Welcome to another episode of the Sustainable Clinical Medicine Podcast!

Dr. Sadie Elisseou, a primary care physician in the US VA system in Boston, Harvard and Boston University educator, and trauma-informed care expert, discusses her path into medicine and how working with veterans led her to trauma-informed practice after noticing patients’ discomfort during routine exams. She explains trauma-informed care as creating physical and psychological safety through mindful nonverbal communication, transparent agendas, permission-seeking, and reducing power dynamics, with examples such as thyroid exams and avoiding phrases like “for me.” She highlights VA onboarding on military experience, notes higher ACE rates among volunteer-era veterans, and describes how staff behaviors and clinic environments shape patient stress. The conversation also covers clinician wellbeing and burnout prevention via self-care, team debriefing, boundaries, therapy access, and time-management strategies like scheduled breaks, batching tasks, finishing notes between visits, and structuring varied work roles.

Here are 3 key takeaways from this episode:

1. Trauma-Informed Care Creates Safety Through Small, Intentional Actions: Physical and psychological safety in healthcare settings comes from deliberate practices: positioning yourself at the patient's side (not behind them), asking permission before examinations, explaining what you're doing and why, ensuring clear exits, and avoiding phrases like "for me" that emphasize power dynamics. These don't take extra time but transform the patient experience.
2. Shifting from "What's Wrong With You?" to "What Happened to You?" This mindset shift moves from blaming difficult patient behaviors to approaching them with curiosity and compassion. When patients are agitated or angry, it's often rooted in pain or fear. Co-regulation techniques—modeling calm through your own presence and validating their experience—can help both you and the patient settle into a more productive interaction.
3. Preventing Burnout Requires Structural Self-Care and Intentional Boundaries: Sustainable practice isn't about luxury spa days—it's about taking mindful breaths between patients, batching tasks by day (clinic on Mondays, administrative work on Thursdays), finishing notes immediately after appointments, scheduling regular breaks throughout the month, and setting non-negotiable hard stops. Varied work schedules that incorporate teaching, research, or consulting can also prevent monotony and reignite passion for the work.

Meet Dr. Sadie Elisseou:

Sadie Elisseou, MD is a practicing physician, faculty at Harvard Medical School, and leading subject matter expert in trauma-informed care who teaches clinical healthcare professionals how to provide top-quality care to trauma survivors and consults for organizations that wish to cultivate wellness and help team members engage through stressful times.

Connect with Dr. Sadie Elisseou:

🌐 Website https://www.sadie-elisseou.com/

LinkedIn https://www.linkedin.com/in/sadie-elisseou/

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**** Charting Champions is a premiere, lifetime access Physician only program that is helping Physicians get home with today's work done. All the proven tools, support and community you need to create time for your life outside of medicine.

Learn more at https://www.chartingcoach.ca

**** Enjoying this podcast? Please share it with someone who would benefit. Also, don’t forget to hit “follow” so you get all the new episodes as soon as they are released.
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**** Questions? Comments? Want to share how this podcast has helped you? Shoot me an email at admin@reachcareercoaching.ca. I would love to hear from you.

Welcome to another episode of the Sustainable Clinical Medicine Podcast!

The host and physician coach Dr. Karen Leitner discuss why the transition to new attending is often harder than training, marked by impostor feelings, shame about not knowing, and decision paralysis in clinical uncertainty. They compare systems in the US, Canada, and Australia, including practice ownership models, overhead, billing learning curves, and how lack of business training and negotiation skills can affect long-term earnings; they share an example of lost income due to paperwork capacity and not realizing support could be hired. They emphasize that regret is unhelpful, mistakes and bad outcomes can happen despite good intentions, and guilt should be replaced with compassion and connection by talking with trusted colleagues. They address burnout dynamics—skipping food, water, and bathroom breaks—advocating radical responsibility, analyzing the “math” of workload, small workflow fixes, and boundaries, including not relying on external praise. Leitner mentions her eight-week coaching program for women physicians.

Here are 3 key takeaways from this episode:

1. Being a new attending is a normal developmental milestone, not a sign of failure: Feeling overwhelmed, looking everything up, and comparing yourself to colleagues 20 years ahead is universal. The struggle isn't because you're unprepared—it's because no one prepares physicians for this transition. It can take 5-6 years to truly feel confident.
2. Self-compassion beats guilt when outcomes don't go as planned: When bad things happen to patients, guilt is the wrong emotion if you showed up with good intentions and made the best decision with available information. Replace self-punishment with compassion for both the patient and yourself—and reach out to trusted colleagues instead of isolating in shame.
3. Radical responsibility means protecting your time and energy—no one else will: No one is coming to save you from inbox overload, double-booked schedules, or skipping lunch. Taking care of yourself (eating, hydrating, setting boundaries) isn't selfish—it's essential for sustainable patient care. Learn to respect your own time before burnout forces you to leave medicine entirely.

