Physician loneliness: Why connection matters in medicine

One of the invisible challenges facing physicians today is the epidemic of loneliness and isolation, which can impact both physical and mental health.

In the latest Permanente Docs Chat episode, host Alex McDonald, MD, spoke with Evita Limon-Rocha, MD, MPH, a psychiatrist with the Southern California Permanente Medical Group, to unpack the drivers of physician loneliness and its substantial impact.

Dr. Limon-Rocha explained how the demands digital communication and multitasking can create a sense of disconnection even while still interacting with colleagues and patients. She emphasized that loneliness is distinct from burnout, stemming from a lack of meaningful professional and personal relationships.

To combat this epidemic, Dr. Limon-Rocha shares examples of intentional efforts to foster connection, like participating in conferences, reaching out to colleagues, and making time for face-to-face interactions.

Podcast transcript

Transcript is autogenerated. Although edited for clarity, it should not be considered an exact replication of the podcast and may also be updated as needed.

Alex McDonald, MD: Welcome everyone to today’s Permanente Docs Chat. I’m your host as always, Alex McDonald. And today we’re talking about a topic that may surprise some, and that is physician loneliness and isolation. We are joined by child and adolescent psychiatrist, Dr. Evita Limon-Rocha. And so welcome Dr. Limon-Rocha. I really appreciate you being here.

Evita Limon-Rocha, MD: Such a pleasure and I’m so happy to be here.

AM: Awesome. Well, again, we’ll start with the standard introductory question. Tell us who you are and what you do.

EL: Most definitely. So I’m located here in Riverside, California. And so I’m a child, adolescent, and adult psychiatrist, and I work with both Spanish-speaking families and also English-speaking families.

The impact of loneliness and isolation on physicians

AM: Very nice. Now again, we’re talking about loneliness. And in 2023, the U.S. Surgeon General put out a report titled The Epidemic of Loneliness and how isolation is a public health crisis. And he took that additional step of really calling it a public health crisis based on the data and the information we know. So why does this matter? Why does loneliness impact health for both patients and physicians that we serve?

EL: Right. So a multitude of reasons. So a lot of people are feeling that they’re not connected with other individuals, whether it be professionally, in their community, they’re not feeling that they’re having meaningful relationships with loved ones like their significant others or family, friends. And that has a big impact in terms of our happiness, our overall wellbeing, and can have other impacts to our health, including effects on our mental health, increasing rates of anxiety and depression along with our overall health, increased stress response, and all the things that come with a stressed body.

AM: Yeah, I think a lot of people don’t really realize how mental health impacts physical health, and your mental health is not in isolation to your physical health. They’re intricately connected. Obviously as a psychiatrist, I don’t want to tell you that, but I see the ramifications of that in my primary care office every day. So thank you for clarifying that and really pointing that piece out. So if someone told me when I was in medical school how much time I would spend in front of a computer by myself as a physician, I never would’ve believed them. On the surface, medicine doesn’t really seem like a lonely or an isolation profession, but it really is. And we know that physicians are constantly interacting with people and colleagues around them, but more and more work is on the computer or virtual, and we’re hearing more about physician loneliness than ever.
So what’s driving this disconnect between what medicine looks like and should be versus what medicine actually is and how lonely and isolating it can be sometimes?

EL: So what I would say is that people in general are stressed in ways that they’ve never been stressed before. The amount of demands that are being asked of individuals is huge, whether it be you’re taking care of your parents, now you’re answering all the medical questions, whether you’re a psychiatrist, family medicine, whatever specialty, you’re still a doctor, a physician at the end of the day. And so you’re going to get a whole host of, “Hey, the doctor said this,” or, “Hey, what’s going on with this?” Whether it be family, whether it be your parents, and now you’re navigating. And I know I’m making calls and scheduling appointments for my dad and helping him navigate the health care system, in addition to many of us are parents. And so we’re taking care of our kiddos, managing their extracurricular activities, whether my daughter is in volleyball, so we are trying to navigate her volleyball practices, her Taekwondo, and then academics.

