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Join us as we dive into the complexities of autoimmune diseases with family physician Pamela Buchanan. Discover the profound connections between chronic stress, systemic inequities, and immune health, particularly for women and Black women. Learn practical self-care strategies, the importance of emotional liberation, and how to challenge harmful societal narratives.
Pamela Buchanan is a family physician.
She discusses the KevinMD article, “The hidden cost of neglecting self-care: the autoimmune connection.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Pamela Buchanan. She’s a family physician. Today’s KevinMD article is “The Hidden Costs of Neglecting Self Care: The Autoimmune Connection.” Pamela, welcome to the show.
Pamela Buchanan: Kevin, thanks for having me. I really appreciate it. I’ve been watching for a long time.
Kevin Pho: All right. Let’s start by briefly sharing your story and journey.
Pamela Buchanan: So, you know, my story—I talked about it in a TED talk—but I grew up being neurodivergent. I am neurodivergent, and people would often question my mother as to whether I was “slow.” My mother was before her time, so she got me tested, advocated for me, and found out that I was actually gifted. From that point on, I was able to learn differently.
I then went to medical school, and I do enjoy medicine. I do have a short attention span—I have ADHD—so I barely practiced primary care; instead, I gravitated toward doing emergency medicine. I work now in emergency medicine.
I think I kind of got to this point because during the pandemic, it was rough. I work in St. Louis, just outside the city, about an hour away in a rural area, and when the pandemic hit, it was usually one doctor working one facility. It became overwhelming—I became stressed, suicidal, depressed. I’d never had that before, and so I realized at that point how hard it is for people to get help and how important it is to get help for your mental health. Also, a colleague of mine at the time committed suicide.
Kevin Pho: Tell me more about the challenges you faced when you felt these behavioral health struggles. You said it was so difficult for people to find and get help. How did you manage that?
Pamela Buchanan: You know, I used to be a doctor who was quite annoyed when people came to the ER over and over for their mental health issues. I’d say, “This is not the place for that,” because I thought they could just go see their psychiatrist or therapist. But I found in my own journey that it’s quite difficult. When I needed help, I called multiple places—nobody was taking new patients or they didn’t take my insurance. Ultimately, I ended up paying out of pocket, and I’m just blessed that I could afford to. I don’t think I would be well if I couldn’t have paid out of pocket.
Kevin Pho: And how are you doing today?
Pamela Buchanan: I feel great. I’m doing well. I’ve learned how to set boundaries, and I’ve learned tools to be happier, to be calm, to accept things, and to make things better for myself.
Kevin Pho: You tell more of your story in your KevinMD article, “The Hidden Costs of Neglecting Self Care: The Autoimmune Connection.” What’s this article about for those who didn’t get a chance to read it?
Pamela Buchanan: Well, I began really exploring self care during my journey with depression and suicidality. I’d never thought about it because we’re doctors; we just go, go, go, do, do, do. During the pandemic, the world needed us. I never got COVID, so I probably worked a lot more than my colleagues. If someone went down with COVID, I filled the shift. Also, I had the stress of dealing with my family—I have a son who has an autoimmune disorder, so I was terrified I’d give him COVID and kill him. There were all these stressors.
I learned that I had to figure out what was important for me to be OK. I had to figure out how I could reset, how I could release, whether I could continue in this job, and whether it was good for me. So I explored all those things and realized I needed to work less and that I didn’t need to work as much as I had been. I could say no. It’s hard, because the hospital would call and say, “We have nobody,” but I learned to say no. I learned to be present—not in the past or the future—just in today, with my family. It’s important. I figured out what is important to me and to do those things. Anything that falls outside of that isn’t imperative, and I’ll do it only if I can.
Kevin Pho: In your article, you note a connection between stress and trauma and the development or progression of autoimmune diseases. Talk more about that.
Pamela Buchanan: Oh, this was eye-opening. I read something by Dr. Maté, and he talks about how some people have a gene that’s just dormant until it’s activated. You may have a gene for an autoimmune disorder—let’s say rheumatoid arthritis—and one of the things that activates it is stress, especially repetitive stress, something they call a “weathering effect.” I realized that’s me, because I’ve had issues with joint pain, and when those stressors come, I feel bad.
Also, there are stats—undeniable stats—showing that women have more autoimmune diseases than men. Eighty percent of autoimmune diseases are in women. It makes sense, because women are often more stressed than men, especially those who work plus take care of the home. That’s true for me. Even beyond that, for African American women or Black women, the rates of autoimmune disease are even higher. So I really felt that was an important point people need to know so we can do something about it. When there’s something we can do about a problem, we have to share it as physicians and responsible members of society.
Kevin Pho: With the progression or worsening of your autoimmune conditions, you said you felt bad. Specifically, what kind of physical symptoms were worsened by the stress you were experiencing?
Pamela Buchanan: Relationship stress, work stress—those types of things led to a lot of joint pain, just aches everywhere, extreme fatigue, and stomach cramps. But my main issues were the extreme fatigue and joint pain. Before, I was taking medication for it, but when I learned to modulate my stressors, that became less necessary.
