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Introduction
Transcript:
This podcast discusses trauma related to illness, including suicide. If you’re having suicidal thoughts, you can dial or text the Suicide and Crisis Lifeline at nine, eight eight. That’s 9-8-8.
David Pace 0:00
Hi, my name is David Pace, and this is Pace Yourself, a podcast from the University of Utah College of Science and Wellness. Today, my guest is Dr. Kyle Bradford Jones, an associate professor in Family and Preventive Medicine at the University of Utah School of Medicine. His clinical practice is at the Neuro Behavior Home Program, a patient-centered medical home that cares for individuals with developmental disabilities. Kyle is the author of three books, including the award-winning “Fallible, a Memoir of a Young Physician’s Struggle with Mental Illness.”
Welcome, Kyle.
Kyle Bradford Jones 2:20
Thanks, glad to be here.
David Pace 2:20
It’s really nice to have you here. First met Kyle not that long ago at a book signing event. It was a lot of fun. And, actually, I wanted to kind of start with this book. One of your books. It’s a memoir. And I wanted you to read not the opening necessarily, but it is an excerpt from it that kind of frames, I think, for the reader or the listener here what the book is about. And what kind of prompted it.
Kyle Bradford Jones 2:53
Sure.
Antagonistic dichotomy
“Doctors live in an antagonistic dichotomy. They need a thick skin, but a soft heart, a sharp mind amidst extreme fatigue. A compassionate soul with a firm demeanor and complete selflessness at the expense of mental and physical health. The messages medical students get are harsh. Don’t be weak. Dedicate yourself to the care of the patient at all costs. Don’t question your attending. Ignore the fact that you don’t get to eat or sleep and remember that leaving the hospital is abandoning your patient. Don’t do too little because you need to rule out all the scary diseases, but don’t do more than necessary because overtesting and overtreating is also harmful to patients. See patients more quickly to maximize billing and revenue. But don’t skimp on your time with them because they need to give us good satisfaction scores. Make sure you get good marks on your quality measures, but don’t ignore all the other aspects of caring for your patient just to focus on those metrics. Follow this treatment protocol to a “t,” but personalize your care. Even the brightest and strongest don’t stand up well to such contradictory expectations.”
David Pace 4:11
So, wow, that’s very revealing if you look at just the order of or what it is a physician or a health professional is expected to do. And I think the word there is contradictory elements. My understanding is that one in three physicians will suffer mental health issues with three times higher overall suicide rates than the general population. Is that correct?
Kyle Bradford Jones 4:39
Yes. Yeah, I know it’s crazy high. And there are even higher rates than that amongst medical students and residents.
David Pace 4:48
What was your experience as a resident? I mean, I think I know the answer to this But I’d like to have you maybe articulate it a little bit for our listening audience.
Kyle Bradford Jones 4:59
Yeah. In short, it was tough. I mean, you know, we would have 30-hour shifts. And so, of course, at the end of that, you can’t think, you are no doubt, hopefully not, doing some harm to patients or not thinking through things fully. There was also it’s been found that if you are driving so when we would drive home after a 30 hour shift of no sleep, it’s the same as driving drunk. You have that constantly, and you have these kind of like in there, just these constant requests and demands of your time. And so, of course, I didn’t see my family a lot. I felt married to the hospital. Like I was there all the time. There is a lot of emotional abuse that goes on in medical training. And I can safely say this is improving, and I think the experiences had now are better than when I went through training. But then also my experiences were better than the previous generation. But it’s still difficult, and it’s still pretty pervasive.
David Pace 6:21
I’m reminded of when I was in high school and a movie called the “Paper Chase” came out and was about going through law school at Harvard, and it kind of reminded me of that movie when I was reading about some of these experiences that medical doctors in training, if you will, have. And it’s built to destroy you. Yeah, exactly. Yeah. At least it was based upon this movie. But yeah, I was reminded of that ,and I was reminded of the fact, of course, we are observing Mental Health Awareness Week here at the University of Utah. So it’s kind of concerning that our doctors are mentally ill or some of them are. And that’s not even talking about the general population where mental illness is a huge issue right now. And so, yeah, I mean, talk about that interface. I mean, are you here to reassure us? Or are you here to scare us?
