This week on the podcast…
This week on the Uncharted Podcast, practice manager Stephanie Goss is joined by her dear friend, Dr. Phil Richmond. Phil is the Chief Medical & Team Wellbeing Officer at Veterinary United and the Founder of Flourishing Phoenix Veterinary Consultants. He is an advocate for positive culture and individual, team and organizational psychological health, safety, and wellbeing in veterinary workplaces. Phil was also voted Most Funny in his high school class, was the NASA 1996 FL State Powerlifting champion (Juniors, 23 & under) and has seen Rush in concert more than any other band. That's what I call a bio!
Stephanie and Phil are talking through a recent conversation had with some managers after a team member at someone's clinic called off for several days and then told their manager that they were admitted to the hospital following an overdose. This is someone who is newer to the team, performing well and this manager was asking how to navigate this. The discussion turned towards disciplinary-like actions – taking away keys, possible termination for the no call, no show, drug testing and more. Stephanie and Phil wanted to talk through why the default response is often to frame substance/alcohol use disorder and mental health crises in a disciplinary way; what we can do to examine our own bias when it comes to these challenges and leadership and how to begin taking steps to change the culture within our practices, our communities and veterinary medicine as a whole. Let's get into this…
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Thank you to our sponsors! To learn more about this week's sponsor, GuardianVets, check out their website HERE.
Do you have something that you would love Andy and Stephanie to role-play on the podcast – a situation where you would love some examples of what someone else would say and how they would say it? If so, send us a message through the mailbag!
We want to hear about your challenges and would love to feature your scenario on the podcast.
Submit it here: unchartedvet.com/mailbag
Upcoming Events
New Workshop Series! Practice Owners and Managers, are you ready for some workshops to help kick-start 2023? Is this the year that you tackle creating a foundation of culture for your organization? Do you want to have a practice vision and values that do more than just look pretty on your wall? Do you want to have the right people in place on your team so that you can move forward in the same direction this year? Are you lost at where to start with leading meetings like this for your team? If the answer to any of these questions is YES, we've got you! The “Start Your Year Off Right” workshops can be taken together as a series or independently based on your practice needs.
Start The Year Off Right: Finding Values & Your North Star with Dr. Andy Roark
Start The Year Off Right: Loading the Bus with Stephanie Goss
Start The Year Off Right: Lead A Vision & Values Meeting with Dr. Andy Roark & Stephanie Goss
Upcoming events: unchartedvet.com/upcoming-events/
Episode Resources
VMX Talk: come see Stephanie and Phil present together: When a Team Member Needs Help… What To Do When
Sunday, Jan 15 at 8am in Hyatt management area
At VMX: Veterinary Recovery Meeting is Sunday Jan 15 at the Hyatt from 4-8pm in Celebration 14.
PERMAH Survey Information – Workplace (and personal) well-being assessments
Mental Health Audit – Use the workplace mental health audit tool to find out how your workplace measures up.
Vets4Vets – VIN Foundation Vet Peer Support Network
Episode Transcript
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Andy Roark:
Hey Stephanie Goss, you got a second to talk about GuardianVets?
Stephanie Goss:
Yeah. What do you want to talk about?
Andy Roark:
Man, I hear from people all the time that are overwhelmed because the phones never stop ringing. And I'm sure you hear from these people as well, like our caseload is blowing up, and the doctors are busy, and the phones just don't stop.
Stephanie Goss:
They never stop. That is a true story.
Andy Roark:
I'm amazed by how few veterinarians know about GuardianVets. This is a service where you have registered technicians who can jump in virtually and help you on the phones. You can flip the switch and GuardianVets can jump in and take some of the load off the front desk. And they can handle your clients and get them booked for your appointments and give them support. And it really is a godsend.
Stephanie Goss:
Pre-pandemic, it was amazing to me how many people hadn't heard about it for after-hours call help. But at this point, I can't believe how many people don't realize that they are offering help during the daytime as well. Which I would think right now is a huge benefit to practices because everybody is shorthanded. Everybody is drowning in phone calls and so we talk about it, we've talked about GuardianVets a lot on the podcast. And every time we do, we always get somebody who says, “What is that?”
Andy Roark:
Guys, if you're not familiar with GuardianVets, if you think that you could use them help on the phones or up at the front desk, check them out. It's guardianvets.com and if you mention our podcast, me and Stephanie Goss, you get a month free. So check it out guardianvets.com.
Stephanie Goss:
Hey everybody, I am Stephanie Goss and this is another episode of the Uncharted Podcast. Just a quick warning at the front of this episode, there is some swearing in this episode so if you are listening with kids in the car or at home, you may just want to be aware of that. Or other people who just don't like to hear swearing. Know that that is a thing that happens a few times in this episode. Number two, we are talking about substance use disorder, alcohol use disorder. We do talk about suicidal ideation and suicide. So heavy topics that we did our best to cover in a way that hopefully is not upsetting or triggering to anybody. And as always, we want to be upfront and make you aware of what's happening before we get into it. So if those subjects are upsetting to you and you may want to take a break from the episode, that's totally fine. We'll see you back next week. If not, let's get into this.
Meg:
And now the Uncharted Podcast.
Stephanie Goss:
Hey everybody, welcome back to another episode of the Uncharted Podcast. Andy is not with me this week and that makes me very excited because sometimes I think we need a break from our energy. And because it means I get to have one of my most favorite people in veterinary medicine with us today. As a special guest, my dear friend Dr. Phil Richmond is here. We are going to talk today about substance use in veterinary medicine. It is a passion, something that is near and dear topically to both Phil and I's hearts. I'm going to let him introduce himself. Phil, welcome to the podcast.
