It's About Physician Humanity, Not Burnout: Part 2

In the final installment of this 2-part series, novelist and transplant surgery specialist, David Weill, MD, discusses physician burnout, the effects of isolation, finding solace in faith, and the importance of connectedness with other physicians and personal family and friends. Dr Weill is interviewed by Professor of Clinical Psychiatry at SUNY-Downstate Health Sciences University in Brooklyn, Michael F. Myers, MD, DLFAPA.

Dr Weill’s novel, Exhale: Hope, Healing, and Life in Transplant, “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.”

Watch Part 1

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

Facebook: @david.weill

Twitter: @davidweillmd

LinkedIn: @davidweillmd

Instagram: @davidweill1

Read the transcript: 

Dr Myers I feel that your book is more than one physician's chronicle of being the director of a pulmonary transplant program in the impact of that on your health and functioning, which we'll come to in a little bit. It's also a story of a father, a son, and their loving, but somewhat complicated relationship.

David, you can give the back‑story to this in a moment. On page 100, you write, "When we got into the preop area, where the transporter would need to take him back, my father and I stared at each other, both of us struggling with what to say. Finally, he broke the awkwardness. Eyebrows arched, he had a smile on his face.

"'Well, is there anything else you want to know from me?'" Your response was? "No, I don't think so. I think I'm good." Can you speak? I know it's big. You write about it a lot in the book, but tell us about your relationship. Tell us about your dad, your relationship.

Dr Weill: I would say that neither one of us, particularly when I was younger, were great at expressing our emotions. He was a German immigrant to this country, and talk about growing up tough. He grew up tough. He had to leave his country. His parents worked all the time. He was the kind of person that was not used to expressing his own emotions.

In fact, his most favorite quote, and that he used to tell me when I was a little kid, was by Benjamin Disraeli, who said, "Never complain and never explain." It should have gone on his tombstone because that was really him in a nutshell. That was him.

When it came time when he was sick, it was an awkward relationship because here I was a transplant doctor, and my patient really was becoming my father, more or less. I felt again responsible for how he did, even though I was not involved in his clinical care at all.

I wanted to desperately see that operation go well and for him to live a long life, but he became dependent on me in a lot of ways to help make that happen. It was a role reversal, but he's somebody that I looked up to quite a bit. He had a lot of admirable traits. He was a research physician, pulmonary doctor, internationally known, lots of accolades, but he was a tough guy.

He was not somebody, for instance, that would have written a book about the emotional parts of his own psyche and the experiences he had. He was somebody that actually kept most of that to himself.

Dr Myers: I know we don't have a lot of time on this, but I would urge everybody listening to pay attention to the passages in this book that address your relationship with your father. It's so universal. There will be women who read this, who'd be able to identify with family relationships. I'll make one quick thing [laughs] I remember, and this makes me smile and laugh, actually.

You'll remember, David—after the transplant. This had something to do with general etiquette where you wanted your father to write and to thank the donor. The pushback you got from him...

Dr Weill: That was my father. He mostly didn't write the donor family because I asked him to write the donor family. That was mostly it. Oh, well.

Dr Myers: That's what I mean about your book. You've got these things in there that are so universal and families that were so wonderful. Earlier when I used the descriptor raw, I also liked the way that you report to the reader to what's going on inside your heart, what's going on inside your mind that you don't vocalize, and often with a few very nice expletives as well.

Dr Weill: My mother was disappointed with that. She asked me if I could clean up my language a little bit a couple times.

Dr Myers: As we get to the final third of your book, a lot happens. There's 3 matters I'd like to ask you a bit about. We touched on them a little bit. Your decision to take a sabbatical and that began shortly after your father's memorial service. Perhaps that was already in the works. You can talk a bit about your use of the sabbatical, your plans to convert to Catholicism.

You first mention burnout and your call for a different term, physician humanity. That's why I borrowed all of that for the title of this program today. It really fits so nicely. On that page in the book, you describe why we need it.