Meet Dr. Karen Leitner:

Dr. Karen Leitner spends the bulk of her time helping women doctors recognize their amazingness and feel better in their lives (in addition to getting paid what they deserve.) She lives outside Boston< MA with her husband, her beloved mini goldendoodle Oscar, and three school-age daughters—and loves to travel, sing karaoke, and fight the patriarchy (preferably in that order).

Connect with Dr. Karen Leitner:

🌐 Website https://www.karenleitnermd.com/

Instagram https://www.instagram.com/karenleitnermd/

🌐 https://go.karenleitnermd.com/masterclass free class for women physicians
looking for more time/less stress

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Would you like to view a transcript of this episode? Click Here

**** Charting Champions is a premiere, lifetime access Physician only program that is helping Physicians get home with today's work done. All the proven tools, support and community you need to create time for your life outside of medicine.

Learn more at https://www.chartingcoach.ca

**** Enjoying this podcast? Please share it with someone who would benefit. Also, don’t forget to hit “follow” so you get all the new episodes as soon as they are released.
**** Come hang out with me on Facebook or Instagram. Follow me @chartingcoach to get more practical tools to help you create sustainable clinical medicine in your life.

**** Questions? Comments? Want to share how this podcast has helped you? Shoot me an email at admin@reachcareercoaching.ca. I would love to hear from you.

Welcome to another episode of the Sustainable Clinical Medicine Podcast!

Psychologist and psychometrician Dr. Bryan Sexton, Chief Wellness Officer at Duke Health Integrated Practice, discusses how his early quality-improvement work in Johns Hopkins ICUs revealed that high staff burnout undermined readiness for interventions like bloodstream infection reduction. He explains measuring burnout—especially emotional exhaustion—and how adding metrics like work-life integration and emotional recovery enables personalized wellbeing “profiles” and targeted interventions. Sexton describes evidence-based, one- to two-minute “bite-sized” tools (e.g., humor, awe, gratitude) designed for busy clinicians, and how Duke embedded these into continuing education with private feedback to boost engagement; a five-hour, eight-day CE program published in JAMA Network Open (Sept 2024) showed improvements, particularly for those struggling most. He outlines a 7-minute gratitude letter exercise, its research roots (Emmons, Seligman), wellbeing-informed leadership practices, and directs listeners to free tools at caws.dukehealth.org.

Here are 3 key takeaways from this episode:

1. Assess Wellbeing Before Adding New Tasks: Healthcare workers experiencing burnout lack the capacity to take on new initiatives. Organizations should measure emotional exhaustion and wellbeing readiness before implementing quality improvement programs or system changes. About one-third of ICUs weren't ready for innovation due to burnout - addressing wellbeing first is essential.
2. Bite-Sized Interventions Have Lasting Impact: Simple 7-10 minute wellbeing exercises (like writing a gratitude letter) can produce measurable improvements lasting 6-12 months. These micro-interventions are designed for busy healthcare workers who want something that takes minimal time, provides immediate relief, and creates long-term benefits. The effects actually continue improving over time rather than fading.
3. Wellbeing is Contagious - Both Ways: When 60% of a team engages in wellbeing interventions, even those who haven't participated show improvement through contagion effects. However, this works both ways - negativity and burnout also spread. Getting "enough" people engaged (not everyone) can create positive cultural shifts that lift the entire team.

Meet Dr. Bryan Sexton:

Bryan is the Chief Wellness Officer of Duke Health Integrated Practice and Director of the Duke Center for the Advancement of Well-being Science. After 30 years as a psychologist, psychometrician and investigator, he now works with leaders to assess and improve culture and work-force well-being. Bryan has conducted and published large studies and randomized controlled trials showing how to cause enduring improvements in the well-being of our workforce. He has authored over 100 peer reviewed publications, and his research instruments and well-being interventions have been translated and used in over 30 countries.

A perpetually recovering father of four, he enjoys running, using hand tools on wood, pickleball with friends, and hearing particularly good explanations of extremely complicated topics.

Don’t miss this enlightening conversation! 🎙️

Connect with Dr. Bryan Sexton:

🌐 Website https://caws.dukehealth.org/

LinkedIn https://www.linkedin.com/in/wellb/

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Would you like to view a transcript of this episode? Click Here

**** Charting Champions is a premiere, lifetime access Physician only program that is helping Physicians get home with today's work done. All the proven tools, support and community you need to create time for your life outside of medicine.

Learn more at https://www.chartingcoach.ca

**** Enjoying this podcast? Please share it with someone who would benefit. Also, don’t forget to hit “follow” so you get all the new episodes as soon as they are released.
**** Come hang out with me on Facebook or Instagram. Follow me @chartingcoach to get more practical tools to help you create sustainable clinical medicine in your life.

**** Questions? Comments? Want to share how this podcast has helped you? Shoot me an email at admin@reachcareercoaching.ca. I would love to hear from you.