Doctors out of the woodwork
Kyle Bradford Jones 7:30
Well, hopefully my purpose and my efforts are getting physicians more comfortable with getting help, being willing to admit to ourselves what’s going on. And when I started writing about my experiences with mental illness — I began writing about ten years ago — immediately lots of physicians and colleagues kind of came out of the woodwork. So to speak, and would say, Wow, I didn’t know. I didn’t know someone else was struggling with this. And it was just so many people. And I thought, boy, we really need to be talking about this more. And I feel like in the last maybe five or six years, that’s exactly what’s happened. It has become much more a priority, both for trainees but also for physicians in practice. And there are still some barriers, such as the, like I read the contradictory expectations. Obviously, as a physician, you’re dealing with life and death. And even if it’s not that drastic in your patient, you’re dealing with quality of life and pain and suffering that sometimes you just can’t do anything about despite your best efforts. But then you have licensing boards that ask questions about your mental health history, and if you receive treatment for mental health. You have all of these different things that still aren’t quite in the right spot to help us to be able to move forward. But I will definitely say that there is more conversation about it, and a lot of physicians are much more open to discussing this and hearing about it.
David Pace 9:20
Yeah. I was talking recently with Susan Sample, who works with end-of-life cancer patients at Huntsman Cancer Institute. And she’s the writer-in-residence up there. And she talked about a lot of different things, obviously, but also the fact that doctors have this sense that they’re not just there to keep someone healthy, but to keep them from dying. Yeah. And that that’s kind of contradictory in and of itself when you realize that death is part of living and part of our lives and part of, you know, it’s the trajectory we’re all headed towards that. And yet there’s a certain, I don’t know if you could explain this better than I could, but there’s probably a certain sense of guilt or certainly a sense of loss when you feel as though you’re not keeping to the Hippocratic Oath, which somehow morphs into this notion that you’re supposed to keep everybody alive that’s in your bay, you know, in your unit. Yeah. Has that been your experience?
Kyle Bradford Jones 10:32
Yes. And it it feels like failure if one of your patients dies. And it could be totally natural, like you say, it’s a part of life, obviously. And even if there was nothing that could possibly have been done, you still feel that like, Geez, what? What did I not do that I should have? Or what did I do that may have have worsened the situation? Again, I do feel like that’s improving in terms of our training and how we approach death and dying and end-of-life issues. But it’s still fairly prevalent to have that feeling of, Shoot. my patient died, therefore I failed as a doctor.
David Pace 11:18
So when did you know, at what point what were the early warning signs, if you will, that what you were experiencing was not just a sadness or, you know, a difficult week or a difficult year?
Kyle Bradford Jones 11:36
Right.
David Pace 11:37
When did you realize that maybe this was clinical?
Kyle Bradford Jones 11:40
So it happened during my undergrad years. I was always very high strung. I was trying to get into medical school, so I felt like I had to do all of these extra things and get perfect grades, etc.. And so I was always very anxious and felt that stress. But then one day I had a panic attack, and I feel like a lot of people throw around that term right now. That’s more than just being really anxious. You know, your heart’s racing, you can’t breathe. You feel like you’re going to pass out. You have the sense, kind of the classic term, you have the sense of impending doom. And I thought I had a heart problem.
David Pace 12:21
And so how old were you?
Kyle Bradford Jones 12:23
- 23, Something like that.
David Pace 12:25
Okay.
Kyle Bradford Jones 12:27
And so based on the panic attack, I thought, man, that must be what’s going on. So I saw the doctor ,and he said, You know, that sounds a little more like anxiety. And, you know, there is still kind of that stigma in society about mental illness. But for whatever reason, that didn’t bother me. It was like, oh, okay, well, what can we do about it? You know, I want to feel better. I don’t want to be having these problems. And then, you know, struggled with that off and on throughout medical school. And then when I was a resident is when I was diagnosed with major depression as well. And it was the, hey, I can’t sleep, I can’t think straight, I can’t concentrate. I’m not taking pleasure in things that I usually enjoy. All of these things that go along with more of a clinical aspect of mental illness.
No shame zone
David Pace 13:26
So is it hard? I mean, it’s hard. I’ll say it right out. I mean, it’s hard to convince a layperson and non-medical personnel that, you know, mental illness is not something to be ashamed of. It must be doubly hard with medical personnel because it’s almost like you’re a candidate for political office and you have to prove that you are a super dude or a super lady or whatever you want to call it. And therefore you cannot be seen as being weak in this clinical way. But we are talking about an illness.
