Dr. Stacy Loeb on obtaining board certification in lifestyle medicine

“Thriving in Urology” is a new video series hosted by urologist Amy M. Pearlman, MD, of the Prime Institute in Coral Gables, Florida. Each video will contain conversations on combating burnout by cultivating balance within one's work life. In this installment, Pearlman interviews Stacy Loeb, MD, MSc, PhD (Hon), regarding sources of burnout in addition to ways she finds fulfillment in her career. Loeb is a professor in the departments of urology and population health at NYU Grossman School of Medicine and Perlmutter Cancer Center in New York, New York.

Transcription:

Pearlman: Now, thinking about in the context of all these hats that you wear, what are some of the things that burn you out in a given day?

Loeb: Obviously, there are a lot more administrative nightmares than in the past. I'm sure that everyone grapples with their Epic inbox or whatever medical record they may be using. It can be challenging, for example, when you have all these questions coming in through online portals, and this isn't something that we receive any dedicated time or compensation to address. But of course, people out there are anxious and scared and would like a response from the doctor. That can be a real challenge.

On the research side, a real challenge is just getting funding for research. Many of these federal grants, for example, may have a, let's say, a 14% or 18% acceptance. So you could spend 6 months working on a grant proposal—and I'm talking nights, weekends, giving up a lot of personal time—and then it doesn't get funded. That can be a very challenging process to experience—repeated failures or rejections on the research side, for things that you put a lot of work into. I think many of us, who work very hard, are used to seeing some product or something come out of very hard work. You work on a research project, and eventually it gets published, or you work very hard in your clinic, and you get through the day and you sign all your notes, and you feel a sense of accomplishment. So I think that having grants that don't get funded feels like something that you've worked on some of the hardest work you've ever done in your life, and then it's like a slammed door in your face.

Pearlman: What are some of the things that feed your soul, that energize you?

Loeb: I mean, I think some of the things that caused us to be doctors in the first place: meeting with patients and their family members and really feeling like you can help them on their journey. Recently, I did my board certification for lifestyle medicine because I really wanted to focus more on the whole body, and also helping patients more holistically with things like physical activity, nutrition, sleep health, and mindfulness. So I think that that has helped to keep the spark, keep up excitement, to just bring this new area into practice and a different way to help people. And then for some of the grants that do get funded, working on the project and seeing the results and bringing them back into the clinic and talking to patients about it, and sharing them on the radio and on social media, all of that feels really rewarding, especially after having experienced many rejected grant proposals.

Pearlman: With this certification that you got in lifestyle medicine, do patients schedule a visit specifically to discuss your expertise in lifestyle modification related to prostate cancer?

Loeb: They absolutely can. This is all very new, since I just got this board certification a couple of months ago. But yes, absolutely. This is something that can be integrated into any visit or a visit in and of itself. I do think that it's something that is just so relevant in urology, because so much of what we do has interlinks with the 6 pillars of lifestyle medicine.

If you take ED for example, obviously physical activity and nutrition are very important for erections, as it's such a surrogate for cardiovascular health. And then more and more, there are data on the links between things like obstructive sleep apnea and sleep disturbances with issues with sexual function. Of course, use of different substances, whether it's [tobacco] or alcohol, can affect erections. It's the same with mental health. If you're experiencing anxiety or inter-relational issues as part of a couple, that can all affect it. If we are not addressing these pillars of lifestyle medicine, I feel like we really wouldn't be providing the most optimal care for the patient. So I definitely think that getting away from just giving a pill or doing a surgery and helping people to improve their life as much as possible is just so important.

Pearlman: Absolutely. Now, my sense is that when people think about this lifestyle medicine conversation, that it's a barrier because we think that it has to take an hour to discuss all of those things, right? Is that true, or can you really get through the highlights of that conversation in a shorter period of time?

Loeb: I think [you can]. I think even just assessing what area the patient might be willing to work on, that could be a way to shorten the conversation. People ask me all the time, "what's more important, diet or exercise?" And that's just not really an answerable question, because everything is important. From the perspective of lifestyle medicine, what is most important is what the patient is most motivated to work on in the here and now, because telling them about all these other things that they're not motivated to work on right now is unlikely to cause behavior change in the near term. And so I think if you really have limited time, then discussing which of these different aspects of lifestyle they may be most motivated to work on right now would be a very good place to start. Certainly, there are a lot of handouts. Even the American College of Lifestyle Medicine has handouts on all these different topics. I'm a big person in terms of either handouts or QR codes. I know you have these nice patient education videos. However you want to do it; there are certainly other ways to share information with the patients where you don't have to take up a lot of time in each individual patient encounter.

Pearlman: Absolutely. I was educating some men in a fraternity recently, and all I had to say was aerobic exercise is just as effective as Viagra for improving erectile function. At the end, I asked, “what's the next better decision you're going to make?” A guy raised his hand, probably 20 years old, and said, "I'm going to add aerobic exercise to my resistance training program." And that's all I needed to say. It took 5 seconds. People are so hungry for the information that you've recently had your certification in.

This transcript was edited for clarity.