It's About Physician Humanity, Not Burnout: Part 1

In this 2-part series, Psychiatrist and Professor of Clinical Psychiatry at SUNY-Downstate Health Sciences University in Brooklyn, New York, Michael F Myers, MD, DLFAPA, interviews novelist and transplant surgery specialist, David Weill, MD, about his book Exhale: Hope, Healing, and Life in Transplant that focuses on physician burnout and how it impacts mental health.

Dr Weill’s novel, “is the riveting memoir of a top transplant doctor who rode the emotional rollercoaster of saving and losing lives—until it was time to step back and reassess his own life.”

In part 2, they discuss physician burnout, the effects of isolation, finding solace in faith, and the importance of connectedness with other physicians as well as personal family and friends.

You can follow Dr Weill on the following social media channels:

Facebook: David Weill

Twitter: @davidweillmd

LinkedIn: @davidweillmd

Instagram: @davidweill1

Read the transcript:

Dr Michael Myers:  Welcome to the program, and it's called "It's About Physician Humanity, Not Burnout." My name is Dr Michael Myers. I'm a psychiatrist and a professor of clinical psychiatry at SUNY‑Downstate Health Sciences University in Brooklyn, New York. I'm also a specialist in physician health, and I'm excited to introduce you to my guest today, Dr. David Weill.

Dr Weill is the principal of the Weill Consulting Group in New Orleans. He's the former director of the Center for Advanced Lung Disease and Lung and Heart‑Lung Transplant Program at Stanford University Medical Center. We're here today to talk about his wonderful new book, which is called "Exhale: Hope, Healing, and A Life in Transplant." Welcome, David to Psych Congress.

Dr David Weill:  Thank you, Michael. Great to be here.

Dr Myers: Very early in my first read of Exhale, because it's been more than one read, I knew that I wanted to interview Dr. Weill for this podcast. In fact, it was on page 10. Now I'm going to read to you what I read, "Cindy is waking up. Eyes searching the ceiling. Shaking her head slowly. Coughing a silent cough around the endotracheal tube.

"I stand up and lean over her in the bed, coming into her field of vision from out of nowhere, it must seem. I smile at her, and her eyes sparkle. I tell her that we'll get the two bucks soon as the transplant was a success, and she's a rock star. I'm so proud of her. Her eyes start to fill with tears, and mine do, too."

David, let's get started. Tell us about your process and your decision to write your memoir.

Dr Weill: Thank you, Michael. When I left Stanford in 2016 after a long career on the front lines of transplant medicine, I had a lot on my mind. I had not only the patients' stories, the team dynamics, behind the curtain look at how we deliver this care, but I've kept a journal for 20 years and had a lot of stories to tell, stories that I wanted to process.

I sat down to write the book to let readers into this world that they may not know much about. I also think that it helped me process some of the vast array of emotions that I was having about doing this work, both the good and the bad parts.

Dr. Myers:   Do you want to expand a bit on that about how long it took you or the process of writing itself? I know you touch on a certain amount of this in the book. For those who haven't read your book...

Dr Weill:  Sure.

Dr Myers:  Go ahead.

Dr Weill:  I got the first draft out in about six months. I wrote about 85,000 words in six months, which is pretty fast, and then went back, edited the book for the next year and a half. The first draft came out pretty fast.

I am a morning person. All my writing, essentially, happens in the first three to four hours after I get up. Then I go back in the afternoon, and look at what I wrote, and see if it makes any sense at all. I was amazed at how quickly the first draft came out. I had a lot on my mind and a real need to write those scenes and to tell the stories. That's how it worked.

Ultimately, it came together in a book form with great editorial help. Anybody that's familiar with the book process knows that it slows down at that point. It was another year before the book hit the bookshelves.

Dr Myers: Your book is full of stories, moving, courageous, heart‑wrenching, and occasionally very funny anecdotes. Dexter, Emily, Amanda, Ken and his wife Dotty who wrote you a note, Tina, there are so many. Can you pick one and share the highlights with our listeners, anyone?

Dr Weill: Yeah, I can. I like to think of myself as somebody that was thinking outside the box for our patients and also advocating strongly for them. When Dexter came to meet us, for instance, he had heard about the fact that I had transplanted people with the same kind of rare cancer that he had, a non‑smoking‑related lung cancer, just a bad‑luck disease more or less.

There was hesitancy among our transplant team at Stanford to transplant somebody like that simply for the reason that it hadn't been done before there. I advocated for him, wanted to take a risk for him, and thought we could get it done. It was gratifying that we were able to do that. Dexter was not a man of much emotion. He was an engineer, both as a profession and in personality type.

He didn't show much emotion until the very end when he was walking out of the hospital with a new set of lungs knowing that he wasn't going to die from this cancer. He was going to be able to see his two young daughters grow up. He and I embraced outside of the hospital at Stanford. I'll never forget that moment. In fact, I still get holiday cards from him every year. It's been incredibly gratifying.

Dr Myers:  You used a word that resonates with me. Dexter isn't the only story. To paraphrase you, David, hesitancy among transplant team members or something...I have the feeling that many times that you've reported in the book, you went to bat for patients who either had been rejected elsewhere or your colleagues had a lot of ambivalence about, number one. Tell us about that a bit.

Dr Weill: My attitude toward our field is that it's a high‑risk profession. It's a high‑risk area of medicine even on a good day. There's calculated risk that we can take with individuals. When I saw a patient that would come to our transplant center that needed a transplant, needed the life‑saving operation, my first inclination was yes. I had to work my way back to no.