Kyle Bradford Jones 14:08
Yeah.
David Pace 14:08
Maybe the emphasis should be more on illness when we’re talking about mental illness and anxiety.
Kyle Bradford Jones 14:16
Absolutely. Because, yeah, there’s always the joke of the doctor who thinks that they’re God, and in many ways, that’s kind of a protective mechanism of, hey, if I can focus on doing my best, then yeah, my patients will do better. They’ll live longer, you know, or won’t die. Exactly. And so we’ve kind of convinced ourselves like, okay, well, yeah, I have more control over this than what we really do. But then you have physicians who substance abuse is much more common among physicians. I had a lot of experiences, especially as a resident and as a medical student, where my attending physician was inebriated or, you know, I’ve known many physicians who have turned to illicit drugs because that’s an easier way to cope than admitting, well, I have an illness. And, you know, whether it’s medication you need or therapy or a combination or whatever it may be, it’s easier to just turn to those substances to self-medicate and deal with things that way.
David Pace 15:35
Makes me wonder about, you know, I used to work in the airline industry as a flight attendant actually for 25 years, and it’s very performance oriented, as you can imagine. In fact, they used to tell us in training, you know, that when there is an emergency on the airplane, everybody is going to be looking at you. And what your face tells them is how they’re going to feel, because they’re in a very vulnerable place. They rely on you suddenly, exquisitely, to make it okay. And I’m wondering if that’s true also in the hospital setting or in the medical setting, is that you’re on stage ,and you’ve got your costume, literally the stethoscope around your neck and the white lab coat, and you’ve got the audience and you’ve got the the scenery and the toys, as it were, the props. And I’m wondering if it would be interesting to look at medicine through the lens of the theater, you know, I mean, yeah, because everybody knows that actors are really screwed up, and they don’t know they don’t know how to get off stage. And it’s a drug, man, walking down the hall, you know, in your white shoes. And people are looking at you like you are a bit of a demigod.
Kyle Bradford Jones 17:00
Yeah.
David Pace 17:01
I mean, my wife just went through open heart surgery in April. And so we were very embedded in the university medical system for quite a while. And I think I could write a couple books about that.
Kyle Bradford Jones 17:15
I’m sure you could. Yes. No, it’s interesting you describe it that way as kind of performative because it does feel that way. And there’s kind of a joke where the worst thing for a patient is if the doctor is really excited about your diagnosis because that means it’s rare, it means it’s interesting, it’s weird. And so if the doctor’s like, oh, you’ve got this, then they’re like, oh, maybe I should be a little alarmed. So and you know, when it’s terrible news, you want to deliver it as well and as professionally as possible. So you try not to to really show too much of a negative face. But, you know, at the same time, we’re all human. It’s a human interaction. And it should be that way.
David Pace 18:08
Yeah, I don’t want to make too much of the theater metaphor, but I was maybe this is a good time to pivot a little bit to one of your other books, which is your satirical novel called “Hospital! (Exclamation Point), a Medical Satire of Unhealthy Proportions.”
Kyle Bradford Jones 18:28
Yes.
David Pace 18:30
Which came out in 2022. And I just read the excerpt that you had on your website, which we’ll put in the transcripts so that our listeners can read more about your work. But just the opening scene is is pretty telling. And I wanted to just read the first paragraph of that. I think it’s the opening scene when Dr. “Camus” [Kamas] not Camus [Cam-oo].
Kyle Bradford Jones 18:56
Right. So it is “Camus.” But yes. He doesn’t want to be affiliated with it the French. Right.
David Pace 19:01
Yeah, of course. I think you’re from Utah, so I know I understand where Camus meant.
Kyle Bradford Jones 19:07
Right.
David Pace 19:08
But this is the opening and it really sets the tone for this entire what looks like a really hilarious telling book. I mean, “Doctor Camus powered down the hallway of the Peloton Forward Crescendo Care Amicus Health Priority Catalyst Wellness Code Blue Memorial Hospital of her motherly excellence, whose slogan is ‘We Are a Hospital.’ The tale of his rumpled white doctor’s coat trailed behind him like the cape of an angry 19th century magician.”