There are other people who are calling for different names too, moral injury, things like that, getting rid of the term physician burnout, that sort of thing. I realize I put 3 things in there. The first one had to do with your sabbatical, your plans to convert to Catholicism. The other has to do with physician humanity.

Dr Weill: With regard to the sabbatical, I had a project that I wanted and needed to take a sabbatical to complete. I was leaking oil. I clearly was struggling at that time, especially after my father died.

It was fortuitous that I also had a project that I wanted to work on to write the recipient selection guidelines for our transplant society. That fit pretty well. The sabbatical, as it turns out—I had trouble articulating this at the time ‑‑ it was a test run for leaving the field altogether to try to see whether or not I could live without it.

I knew that it would live without me. I wasn't sure I could live without it. So much of my identity was wrapped up in doing that kind of work.

I took a little bit of time off to research and to write the selection guidelines for our society. I wanted to go back at that point. I thought that I owed it to myself and to my team, frankly, to go back and to see whether or not I could do this for the long term or not. It turns out, just a few years later, I was gone for good.

With regard to Catholicism, I was someone that did not grow up with any formal religion in my life. My father, as I mentioned, was a Jewish immigrant to this country, but did not practice his religion, nor did his father. Even though I come from a line of 500 years of rabbis prior to that, my grandfather did not practice his religion.

My mother is Southern Baptist and grew up in Selma, Alabama in a small town of Civil Rights fame. They, essentially, asked us ‑‑ I write about this in the book ‑‑ about whether or not we wanted any religion in our life. At that time, I was interested in playing with my friends. I said, "No, I'm good on that. I'll take my Sundays back." We grew up without any religion.

As time went on ‑‑ I'm not the first one to experience this ‑‑ I met crisises in my life and I yearned for a religious foundation. I had seen my wife and her relationship with Catholicism and admired it.

My children were baptized in the Catholic Church. They went every Sunday. I went somewhere else on Sundays. I couldn't do that anymore. I needed to be with them. I needed to have that foundation. Catholicism fit in well with that.

Dr Myers: Let me go into this and then we'll swing back. You learned a lot over those long years of logging so many hours per week. You don't count those number of hours. I assume that you're working many hours per week being devoted to your patients, their families, your advocacy work, your public service work.

What lessons have you learned? What advice do you have for someone considering a career in transplantation work? This would then bring us into that whole area of you're first mentioning burnout and then physician humanity.

Dr Weill: I've talked with a lot of groups since the book came out in all areas in medicine and some outside of medicine. The mistake that I made toward the end of my career in the hospital was one of isolation. Isolation is the enemy of what we do. With the pandemic raging, it's particularly difficult right now to stay connected.

For me, the answer was always connection to the 3 Fs: family, friends, and faith. It's so important for young doctors, medical students, or in any field to develop those habits early. I didn't have that habit. My habit was to go to work. The rest of it was going to be secondary. That was my habit. Work came first.

Instead, probably the best thing for medical students, residents, young attending physicians is to try to get used to incorporating a connectedness, a self‑care, if you will, early on. Then that becomes habit. I did not do that until much, much later in my career.

Then it became, "If I don't learn that, I'm not going to be able to go on any further." It became a matter of self‑preservation for me to learn that. I have now but didn't have that through much of my career.

Dr Myers:  Before we stop, I want to spend a few minutes hearing you talk about some other things that are beyond your book. I'm aware that you've written for the Popular Press, Wall Street Journal, Washington Post, Chicago Tribune, Los Angeles Times, to name a few. You've been interviewed on national TV. You've testified before the US Senate.

I spent some time on your website. By the way, I want to repeat it for those who are listening to this, davidweillmd.com. I urge the listeners and viewers of this program to visit Dr Weill's website as well, davidweillmd.com. There are two pieces you published last summer that resonated with me, and I'd like you to tell our audience about.

