Thanks. I'm Denny Stanfield. I'm from Cincinnati, Southern Ohio. I've been there, well, my whole life except for a few times when I left, but I've been in practice there 31 years. So stress, stress management, and the joy of being an orthopedic surgeon. So this talk kind of, well, there's no complications or there's no problems, you know, with my involvement with other activities that have anything to do with stress, right? So this timeline here, I'm going to talk a little bit about congratulating you guys and you ladies. I'll talk a little bit about stress and then we're going to drop down real low and what happens if you have too much and then we'll try to come back out of that, deal with stress, and then talk a little about the joy of orthopedics. I have talked about this a lot. I talked about it once in an academy instructional course lecture and I never heard from them again. So I think I depressed everybody so much that they never wanted to have that lecture again. Anyway, I'd say, first I want to say congratulations to everybody. I don't know how many of your fellows or residents, but I think you've chosen a great profession. For me, this is the best job in the world. It is fantastic. I love it. It's the best job in the world and you've made it almost. So I think it's good that you can take a deep, a big deep breath. You can kind of raise your shoulders, stick your chest out, be proud of what you've accomplished because you're almost to the top of this mountain. This thing that started maybe in high school or grade school and college and in medical school and in residency and in fellowship, you're almost to the peak. Well, I've been to the peak and it just starts to get hard. It really starts to get hard now once you've stood on the peak. So some things for you to think about, and I'll be a little philosophical here for a bit, I apologize. As you get into practice, you will find that your colleagues, especially in private practice or even if you're hospital associated, your colleagues are your most valuable business asset. You will develop a bond and then the question comes, what do you do when they are in trouble? And I'm not talking about legal trouble. I'm not talking about, you know, with the police or anything like that. I'm talking about trouble like right here. So what do you do? So the answer is pretty simple. It's just do something, just do anything, but don't let it continue if there's a way that you can intervene. So this is my partner, 43 years of age. As you can see, he's kind of, he's a big guy, he's a handsome guy, he's a healthy, big, strong dude, had a great practice, but he had trouble. He had trouble here and it got to the point where he just couldn't take it, so he stopped. He took care of it himself, at that time I was a leadership in our group and I didn't know anything about it. I didn't know he was in trouble. I can tell you loss of a colleague is emotionally devastating, emotionally devastating. I've actually lost more than one, only one to suicide, but however it happens, suddenly it's terrible. So not only is it your loss, it's their children's loss, it's their wife's loss, it's loss of the physician for many patients who have depended upon them. All of the hundreds and hundreds of patients. It's huge financial loss to your group and if your group's small and he's a high or she's a high practitioner or a high producer, it could collapse your group. So hey, how's it going? You doing okay? That's a pretty mundane question. I ask it many times during the week, passing somebody in the hallway at this meeting, but it could be a life-saving question. If asked more sincerely and if the colleague was not afraid to answer honestly, afraid to answer honestly. So physician burnouts everywhere, we're all at risk. Numbers are pretty high. Numbers are probably harder than or higher than reported because we're all too damn proud to speak up. Burnout can be a risk factor of depression or suicide, obviously. It's estimated about a 400 docs a year in the United States commit suicide. Burnouts pathological, develop sleep issues, emotional exhaustion, depersonalization, cynicism, and a feeling of low personal accomplishment. That last one's somewhat unbelievable to me, that anybody at this stage of your career could actually feel a lack of personal accomplishment, but they do. So the personal characteristics that got you here are the risk factors for burnout. You're a perfectionist, you're an overachiever, you're a winner, you're a leader, probably were a leader of your high school, probably a leader in your college, probably a leader even in your medical school class. It's all stressful. These personality traits tend to set you up for a situation where you are unwilling to admit that you can't accomplish your goals. And you fear that asking for help shows sign of weakness. It's okay to ask for help. And it's okay to say no, I just I just can't do that. I can't be on that committee. I can't you know, serve that role. I can't be that director. The one thing we have to do is eliminate this fear of demonstrating any sign of vulnerability. So