Dr. Phil Richmond:
Hey, thanks Steph. It's great to be here. And I would say, I know Andy's not here, I'm like the Wish app version of Andy Roark. For anyone not seeing the video.
Stephanie Goss:
You're a good substitute for Andy. So for the people who are listening who have not had the chance to see you, hear you, know you, in veterinary medicine. Can you tell us a little bit about your background and how you and I came to be connected?
Dr. Phil Richmond:
So I'm really grateful. I sit right now in a seat with a group called Veterinary United. I'm the Chief Medical and Wellbeing Officer and super cool is Tom Bankstahl, Dr. B who's the CEO. He and I right now are the only two veterinarians in the US who have a certification in applied positive psychology. So he feels really strongly about that aspect of veterinary medicine. So super, super excited about working there. But on a grander level, and this is why all of us are doing what we're doing is trying to change the face of vet med.
And trying to change what has been, keeping what's working well. But then what are we struggling with certainly in work design and that. I also sit as the chair of the Florida Veterinary Medical Associations Wellbeing Committee, and I am super excited, I get to work every time I say this is… So I'm sitting on a committee for the CDC in NIOSH for healthcare and psychological health and safety. And then just really working on a number of projects around that in Vet Med and I get to work with some of the coolest people including you, Stephanie Goss in veterinary medicine. So just very, very grateful and I think we might be able to get into a little bit of my story of that as we go on.
Stephanie Goss:
So you and I are both red dot people as I'm listening to you talking, I'm like, “Oh, that's a lot of projects on Phil's plate.” Let's just acknowledge that right up front. We are red dot people and we bonded immediately I think probably within the first 10 minutes of talking to one another. We did the jumping up and down like, “Did we just become best friends kind of moment?”
Dr. Phil Richmond:
Totally stepbrothers.
Stephanie Goss:
Which I've never actually seen that movie, but I can picture the jumping up and down in my head. Because that's what Phil and I did because we just have a lot in common. And then as we started talking and getting to know each other more and discovered some things about our own personal lives and histories, we were just like, “Oh my gosh, we had way more in common than we thought.” So we have been a part of the Uncharted Community together for several years now and you and I both nerd out about wanting to make change in veterinary medicine. And our work together started in a very small corner within the Uncharted community in terms of creating safety and space for those in recovery in our community and has grown. And we are actually, a few short weeks from doing this recording, we are headed to Florida to do to speak at VMX together, which we are both really excited about.
Dr. Phil Richmond:
Super excited.
Stephanie Goss:
And if you're listening and you're going to be at VMX, you should come say hi. I will drop our session info into the show notes. But we are presenting on Sunday morning together with two human medicine doctors and we're talking about pieces and facets of veterinary leadership when it comes to helping our people. Like when we know that there's a problem, how do we handle crises and support? And so we're super excited to do that and as we are getting ready for that, you and I have started, we have this text chain where we see things or we hear things, we have people ask us questions and both of us regularly get questions from managers but hospital leaders in general asking, “Hey, there's this situation happening with a member of my team. Or someone I know is in this position when it comes to substance use or alcohol use or mental health challenges and I don't know what to do.”
And there was something recently that came up, somebody asked me a question because they had a member of their team who hadn't been with their team really long and they have by their admittance, been a pretty good employee. And then last week they texted and said, “Hey I'm not going to make it into work.” And there was no follow-up and no details. And then a few days later they replied back to this manager that I was talking to and were like, “Hey, I am actually in the hospital. I overdosed last week and I'm going to be here for a little bit and I'm not sure what it looks like from here.” And I thought it was great that this manager was asking questions and in the group that we were having the conversation with a lot of the response, an initial reaction from fellow managers was tread really carefully. And let's look at this from a disciplinary perspective.
They know called, no showed. They should just like what is your policy on that? You can just dismiss them and get rid of the problem. And I immediately texted you and was just like, “This makes me see red.” And you and I had a great conversation, I was like, “Let's do a podcast about this.” Because we get asked questions like this all the time and I think it's one of the things that you and I are both passionate about. Breaking down the stigma when it comes to mental health challenges, substance use in veterinary medicine. And so that's the context of what we're going to talk about today. We're going to talk about our typical headspace and actions in this specific instance. But as I suspect knowing Phil and I's conversations will probably meander a little bit along the way. Right?
Dr. Phil Richmond:
Right.
Stephanie Goss:
So let's start though with a headspace perspective. So why does this kind of thing make both you and I see red? And also how do we keep ourselves from just being angry about it? What do we do about it? Why are we here? Why are we talking about this in vet med?
Dr. Phil Richmond:
Absolutely. And the thing is that in the US the stigmatization of alcohol and substance use disorder is significant. And that's really where the crux of the issue comes up, is that we look at, Oprah just published a book. But there's an excellent psychiatrist, neurologist, and he says what we need to ask the question is instead of saying what's wrong with you is ask what happened to you. And some of the numbers that I wasn't aware of until I got involved in this is one of the things that we know is that in medical professions, medical professionals at a rate of 12 to 15% at some point in their career are going to meet criteria for alcohol or substance use disorder. In two, go ahead.
Stephanie Goss:
That's a huge number.