And so I feel that truly we are being asked to do a multitude of things all at once in addition to our other hat of being a physician and answering all sorts of questions from a multitude of areas, whether it be Teams or secure chat or the actual messages. So there’s a whole host of emails and how many emails, whether it be work email, personal email, work phone, and your home phone if you have to. So it’s just a multitude of data and sources of information that we’re trying to navigate all at once. And so it’s just a really, really stressful environment that we’ve never really been placed in. We never had this option of “I can message my doctor on Saturday night and expect a response Monday morning.” So I think this data age has caused a lot of unrealistic expectations from a lot of individuals and of ourselves.

We feel like, “You know what? I went through medical school, I can do it all.” And it’s pretty exhausting to try to navigate all of those competing demands.

The difference between burnout and loneliness

AM: I think, yes, there’s so many different ways and almost too many ways to communicate in this day and age and getting pulled in multiple different directions. And sometimes when you can’t really connect with that person in front of you, be it a patient or your nursing staff or your back office staff or your colleagues, you’re not really present because you’re being pulled in so many different directions. And that can feel very isolating sometimes, especially when a lot of our work is in front of the computer. Now, a lot of times people will use terms like burnout or depression and loneliness all interchangeably, but help us explain why physician loneliness is different and why we need to recognize it as its own sort of unique challenge.

EL: So in terms of loneliness, when I think of loneliness, I think of that connection. We are feeling that we are not connected to our colleagues. We’re not feeling connected to our families. We’re not feeling connected to our friends. Our social interactions are inadequate. And so I think that that’s important to think about, well, what are we talking about when we’re talking about loneliness? In terms of just really briefly going back to what we were talking about earlier, it’s

Also in terms of all the different things that we’re managing, it’s a cognitive load. It’s pretty heavy in terms of the amount of information and sources and decisions that we’re making in a day, it’s pretty exhausting. So then what does that leave us after the workday has ended or when we’re in our workday trying to navigate all these different conversations that take a little bit of us in terms of our energy and our focus? It leads to a pretty exhausting day. So then you don’t necessarily have the energy to make those connections. And I think one of the things too is that it takes extra work to connect with people in a non-digital way.

So I tell my patients, I tell my colleagues, I’m old-fashioned. I’ll pull up a conversation and I will prefer to have a conversation, see someone’s face, rather than just type a conversation and move on. But given the fact that we’re asking to do a bunch of things at once, it’s really hard and it’s extra work to do that, to have that connection with somebody to say, “Hey, you know what? This is so much easier. Let me just talk to you and let me have this face-to-face interaction and let’s talk about it,” as opposed to this quick let me list done. And people see that all the time with text messages. I can just text them and I don’t have to do the hello, goodbye, all this other extra stuff, wait for them to answer the phone. I just done and they can text me and I got a response, then I move on.

But I think that’s the other piece too. It takes extra work to try to connect with people and have conversations and see people’s faces. And especially when we’re being asked to do 10 different things and we’re like, “I’m tired. I don’t really feel like all this extra work that it takes to have these meaningful connections, which are really, really important for our wellbeing and for our overall spirit.”

AM: And I think that what I’ve heard, I hear you encapsulate this really well and what I’ve heard is we live in this sort of transactional world where we’re transactioning with patients, we’re transacting with our back office staff, we’re transacting with our families all through these digital communications all at the same time. But they’re transactional versus relational pieces, which can be really challenging and it does not feel the same. So I know that I remember this a couple of weeks ago, I was doing a secure chat with my nurse going back and forth and I was like, I just picked up the phone and called her and we cleared it all in about 30 seconds. And so I think sometimes in an effort to be efficient and transactional, we sometimes lose those relational pieces, which are so foundational. Do you feel like that’s a fair assessment?

EL: I would agree. And I would say that when we’re having these conversations, we learn about individuals, what’s going on in their lives, their victories, their losses, things that are stressing them out. And I feel like sometimes as we’re communicating that what’s going on, that the rest of the picture is lost and missed. And I feel like that heart where we are connecting with other individuals or learning about what’s going on, we work more effectively the more connections that we make. But yes, we are under this time crunch of, “I’ve got to get through all these messages, I’ve got to return all these phone calls, and then I got to get to my second job, which is my parent role or my caregiver role or whatever other hats that we wear. And so I’ve got to be efficient.” It is incredibly taxing and incredibly tiring.

Learning the signs and indicators of loneliness

AM: Well said. So what are some of the early signs that a physician may be experiencing loneliness that they may not even recognize themselves? What are some of those early indicators?

