The Locumstory Podcast - Telehealth locums, life coaching, and self-care with psychiatrist Dr. Mariam Aboukar

Chase Johnson: Hello, and welcome to another episode of the welcome story. Podcast I'm chase, Johnson. And today I'm joined by special guest, Dr. Miriam Aboukar, who is a licensed psychiatrist, and recently completed a fellowship in child and adolescent psychiatry at Harvard Medicals Boston Children's Hospital.

Chase Johnson: Dr. Aboukar, practices, psycho, pharmacology, and psychotherapy. And she is also the director of wellness at an Medspiration, a podcast that discusses medical science and evidence-based tools that can improve our daily quality of life. Dr. Aboukar has been working welcomes for several years and is actively working a telehealth assignment for a facility located in Illinois. Thanks for joining us today, Dr. Aboukar.

Dr. Mariam Aboukar: Oh, thank you, Chase. Thank you so much, and you can call me Mariam. Thank you for having me on the show.

Chase Johnson: In addition to being a license psychiatrist, it sounds like you've also had a background in nutrition, science, and over 10 years of experience in life coaching, training. How do you combine all 3 of those skill sets? while practicing psychiatry?

Dr. Mariam Aboukar: That's a great question. Oftentimes looking at my resume or my background, it may look like, how do those connect? Well, interestingly enough there are a lot of micronutrients whether they're vitamins or minerals that are building blocks, shall we say to developing certain biochemical mechanisms and neurotransmitters. So, let's say, serotonin or dopamine. Norepinephrine etc. They need various types of micronutrients. The 6 B is one B 12 is extremely important for the peripheral nervous system you know, you know something very interesting that I share with my patients, and that is about magnesium. And, interestingly enough, you know a lot of benzodiazepines which increase Gaba are highly abused. You know the zanies Adaman clonapins, etc. Can be highly abused, and primarily our, system is very our society. We're very much so in an anxiety kind of ridden society these days. There's a lot of survival kind of go go go! Whereas we're still seated on the desk. We're not really releasing that kind of that threat that perceived threat. And, interestingly enough, magnesium helps clear out glutamate, which is the excitatory neurotransmitter, the opposite of gaba, and it then makes it in the brain feel as though one has a higher level of gaba to glutamate ratio and can be another way to reduce anxiety instead of taking events, or they as a be. So, it's the better one. So that's just one example. Just wanted to give you one example of something that I use in terms of nutrition in my day to day. So, I find that foods are extremely important to exceptionally important and how our brain works without the necessary building blocks. We cannot build the appropriate neural transmitters to have positive mental health. Additionally, to answer your second part of your question about life coaching, I use emotional regulation skills often emotional intelligence and social intelligence training. Most of my training in with the life coaching, and I find that, having a coaching model and looking at emotional intelligence. Which is defined as per my personal definition, and what I was trained in is the ability to recognize one's emotions and themselves, and therefore be able to recognize it in others. And so when one is able to recognize their 5 primary emotions. And what I teach my patients is fear anger, sadness, joy, which was a part of the right graduate school for the realization of human potential over in Chicago, they taught us those 5 primary emotions, and in doing so we're better able to help our patients develop a repertoire of how they're feeling in the moment as a form of self-care and as a way to regulate their emotions, so that, instead of, for example, expressing anger and irritability, they can recognize that they're actually anxious, or that they're actually sad. But they have a hard time expressing that sadness, or have a hard time, or certain mistaken beliefs about being sad or being anxious, and is it okay or not? Okay to say, hey, I'm sad, or I'm nervous, but it's easier to say, hey, I'm angry or express it as such. So those are just some simple examples of what I do, but they're very much so interrelated. I practice with a very holistic approach to wellness, and I find that where there is positive mental health there can also be greater. Shall we say? physical health? It's not a guarantee, of course, but it can certainly help. The cost.

Chase Johnson: Feels like, the two are relatively interrelated.

Dr. Mariam Aboukar: Yeah, yeah, absolutely.

Chase Johnson: That's great. Well, also, from what I'm hearing, it sounds like, you just have a little bit more tools in the tool, though, compared to some of your other colleagues.

Dr. Mariam Aboukar: I guess so, you know. For a long time, I thought maybe I was behind the ball. I had all these different interests, and I was wondering, why is that? But I realized I was an integrative psychiatrist in the making, I guess.