Kevin Pho: And with the connection between stress and autoimmune diseases, are there any specific autoimmune diseases that are particularly sensitive to stress, or is it the entire spectrum?
Pamela Buchanan: When I read Dr. Maté’s work, he didn’t specify any particular one; he just mentioned them generally. Rheumatoid arthritis, Crohn’s disease, lupus—all of those can be sensitive to stress.
Kevin Pho: When you sought out behavioral health to manage some of the stress you were experiencing, tell us about that. Did it improve your physical symptoms from the autoimmune diseases?
Pamela Buchanan: Yes, because learning how to manage your emotions and learning to deal with stressful situations in a healthy way, instead of internalizing them, is the key. Dr. Maté talks about how you internalize bad feelings in your body; you internalize stress in your body. What I learned to do is own my feelings and feel what I feel instead of locking it away. If I’m upset with my partner, I’ll say, “Honey, I’m upset, and here’s why.” If I’m upset at work, I’ll tell my director, “I’m upset, and here’s why—can we fix this?”
It’s a good time to be a doctor in that sense, because hospitals are short-staffed; there’s a shortage, so they’re more receptive to our needs. I’ve tailored my work schedule to fit my life. In general, I work Tuesdays and Wednesdays, and that’s it. If they call me for a Thursday shift, I’m likely to say no, because that’s my boundary and it’s what has kept me healthy.
Kevin Pho: Let’s talk about setting boundaries. This often comes up when discussing stress and burnout. One of the common themes is that physicians need to be more firm about boundaries and saying no, and that’s not inherently part of our training. Tell me the process you took to set those boundaries. How difficult or easy was it for you?
Pamela Buchanan: I went through my therapist to figure out the kind of person I am and why I do what I do. A lot of times, it’s people-pleasing. That’s from the rejection I felt in childhood—being neurodivergent, being made fun of. Once I realized that, it opened my eyes: I don’t have to do that.
Then I made a list: What are the things that make me happy? What are the things that I need? Those are the things I do, and I prioritize them. People come to me because I’m a pillar in my community, I’m respected, and people want my opinion and my time. I feel like I should give it, especially being a minority—there aren’t that many of us, and people will say, “We need you to speak here, do this.” I have to ask, “Does this fit with what’s important to me?” If it doesn’t, then I won’t do it. It’s hard, and I do ruminate, but I’m getting better each day because it’s a practice and a skill set that isn’t inherent. We have to work at it.
Just this past Saturday, I said, “Today is the day I’m not going to work or do anything related to work.” I said, “I’m just going to do Christmas and family.” I really had to focus—we were watching Christmas movies and doing Christmas stuff. That’s how you do it. You practice it like anything else.
Kevin Pho: As you said, autoimmune diseases are fairly prevalent throughout society. For physicians with autoimmune disorders, is there a way to destigmatize that and bring it out in the open, given that stress affects them disproportionately? How can physicians deal with the intersection of their autoimmune conditions and the stress they face?
Pamela Buchanan: Well, of course, medically you do what’s appropriate for your condition. Everyone’s course is different, but we don’t have to be as stressed as we are. There’s another way to be a doctor. I’ve been in hospital systems where they count beans, but you can do your job well and start a conversation with your employer about why quality is more important than quantity. There’s value in patient satisfaction, and there’s value in your well-being, because if you’re not well—if physicians aren’t well—then nobody is going to take care of the public. That’s scary to me right now, because so many of us left after the pandemic. The statistics vary, but I know about 41 percent of doctors and nurses left after the pandemic. I think, “Who’s going to take care of me when I get older?” So we have to take care of ourselves. It’s nonnegotiable.
Kevin Pho: Tell us about some of the conversations you’ve had or you’ve heard colleagues have with administration, articulating those very points.
Pamela Buchanan: So many, right? One good friend of mine works in the ER and says, “I want to make sure I see the patient and provide proper quality care,” but her job tells her she’s not pushing people through quickly enough. Then she has to say, “This patient had this or that,” and so I tell her, “You need to own your space.” Again, it’s hard to create a doctor quickly, so we’re in the driver’s seat right now, and I love that for us. You have to have a conversation with your boss or your director: “This is why I do these things, and this is how I’m comfortable practicing. If I do it differently, I fear I may make mistakes, and that would be bad for the hospital and bad for risk management. So I’ll continue doing it like this, because it’s where I operate best—my zone of genius.”
Kevin Pho: We’re talking to Pamela Buchanan. She’s a family physician, and today’s KevinMD article is “The Hidden Costs of Neglecting Self Care: The Autoimmune Connection.” Pamela, let’s end with some take-home messages you want to leave with the KevinMD audience.
Pamela Buchanan: My take-home message is that you have to take care of yourself. There is only one you, and self care is nonnegotiable because the cost is too high if you neglect it.
Kevin Pho: Pamela, thank you so much for sharing your story, time, and insight. And thanks again for coming on the show.
Pamela Buchanan: Thank you.