Dr. Phil Richmond:
Huge number. And so if you don't know that number, that's more than one in 10, is that we're out there. But what do we think about when we think about somebody who's in, when we use the term alcoholic. Even that image that pops up, sometimes It's somebody with an overcoat, in the stigmatization of under the bridge, drinking out of, unable to stop drinking. And that is not what, it can be. Some of us can go to that place, but that is not what it is. Many of us are intelligent medical professionals and intelligence has intelligence, moral fortitude and grit have nothing to do with alcoholism, alcohol use disorder and substance use disorder. It is not a moral failure and that is the thing, it's a mental condition that we have. And so it's really how do we frame it in the first place? And I just love that reframe of instead of asking what's wrong with you, compassion and saying what happened to you. And go ahead and stop.
Stephanie Goss:
I think that's huge, because the stigma, starts with the mental image when you ask somebody. And I think that's why these questions make me see red is because the answer for most of us just as humans is we have been conditioned as a society to look at substance use disorder, alcohol use disorder, mental health challenges as other people. As a problem that couldn't affect us, that happens to other people in this dark and shady and nefarious kind of way. And the picture that comes to mind is a very negative one. And so we start by already being biased in our thinking because of the stigma that surrounds it.
And so when there are challenges in our own backyard, and I love that you brought up the medical professionals because that's huge and we are a part of that as veterinarians. And we also know that on a very, very broad level, I think the most recent numbers that I saw are a little bit older at this point. They're from 2017, but the substance abuse, mental health services administration does a survey and the 2017 number said 20 million Americans 12 and older had been impacted by substance use disorders. That's statistically a staggering number. And so and I were talking about the fact that when we talk to people and you were saying when you lecture, you actually ask the question, “How many people have been impacted or know someone who's been impacted?” And lots of hands in the room go up.
Dr. Phil Richmond:
Lots of hands, most hands.
Stephanie Goss:
And at the same time when it comes to a leadership perspective, when I ask the question, “Hey, have you ever had someone who's been impacted by this in your practice?” I see so many leaders say, “No.” And I think the answer really is yes and they just don't know it. It didn't impact work, it was a secret. And so I think for me a big part of the stigma is to look at the perspective that, not normalize it in the sense that this is okay, but normalize it in the sense that this is happening. And it impacts a vast majority of us and we have to start to talk about it.
Dr. Phil Richmond:
And like you said is that it was a secret. And then we ask ourselves why is it a secret? Why is it a secret? There was a study that just came out, you and I were talking about it just recently. Is in September of 2022 there was a survey that came out. One in seven physicians, one in seven physicians admitted to consuming alcohol or controlled substances at work, one in seven.
Stephanie Goss:
At work?
Dr. Phil Richmond:
At work, that's at work. More than one in five say that they consume alcohol or controlled substances multiple times per day. And then in 2017 there was a survey done by the Mayo Clinic and it was a robust survey. They had, I think it was about I think 7,500 physicians. The 7,400 physicians answered this survey. In that survey, just alcohol is what they were talking about, just alcohol. 12.9% of male physicians and 21.4% of female physicians met criteria for alcohol use disorder.
Almost one in four of us, one in six to one in four meet criteria. So why in the hell are we not, why do we not talk about it? We also know in talking about suicide, just to give a warning is that 50 to 60% of suicides have alcohol or drug relation to it. And so that is something I feel very strongly about and both you and I are certainly advocates for suicide prevention in the profession. But if we're not talking about this, we can't truly be helping one another. And it's like, “Why are we not having these discussions?” And it's stigmatization and then it's the fear of if I come forward with this, what's our knee-jerk response is that it's going to be a performance issue. It's going to be a fitness-to-practice issue. And so what happens is that we hide it.
You just mentioned the secret and this was my story, is I hid it until I couldn't hide it anymore and I almost didn't make it Steph. But yet this could have been, people saw and I'm not saying that, but the signs were there long before I got to that point. And so if the climate was changed and we can have these open and honest conversations and say, “Wow, I've noticed I'm coming home and I'm having three or four drinks where I haven't done that before.” Because what was funny for me is I took that self, the assessment, the 20 questions that see if you're an alcoholic. And I took, I got a 19 out of 20 and it was like there's a hot, and I'm like, “Well this is bullshit, crap.” And I'm like, “Because if this was true-“
Stephanie Goss:
I don't have a problem.
Dr. Phil Richmond:
I do not have a problem, I'm in-
Stephanie Goss:
I'd be falling down at work.
Dr. Phil Richmond:
Right, because I started moving the goalposts. I was like, “Yeah, I can't have a problem.” And that's the old rationalization is because I don't want to be viewed as the person in the overcoat with the bottle in the bag under the bridge. I don't want to be viewed like that, I'm a medical professional, I'm going to school, whatever. But those two things are not…we need to be able to have this conversation in a psychologically healthy and safe space. So that's what we really want to change. And changing the intervention from where there's a crisis where we have to take, where somebody is visibly affected-
Stephanie Goss:
We have to act.
Dr. Phil Richmond:
… at work and we have and we have to act. To where if we roll back the clock or if we go back, we saw those things. And this is, I think what we're going to get into today, is what are we doing in our practices? What are we doing in our workplaces to set the tone to say it is okay to come forward with these things. Are we doing things where we talk about the access to our mental health resources are there. Are we engaged with our employees? Are we somewhat vulnerable with our employees as well about our own struggles as leaders to a safe point? But do we feel safe coming forward with that? And that, the goal is, not when we talk about don't, instead of just pulling people out of the river, let's go a mile up and find out what could we do to help them from falling in the river in the first place. And that's the goal.
