s be in touch. In fact, I’m putting together the outline for a virtual retreat right now. We’re overdue for having the opportunity to come together, support each other and find ways to replenish ourselves while we strive to continue to do the work we dedicated our lives to do.
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
Welcome to the Physician Interrupted Podcast.
In this piece, Kernan reflects on an OpEd posted on Medscape by medical ethicist Art Caplan exploring clinician anger while treating anti-vax patients.
It’s a privilege to have you as a listener. I’d love to hear your reactions as well as any feedback you have on the podcast itself. It’s still a work in progress.
Got a topic consistent with our focus that you’d like us to do a podcast on? Lemme know! Want to be my guest to dialog about burning topics in medicine? Would love to hear from you and explore further.
We’re growing our audience of listeners and readers so be sure to share and encourage your people to subscribe - it’s free! No spam, no nonsense. The main reason to sign up is so that you can get notice of our posting a new article or podcast. I’m not yet on a regular posting schedule, so I wouldn’t want you to miss a rich piece simply because it fell off your radar. But even better, you get the actual article in your email! And a link to the podcast!
And you can now pick up the Physician Interrupted podcast on most major podcast services!
Happy New Year to you and yours and hope you’re staying safe, well, upbeat, and hopeful.
Thanks for listening to the Physician Interrupted Podcast! Subscribe for free to receive notice of new posts and episodes.
And, while you’re at it, feel free to share it.
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
The amorphous matrix of clinician distress.
Here is Part 7, the last of our series exploring the Matrix of Clinician Distress.
We offer a somewhat expanded representative scenario and can more clearly discern its individual components. Lumping all of these component syndromes together under the designation “burnout” as has been routinely done through the present is obviously problematic. By not naming and addressing the component elements of a clinician’s distress and enabling appropriate approaches, these syndromes have been ignored. In essence, they’ve been painted over by the broad brush of “burnout.”
The Matrix Deconstructed
Not only do the component syndromes not get the professional attention they need, the clinician is led to believe that the generic stress management remedies applicable to burnout should suffice to make everything better. Of course, the implication is that if one doesn’t get full relief, then something must be wrong with the clinician or they're not utilizing the offered remedies, or the burnout is so severe that these broadly applicable remedies can’t work and thus the clinician must be mentally ill. Almost never has it been considered that the assumed diagnosis - burnout - might be erroneous.
I suggest that perhaps the burnout construct itself an inherently flawed and needs to be revised to give consideration to a wider understanding of what’s plaguing clinicians and making them so miserable that they’re leaving the profession.
We recap some key takeaways from the series and close with some action recommendations especially for coaches and therapists; organizational leaders; and clinicians who themselves are grappling with one or more of the component syndromes.
I hope you’ve enjoyed the series and would welcome your comments and your sharing the series.
If I can be of help to you as you explore how best to approach clinicians’ distress, please let me know. You can send me an email directly from Substack. Or drop me a line at CPR@physicianrights.net.
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This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
Though Part 6 was written as a single article, we thought it best for the podcast to break it up into 2 different segments.
This segment, Part 6A explores discrimination in its various forms and sexual harassment as significant contributors to some clinicians’ distress matrix.
We’d love your comments on the piece.
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
In this episode, we explore two major stress clusters which can independently contribute to clinician distress. Being a defendant in malpractice litigation causes off-the-scale stress over a prolonged period. So too does dealing with entities in the MRTC - the Medical Regulatory Therapeutic Complex (see our article exploring this in the footnote below).
Additionally, see a short video done by investigative journalist PJ Randhawa concisely relating the concerns about one PHP.
And the piece “To Heal or Not To Heal, Physician, That Is The Question”.
Would love to hear your comments below. And if you’ve found it informative, I’d be honored if you would share it with your colleagues.
Next session we cover two of the more insidious but nevertheless powerful sources of clinician distress: stress that results from discrimination in its various forms; and stress endured from the bully culture of medicine.
Thanks for listening!
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
(The entire Matrix of Clinician Distress series is available in article and podcast format - see footnote for more explanation on how to find.)
This is Part 4 of a 7 part series exploring the matrix of clinician distress. Here, we cover the two primary mood syndromes that, when they meet certain symptom criteria, i.e. enough of the symptom array, and exist for a certain duration and adversely impact your personal or work life, are considered “disorders.” Once they reach this level, then professional help is advisable.
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
(The entire Matrix of Clinician Distress series is available in article and podcast format - see footnote for more explanation on how to find.)
Turns out, what started as a three-article series expanded by necessity to become a 7 part series. This podcast and article explore the syndrome of grief (the emotion accompanying the process of bereavement), and the stress syndromes pertaining to psychological trauma.
