# DTD 185 - Drive Time Debrief Episode 185
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This is the Drive Time Debrief, episode 185.
Hey guys, welcome back to the podcast. I'm Amanda, I'm Laura, and I'm Kendra. And today we are absolutely delighted to welcome Dr. Mark Sullivan to the podcast. Dr. Sullivan is a board-certified internal medicine physician in Arlington, Virginia, and he's passionate about caring for the [00:01:00] whole person—mind, body, and spirit.
He is the kind of doctor who assigns homework like better sleep and work-life balance. Thank you for doing that, because he wants his patients to truly thrive. He studied political science at Notre Dame, earned his MD from the University of Rochester, completed his residency at Stony Brook, and holds a master's in medical humanities and bioethics.
His approach to medicine is both highly skilled and deeply human. He is a bilingual Spanish speaker, and Dr. Sullivan has worked in Latin America and across the US. He writes powerfully about rebuilding trust in healthcare, navigating burnout, and bringing compassion back to the clinical encounter.
This is my favorite part: Outside of the clinic, he's a proud dad, college football fan, aspiring flamenco guitarist, and soccer coach. So today we're diving into physician burnout, whole person care, and how to bring the soul back into medicine. Dr. Sullivan, welcome and thank you so much for joining us.
Thank you, Amanda, Laura, and Kendra. It's [00:02:00] great to be with you. Thank you to your audience. It's wonderful to be with you today and I look forward to our conversation.
So I'm actually gonna start us out and let's talk about what happened to the heart of medicine. So you have practiced medicine across borders and over decades. And from your view, how have the soul and spirit of doctoring changed over time? Or how do you believe that connects to the rise of physician burnout?
Yeah, thank you. So I don't think the soul or the spirit of medicine has changed at all. I think it will always be something—it will continue to be something. And the question we have to ask ourselves is: are we going to allow the soul and spirit of medicine to come out, to flourish? Are we gonna nurture that as a society, as a medical profession?
What do I think the soul and the spirit of medicine are? I think I would paraphrase the words of one of my greatest mentors, Dr. Edmund Pellegrino, that there's something about medicine called the internal morality, or what makes being a doctor special. And that's that a patient comes to you in a moment [00:03:00] of distress, in a moment of vulnerability, and they ask you for help. And as the doctor, you usually respond, "How can I help you?"
And in making that profession, in saying, "How can I help you?" you are promising two things. One, that you have the competence and the knowledge to help that patient. And two, that you're gonna make decisions with the patient in the patient's best interest. So I think that will always be the essence of medicine. It will always be the soul of medicine, the spirit of medicine. It's about that relationship.
Now the question that you asked, which is a great one, is: as a society and as a profession, are we going to allow that relationship to flourish? And hopefully we are. And I think we are. I think what leads to burnout are all the things that distract from that relationship, all the things that pull us away in multiple directions as we're trying to nurture that, as we're trying to listen to our patients, as we're trying to think in a calm way. What's in [00:04:00] their best interest? And we don't know what's in their best interest unless we have time to know what their values are, know what gives them hope and joy, but also what causes their fear and their anxieties. And that's the privilege of being a doctor. That's what I think we all want, or especially what I want.
But you're right. There are moments and challenges in our current ailing healthcare system that create burnout because they distract us or they almost bottle up that spirit or that soul.
I love that. Yeah, you're exactly right. I think so—you have built your practice around listening to patient stories in a system that rushes everything. How have you seen that slowing down actually protect you from emotional exhaustion, and what are some practical ways you've found to incorporate that in the rush, rush, rush atmosphere?
Another great question, Amanda. Thank you. I think the hardest part about being a physician when you're being distracted and pulled in many different directions is that you feel that you have to be very efficient. [00:05:00] You feel that you have to meet a certain quota. You are worried because you're there and you're trying to be present with a patient, but you know that you have two other patients in the waiting room because you've gone over time, and that's a horrible feeling. That shortchanges the patient, and honestly, that shortchanges us as medical professionals.
It's not easy to work around those constraints, but I think the first thing is protecting that time. And what I do with my patients is I like to schedule a one-hour visit. Before we're talking about any medical issues, any acute or chronic medical issues, I ask my patients, "How do you define health and happiness for yourself?" I ask for their definition of that—that's going to be a springboard for future discussion as their primary care physician.
I also take an inventory of four areas of their life, and those are their sleep, their nutrition, their physical activity, and their sense of work-life balance or professional boundaries. I'm so appreciative in listening to your podcast—now you really help doctors [00:06:00] with that and you help them feel that it's okay to set those professional boundaries, and I help my patients do that as well.
You're speaking our language, doctor. We love that. That's right. Thank you for inventorying their sleep. That's right.