Stephanie Goss:
And I love that and I think as a leader and as a manager and from an HR perspective, you and I were talking before we started recording. And I was saying when I became a manager there were no classes on this. I didn't get taught this shit. Nobody said, “Hey, you should think about these things.” Being totally candid and honest, the bare-bones information that I got from an HR perspective was, your handbook needs to have a drug-free workplace policy. And that was it for years and years and years. That was how I managed was, there was one policy in our handbook that we are a drug-free workplace. Because I could then use that to performance manage problems away. So if we had to cross that bridge, we had the safety net that said, “Hey, legally as an employer I've got this in here and if this is violated, I don't have to do anything else but write the discharge and move on.”
And so I think for me a lot of it starts with getting honest about the fact that we don't talk about it and start to talk about it. Start to talk about it more, which is a passion for both you and I, like breaking down those walls because we know that stigma continues to happen because we're not talking about it. And we're not talking about it loud enough and often enough. And that's when change starts to happen and becomes radical when we start to talk about it. So for me, I think a lot of it is starting with looking at our own perspectives as leaders in a candid way. What are our biases? What are we thinking? It's human and it's okay. And I'm saying this from the perspective, even someone who has been a part of the recovery community, someone who has been touched in my own personal life by substance use disorder. And has had family impacted by substance use disorder, I still completely admit that for a long time, the bias that I had was that this is something that happens to other people.
I was raised in a good family, I was the first person in my family to go to college. This isn't something that happens to people like me, that happens to people like my family. And so I had to do a lot of work on a personal level to break down my own bias and my own self feelings but also feelings towards others. And so I think as leaders taking that first step and looking at how are we thinking, how are we viewing it? Because just statistically if we keep thinking about it from the perspective of this happens to other people, it doesn't happen in my clinic. We're going to always be behind the curve. Because the reality is it is happening in your clinic. And if you think that it isn't, if you think that it hasn't, you're wrong. It just happened in secret.
Dr. Phil Richmond:
A hundred percent. And that is interesting and this is and the well-meaning, I mean this out of a huge amount of respect. When I was at UF and we were talking about it and I asked, I said, “How many students have we had referred to Florida's physician's health program?” And they said, “Zero.” And I said, “Okay.” And this is what I'm saying, is that this is an institutional, it's just not something that's talked about. And in human medicine the data's all there. So they see it and they're taking positive actions for this and opening up the conversation. Because again, they have the surveys, they have the data. We have a couple, a handful of studies, but there was one that came out from medical students. And medical students, 32.4% of medical students met criteria for alcohol use disorder.
And there was a study that came out, I think it was in 2017 and they did one with vet students, same thing. This is to everybody in the hospital, is affected, just it doesn't, alcohol and substance use disorder doesn't go, “Oh I'm just going to affect accountants or whatever.” It's that we are human beings who were taught to do the job of veterinary medicine. So we as human beings have things that happen to us that put us at a higher risk of this being there. And that was something that I thought we might step into too, talking about adverse childhood experiences and trauma-informed workplaces, if that feels right.
Stephanie Goss:
Yeah, I love it. So I think that is a good segue for us to talk about what are some of the, so we recognize that there are problems. We recognize that there are challenges and usually for most of us as leaders, because there still is the stigma because it is secretive. There is generally, we're finding out further down the line, like you said, we're a mile down the river. There is a crisis. Someone is actively suicidal, somebody is actively in substance use crisis, somebody has OD'ed at work or at home. And like this fellow manager that I was talking to, we're getting the call saying, “Hey, I'm not coming to work.” Then we're managing in crisis mode. And so I think for you and I, a lot of it is we need to do things better as a community, as an industry, to have resources to support the crisis mode. And that's a whole other soapbox. But I think for you and I, a huge piece of it is how can we start to turn back time?
Dr. Phil Richmond:
Yes.
Stephanie Goss:
How can we wear our Time Turner necklace and flip it back a notch, and be able to look at, how do we start to impact and support the team? How do we start to look at the team as human beings recognizing that this is something that impacts a vast majority of the American population. How do we start to do things to create a safe space in our practices where people can be human, where someone can say, “Hey, I need this help.” You and I are both the kind of people that we might go up to our manager and be like, “Hi, I am in recovery and I need to go to a meeting today.” But recognizing that not everybody is going to be able to have that forwardness and how they address it with their management.
But creating this space where if somebody on our team says, “Hey, I need to go to medical, I need to go to some medical appointments over the next couple of weeks and I need to flex my schedule to make that happen.” Where we create this culture of safety where somebody can say that and we're going to support them instead of being like, “Well we've got patients to see I need you here.” How do we start to look at people as humans? And I think you have so much to share in that arena. So maybe let's take a quick break here and then we'll come back and we'll start to dig into some of the action steps. What are some of the things that we can do as leaders? What are some of the processes that we can put in place? How are ways that we can support and educate our team to be seen as human beings first. And veterinary professionals maybe second. And how do we support each other in that regard? Does that sound like a plan?
Dr. Phil Richmond:
Perfect, love it.
Stephanie Goss:
Okay, let's take a quick break. Hey everyone, it's Stephanie and I just want to jump in here for a quick second and say Happy New Year. I am hoping that in the new year you are thinking about spending some of your CE money and coming to join our community, if you're not already a member. We've got all kinds of great things happening in the community regularly. And one of the big benefits of being an Uncharted member, means you get access to all of our monthly workshops at no additional cost.