Grief and Trauma – Exploring the Fuller Clinician Distress Map
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
(The entire Matrix of Clinician Distress series is available in article and podcast format - see footnote for more explanation on how to find.)
Turns out this is a 7 part series. And for easier listening, I broke up Part 2 into three sections. This is Part 2 A. Here we delve into Burnout and its close cousin Compassion Fatigue.
Burnout Defined
Defined according to criteria progressively established by Christina Maslach and Richard Leiter, the essence of the burnout syndrome is this: it’s an occupational stress syndrome characterized by fatigue, detachment, and a reduced sense of accomplishment which especially afflicts people who do “people work” of some kind.
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
(The entire Matrix of Clinician Distress series is available in article and podcast format - see footnote for more explanation on how to find.)
Burnout, compassion fatigue, and moral injury are not interchangeable terms. They are distinctly different phenomena in the matrix of clinician distress.
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit physicianinterrupted.substack.com
Sexual harassment is a very significant problem in healthcare.
My guest is Animah Kosai, a lawyer by training who has extensive experience in organizational ethics and compliance.
Seeing the need to help individuals in organizations victimized by sexual harassment or punished for their whistleblowing, Animah was inspired to start Speak Up At Work to empower employees to understand the processes and develop the skills to come forward to uphold their rights and hold wrongdoers accountable. As former general counsel for a large multinational oil and gas firm, she also recognized the need that organizations themselves have to create healthy organizational cultures which are in fullest compliance with law and which foster environments of respect and inclusion.
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Send in a voice message: https://anchor.fm/kernan-manion/message Support this podcast: https://anchor.fm/kernan-manion/support
There was a piece posted in the popular physician-oriented website KevinMD.com by an anonymous physician entitled "I’m sorry: Why I lost my love for medicine.” Understandably, it generated a significant amount of comments and shares. But, as is the way with so much on the web, it’s very easy to miss some really important essays. And I didn’t see it until someone shared it with me only a month ago on the heels of a discussion we’d had about burnout, one of my key areas of interest.
As I read it, I identified immediately. It conveyed the sense of being overwhelmed, bombarded, put in no-win situations, taking in so much demand and negativity and feeling demoralized, exhausted and seeing no way through, and the only option being “out.” I read it out loud to myself, once, and then again, and again. In fact, it so deeply resonated that I got choked up as I read it. And since I have coached many physicians grappling with burnout, I felt that it might be helpful simply to do a dramatic reading as part of a podcast introducing the topic of burnout. Clearly, it’s one of the major reasons why physicians' careers get “interrupted.”
Roughly 50% of physicians today are grappling with some element of burnout. There’s a pervasive sense of dissatisfaction across all age ranges and specialties. Worse, because of the malignant ways medical boards invade physicians’ privacy and compel referral to a non-overseen “physician health program” enterprise from which there is abundant evidence of psychological abuse, physicians are inclined to avoid seeking help and , should they pursue help, to attempt to conceal it from their peers, their employer and certainly from their medical board and PHP.
As a result, demoralized and burned out physicians are leaving the field, and encouraging others not to enter it. If they don’t get help with their burnout, it may deteriorate into an emotional illness like depression or, if depression or anxiety was already present, greatly intensify it. And untreated, whether for fear of stigma or opportunistic and traumatic handling by one’s medical board, peer review / performance appraisal entity or the PHP, the risks of disabling outcomes are greatly increased. And that is such an unfortunate loss.
I know this will be one of many visits to the topic of burnout. I welcome hearing your thoughts.
(see: https://www.kevinmd.com/blog/2019/07/im-sorry-why-i-lost-my-love-for-medicine.html)
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Send in a voice message: https://anchor.fm/kernan-manion/message Support this podcast: https://anchor.fm/kernan-manion/support
In Part 2 of Questionable Drug Testing, host Dr. Kernan Manion continues an amazing conversation with Dr. Michael Langan, author of the blog DisruptedPhysician.com. Michael has intensively studied the PHP (physician health program) movement and its 47 state programs’ use of inappropriate alcohol biomarker drug testing in assessing physicians referred for the question of substance abuse-related occupational impairment. The EtG urine test as well as others routinely used by PHPs are known to produce false positive results. Use of these tests in such a forensic environment was strongly advised against by SAMHSA, the US Substance Abuse Mental Health Services Administration, specifically because such alcohol biomarker tests were KNOWN to have a very problematic incidence of false positivity. However, these test results are still routinely being used to mandate compliance with PHP’s incontestable diagnosis of definitive alcohol abuse and its “recommendation” to the medical board (MLB) that the physician immediately cease practice and go to a PHP-network facility out-of-state at exorbitant cost under threat of loss of license and public humiliation. These tests were never intended to answer the question of “occupational impairment” or even to establish a diagnosis of “substance dependence,” and yet PHPs portray as much to the MLB and to the rights-deprived physician and his/her counsel who naively accept this as established scientific proof. The physician is deprived of any recourse to contest. As presented, there would be little doubt that such a knowingly wrongful process is equivalent to fraudulent diagnosis. The consequences for the wrongfully charged physician are dire.