I think it's so important to start with that because that sets the tone for anything else that we do in terms of prescriptions, tests ordered, referrals made, but it takes time. And what we really look for from our administrators is the opportunity to protect that time because we know if we do that, we will take the best care of our patients. We know they'll be healthy—God willing, they'll stay healthy. And that's what the goal is, right?
Yeah. And up until now, it all sounds very idealistic, but it turns out—and I appreciate your authenticity—you've had some moments of burnout in your own career. When that has happened, what has helped you reconnect with your purpose and what didn't help?
Yeah, I've had several moments of burnout in my career, and again, those have been ones where I question whether I am a good [00:07:00] doctor, whether I am in the right field, whether I can continue and sustain the pace.
I think things that have helped are conversations with mentors that I really trust, that have inspired me, that have that soul and that spirit on display. It's my family. It's my personal faith. I view what I do as a calling, and many times when I question if I'm doing the right thing or if I'm not a good doctor because I don't get all my notes done on the same day, etc., I remind myself, "Well, why did I feel called to become a physician?" And I remind myself of what matters in what I do. And that's obviously taking care of the patient and reaping the reward of that relationship in terms of my own perspective. And when I've reminded myself of that, I've been able to come out of burnout and I've been able to surround myself with colleagues that support that as well.
I think what hasn't been helpful are programs that are aimed at improving efficiency or programs that are [00:08:00] aimed at focus like "you are the problem" and not like "the distractions are the problem." And again, it's very hard. It's very hard to come up with solutions, but what I've appreciated from hearing your podcast is you're very much helping empower physicians and healthcare professionals in an authentic way, and you're trying to reprime that spirit, that soul of medicine, and let them know that that's okay. That's not soft medicine. Obviously we wanna practice evidence-based medicine and we do every day, but it's not soft to really care about your patients. It's not soft to want that relationship. And when you empower colleagues and let them know that that's okay, that's where patients are gonna be best taken care of, and that's when physicians are gonna flourish.
Right. I really appreciate you saying you know that you got back to your why. We preach that all the time on our podcast, but also in our one-on-one sessions with physicians. I think it's very easy, like you said, with all the distractions to forget your why. [00:09:00] And I'm like you—I felt at a very early age called to medicine, and I really feel like that grounds you on the daily if you need it. Mostly, you can come up with whatever ritual you have—meditation, prayer time—but really remembering and focusing on that why, like, why are you doing this? Aside from all the distractions, man, that really does allow for you to reground and reshift your perspective and give you that energy again, that spark and that light, that motivation that was like, "Oh yeah. Oh yeah. Oh yeah. Despite all these headaches and hoops I have to jump through on the regular, I do have a purpose. I do have a calling." So I appreciate you reiterating that.
You've studied clinical ethics and medical humanities. What's the ethical cost of physician burnout for doctors and for patients?
Yeah, that's a great question. I think that I call burnout moral injury. And I think of burnout [00:10:00] and moral injury as an external factor that is eroding that relationship. The cost is an unhealthy physician. The cost is unhealthy medical decision making on patients' behalf. The cost is a leaving physician workforce, a shrinking physician workforce. And ultimately the cost is an ailing healthcare system.
I think that we can change that. I think organizations like yours, programs like yours, should be part of every medical training program. It should be part of every administrative program. It should be part of practice programs as we as practitioners struggle with these on a daily basis. But the costs are dire and it's people's lives—it's people's health.
And the beauty about being in medicine or thinking about illness is that we all become [patients]. There's not one person I've met that has been able to avoid that, and it [00:11:00] starts with everyone, you know, from the people that keep our hospitals very clean and help support patients in that way to the administrators that help run our hospitals. We'll all face illness and we have to ask ourselves: What kind of healthcare do we want for ourselves and for our families? So it's very serious. It's something that I'm very hopeful for. I think we can really improve, but we have to make those big questions prominent and we have to come up with solutions for them.
I agree. It does help when your whole team is healthy. That's right.
So let's talk about tech. Technology sometimes gets in the way of care, even though they wanna pitch it as "Oh yeah, faster, smarter, better." Right? This tech, this new tech is gonna make your job easier. Do you think all the digital noise contributes to moral injury or burnout? And can you give an example where tech has created more stress than support?
Yeah, so absolutely. You know, I'd start by saying I'm not a Luddite. I live in the real world. I like technology. I think it [00:12:00] can be helpful. But the technology should work for us as medical professionals and us as patients. We shouldn't work for the technology. And I think that's the reality. I think many times the noise that you're talking about is us feeling that we have to work for the technology, and that obviously is very distracting to patients, but...