But if you're like, “I can't afford to do membership right now, but I would love to get in on some of the things you're doing.” Head over to the website unchartedvet.com/events because we have got a rapidly growing calendar of all of the things that are coming in 2023. Andy and I are kicking off the year with a three-part, start-the-year off-right workshop series in January and February and we would love to have you join us. You can come for one, you can come for all three, you do you, but we would love to see you there. And now back to the podcast.
Stephanie Goss:
Okay, well we are back. So we talked a little bit about the headspace and a lot of it is about just acknowledging the stigma and doing some self-reflection and some looking at how we're approaching things. And it's funny because I get asked questions a lot like this question from this fellow manager and my first response always now, and it wasn't always this way. But now my first response is, “If you had a team member text you and say, I'm in the hospital, I just found out I have cancer” what would you do? Because the response to that should be no different than the response for any other reason that somebody's in the hospital. The reason shouldn't matter. But it does, because as a society there is stigma and there is judgment. And we look at somebody who has cancer as, “Holy shit that's not something they could control.”
Like for them, this happened to them. And we don't afford that same outlook to people who are having mental health challenges or crises or a disease. We don't afford that to substance use disorder or alcohol use disorder. We look at it as they are in control of this, this is their fault. And so we look at it very punitively. And so I think the first thing from an action step perspective after we do some self-reflection is start to look at how can we, we have an incredible power to teach our team that our first response is as fellow humans and is one of empathy.
Which is you are hurting, you are in pain, you are in the hospital. How can I support you? Can I send you food? What do you need? Because it's no different. And so I think for me, it's about how do we start to set that groundwork consciously and unconsciously in our team, to look at substance use disorder, to look at alcohol use disorder, to look at mental health and disease and say, “How can we approach it from a more stigma free perspective?” This is not something that they chose. This is not something that they can control from that perspective. Yes, there are things, I can control my actions and I should be held accountable for my actions and at the same time, this is a disease process. And what would we do if one of our patients had a disease?
Dr. Phil Richmond:
And I think there's a way that we can frame that conversation that makes it easier for us to have more cognitive empathy for what's going on with our team members.
Stephanie Goss:
Yeah, you're doing some great stuff here with your teams. Tell us about some of the framework that you're using for clinics to be able to start to look at this.
Dr. Phil Richmond:
So one of the fascinating things to me was that I found out maybe three or four years ago, maybe not even that long, actually, of this assessment that was done back in the late nineties, early two thousands. And it was a big study that was done by the CDC and Kaiser. And what they looked at is they found that people who have these experiences that are adverse, and that's a kind word and we'll go into a little bit what some of those are. But they had an assessment of 10 adverse childhood experiences that they would ask, they were yes or no questions. Did these things happen to you before the age of 18? The critical point is that our brains are still forming. And that is from a neurobiology and pathophysiology point of view, it is genuinely fascinating. Although these things happened to me, to know what happened in my brain when I was 8, 9, 10 years old.
That set the stage for some of these things that came up later in life. So this assessment is, were you ever physically abused by a family member or someone in the household? Were you ever sexually abused by someone in the household? Were you ever verbally abused? Were you ever felt to feel like you weren't loved? Was there often not enough money to pay for food? Did you have a family member who had an alcohol or substance use disorder? Did you have a family member who had a mental illness? Did you see violence in the home? Did you have a parent who was incarcerated? Those types of things. What they found, and this is amazing, is that if you had four or more of those experiences in childhood, you are seven to 10 times, seven to 10 times more likely to have an alcohol or substance use disorder.
You are 6.8 times more likely to have anxiety and when it comes to depression, five times more likely to have depression. All of these things are connected. And then we talk about suicidal ideation, 10 times more likely to have suicidal ideations. 37.5 times higher rate than someone with zero ACEs to have attempted suicide. So if we had any of our patients have risk factors that gave us those kind of numbers, as clinicians, as veterinary professionals, we would do everything that we could to minimize those. Now we're in a position in the workplace that we can't minimize those, but I want to let everybody know is that 12.5% of Americans have four more of those. So not just in the workplace, but think about, so people that we work with, we're sure they have-
Stephanie Goss:
People we interact with.
Dr. Phil Richmond:
Clients that have it, that act in a way sometimes that we don't like. It's learned behavior that kept them protected when they were children. And I really came onto that when I got some bad feedback. I was like, “Dammit, I act like I was 10 years old.” And it was like this light bulb went on and I was like, “Dammit, it is.” That's part of it. And so neither one of us are mental health professionals. This is just an observation on this. So it just was fascinating to me. And so what we ended up seeing at the practice that I was at before is we had someone who went through, had an issue with feedback and I was very vulnerable and open. Now from an HR perspective, I'm not going to necessarily recommend doing this, so-
Stephanie Goss:
I'm going to stick my fingers in my ear for a second-
Dr. Phil Richmond:
So, “La, la, la, la, la.”
Stephanie Goss:
“La, la, la, la, la.”
Dr. Phil Richmond:
But we are at work practice, we were very intentional about psychological safety and vulnerability and support. And so I said, I felt the same way. And I said, what was interesting is that I had taken this assessment and had this and everybody in our clinic up until, well, not everybody in our clinic. The medical team, up to that point, we had all taken this ace. Remember four or more, you get all these things, six or more, which I have six out of 10. Six or more, we potentially will on average die 20 years earlier than the general pop or people with zero. But all these manifestations come up. Our average in our medical team was six. And so it fundamentally changed how we interacted with one another.