(Due to the length of the original interview and its immense importance, the podcast was divided into two separate podcasts. This is Part 2.)
If you’re a physician, physician’s counsel or simply interested in a deeper exploration of the specifics of the ill-advised use of such tests, the harms that may ensue and potential approaches to confronting this wrongdoing, be sure to visit [https://www.physicianrights.net/drugtestwebinar] to be notified of our upcoming free live webinar specifically devoted to more deeply understanding these harmful practices and what you can do to defend your rights. We’ll send you the Zoom webinar and Facebook Live logistics as soon as they're finalized.
This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
Send in a voice message: https://anchor.fm/kernan-manion/message Support this podcast: https://anchor.fm/kernan-manion/support
Host Dr. Kernan Manion talks with Dr. Michael Langan, an internist / geriatrician formerly with Mass General Hospital and now a consultant, researcher and author of the blog DisruptedPhysician.com. Michael has intensively studied the PHP (physician health program) movement and its state programs’ use of highly questionable drug testing in assessing physicians referred for the presence of substance abuse related impairment. He reveals that one or more of the urine tests routinely used by PHPs are known to produce false positive results. Further, use of these tests in a forensic environment was strongly advised against by SAMHSA, the US Substance Abuse Mental Health Services Administration, specifically because such alcohol biomarker tests were known to have a very problematic incidence of false positivity (due to high sensitivity but low specificity). Worse, these test results were then being used to mandate compliance with PHP’s “recommendation” to the medical board (MLB) that the physician immediately cease practice and go to a PHP-network facility out-of-state at exorbitant cost under threat of loss of license and public humiliation. And these tests were never designed as an assessment of “impairment” or “substance dependence,” and yet this is what the PHP is portraying to the MLB and to the rights-deprived physician and his/her counsel. Worse, once accused, due to a complete absence of due process, the physician is deprived of any recourse to contest. (Due to the length of the interview and its importance, the podcast was divided into two separate podcasts. This is Part 1.)
If you’re a physician, physician’s counsel or simply interested in a deeper exploration of the specifics of the ill-advised use of such tests, the harms that may ensue and potential approaches to confronting this wrongdoing, be sure to visit [https://www.physicianrights.net/drugtestwebinar] to be notified of our upcoming free live webinar specifically devoted to more deeply understanding these harmful practices and what you can do to defend your rights. We’ll send you the Zoom webinar and Facebook Live logistics as soon as they're finalized.
This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
Send in a voice message: https://anchor.fm/kernan-manion/message Support this podcast: https://anchor.fm/kernan-manion/support
Excited to give you a heads up about an upcoming podcast on Physician Interrupted.
Confronting Questionable Drug Testing in PHPs.
Very pleased to have as my guest expert Dr. Michael Langan who’s extensively studied the use of highly suspect alcohol biomarkers in PHPs. What he reveals is that not only are there very serious questions about the appropriateness of these tests for PHP intake screening purposes, their false positive rate may be wrongfully sending physicians to costly in-network evaluation and treatment centers. Worse, it appears the PHPs and the medical boards know these tests are both known to produce false positives and their use has in fact repeatedly been strongly advised against by at least one federal health agency. Dr. Langan suggests that what we’re really looking at is a massive scheme of intentionally fraudulent diagnosis. This will be one you don’t want to miss.
This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
Send in a voice message: https://anchor.fm/kernan-manion/message Support this podcast: https://anchor.fm/kernan-manion/support
Various forces can adversely impact a physician's career. However, that unseen entity - the Medical Regulatory Therapeutic Complex (MRTC) consisting of the regulatory entities that hold life-and-death power over a physician’s career - is one that is both the least understood but the most potentially dangerous riptide that can literally end one’s career with no recourse. Few are aware of its pervasive presence, much less of its potential career lethality. And that’s why it’s vital for physicians to understand what it is, how it works and what you can do to navigate this perilous territory.
Here, we explore the 10 Commandments for surviving a career riptide in this environment.
Perhaps the two most important are #1 and #10. Know that this extremely dangerous threat exists; and prepare fully to steel yourself for the ordeal, preparing thoroughly and following a well-thought out strategy while also keeping yourself in balance and not going over the rails.