Example: in my daily clinical practice, we have maybe two email addresses—I think a lot of people have more. We have a patient portal, we have a task inbox, we have chronic disease management or chronic management portals. The list goes on. And prior authorization portals. And that's very distracting. And I think we sometimes become addicted to completing tasks on those portals. There's something in our brain that lights up when we complete an easy task and we get rid of it, then just to wait 30 seconds later for maybe 30 more [00:13:00] tasks to pop up.
So I think the noise is very detrimental to, again, the patient-physician relationship. I think that really, as physicians and healthcare professionals, our time should be spent with the patient. And it doesn't mean that we don't have to look at data. It doesn't mean that we don't have to interpret images, but the focus is on the patient because again, that's what fulfills us and that's what delivers the best care.
I really hope that some of the new artificial intelligence works to streamline these ancillary tasks so that we can restore that relationship. And I think there's a lot of promise for that, but we have to be at the forefront of making sure that the technology's working for us and that we're not working for the technology.
Yeah, I think that's a strong stance because I think while technology—there is a lot of opportunity there, I do agree there's probably not enough input from the patient-facing population of healthcare that could really put input [in]. [00:14:00] But then again, you know, a lot of times it's because we're patient-facing that we don't have the time to really rely on those committees or have our input. And so it does become a frustration.
You've compared medicine to air traffic control, which makes sense from a systems perspective, but not a human one. Do you think that kind of efficiency culture is burning doctors out?
A hundred percent. And the comparison to air traffic control in that article was to illustrate a situation where artificial intelligence really has been implemented for years in controlling plane patterns, coordinating timeliness. But what is missing from those algorithms? And I have a great friend that works as an air traffic controller down at Miami International Airport, and he always says a few things. He says these technologies are only as good as their programmer, so [00:15:00] it's all about intention. What is the intention of this program that I'm designing? Hopefully it's in the best interest of that human person, of that traveler.
The other is those algorithms work well when things are working normally as they're expected to be. But when five patients show up in the emergency room and they're in a lot of strife and it's a high acuity situation, what's going to really take over is the mind of that physician or that healthcare professional. And it's going to be because there's a human element to that. There's a human worry. My friend, when the big thunderstorms come in—I think what makes him so good at what he does is not because he is so good at interpreting data, which he is, and how he can command those systems, but it's because he has a personal connection or a responsibility to those 200-plus people on the plane. And he's gonna make a decision that's going to be focused on saving those people's lives, getting them to land safely, out to their destination.
That's what we want as physicians. We want to get patients to their destination. We care about them. The famous article I think we've all read is Francis Peabody's [00:16:00] presentation on "The secret of caring for the patient is caring for the patient." The computer can't replace that. So I think it goes back to our initial discussion—the soul and the spirit of medicine. We have to nurture that, but ultimately doctors make the medical decision with the patient in their best interest. A computer can't replace that.
I love that. And what I'm hearing is reminding me of—I don't know if you'd call it a proverb, but a saying that really resonates with me a great deal, and that is "to be heard is to be healed." And what I'm hearing from your practice with your patients and with other humans is that you want to give the time to find out about them and to really truly hear them. And I just think the importance of that cannot be overstated. I was talking to a client yesterday about her frustration with patients coming in wanting—[00:17:00] you know, they've been on TikTok or they've been on Google and they want all these tests and they wanna feel some agency and control over their own health, and they don't have the training to really understand why they don't need a full body MRI or whatever it is they want. And we can approach them with a listening ear and really seeking to hear what the deeper concern is, and many times come to an understanding. But if we come to them with frustration and irritation that they've done all this research and don't wanna listen to us, it kind of puts a block there. But when we can hear them and help them feel heard, it really moves the needle. Am I accurate in that?
Beautifully said, Laura. I couldn't agree more. And it's frustrating even when myself and my family have received care. You know, my wife and I are medical professionals and we get it. We know the constraints are there. But there's something about being allowed to listen to the patient, like you said, that is really the essence of healing. [00:18:00] I think yes, I give prescriptions. Yes, I order tests. Yes, I refer to consultants. But I really think what heals the patient and what the patient is coming to your office for or to the emergency room [for] is they're in a moment of distress. They're going through an existential crisis, and they need to be heard, and they need another human being to connect with them, to let them know it's gonna be okay, to let them know that their suffering is expected. It's normal, it's not a lack of courage or a lack of faith or a lack of knowledge. But they're there to be helped and we fortunately are in a privileged position to be able to help them. And that's I think what transforms people's lives. I know it transforms my life as a physician, gives me perspective. And hopefully it helps my patients as well.
But I couldn't agree more. And we need to, as doctors and healthcare professionals, be allowed to listen to patients. We can't be distracted. We can't be worried because we only have seven to 15 minutes to be with a patient that we just have to brush this patient off. [00:19:00] Or, you know, our mind is in a lot of different places when we're really having this unique opportunity to heal. We can't miss that for the benefit of both parties involved.