We did, on certain occasions, turn people down for transplant. I wanted to not follow a playbook. I wanted to use whatever judgment that I had to try to figure out a way to get it done rather than think of a reason not to get it done.

What I see in a lot of transplant programs across the country that I work with now in a consulting role is a risk aversion that's based on not anything, in particular, that's scientific. It's just based on conventional wisdom. Throughout my career, I tried to challenge that as much as possible.

Dr Myers: I want to stay on this theme for a moment. You use judgment. You use conventional wisdom. It's your branch of medicine and field. There are so many biomedical factors and things like that.

Where does either the emotional, or the cultural, or those kinds of sometimes non‑descript or feelings that you must have had about particular individuals that, despite A, B, and C, this is someone that we should give this person a chance?

Dr Weill: I don't consider myself great at all areas of medicine at all. One area that I do do pretty well is have a sixth sense about people. I trained a lot of transplant doctors over the years, now more than 20 that are out there in various programs.

The most difficult thing for me to teach them was that sixth sense about people about who has the fortitude, the resilience to get through this very difficult and complicated treatment regimen. I tried to assess that from the moment I met an individual patient. To me, that was the most important factor.

All the medical parameters and the clinical information we got, we certainly looked at all of that. What I wanted to focus on ‑‑ I talk about this in the book ‑‑ is the more subjective. Does this individual have the right stuff that when the going gets tough, are we going to be able to dig in together and get them through it?

Some of those patients I write about were the most satisfying. As you pointed out, they'd either been turned down by other programs, or even considered too high risk at our program. Yet they did have that extra special something that is hard to define, but that got them through the entire ordeal. When I look back at my career, those moments were so special.

Dr Myers: I'm delighted to hear you speak like this and use the word subjective. This is another reason why I liked your book so much. As you know, I'm a psychiatrist. Our audience is largely mental health professionals. That's the nature so much of our work.

There are so many medical students who go into psychiatry because they have this sense. They want to see if they can do something for individuals who perhaps are marginalized, have suffered a lot of discrimination, or something like that. I felt, in some of the cases that you described so eloquently in your book, that there was this subjective sense.

Dr Weill: I got very interested, speaking of psychiatry. As I went through my transplant career, a burgeoning area of medicine, which I'm sure you and your listeners know a lot about, is the area of transplant psychiatry. A whole sub‑specially developed around taking care of these kind of patients.

Assessing them as potential transplant candidates, and then the challenges that they go through post‑transplant. I got very attuned by working with some fantastic psychiatry folks to the psychological component that goes into receiving organs from another person. From walking up to death's doorstep, and then having a second chance at life. What you say resonates with me quite a bit.

Dr Myers: I'm going to quote you again from your book. You're writing, in this case, about Tina, and her family. You write on page 225, "As she lay dying, I leaned over and kissed her forehead." This is such an affectionate gesture, perhaps felt by more physicians than we realize. One that very few physicians would enact, let alone write about.

I see this as a form of role modeling, especially for medical students and residents who read your book. Can you say more about this?

Dr Weill:  As time went on in my career, all of us start out our career as a blank slate. Many that I see in the profession become anesthetized, if you will, to the suffering, to the emotional component of medicine, and to the death and dying part of what we do.

For me, it was the exact opposite. I actually became more attuned to that as my career went on. There was an upside to that, and a downside to that. There were two big events that made me think that way, and get more in touch with the humanistic part of medicine.

That was, firstly, my father receiving a liver transplant early on in my career. I got to see that experience from a family member side and a patient side. Then also, when I had children on my own. It was no longer that I was taking care of somebody else's kids or somebody else's mom. I was taking care of my own kids, my own mother, and my own father.

It got me actually closer to my parents. I've never been sure if that's true of most doctors, or how that works. That was my experience. When I wrote about Tina, that was toward the back half of my career. Certainly, when I felt so close to her that I thought it was the only gesture that I could do, was say goodbye to her in a very personal way.

Dr Myers:  [14:30] Exactly. That's right. It was lovely. It was so moving to read that. By the way, I'm going to mention your dad in a minute. Before I do, what you just said, this is a bit of a segue into my next question, which is about your passion for your work.

It comes through in "Spades," in your memoir. It's palpable, I would say admirable and raw at times. Can you talk a bit about that, about how it's worked for you, works for you, but sometimes doesn't?

Dr Weill: My passion for our field started immediately when I first saw that transplant was possible, and that I was going to be a transplant doctor. I considered the stakes so high, and my investment in it incredibly high from the get‑go, to the exclusion of anything else.

My wife calls it my first true love. In many ways, it has been. I consider it my responsibility to do well. I would do anything to make that happen. I would drive myself to a standard that I sometimes couldn't meet. I would definitely drive my team to a standard that they sometimes couldn't meet. It was a desperate attempt to save these people's lives.

In some ways I write about in the book, transplant was the perfect vehicle for me to express this. In other ways, it was bad for my psyche. By its very nature, there's going to be times when it doesn't go well. Even as my career progressed, even at the very end, I found that difficult to accept. I don't think I ever learned how to accept that. I'm not sure I ever will.

Dr Myers: Thank you.

David Weill, MD, is the former director of the Center for Advanced Lung Disease and the Lung Transplant Program at Stanford. He is currently the principal of Weill Consulting Group, which focuses on improving the delivery of transplant care.

Dr Weill’s writing has appeared in the Wall Street Journal, Salon, Newsweek, the Chicago Tribune, STAT, and the Washington Post. He also has been interviewed on CNN and by the New York Times, the San Francisco Chronicle, and the Wall Street Journal.

He lives with his wife and 2 daughters in New Orleans.