Yeah, I got the sense that this was a riff on the television show House, played by the actor Hugh Laurie in the TV series that started in, I think, 2004.
Kyle Bradford Jones 20:03
Yeah, about that.
David Pace 20:04
And he’s just insulting to everybody. Even the patients. Especially the patients.
Kyle Bradford Jones 20:13
Well, that’s kind of the trope of, I would say most medical shows or movies. You have the doctor who’s absolutely brilliant, who is a terrible person and hates people and is really rude, But because they’re brilliant, it’s okay. We’re going to tolerate it.
Hippocritic Oath
David Pace 20:30
We’re going to give him a pass.
Kyle Bradford Jones 20:31
Yeah, exactly. So Dr. Camus or “Camus,” he definitely has that persona, except he’s not very smart. And so you, uh, you kind of have the trope is flipped on its head a little bit, and yet the hospital still won’t get rid of him. But I mean, writing satire is so much fun. Like, Oh.
David Pace 20:54
I could tell you’re having a lot of fun.
Kyle Bradford Jones 20:55
Oh, yeah. So I had four kids, and at the time I was writing it and both of my boys were teenagers, and we just had the funnest time just sitting around coming up with gags, coming up with things and putting it in the book. And it was great. And now I have a Substack newsletter that comes out every week called the Hippocritic Oath, which is also Onion-style medical satire. So do you.
David Pace 21:24
Have quite a following of medical personnel?
Kyle Bradford Jones 21:27
You know, it just came out last month, so it’s growing.
David Pace 21:30
But we want to know the analytics on that after a while.
Kyle Bradford Jones 21:34
Well, and the nice thing about working with medical students and residents is you can say you need to subscribe, otherwise I’m going to fail you. So, you know, I have that up my sleeve when I need it
David Pace 21:46
So you are Doctor Kamus, after all I think, yeah.
.
Kyle Bradford Jones 21:49
Hopefully not too much. But there’s there’s probably an element in there.
David Pace 21:53
Highly questionable. Yes, indeed. Well, I mean, the rest of this description as it’s told — and actually I have to say this, Kyle — what I’ve read thus far, there’s a smoking gun in here and it’s called the narrator, who is a Brit. And I want to know more about him or her. Definitely.
Kyle Bradford Jones 22:17
Yes. You will learn a lot about her. She’s yet playing on another trope of the very highbrow female British narrator with this lovely accent. She is not that.
David Pace 22:35
Oh, okay. She has her own foibles.
Kyle Bradford Jones 22:38
Exactly. She is also kind of a terrible person with an awful accent and is kind of the opposite of what you typically see in movies with that. So there’s a lot of seeing the tropes and turning them on their head. But I think the book is hilarious. My wife does not.
David Pace 22:59
Oh that’s interesting
Kyle Bradford Jones 22:59
That’s okay. So I don’t know if anyone else does, but I enjoy it. So that’s what matters.
David Pace 23:04
To each his own. Well, just one last hilarious part is that he has a censor who follows him around with a ,what do you call those little air horn air horn. Yeah. And he’s so good at bleeping out all the profanity and how convenient for you, because as an author, you didn’t have to put in the F-word.
Kyle Bradford Jones 23:24
Exactly.
David Pace 23:26
Which can get very tiresome after a while, even for somebody who uses the F-word more than he should. So, yeah, I mean, it’s a delightful book, what I’ve read, and it’s gotten some good reviews, I think. And yeah, I would recommend it. And I haven’t even read it yet.
So getting back to the personal story and the memoir that you wrote, you said you mentioned that there were a lot of people who either heard about this book or read it or both, and they came forward, and that must have been a consciousness-raising exercise as much as a literary one, it sounds like. I mean. I’m assuming that, you know, the audience is, of course, people like yourself who are in the industry. Did I just use the word “industry”? But yeah.
Kyle Bradford Jones 24:19
That’s what we’ve made it out to be.
David Pace 24:20
So everything in a capitalist society, everything becomes an industry after a while. So we have to kind of give them that. But can you tell us a little bit more about the story about how you felt that you moved through or transcended or managed the diagnosis of mental illness that you had? And … how’s it going? I mean, you’re the one that wrote the books, right. To call you out on that.