based on medical school interviews, every time students achieve what looks to the rest of us like a successful milestone, getting into college, getting into medical school, getting a great residency, it's competitive and clinically specific. It is to some of them the opening of another door to a haunted house, behind which lie demons, suffocating uncertainty, and unimaginable challenges. But still, students bravely meet these challenges head on, while we continue to blindly ratchet up our expectations of them. Weakness is not permitted. We tend to reduce our feelings when we should be authentic. We need to learn to display our vulnerability. We all have hearts and we all have souls. You have to recognize that vulnerability is your strength. So what do we do? Well, first, when you think a little bit about teaching methods, which have changed, but we have to treat our students and our residents and our fellows with respect, we have to stop humiliating them. And we have to reduce the pressure and stop teaching by fear. So what do you do in your practice, though? What if you're not an academician? Just in your practice, your group, what can you do? So the first thing I would say would be just talk to your partners. Don't come to the office, go straight to your clinic, get right at it, bust ass all day, get done, grab your stuff and go home. Walk around the clinic, say hi to your partners, see how everybody's doing. Ask them if they're doing okay. Be a little bit more social. Plan times or events just to talk. Develop ways to gather with each other. We are not too busy for that, even though we think we are. Consider one on one meetings, especially if you're a leader. If you're in a leadership position of your group, talk to your partners. Sometimes we have a business meeting and we've intentionally tried to spend the first 15 minutes of it or so just talking. You know how your kid's doing, what's going on. It doesn't have to be a 60 minute straight every minute business. Watch for signs. And you know, as I mentioned, I was a leader when I lost my partner. There were signs. I didn't recognize the signs until people told me about them. And I'm like, Oh, yeah. Oh, yeah. So some of the signs are they're having marital problems. They miss meetings. You have group meetings and suddenly somebody's not showing up. It's like time after time after time. They come in late. They look a little disheveled. They're you know, they used to be really well dressed and then suddenly, you know, they're not they're not kind of themselves. Behavior changes in the office behavior changes in the OR. Those are signs. So it take them aside and say, Hey, what's going on? What's the problem? Can I help you? This one's pretty tough. This is a medical students note to her parents. I know you may not understand why I didn't seek help. I don't know if I can really explain why this choice just seems to make sense to me. I know I had such a seemingly bright future. And I know I would have been such a successful doctor and wife and mother. But all I ever desperately wished for is to not feel like not existing would be preferable to being who I am and living the life I live. I love you both so much your daughter, a medical student. So anyway, I'm bringing you way down and I apologize. It gets better. You know, I'll just say that physicians commit suicide twice as much as their patients. 100% of these deaths are preventable. Most of the cases are not random or unplanned. These are planned. All are brilliant, brilliant, talented, sensitive people, highly competitive in what some would call an inhumane environment that we practice in. They all try to hire their depression and appear highly functional to most until their suicide. Most of them leave notes because that's what we're trained to do. So sometimes the strongest among us are the ones who smile through silent pain cry behind closed doors and fight battles nobody knows about. So even signs like this in the office could be could be a clue. So again, what should you do? I think you should talk about stress in your group or in your hospital. You should teach or if you teach stop the abuse and teach with respect. Watch your colleagues and don't ignore any of the signs. Reach out to trouble colleagues. When someone says I've had a really bad week. You know, you might want to kind of stop and go hey, tell me about it. What's going on? Be a mentor. That's what we're talking about. So we're going to start moving up from the depths. Okay. So I would say encourage your colleagues to take care of their health. I mean, a long time ago, I was president of our group and we were having a retreat and I put that slide up like you guys all should get a physical. One guy did. He was sicker than we thought. He recovered from it, but it probably saved his life. So don't ignore your physicals. Get some exercise. Make it a priority instead of rather than just talking about it. Kind of introduce the idea of play like a little recess, maybe once a week or, you know, one day a week at lunchtime or something. Ask someone to play golf, tennis, whatever they