The first is an open letter to 2021 medical school graduates. You might have touched on that a moment ago. I love that piece. I'll tell you why I love it. Not only do I, of course, work with medical students all the time, but I found it so invitational, respectful, and humble. We're so used to giving all of this advice from on high to medical students. This was very different, David.

The second, which you've already touched on and you maybe don't need to go into that now because it would be redundant is "Finding My Religion" where you go into that in some detail. Do you want to tell us a bit about that?

Dr Weill: Yeah. With regard to the open letter to the medical students, I began to think a lot about and was asked a lot about, "Well, what would you tell a younger version of yourself?" I decided, like I regularly do now, that in order for me to know the answer to that question, I had to sit down and try to write it.

It ended up being more or less an open letter to young people that are going into our field. What do I wish someone had told me late‑‘80s when I went into this field, when I was attending medical school?

I realized that I came up in a different generation of physicians, a different generation of medical training where there weren't a lot of people asking me how I was doing, how I felt, was I OK or not. Basically, the response at that time, as I'm sure you well know and your listeners well know, was. "Work harder, be tougher, work harder and things will work out."

I wanted to send a different message to young doctors right now. I talked to some medical student groups in some of the work that I've done to promote my book and tried to tell them that they're going to have to develop this skill right now. They can't wait until later in their career when things slow down, when they have more perspective. They need to develop it right now.

One silver lining of the pandemic may be that we all in medicine, both the young and old, are thinking about the emotional health of the workforce in ways that we haven't done that before. I don't need to tell you that it's been evident for some time that healthcare workers have been under duress, well before the pandemic.

The pandemic has highlighted it for the people outside of medicine, finally. Now, I see the hospitals that I work with trying to address it. Some are doing a good job of that and some not as good. They're at least trying to address it. That's why I wanted to write that.

The second piece, not to reiterate everything I said before about religion, I wanted to tell a story about my own identity crisis, if you will, with religion where I wanted to explain how it feels growing up without any particular religious affiliation.

You live off on an island a little bit if you don't have affiliation with one religious group or the other. That sense of belonging has been recognized for a long time as being important to an individual's mental health development. That's something that I lacked as a child.

Dr Myers: By the way, I'm glad you touched on that. It's now coming back to me, even though I just read this a couple of weeks ago. You articulated something there that I hadn't thought about or seen before. You just said it now. There's a sense of otherness, like, "I'm not quite this or I'm not that." I don't know if that's the word you use or not. You felt it, obviously.

Dr Weill: It's interesting. I grew up in New Orleans. New Orleans has a multi‑generational Jewish community here, which many may not know it being in the South and so forth. I wasn't part of that. It's also got a group that is more aristocratic, high‑society, gentile. I wasn't part of that either.

I existed in this never‑never land. I was aware of that as a young child. I wasn't quite Jewish. I wasn't quite Christian. It did, in me, impact the way that I saw myself and my own identity.

Dr Myers: David, I'm just about ready to wind up. Are you working on another book? What's next? Anything you can share with us or alert us to?

Dr Weill: Not surprising given the conversation that I am looking back at some of the past generations in my own family and my own experience with identity. I'm looking into some of those issues.

It involves a lot of research going back to Germany on my father's side, and the Civil War, and the Civil Rights Movement on my mother's side. I'm in the midst of doing quite a bit of research in that area and hope to put it into book form pretty soon.

Dr Myers: Very nice. I know I read something else. You're also doing some policy writing too or you have done that.

Dr Weill: Yeah, I have. I've become very interested in the way we distribute organs in this country and the transplant arena, the equitable or lack thereof nature of how we do it. I've become very involved in that, been interested in that. I've had to weigh in on COVID issues as well, particularly as they pertain to transplantation.

Dr Myers: David, we've come to the end of our time for today together. On behalf of Psych Congress, I want to thank you for this interview. You've not only educated us about the everyday world of lung transplantation, but you've enriched us with your enthusiasm, your humanity, your transparency, and kindness. What a gift. Thank you.

Dr Weill: Thanks for the conversation. I really enjoyed it. 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.