Kyle Bradford Jones 24:45
Oh, totally. Yeah. I’ve been on medication for 20-plus years. I’m still on medication now. I still have a therapist. Things are going quite well right now for me and have been for for quite a while. I do think writing the book was a bit cathartic, which certainly helped in lots of ways. But looking back on some of those times — and my wife and I talk about this a lot because we were married at those times as well — ‘m not quite sure how we made it through. Not quite sure how, uh, how we were still successful in some of these things. You know, all along. I was not hesitant to have medication and therapy and what-not. And I will say not everyone with mental illness needs medication, and that’s okay. But for me, I definitely did and still do. So we were able to get much of the help we needed, but still, obviously you have to live through it. It’s still a really hard thing, but thankfully things are going well right now.
David Pace 25:55
Nice. So being in, you know, being in Mental Illness Awareness Week, I think is the proper term for it. What would you what would you say to your average Joe Blow or Jo Josephine about mental illness as someone just on the street? I mean, you’ve got a very particular take on it because you not only live with it yourself, but you’re in a setting where mental health is part of the wellness protocol, right? Or the agenda of the health industry. Well, what would you say to somebody who is struggling as an undergraduate like you were? Was it Utah State where you did your undergraduate work? What would you say to somebody, a nd what’s your advice? And if you if you had somebody sitting here, a young woman or young man.
Think you might need help with mental illness?
Kyle Bradford Jones 26:57
First of all, uh, it’s okay. And what I mean by that is you’re not less of a person. It doesn’t mean your talents are any less valued or helpful for yourself or others. We all struggle with different things. It is an illness that there is help for. Now, sometimes it’s tough. Sometimes if you do need medication, it may take trial and error to find what works for you. Sometimes if you have a therapist, you may need to meet with a couple of different people to find someone that you gel with.
David Pace 27:36
Or shop around a little bit.
Kyle Bradford Jones 27:37
Yeah, and that’s totally fine. And they fully recognize that and agree with it and that’s fine. But don’t neglect getting help. Help is available, and you are not less of a person for getting it. My mantra over the last four or five years has become just allow yourself some grace. And I really have come to accept that. Things are not going to go perfectly or exactly how I want them to. That’s okay. Things can still work out.
David Pace 28:11
So there’s and maybe because we live here in Utah where religion is a civilising force for a lot of people. There’s this term called “scrupulosity.” Have you heard of that? And it’s really a disorder, from what I understand, that is based upon — maybe you can talk a little bit about it. You know, without I mean, it can happen in any religious faith or perhaps no religious faith. But what is it exactly? And how does it how does it impact young people, for example, in a university setting.
Kyle Bradford Jones 28:53
Yeah. So I am religious. I am a member of the Church of Jesus Christ of Latter-day Saints. And I actually talk about this in the book is a lot of times the being a member of the church helped and a lot of times it really hindered my dealing with my mental illness. Scrupulosity that you reference is kind of that idea of like, boy, I got to be perfect. I’m going to do all this exactly right. I got to follow the rules perfectly. And if I don’t, I’m a terrible person. This is awful. Yes, period. And during those times when being a member of this church was harder on my mental health, a lot of it surrounded that scrupulosity. But it was as much of the culture surrounding many of the members and kind of the assumed, doctrines or beliefs that weren’t necessarily fully based. And when it was helpful was more when I focused on my relationship with God and building that and some of those deeper foundational principles that were important to me. But, it’s very common amongst, like you say, any religious community when a significant amount of people you live around are part of the same faith, you oftentimes do get some issues with mental illness and some of the scrupulosity.
David Pace 30:31
So it’s really an obsessive compulsive.
Kyle Bradford Jones 30:34
Very much like that.
David Pace 30:35
Yeah. Okay. You know, and I think a lot of us are familiar with that term in a variety of settings or in a variety of behaviors. We’re getting close to having to sign off here, but I wanted you to talk a little bit about your work with folks that suffer from disabilities and how does mental illness play into that? Are there special opportunities as well as special challenges in those settings?