might want to do. And for each of you, I'd suggest that you reevaluate your personal situation. Am I headed down a path of progressive stress? Am I too focused on esteem and financial rewards and status? How is my health? Really? How is my health? Do I need to modify some things? Like maybe a little bit more of this. So if you're suffering, please tell someone, please. So, so I got this is kind of a separate talk, but it kind of brings us back out. Okay. And I'll go through it quickly. So one of the talks I've wanted to get for a long time is kind of what's this all about? Like what we're doing here? What we do in our profession? What is it all about? What is this job? And what makes it so great? Well, I would say it's not the torn ACL that makes it so great. Last night, I was in my room kind of actually kind of tuning this up. And I was on my headphones, I was listening to a little thing on YouTube. And I heard this quote from 1997. It said there's a title, this guy said there's a tidal wave of bullshit to endure throughout your life, a tidal wave of bullshit. So it's like all around us. You know who said that? George Harrison. For those who don't know, George Harrison is a beetle. This was he said this in his last interview before he died of throat cancer. The total wave of bullshit. I love that quote. I'm going to use it all the time. Anyway, so what's it all about? I'm still working on what it's all about. But I can tell you that I love to operate. I mean, it's it's the big day. You know, when it's our day. It's just I just feel better going to work. But that's not it. That's really not what it's about. I can tell you what it's not about. Those are easy. It's not about money. It's not about stats status. It's not about how many surgeries you do a year. And it's not about how many RV use you accumulate. And I don't want to hurt anybody's feelings. But it's not about you either. It's really not about you. It's hard to give a whole talk on it's not about you because I'm thinking of I would come. So I had to slide it in there. Well, here's what it's about. And if you've gone to some of the talks today, I kind of feel like I'm repeating myself or repeating what's been said. But it's about relationships. And it's about collaboration. It's about what we're doing right now. It's about coming to this meeting. It's about seeing people that you love. So it's about relationships with your peers, former residents, fellows, partners, people, for most of you that you may have not met yet. That's what it's about. It's about the people you're going to meet and become friends with. It's it's really as I get older, it's about relationships and collaboration with patients and their families, you get to know them. You know what they do, they know what you do, they know your habits, you operate on them, they go away, you don't see them for 11 years, and suddenly they're back. And it's another problem. But it's about that relationship that brought them back. And it's just so fun to see them. It really is. It's about your co workers. Relationships, collaboration with your team. Enjoy that relationship, appreciate them work together, Seth talk about taking them out to eat, just do anything, you know, you bring them candy, they love it, you know, just anything. And then most importantly, it's that relationship and collaboration with your family, and your friends. And watching kids grow up and developing even a longer relationship with your spouse. It's truly about making things better. Not just for you, but mainly for others. We are all trying to make things better. Not just their knee, the world. So I would say turn back to yourself, turn back to innocence, turn back to simplicity, turn back to why you're all here, find things that make you smile, things that make you happy. And that will help your stress level. You need to seek those out and go back to them. You were a kid once find joy and peace in what you do and what you are doing. That's what you need for a rewarding life and rewarding career. That's what orthopedics needs of you. That's what we want of you. It's what the world needs. And it's the very, very best of you. This was me just a few weeks ago. I was just driving on Skyline Drive in Virginia. Stopped a little pull off. And we were looking over the, you know, over the side of the mountain. I'm just like, this is a cool rock. I'm gonna hug it. My wife thought it was ridiculous, but she took a picture. So our profession is an honor and a privilege, which comes with some obligations. Those obligations should not be looked upon as a burden. Look at them as a wonderful gift that each of us has been given. It is a wonderful gift. The gift is to help, to care, to serve others and to give others comfort when they are in our presence. Our powerful gift is to give back. So enjoy it. So find your joy. This is me after 20 days in a single man tent in the Sierras. And that's a selfie. I was just not going out of my mind, but it was good. Thank you all very much.

orthopedic surgeon

stress management

joy of being a surgeon

physician burnout

supportive environment