Chase Johnson: Switching gears a little bit. Can you tell us a little bit about how you got started doing? Look and tenants? And what makes you interested in it.

Dr. Mariam Aboukar: Oh, that's an excellent question. It was never a plan I unfortunately contracted Covid in March of 2020, March thirteenth, Friday, the thirteenth, actually as ominous as that sounds of 2020. And it was a symptomatic diagnosis at the time because we didn't even have testing appropriate testing. And I had the flu like symptoms with the nausea and the severe brain fog. Severe fatigue felt like I had gotten hit by a bus, and it was the first time I ever had any GI symptoms with a flu. I never really have that up historically, for my body and I didn't know what it was, and then I started to have what I now know to be long Covid. At the time I wasn't sure if it was a reinfection, but every couple of weeks, or whenever I would get tired, or after I was on call, or after I was moonlighting, I would develop these severe night sweats where I was you know, I'll spare you the details. But let's just say I had a lot of severe symptoms. and it was recurring over and over again, and I didn't know what was going on, so I was finishing up my residency at Advocate Lutheran General Hospital over in near Chicago, Illinois. Great program I love them. They're excellent. And you know, I started to wonder what's going on with my body, and then I started fellowship at Boston Children's with Harvard Medical School in child adolescent psychiatry, and I started to notice that my body was just different. I was crashing, and so there was a moment when I crashed. For about 36 hours my parents got so scared they called Ems. They didn't know if I was alive or what I was arousable, but my oxygen was low, my heart rate was significantly high as high as tool for at rest. They took me to the hospital found out that I had had some, you know, various organ damage thankfully. Now it's been reversed which is really interesting. you know, amazing. I I found a functional medicine position, and I worked very hard with specialists. both in Boston and outside of Boston in any case. So now I'm out significantly better and vertical. But I took time off. So, I actually started my fellowship, but didn't complete it because I got too sick. So, as I was trying to complete my fellowship training, I realize that I needed some time off, because I was too ill. I needed time to reboot. because what good use am I to my patients if I am not healthy, so the science was very limited at the time. It was very difficult to ascertain what exactly was going on and about. In September of 2020 I was able to recognize that there's something called post covid syndrome, or long covid syndrome, or multi system, inflammatory syndrome, or post Covid post-acute you know, a covid disorder. And so, with that, said, I took some time off, and starting back in January, I wanted to start back with a kind of a smaller contract. I guess a shorter contract to see how I was doing, and I did that in January, and I did about a couple of weeks and notice myself getting back into the groove. And they really liked me there, and I decided to continue, and I continued to. I I found myself really liking locums because it was flexible. you got to try different areas around the State or around the States and you weren't necessarily married to it at first, you know. You could kind of figure it out. See if you like. The people see if you like, the environment. And then I stumbled upon global medical staffing recently, which was excellent, so I got to do a telemedicine gig right now, and that's been extremely flexible and has been one of the better places that I have been placed. Yeah. So, I tend to really enjoy seeing patients in person. I am somebody who likes to be there. Roll my sleeves up, you know. Get down and get dirty in a good way, you know, in a professional way, and really try and be in the trenches with patients and with the team. So, it was a very difficult decision to actually go fully on 100, Tele, but I did it for my health. I did it because I knew that at the time I was still healing at the time. I couldn't stand for more than 5 min, not even 2 min without my heart rate creeping up to above 160, and I used to be at rest at rest, 60 60 to 70 at rest before Covid. And so, I knew that I neede to take a step back, and I didn't want to, consistently to continually be exposed to Covid again and again, and to get sicker over time so, I did this primarily as an investment in my health, and the benefits that I've reaped have been actually exceptional. I was so ill that I had to move back in with my folks, which is really hard at 34, you know. After having been away for like 10, 15 years more than that, yeah, about 15 plus years. And I was so ill I needed to be taken care of, and that was that so bad and now that I'm gaining my strength, and I'm much, much stronger.