Ah, I love that. So I also love that you give your patients homework on lifestyle changes. I feel like so many of us have just kind of given up on this because we're afraid of pushback, but you give homework on lifestyle changes like sleep and movement. If you could give doctors similar assignments to fight burnout, what would make your top three?
Yeah, so I think I would recommend the following. The first would be—would I recommend all my patients as their pillars of health? Because we gotta practice what we preach and that's very important. And that's prioritizing sleep, that informs good nutrition, that fuels regular exercise, and that creates work-life balance or professional boundaries, which sustains the ability to do all of those. So I'd start with that. You have to do that.
The second is—and [00:20:00] I heard some great interviews that you had with other physicians and a lot of individual work that you've been doing on this—is not feeling guilty when you take care of yourself. You know, we were all drawn to medicine. We had this calling and we want to put our patients first. And I think a lot of my burnout, partly with some wonderful mentors that set a high bar of a standard of what medicine is all about, was trying to fix everything and trying to almost wither away for the benefit of my patients. That's obviously not sustainable, and fortunately I had mentors in medical school and residency that helped me realize that, you know, I very much respect when doctors set professional boundaries and say, "You know, I could take this other call. I could see one more patient. But I gotta take care of myself. I gotta take care of my family so that next day I can do it again. And so I can do it for years to come." So the second is, don't feel guilty [00:21:00] about taking care of yourself. It's not mutually exclusive in your goals to help the patient.
And the final thing is, I think this goes back to the earlier discussion with Kendra—think about those mentors that really carried you along the way. Call them to share your gratitude with them. See where they are in life. See what they're struggling with or what they're happy about. And just be grateful, you know, and maybe both positive role models and maybe some negative role models because they both really helped you and given you perspective. Stay connected with those mentors and those colleagues that really impacted you during your training and talk about the soul and spirit of medicine and strategize on how we can grow this both personally and in our nation. I think I'd start with those three. I know they're quite big, but I think those are the most important in my perspective.
Yes, those are excellent. And to go back to the professional boundaries and to not feel guilty about not taking on that add-on [00:22:00] patient or not taking that extra call. I often will talk to clients and point out that it's not only self-preservation, it's kind to your future patients so that they have a well-rested, healthy, not anxious doctor taking care of them. It's kind to your family. Really, it's so much kinder to have those boundaries than to let ourselves leak out everywhere and show up a resentful shell of the person that we really could be.
Yeah, I think it's really important.
I wanted to ask, is there a website or is there a best way for people to get in touch with you? Are there downloads or articles or what should we share with listeners?
Yeah, so I have a column that is published in Physician Weekly. I believe the medical address is physicianweekly.com and a lot of those articles are also linked on our website, our practice website, which [00:23:00] is NVAfamilypractice.com. So you can find my articles, my colleagues' articles on there. And they're wonderful. Hopefully they help patients and they help other healthcare professionals, but that's probably the easiest way and always up for a phone call, always up for an email. So, always happy to help in any way.
Thank you for what you're doing. You are really inspiring. And I know I can think of several clients that as they're listening, they're gonna feel very inspired by the way you're practicing and you're a great example.
Well, thanks so much, team. That means a lot to me. I'm so proud of what you're doing. I can tell just by hearing a few of your podcasts how much it's impacted my life and how it impacts those around you. I think your work is what will allow that spirit and soul of medicine to flourish. And we need more of that. And we need that in different spaces. As I said, office practices, hospitals, academic institutions—we need that [00:24:00] everywhere. And when that becomes center stage, when everything flows from that internal morality or that—what makes being a doctor or healthcare professional so special—that's when we'll be in a great place and people will be very healthy and happy.
Thank you, Dr. Sullivan, for coming on today. We are honored to have you as a guest. We align completely with everything that you have said today, so thank you very much for your work. Keep going. We are your biggest fans and we'll keep rooting you on from our corner of the US. But we are inspired today and we know that our listeners have been inspired. And thank you so much for your courage to show up every day as the best version of yourself and doing what you can every day to accomplish that very purpose.
And thank you to our listeners for listening. And please leave a review. We love to see that five stars and the comments that you leave and it helps doctors find us. So if you have any experiences or just wanna give a shout out to Dr. Sullivan, we will make sure he gets those. [00:25:00] But email us at [email protected]. And don't forget, follow us on the socials. You can find us on Facebook, Insta, TikTok everywhere that you love to follow, and we wanted to invite you to join us for our next free masterclass called "Five Steps to Freedom From Burnout," where we will give you practical steps to thrive in the dumpster fire of medicine.
So scroll down in the show notes, click the link to register. Even if you can't make it that night, go ahead and register because replays will be available. So until next time, you are whole, you are a gift to medicine, and the work you do matters.
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