Stephanie Goss:
And you have a small team.
Dr. Phil Richmond:
It's smaller, yeah.
Stephanie Goss:
You're not talking about working in a hundred-person hospital?
Dr. Phil Richmond:
Right. Maybe we had 10 people in the medical team.
Stephanie Goss:
Because I think for a lot of us, when we think about it and we think about this, again, it goes back to that this happens to other people. This is why I love this example from you is we think, “Oh, okay, in a big hospital where they have a hundred people, maybe a lot of the people on your medical team, this could happen to you.” When we think about, “We're a small practice and there's 10 of us, or there's right eight of us, we couldn't possibly have those numbers statistically.” And that's what I think for me, it was so impactful in hearing that. Yeah, absolutely eye opening.
Dr. Phil Richmond:
And so the other thing that's interesting, so we know my source, so I've been in recovery since 2008. But I was on a podcast with a PTSD specialist that works with veterans and first responders and that. And so I was talking about my initial burnout when I was working, on my days off I was working and I was doing all this. And she goes, “Welcome to another trauma response.” So the same behaviors that helped protect it, because the alcohol and substances helped, they were a way to change the chemistry in my brain and for me to deal with that anxiety and the other things that were going on. However, overworking, workaholism, being a workaholic, those type, but what happens-
Stephanie Goss:
Staying till 10 at night in the practice.
Dr. Phil Richmond:
We reward it and we're not watching out for those people. And dammit, those are our superstars, potentially are just manifesting it in a different way. And we got to watch out for them too. And that's what we're going to get into next is how do we then have those discussions? What are we doing structurally as a practice to set the foundation so that these conversations can potentially happen? Not necessarily talking about ACEs, but just mental health in general and normalizing the discussion around mental health. Normalizing taking time off, normalizing utilizing our EAPs. Normalizing utilizing what we have at our disposal.
And then hopefully we can be a mile up the river and help our folks so that we can have these discussions so that we don't have a fear that I'm going to get fired. Or I don't have a fear that this is going to happen. And as a manager, my only option isn't creating a performance improvement plan with the thought that I'm probably going to fire this person in three weeks because they're not… Because if nothing changes, nothing changes. We all know, if there's no intervention and I can't change me with the same brain that got me into it in the first place. You can't just tell me stop doing X because it's hardwired in my brain. I need help to do that.
Stephanie Goss:
And I'm so glad that you brought that up because that is one of the things that is really, it's hard for me to see, and I see it every single day. I check in with the communities and groups in veterinary medicine that I'm a part of, and every single day somebody has made a post about, “Yep, I was here again till 10, and now I'm sitting at home and I poured myself a glass of wine and I'm going to sit here and I'm going to numb my thoughts about the day.” And we normalize that because generally the responses are, “Cheers, I'm sitting here with my glass too.” There are the, “Yeah, but we took care of the patients. Yeah but, yeah but, yeah but.” And I think that for me is one of the most important pieces is to not overlook those things that are not overtly negative. And this is an area where we don't know what we don't know.
And I'm glad that you said neither of us is a mental health professional. And this is where I as a manager had to lean into educating myself, to learning from the HR perspective, certainly. And from the legal perspective as a business person, as an employer, what do I need to do to protect my people, to protect myself? All of those things are valid. But also doing some education about just in general, what is trauma? Learning about tools and resources like ACEs, learning about psychological safety as a topic.
And I think we've come a long way in veterinary medicine in some ways towards opening our mouths and starting to have these conversations, but not far enough. So let's talk specifically about some of the things that you are super passionate about and things that we can do as leaders in our practices to start to open the doors to the conversations. And we're a mile ahead. We're looking at before we know that there's a problem, what are things that we can do to open the door to the office, so to speak. And have the honesty and the vulnerability and the safety for our teams to start to talk.
Dr. Phil Richmond:
So it's very much like when we have an emergency come in, the best thing to do is that everybody has been taught, everybody knows what their role is before that emergency walks in the door. So it's all laid out. It's all set down. We all know how we respond so that it's normalized. That's the beautiful thing about, and it's a beautiful well-oiled machine when an emergency comes, well, when we're doing all those things. And it can be a thing of beauty, why are we not doing that again? Right now, we're in such a reactive, reactionary state in veterinary medicine that we're reacting to a mental health crisis. So let's look, just like we would look if we're checking the books or we're doing that. Can we do a mental health audit of our practices, policies, systems that are in place? And so that's what we can do. We can-
Stephanie Goss:
What does that look like?
Dr. Phil Richmond:
So we can start asking ourselves just some fairly straightforward, simple questions. What's our practices mental health policy? Oh, we don't have one. Let's look into what-
Stephanie Goss:
Okay, let's start there.
Dr. Phil Richmond:
Yeah, so let's say, what's the vision? What do we envision that to look like? What would we want, if we were in that spot, what would we want within the realm of HR? But there are options within that realm that we can do to support people. The US unfortunately is about five to 10 years behind every other civilized country in the world when it comes-
Stephanie Goss:
Not surprising.
Dr. Phil Richmond:
Yeah, not surprising. But Canada, so I'm certified for the psychosocial risks and psychological health and safety process that is the Canadian standard. And then I work with a big group in Australia who's one of the leaders in workplace wellbeing. And so these psychosocial risks, think about it like OSHA for our brains, that's how I like to describe it. We do this stuff for OSHA.
Stephanie Goss:
I love that.