Nobody wants to be a bag of diagnoses
Kyle Bradford Jones 31:10
Absolutely. So, all of my patients have a developmental disability. I would say maybe 80 to 90% have an intellectual disability of some sort. The majority have autism. A lot of them are non-verbal, can’t really communicate much with you. And so when they are struggling with some thing. It can be something physical. They’re just not feeling well. It can be something emotional or behavioral. They oftentimes will lash out behaviorally and so then it’s okay, let’s try to figure out what’s going on even though they can’t really communicate a lot with us about what they’re experiencing. And the clinic that I’m at, all of the patients who are seen there do have a mental illness of some sort. And so I think I am better at working with this population because of my experiences with mental illness. And I think it’s also very healing for me. And so it kind of goes both ways, I think.
David Pace 32:25
It’s helpful and healing to you to help and heal others.
Kyle Bradford Jones 32:30
Yeah, exactly. I understand to a certain extent some of what they’re experiencing. Certainly not all of it, of course, but because of that, I’m able to have a lot more empathy, a lot more patience and focus more on the individual as a whole as opposed to a bag of diagnoses, so to speak.
David Pace 32:54
Yeah. Yeah. Nobody wants to be a bag of diagnoses.
Kyle Bradford Jones 32:57
No.
David Pace 32:59
We save that for Facebook and political discourse.
Kyle Bradford Jones 33:02
Yes, that’s right.
David Pace 33:05
Not to bring in the election. That’s coming up soon. But yeah, in the last episode we were talking about, we were talking about these anxiety disorders that come from very unique what appears to be I don’t want to say unprecedented times because I don’t know necessarily that it is unprecedented, but it feels that way. And so, you know, there is a lot of anxiety going on right now around not just politics, but institutions that seem to be compromised or actually disintegrating. Some doctors might even say the health care system is doing that. But all of it, it seems like it’s all happening or it feels like it’s all happening because we’re all reading about it, you know, I get it. I get an alert from the Associated Press every five seconds about breaking, nes right? And it’s impossible not to look at it.
Kyle Bradford Jones 33:59
Right. Exactly.
David Pace 34:00
There’s a New Yorker cartoon where this guy is at a cocktail party and he’s wearing one of these cones of shame, they put on dogs, holding his martini. And he’s telling the woman he’s talking to “Yeah, it’s to keep me from looking at my phone.” So I wonder if you could sign off a little bit with this podcast about the unique times that we’re in and the anxiety around that and and how we might best approach that, other than getting a therapist and maybe going on medication. Yeah, I mean, without saying that that’s not a real option. And that there’s no shame in doing that.
Kyle Bradford Jones 34:37
Yeah. You know, there are obviously a lot of different theories about why mental illness is so much more of an issue now. My personal belief is simply that it comes down to we don’t have as much mental or emotional stillness as we used to.
David Pace 34:58
Stillness, interesting.
Kyle Bradford Jones 34:58
And part of it is, like you say, those constant alerts, we are constantly bombarded with information, and we don’t get rest from that. And so our minds and our bodies can’t really process the information like we’re used to doing, like our bodies and humans are used to doing. And so I really think focusing on stillness is a big thing, and it’s something that I’ve tried to focus on a lot more too, to separate myself from some of the chaos. And that’s really hard to do. That’s why it’s such a big problem is because it’s really hard to escape. But focusing on that even a little bit, I think can really make a big difference in our mental health.
David Pace 35:48
Yeah, I would think that being a father of four kids, you have plenty of chaos in your lives because you’re not only trying to manage your emotional life, but there’s as well.
Kyle Bradford Jones 35:57
It’s true. It’s true.
David Pace 35:59
But I suspect you’re doing a very good job. And anybody can write “Hospital! A Medical Center of Unhealthy Proportions” is probably on the right path.
Kyle Bradford Jones 36:10
I sure think so. But, you know, I’m sure most wouldn’t.
David Pace 36:14
There you go. So Kyle Jones. Kyle Bradford Jones, again, is an associate professor in Family and Preventive medicine at the University of Utah School of Medicine. Thank you very much for being with us.
Kyle Bradford Jones 36:27
My pleasure. Thank you.
David Pace 36:28
I was going to say happy mental health. I guess we can commemorate Mental Health Week. Yeah, let’s celebrate it. Yeah, let’s do it. Exactly. And you’ve helped us do that today. So thank you very much for being here.
Kyle Bradford Jones 36:41
Yes, thank you.