Here’s a link to the 10 Commandments handout for quickie refresher: https://www.physicianrights.net/podcast_ep3
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Send in a voice message: https://anchor.fm/kernan-manion/message Support this podcast: https://anchor.fm/kernan-manion/support
This episode of "Physician, Interrupted” examines the “career riptide” phenomenon that occurs via unfair use of licensing, credentialing and "clinical privileges" power that can abuse physicians’ rights with impunity. We begin to explore what you can - and must - do to protect your rights as a physician against unwarranted career disruption.
Imagine that you're walking along the beach enjoying yourself calmly strolling and you see a little puddle and you step in the puddle not aware that it's actually part of a receding tidal pool. And that tidal pool suddenly pulls your feet out from under you and you are swept out to sea in a riptide. Those who know about riptides know that a person's first response if caught in one would be to try to keep your head above water and then turn around and swim directly back to shore. This is invariably futile as it exhausts the swimmer because you don’t have the strength to swim against that powerful tide, so you get exhausted and then drown.
To avoid riptides and to survive them, you need to know they exist, and to know that you can’t do what you’re fist inclined to do, but rather have to first laterally swim out of the powerful current and get completely out of the riptide current before you can even muster the strength to then start swimming back in.
There are various dangerous riptides in physicians’ careers. Malpractice suits are the type that most physicians would identify with. However, one many physicians are not aware of is the riptide driven by an unseen medical regulatory complex which has life-and-death power over your career. That complex consisting of state medical licensing boards, state physician health programs (or PHPs), institution-based peer review committees and departmental performance appraisals are each immensely powerful entities which generally work in sync and whose non-overseen and non-accountable deliberations can irreparably destroy a physician’s career and deprive them of their license and livelihood.
We cover 3 immediate action steps you must take to protect your career. In the next podcast, we cover the “10 Commandments” for survival in these matters.
This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
Send in a voice message: https://anchor.fm/kernan-manion/message Support this podcast: https://anchor.fm/kernan-manion/support
"Physician, Interrupted” is a weekly podcast hosted by Dr. Kernan Manion, an MD physician and psychiatrist by specialty who retired from clinical practice about 7 years ago to devote full-time to consulting, coaching, writing and speaking.
"Physician, Interrupted” focuses on the burning issues facing physicians today and the challenges they face in their careers as clinicians and healers, indeed challenges to their physicianhood itself.
Physicians are under incredible stress today from a tsunami of forces. And that stress is taking a toll. Burnout is reported as high as 50% of practicing clinicians. Physicians are facing immense scrutiny and experiencing extraordinary hassle in practicing their craft.
What’s happening to physicians - and to so many others in healthcare today - is deeply concerning.
Healthcare as a service industry is undergoing chaotic reorganization. As a consequence, the trained professionals who actually do the healthcare work, and here we’ve chosen to focus on physicians though in many ways the podcast is really relevant to all healthcare professionals, are being tossed about in this tumultuous storm. The very nature of physicianhood and healing is being questioned.
“Physician, Interrupted” hopes to address all aspects of the forces at work which adversely impact physician wellbeing, forces that can even shipwreck effortfully obtained careers.
We’ll be covering a host of relevant topics that help bring a deeper understanding to the state of physicianhood today and the forces which impact it.
- Burnout and wellbeing, and finding some balance between work and the rest of your life
- The role of licensing boards and so called physician health programs and the quality control process in hospitals known as peer review
- The joys - and trials - of being a physician
- Dealing with psychological trauma
- Speaking your truth in difficult circumstances
- Assembling a portfolio career as a physician
- And negotiating impossible binds as a compassionate physician in a decidedly non-compassionate healthcare system
We’ll devote significant attention to a particular area of growing concern, that of physicians rights, to fairness, to speak up, to a reasonably balanced life, to pursue their love of medicine without unwarranted intrusion.
And, just so that you know that you don’t have to load up on antidepressants before listening, it’s not going to be Debbie Downer whiner show about how impossible or awful physicianhood has become. In fact, we’re going to be talking about joys and fulfillment as a physician, and remedies; about recrafting your physicianhood; and about actively participating in redefining our role in the evolving healthcare system and healing the very culture of medicine itself.
“Physician, Interrupted” welcomes your joining the conversation, your feedback, and suggestions and corrections. And if you’ve got a burning topic you want the podcast to explore, even better with a guest you have in mind, please let me know.
This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
Send in a voice message: https://anchor.fm/kernan-manion/message Support this podcast: https://anchor.fm/kernan-manion/support