Now, if a patient no shows or whatnot, I can just go upstairs and hang out with my folks, you know. Play with my cats and silly things, right? Go on the bike. I mean really silly things, but it's really good for my mental health, you know.I've been learning just how. you know, telemedicine you. I connect with patients on a daily basis. Every patient I feel that there is a connection with could it be stronger in person, perhaps, but truthfully. It's I feel that it is not. You know it's I believe that it is. You know I still believe that I'm very well connected to my patients. I I have certainly cried with my patients on Tele. I have certain la certainly laughed with them on Tele all time, like very often and they don't seem to have much of a problem with it. Of course they may have some trepidation at first, like, oh, you're on the computer, especially if a patient is paranoid, and they may think somebody is listening in, so I make sure to tell them that if you know you'd like it to be in person, we can certainly connect you with the provider that is instead, you know at that institute or institution in clinic, but most of those that at first were pretty nervous come out of it like I was so involved, you know. So, it's been great.

Chase Johnson: Excellent! I'm glad to hear that, personally speaking, I was seeing my provider in person prior to covid, my therapist, and then it transitioned to a virtual, and it was a bit of a learning curve, I think, for both parties. She's like, you know in person. I can queue off of your body language, and I can see you tapping your flood, or I can see you know certain things like that. Did that take some getting used to?

Dr. Mariam Aboukar: What's nice is I have kind of an insider. I have a medical assistant who's always present in the room, and it's great because she’ll get to text me in the middle of the session, and I'll be, you know, I'll try my best to be as covert as possible. But she'll tell me if somebody is, let's say, tapping their leg, and I can't see I'll make sure to, you know. Have my patients outstretched their hands to do certain tests that we do for antipsychotics like an aes test, etc., to see if they're also, if they're dealing with any tremulousness or anything like that. But yeah, what you know, the smell the any kind of bodily behaviors that maybe I can't see from the waist down any kind of behaviors that happened in the waiting area. That, let's say, I would have been more attuned to had I been in person. Thankfully, my medical assistant, who is there in person, will give me the lowdown, and it's perfect, excellent.

Chase Johnson: So medical assistant in the room. So, are they calling from an actual facility and facing with you digitally?

Dr. Mariam Aboukar: Yes, which provides excellent safety measures for the patients, so I've had to hospitalize patients before. I don't do it often, but I do. I did it once when a patient was extremely catatonic. They were so psychotic that they became catatonic. Catatonia is where a patient is very much so stiff, they're mute, almost mute or mute, and very much so stiff almost they have that rigidity. If you try to move them then they may have some. You know there are various tests that we do to test the other types of characteristics. But essentially, it's it. They can become so psychotic that it can cause a catatonia. And I have to admit them. So, the medical assistant being present, and the parent was also present, which is great. We were able to call EMS, and have the ambulance you know, take them to the hospital. And so I was able to do all the necessary paperwork from afar, which is great and the MA was able to be there and and to be present until they were taken, and I was still on Tele and I was able to talk to the EMTs there while I was on Tele, and to give them the history and things like that. So yeah.

Chase Johnson: I'm assuming. That's kind of the exception. That's not a typical thing not very typical at all.

Dr. Mariam Aboukar: Yeah. So, a telehealth for me currently is primarily outpatient. So, you've got the inpatient in person type of lifestyle where you're running around from patient-to-patient room. And you know, dealing with fires every day, and it's more acute care. But let's say you've got the in-person clinic, you know, so we can kind of compare apples to apples. It is very similar. When I was a resident as a third year, I was primarily just outpatient. I was in person. I had my own office in Chicago and as part of the you know the program, saw my patients. I was caring over 200 patients at the time. I would spend 30 minutes to an hour with patients on average to do therapy. I wasn't a just sign-up script and go, kinda Doc, you know, I really just take my time to do therapy and that's where that integrative approach came in, you know, using the emotional intelligence training, all of that, I was really neat. I tell you what, it's very similar. It's very similar, because I'm seeing that patient. It's me and them speaking, we are connecting. I'm able to prescribe their medications. I'm able to discuss with them any kind of therapy. The cool thing about the program that I'm with right now is that the place has an excellent you know they're very well so integrated. They have an excellent coordination of care. If I have, let's say a therapist or let's say, a patient of mine, I know, could benefit from therapy. I can easily email or have my medical system email, one of the therapists on staff and get them in far more quickly than let's say me having to do it all right. And so I think it really depends on coordination and integration with the rest of the team, and as well as that is that that is how well the telemedicine experience can be in addition to the technology. And I will say the one thing. The one problem I have right now is that we haven't fully transitioned to the to epic. With that, said, our notes, and things are a little bit more archaic at this time, so it's a little bit more challenging, but it is manageable. And so I think the most important thing is to be wary of the coordination of care as well as the technological advances, and to and to be as up to date as possible.