EL: So I would say that it’s feeling like we are not. Who can we count on? Or in terms of if there’s a challenging case, who are individuals that we would be able to brainstorm the case with or feel that we could ask about, “Hey, would you address this sort of situation?” So I would say that lack of ability to feel, who can I reach out to professionally in the work environment? And I tell this, and that’s the beauty about being a child and adolescent psychiatrist too. I tell this to parents, I tell this to any sort of audience, is that it’s so important to be able to say, “What do I know about you?” And like our children, “What do I know about you and what favorite color? What are your likes? What are your dislikes today?” Because all of us are dynamic individuals. We’re all changing every single day in terms of who we are.

And so I think that whether that be professionally knowing things about your colleagues not knowing, that’s important. What do they like to do? Is there anything that I can name that any of my colleagues, their hobbies more than just, this is the person that calls my patients or tells their prescriptions ready, but what do I know about that individual? So I would say that would be one of the earliest aspects of saying, “Hey, what do I baseline know about the individuals that I spend a lot of my day and time with?”

What organizations and individuals do to prevent loneliness and foster connections

AM: Yeah, absolutely. So tell us a little bit more about from an operations point of view. Again, part of being part of Kaiser Permanente is we have all these wonderful resources and opportunities, but not just from an individual level, but what does Kaiser Permanente do as an organization to help facilitate that connection with physicians and between patients and colleagues and those of us to avoid loneliness?

EL: So there’s wonderful conferences that are at our place. I know for me, I look forward to learning at the symposium for psychiatry, and that’s held every single year. They have an in-person version of the conference along with hybrid. There’s a beautiful women’s conference that’s coming up. I want to say it’s actually today and tomorrow, or this weekend, so it’ll be taking place. And there’s lots of wonderful things that come out of these conferences. I know I was part of this group of Latinas in medicine where we had a book club, we had lots of opportunities to connect with individuals. And so I think taking advantage of all those opportunities of attending the conferences if possible, and we can coordinate childcare and caregiver support, that way we can attend those conferences. It’s always important and beneficial. And then organizationally, any opportunities where in person we can connect and see other physicians and have that incorporated into that workday is nice so that there’s unstructured time to be able to connect and have a conversation and opportunities to make, as you eloquently said, connecting the easier choice, the path of less resistance. And so I think that any way that that can be prioritized, that would be ideal.

AM: Yeah. And I know for a fact that a lot of the leaders in our departments are very intentional about helping try to create those spaces to help facilitate physicians connecting with each other and with other people they work with, because the work can take over sometimes, or the job can take over sometimes versus the work requires a team-based effort.

EL: Exactly. And we’re happier, healthier, and work more effectively when we truly feel connected to the individuals that we’re working with and the work that we are contributing to.

AM: I’ll speak for myself, but I’m sure my experience is not unique. Sometimes I’m just so busy and I’m trying to get through my to-do list and all my aspects I need to do for patient care and my administrative roles. And sometimes I feel like, oh, I need to go down the hallway and talk to so-and-so. But instead of going down the hallway and talking to them, sometimes I’ll just send them a message through secure chat or text message or whatever. But I’ve been trying to make a more of a concerted effort to walk down the hallway and see somebody face-to-face and have a little bit more of those relational pieces. And it helps me just feel better about my day, and it gives me a little bit of break from staring at a computer screen. So that’s one thing that I’ve found personally works really well for me to help break up my day, remind myself why I’m here and why I’m doing this work with my colleagues.

And then the other thing too is when I’m seeing patients in clinic, aiming for that flow state where you’re present, you’re in the room, you’re with the patient, you’re not necessarily thinking about the 20 other things you have to do or the next patient who’s waiting for you.
And using our ambient AI scribe tool has really helped me to do that, to be able to connect with patients so much better. So those are some things which I have found work really well for me. What recommendations or advice do you have for other physicians out there who may feel a little bit isolated or lonely? Or what are some other practical steps you think that physicians can take today to make them feel a little bit more connected to the people around them?