Dr. Phil Richmond:
We do, you go in, you take radiographs, you better damn well have your thyroid shield on your plate. You got to have your gloves on.
Stephanie Goss:
The gloves.
Dr. Phil Richmond:
As low as reasonably available or ALARA, I forgot what the whole radiologist, just skip that. But if we know the things that can potentially increase our risk for psychological damage, what are we doing proactively to decrease those? Are we doing things as far, or do we have role clarity? Do we have job clarity? Do we give autonomy? What about reward and recognition? Are we making sure that our teams know that they're doing a good job? Things that we intuitively know, especially in Uncharted groups. But what's cool is the data supports it, is that we need to be very intentional about crafting these things. How are mistakes handled? That's a big one when we talk about psychological health and safety. Do we have situations where technicians get lit up in treatment verbally by the doctor if they make a medical error? And I guarantee you the doctors have made errors. I mean have, that's part of… A hundred percent-
Stephanie Goss:
And how are we leading by example as leaders when we make those mistakes, whether it's as a clinician or as a leader. Are we leading with vulnerability? Are we leading with candor? Are we saying, “Hey, I screwed this up and I need you guys to know, A, that I screwed it up. But also, B, what I want to do to fix this in the future so that you don't have to feel those feelings that I'm feeling right now. Because I feel horrible.”
Dr. Phil Richmond:
And as diagnosticians, as clinicians, as medical professionals, as people who need data to make decisions, are we regularly assessing those psychosocial risks. And are we measuring the well-being of our teams regularly? Probably not. Probably not.
Stephanie Goss:
Probably not. I knew that this, as it always does, when you and I start talking, time is always the crunch. And I said to Phil, I'm like, “Listen, we got to keep it tight.” And there are people who are listening who are like, “That sounds great. And where do I even start?” And so Phil and I are going to drop a bunch of resource info-
Dr. Phil Richmond:
A hundred percent.
Stephanie Goss:
… into the show notes this week for you guys so that you can find access to learning more about some of the things we've talked about. The ACEs assessment, the mental health and wellbeing audits in your practice, things like that. So we'll give you resource info. So don't panic because we're not going to dive into a lot of specifics from the time perspective, but we'll put some of that in the show notes for all of you.
Dr. Phil Richmond:
And have our leaders gone through mental health awareness training? Have we given them the tools just like everything else? Have we done that?
Stephanie Goss:
How many of us have mandatory training for our leaders? How many of us have our people assessed in QPR training? How many of us have our teams take just, I'm so glad you said the OSHA thing. There should be somebody on our team whose is CPR and first aid certified, who on our team is getting mental health education? Who is getting education in things like substance use disorder, alcohol use disorder. How are we educating ourselves, that has to be a part of the process for us if we are truly running open, honest, caring, people-forward practices. And I think that's the space that you and I both look forward to impacting the most for sure.
Dr. Phil Richmond:
And so just really getting curious about some of those questions. And if we have an EAP, most practices have one and they don't know how to access it.
Stephanie Goss:
Or what's included.
Dr. Phil Richmond:
And is that information, on a regular basis put out? So it's not, “Hey, we have this EAP. What the hell does EAP stand for? Okay, what does that mean?” Really going over what the benefits are during a team meeting and do we address those things regularly? Do we feel that that's important enough to put on our regular team meetings? Do we have a wellbeing update? Do we have a psychosocial risk update? Are we putting those things on the agenda to talk about?
Stephanie Goss:
I love that. And I think one of the other things that as leaders that we can think about is, Andy and I talk a lot about employee assistance programs and EAPs on the podcast. But going beyond that, when I sat down to think about this and I was thinking about what are some of the things that I learned about in my own journey. Things that wouldn't have even occurred to me as a manager to ask. Like what's included when we are providing medical benefits for our team, what's included in those benefits? Is it included for recovery support services? Can somebody go to inpatient treatment or outpatient treatment as part of our medical health plan? What is their access level to meds to treat substance use and manage addiction? Are they wildly cost-prohibitive if the insurance doesn't cover it? Does our medical services offer alternatives for pain management, like chiropractic or acupuncture or physical therapy?
Basic things like that, that are a part of the benefits that we already offer. To your point about the EAP, it's the same with medical benefits. We can be asking those questions not only knowing the answers to those questions, but making sure that we're highlighting that information for our team. So again, they don't feel secretive about it. I make no secret in my practices now. I don't take meds unless I absolutely have to. And so one of the questions that I always ask an employer is, what does the medical plan look like? I've been using acupuncture to help control pain for years. What does acupuncture or chiropractic coverage look like? Asking those questions so that it isn't a secret so that it isn't something that I feel uncomfortable having to ask about, thinking about those things. The other thing that became a passion project for me is how can we help make the community better and decrease risk factors, especially when it comes to substance use.
I live in an area of the country that has really, really high opioid use and we're up near the Canadian border and it's a systemic issue here. And one of the things that I got really passionate about was can we as someone in the community who dispenses drugs to our patients, can we get involved in drug takebacks? Can we get involved in pharmacy blue box projects where the community can bring back meds, no questions asked. And dispose of them safely in conjunction with the DEA, so that we help limit some of the risk factors. Not only for our team members in terms of making our own homes safer, but making the homes safer of our clients and our friends and family in the community. So things like that, that we wouldn't even necessarily think of that really impact how we're showing up for our team as leaders. And thinking about them as whole human beings and not just the person who's showing up to clock in and do the work for us.