Chase Johnson: I'm sorry if I've missed this. But are you seeing any patients in person currently or no?

Dr. Mariam Aboukar: No, no.

Chase Johnson: Well, it sounds like a like you mentioned the coordinated care team. If there needs to be an all an onsite element, it sounds like there are folks that you can lead on to help you with that?

Dr. Mariam Aboukar: Absolutely. Yeah, I certainly can. Yeah.

Chase Johnson: Good for you. Well, it sounds like locums was kind of a necessity for you. What is your locum's future? What does it look like would you say? Do you think they want to continue doing locums, or what are your thoughts there?

Dr. Mariam Aboukar: I love locums. I think locums gives you freedom. You're a consultant. You have a 1099. You know you're able to try out new things, and with little risk. You're compensated very well. Yes, you may not have benefits. But the compensation is so well that you may be able to actually buy your own insurance and your own benefit packages and benefit plans there is, you know, an ability as a result of that compensation, I've been able to help my folks. I've been able to, you know. experience the ability to manage my health better because I have more resources. Now. I have the opportunity always to sign on if I like this program or whatnot, I could sign on right? But it keeps this hope, and this wonder alive. Right? I think that that's the really cool thing about it is that you don't have to necessarily commit to one path, and you can always go back. You can always go back. I can always go back to Academia if I want to right? I could always go back. I can still engage with a university and have you know, teaching privileges, and to do research and things of that nature and locums allows me to do that because I can do it for just a couple of days if I really wanted to. I don't have to do it full time. I could just do it a couple of days a month if I really wanted to, and then do other things and have a far better work, life balance. And I would highly recommend, if there's any doctor out there who happens to be listening to this podcast firstly, thanks for listening, and secondly, you know, if you are ever down or upset or feeling, hopeless or helpless. If you feel like you're in a really dark place when it comes to your job, or it feels somewhat toxic. I am not blowing smoke up up your skirt, you know, I really mean, try locums before you quit medicine, or try locums before you give up on your life. And we know there's a huge physician suicide percentage which some of my work with my inspiration was addressing, which we can talk about later, in something that I find can help decompress. Some of that stress is the ability to have some level of financial freedom, some level of work, freedom, and a bit of a better work life balance that locums provides.

Chase Johnson: Great, excellent testimony. I think that's fantastic.

Chase Johnson: What else do I have for you? So, what are some of the things that you've enjoyed most about working locums? It sounds like being able to have some freedom and flexibility, being able to see your parents and your cats and loved ones. And when there's a little bit of downtime. Anything else that we haven't touched on that really brings you joy in in a locums capacity?

Dr. Mariam Aboukar: Goodness! I get you to spend more time in my community, less commuting. Gosh! I would say, in terms of playing medicine, that's really nice. The commute I felt like was just waste of time. You know, for me personally, as somebody who is constantly on the go and I feel I can always be better at managing time, you know, that's always you know, the thing that money can't buy right is that is time that peace. And so, I find that to be exceptionally valuable, and I think that anything that gets in the way of that if I could kind of cut the fat as much as possible, that would be most ideal. So, I find that that flexibility it has is excellent. And additionally, when I was working locums, not with global medical staffing, but another staffing agency, when I was in person, I loved that they would pay for your housing they would pay for your car rental, and so the cost of living is lower. Let's say you, you're thinking of moving to another country or to another state. The cost of living then becomes a variable that is more so independent and not as much related. Not as much. It's not something that is related to your hourly rate, you know and that's something else that I wanted to mention, too, is, it's very cool that there's an hourly rate versus a salary. So, there's slightly more rights in the sense that one can theoretically work overtime, right? If they, in fact, work overtime. Now, some contracts may try to get out of this by stating that you know you know no overtime can be made because of x,y,z, which I've had in the past, not currently, but in the past. And that's actually something that is you know; I've spoken to some employment attorneys and things like that, so I think, just, you know, it's important that if anyone is considering it to make sure that they're aware of the contract that they're actively involved in negotiating, negotiation is going to be a very strong suit. I think that's something that I really like to. It's an opportunity, right? It's an opportunity when one can negotiate their terms. It's an opportunity for growth and an opportunity for power, of an opportunity to have a sense of independence and to take control of your own future.