EL: I am very intentional of how I try to communicate. So I definitely make it a point to visit my nurses, see how they’re doing, check in with what’s going on in their lives. I feel like we work more effectively when we know that we are working together in collaboration, which we truly are. I am completely unable to do my work without the clerical team, without the nurses. It would be impossible. And so I am truly, and I think gratitude. One of the things that I do a lot of is these really short gratitude exercises. And so I will just take a pause and name one thing that I’m grateful for. And it could be that, “Hey, you know what? I have a cup of coffee. I love coffee.” Or, “Hey, I’m working towards my hydration. It’s hot outside. I tell my patients to stay hydrated and I’m actually doing it for once.” So I try to do these really short little second pauses in the day and just remember one positive thing that is going well. And I think it’s so important because it’s so easy to focus on lots of negativity, but it’s so hard and challenging to actually do the opposite and say, “You know what?

This is the one thing that I am super grateful for.” And it helps reframe how we think and how we behave. And so I think that is really helpful to me, and it helps me stay grounded in terms of the things and reminder of, “Hey, look, this one thing is going well. It’s great. Let’s cheer for that.” Rather than this list of, “These are all the things that are taking away from my energy and are stressing me out. Let me focus on the good.” But I think also every opportunity I really try to make, it may be annoying to be in the line where the person’s at to do the checkout, but I’ll intentionally do that. It may be annoying to say, “Hey, let’s have a conversation,” and it may take a little bit more time. In my thought process, it takes less time because like you said, sometimes it’s a matter of communicating vocally and then you can handle things a lot more efficiently and effectively. So I think it’s also saying, and I’ll throw out the excuse all the time to my patients and everybody, I’m like, “I’m old-fashioned. I’d like to pick up the phone,” or, “Hey, I’d like to just talk.” And even though it may feel like it’s taking more time, I think it’s definitely, in terms of wellbeing, it helps.

AM: I think that’s great. Thanks for those concrete examples. If you could leave our physicians that are listening today, if you could leave one message about connection, about resilience, about caring for themselves, what would you want that one thing to be that they remember and they take away from today’s discussion?

EL: One thing. Oh, that’s so hard.

AM: We can make it a couple things.

EL: So what I would say is that I really am always impressed with the people that I work with. I work with the most caring and amazing individuals, and whether it be the clerical team, the nurses, fellow doctors, I feel so lucky all the time to work with the people that I do. And I think for me, I would say is that gratitude exercise makes a world of difference. Briefly, one quick story, and then I know we’re coming to a close, but – Please, please. One of the best gifts that I got in medical school was this frame, this wooden frame that had this felt background and these little rhinestones that my mom gave me for when I started medical school. And she told me, “Evita, I want you to remember.” So the blackness of night can be so engulfing.

It can completely make you lost. But if you focus on the stars, you’ll always see beauty. It’s just so important for you to not focus on the blackness of night, but the stars and those wonderful things that are happening in life. And so I feel like I’ve carried that gratitude ever since that moment, and it’s really saved me in terms of just my wellbeing. And so I would say that I would highly, highly recommend that if we can just do that short little gratitude exercise. It really makes the world of difference in terms of helping us reframe the one thing that in that moment is going well for us. And I really feel like it changes our mindset.

AM: Yeah, thanks so much for that. I love it. Well, this has been a phenomenal conversation. We could go on and on, but we like to keep these short and high yield. We know physicians are busy. They have to get out there and make sure they connect with their colleagues, right?
So last question here. What makes you most proud to be a Permanente physician?

EL: So I would say that the ability to fill my cup in a multitude of ways. So working with students, working with the community, being an advocate for mental health, wellbeing, all of those things are just so important to who I am. And if I didn’t have the opportunity to do that, I would feel that I was half the person that I need to be. And so for me, that ability to do all of that work, it really makes me whole. And so I think for me, I’m very grateful for the opportunity to do things like this and talk about mental health, talk about wellness, talk about gratitude, and that being important to this organization and that being important and valued. So I think for me, that’s my gratitude exercise for the moment and what I’m very grateful for.

AM: I love it. I love it. Very well said. And that resonates with me very much, and I’m sure it resonates with a lot of our listeners out there. Dr. Limon-Rocha, thank you so much for joining us today and sharing your expertise. We really appreciate your time.

EL: It’s been a true pleasure and lots of fun. Thank you.

AM: Wonderful. And all of you out there listening, please like and share, make sure you practice some connection today or some gratitude exercises. Thank you for listening and stay tuned for next time.

The views expressed in this podcast are those of the speaker and are not meant to represent the views of The Permanente Federation, the Permanente Medical Groups, or Kaiser Permanente.