Dr. Phil Richmond:
And I would say, if there's one big takeaway of where to focus is that I love the concept in this group that I work with in Australia is very, very big on this concept, which is a me, we and us. So there's individual responsibility and individual things. And this is where I think human medicine got down the road of really pushing resilience training. Resilience training is excellent. Resilience training, individual resilience training will not fix systemic problems. However, and then when we talk about the me part and the we part, me as the team, what makes up a team is individuals, obviously. So we need to have people that can then, and then on a team level, can we create a situation where I feel comfortable admitting a mistake to you. Or I feel comfortable having a discussion with you and you're not going to judge me.
And some of those resilience factors go into the psychological health and safety or the psychological safety of a team. And then on top of that then organizationally is that things that are out of the hands of the employees, what are we doing as leaders and as organizations to facilitate these things? Are we doing our mental health audits? Are we looking at, is everybody taking their PTO? Are we measuring wellbeing? Are we measuring burnout in our team members? What are we doing at that level? And all of those things actually have to come together to create the, as Stephanie Goss's term that I know she loves, unicorn veterinary-
Stephanie Goss:
Unicorn practice. I love it. And I would say as I'm listening to you and I'm thinking about the moving from me to we to us, listening to this, I suspect that there are some people who are like, “Holy hell, this is so much stuff that I never even thought about. And where do I find time for this? Where do I put this on top of the million other things that I have to do as a practice leader, as a business leader?” And I think the thing that both you and I are in firm agreement is this is not a, if you were going along your merry way and you had a drug… If you were me in my early career and you had a drug-free workplace policy and that was it. That was all you did, that was the box you checked. You are not going to be able to go from that at zero to a hundred miles an hour overnight. Recognizing that this is a marathon, not a sprint.
So pick one place, whether it's starting to do some audits with the team, starting to do building, again, psychological safety also doesn't happen overnight. So you can't go from not talking about things that are personal and private and vulnerable with your team if you haven't been doing that. And you all of a sudden are like, “We're going to sit down and we're going to have a group therapy session.” They're going to shit bricks. So it's about finding the places where you can start small and try one thing. Like you said, let's talk about what happens when we make a mistake. How are we going to acknowledge that to each other? How are we going to admit it? What does that look like? Starting small, finding that first building block and then figuring out how do we layer in those other building blocks as we go.
Dr. Phil Richmond:
And on an organizational level, what is our mental health policy? We could literally just ask that question. And that can be our thing for the month is just, do we have one? Can we craft one? What might that look like? And then the other thing that I think about is when we talk about civility in practice, small things that we can do that have a ton of impact, is how would I like to be treated at work? What are three things that we could sit down as a team and say, “When we're talking to another team member, we put our phone down.” We all just have that agree, simple little things like that. And we take three of those things for how we want to treat each other in practice. And that's the step we take. And the thing is that those build on one another and then we have a win. We've done something positive for the practice, and then we just build one on another.
Stephanie Goss:
I love it. As always, you and I could sit here and-
Dr. Phil Richmond:
I know.
Stephanie Goss:
… continue this conversation for half a day. If you were listening to this and you're like, “I'm super enjoying this conversation.” And you're going to be at VMX, I'm going to drop the details on our session into the show notes for you guys, because we would love to see you there. And definitely come talk to us and tell us that you listened to the podcast. That'll make it even more special. But we will also drop resource information into the show notes and some info on how to contact Phil if you have questions or honestly, if you want to nerd out with either of us on these topics, we're always open to further the conversation. And we actually have the first veterinary recovery meeting happening at VMX as well.
Dr. Phil Richmond:
At VMX, yes, we do.
Stephanie Goss:
Which is huge and exciting. That is going to be happening on Sunday afternoon as well. And we'll drop that info in because that is something you and I are both passionate about. Breaking down the barriers so that it's not just about the licensed medical professionals as veterinarians, obviously we need to serve them. But the veterinary community goes far beyond just our licensed veterinarians. And so you and I are both passionate about providing access to recovery resources and just opening the doors to all the members of our team, paraprofessional and professionals. So that is a big win and that's happening at VMX as well. So lots of fun stuff coming in the next few weeks. It's going to be a busy few weeks for us.
Dr. Phil Richmond:
Yes, yes. And I'd also say if you want to get in a meeting, an online meeting, if you're a veterinarian, the Vets for Vets program from the VIN Foundation, Bree Montana, bree@vinfoundation.org, you can get involved with that. We have a great meeting that happens every Sunday. And it's one of my favorite recovery meetings and it's just wonderful and we've got some more resources coming forth as well. So, excited.
Stephanie Goss:
Yeah, I love it. Thanks for being here, Phil-
Dr. Phil Richmond:
Thank you.
Stephanie Goss:
… and starting this conversation. I imagine that as you and I always do, this will spin into multiple other like, “How do we answer this question,” kind of episodes. But this was the first, this was great. Take care everybody, have a wonderful week. Take care of yourselves and hopefully Phil and I will see you in Florida in a few short weeks.
Dr. Phil Richmond:
Looking forward to it.
Stephanie Goss:
Take care. Well, gang, that's a wrap on another episode of the podcast. And as always, this was so fun to dive into the mailbag and answer this question. And I would really love to see more things like this come through the mailbag. If there is something that you would love to have us talk about on the podcast or a question that you are hoping that we might be able to help with. Feel free to reach out and send us a message. You can always find the mailbag at the website. The address is unchartedvet.com/mailbag, or you can email us at podcast@unchartedvet.com. Take care everybody, and have a great week. We'll see you again next time.