Chase Johnson: Excellent! That's great! Good call out! We've talked, or you've touched a little bit on inspiration. And your new incorporation empath. Remind me the name? Sorry empath medicine? Tell me more about them. What's your role in each? What? What are you hoping to accomplish?

Dr. Mariam Aboukar: Yeah, yeah, thank you for asking. So, with me, I am on the board. I will be honest. I was far more active prior to Covid. During Covid I was really focused on my health and wellness. But I guess it did not fall very far from the tree of expiration, shall we say? Because I was, I started to get more into functional medicine. I'm now member of the Institute of Functional Medicine, which is focused on holistic healing for physician, for practitioners. including physicians with inspiration the project. My baby was self-Care Sunday, where I would go on live on Instagram, which is so silly and so simple. But I would just do these live shows, and we would get up to 12,000 views within a 24-hour period from across the world. And it showed me that people were very interested in self-care, and I was just simply having a conversation and doing a Q&A. And helping them. I would start off with the topic about emotional intelligence, or about mental health, or about applying for medical school, or about applying for residency, or about surviving and residency. And I noticed that we're trying to find one's passion, their purpose, etc. things that I was going through at the time, like you know how to manage, or feelings that came up for me when my first patient passed away, things like that. And I got an exceptional amount of feedback, and I realized that people are really seeking a sense of connectedness and really seeking a sense that some hopefulness. I had people I still remember that reached out to me that DM’d me and we're like, I was thinking, I wanted to be a physical therapist as an example, you know but I truly have wanted to become a physician, for example, and I realized I was so afraid that I chose a different path which is neither better nor worse, but that I chose a different path, for whatever reason, out of fear of the time that it would take for training. But really, deep down, I want to become a doctor, and you help me see that? And I thought that was really cool. Yeah, we would see people from all across the world. We had people even come from from Russia, from China, from Argentina, from all across the United States, all across South America, all across Europe, all across Asia. We even had from Australia and New Zealand. We even had somebody from the Gaza strip who was an avid follower every single week, you know. Yeah. And it was awesome. It was awesome. Currently I do hold the role of director of wellness, you know I again, I unfortunately have been focusing on my health the last couple of years, so I hope to return. I love the team. They are some of my best friends, truly. And It's been a privilege and honor to work with them. Some exciting news, I did create recently empath medicine incorporated, and I am the CEO and I hope to grow the company, the business, and it stands for engaging, meaningful physician, patient alliances through humanism and medicine. So, the key here is still very much so in line with inspiration, very much so in line with some of what brought us like minded thinkers together which is trying to make medicine more human, you know. just this morning I was listening to a graduation speech from Northwestern and the speaker was discussing how empathy and compassion are an evolved state of being in humanity, and then oftentimes the kindest person in the room is the most, is the smartest, is the most evolved since fear and ignorance and judgment are very much so a manifestation of kind of a less evolved way of being that those who tend to be the kindest, or those who tend to be the smartest, we say, and do, you know, if one is preparing apples to apples with similar IQ, things of that nature. I find that to be very true as well with physicians. You know that when we take the time to be empathic, when we take the time to be compassionate, when we take the time simply to listen to our patients. We are perceived as being more human, and we develop greater humanism and greater alliances with our patients, and that what does that do? It heals our patients. We actually treat our patients and additionally, it helps us feel good. It's a form of self-care for us as physicians where we know we're creating a sense of a human connection, and I believe that that could be one of the solutions to helping prevent burnout in our doctors today.

Chase Johnson: Well, Do you want to possibly plug. where can we find more information?

Dr. Mariam Aboukar: I think medspiration definitely has an Instagram and a Youtube.

Chase Johnson: But what about empath medicine? How can we track you down?

Dr. Mariam Aboukar: Oh, my goodness, you know. you can email me at empath medicine@gmail.com. If there's anything I can do, and I am in the process of developing an Instagram so empath medicine on Insta would be great and feel free to also reach out to me at Miriam Aboukar online as well. You know, you can email me at doctoraboukar@gmail.com. If there's anything that I can do or find me on Instagram as well. So, if you're either a patient or a clinician, or somebody who just jives with my message and wants to work together feel free to holler, and I'd be happy to assist.

Chase Johnson: Well, thank you again for your time, Mariam. This has been great, and I hope everyone that's listening feels as good as I feel after with you. So that's great.

Dr. Mariam Aboukar: That's very kind. Thanks Chase.