Advocating for Our Own: Pharmacists' Mental Health | Helen Sairany, PharmD, Author

[00:01:16] Mike Koelzer, Host: Helen, for those that haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

[00:01:23] Helen Sairany: My name is Helen Sairany, and I am a pharmacist, but I usually go by the trauma informed pharmacist. I like to introduce myself as a healthcare provider who has a deep appreciation And understanding of trauma and how trauma shows up in our work life as well as our workplace. and I'm hoping that through your platform today that we can touch on some of the topics related to some concepts I talk about in my books.

[00:01:54] Mike Koelzer, Host: Helen, I know that this is your second book and your third book is on the way. [00:02:00] And from what I understand, your first book was more about your early days of trauma. This next book is about maybe expanding it a little bit to how does trauma portray itself. for you. In people who have been traumatized.

And then the next book is more about the trauma that's embedded in corporate. And it's interesting, and I'm sure this was on purpose, but it makes me think then that trauma can start, I don't want to say small, but unknown. And then it grows, it touches. Everybody, in every facet, and since we're all interconnected, trauma plays a big part in relationships and communication and so on. 

[00:02:47] Helen Sairany: it goes Back to the point you made the lack of awareness. 70 percent of Americans, according to the Adverse Childhood Experiences Study, are reporting trauma. They've been exposed to some sort of an adversity. [00:03:00] And the second thing I'd like to emphasize today is that trauma is not limited to combat veteran, for every combat veteran that gets deployed to Whatever country, we declare war on, there are 10 children in our back neighborhood suffering from trauma. Now, this is significant because when you're in a combat, you're expected to experience or to face trauma because you're facing the enemy combatants, ?

But this child is experiencing trauma a source that is supposed to be love. A source that is supposed to be home. So this child is exposed to trauma and then they end up with an understanding because the closest person has let them down. They could grow up with a fractured image of the world and the world we believe in becomes the world we live in.

So imagine that becomes the lens And they create this distrust within that they just can't, develop healthy relationships. 

[00:03:56] Mike Koelzer, Host: Helen, this might be a stretch, but god forbid. I say [00:04:00] that pharmacy school and pharmacies are loving parents. I don't want to make that reference, but

[00:04:08] Helen Sairany: yeah,

[00:04:09] Mike Koelzer, Host: in a way it seems like we went to pharmacy school and maybe were hired in a pharmacy And you kind of think that's your side, maybe it's pharmacy, against the world, but it seems a lot of times people now are almost traumatized in those situations by people you think would take better care of pharmacists, whatever that means, at least respect them. when you mentioned that, trauma opposite of battle where you don't know the. It's people that you thought you trusted. And I can almost see pharmacists kind of saying, Hey, I trusted the university. I trusted the counselors when they said I'd be a good pharmacist. I trusted all that stuff.

And now you left me out to dry.

[00:04:57] Helen Sairany: yeah. And it's interesting that you bring this up [00:05:00] because just this morning I was talking to 1 of my mentees and. And it just, it hit her, and it got to a point where she was like, Can you please repeat what you just said, because it really hit her. I told her that when doctors 

graduate, they practice medicine.

When dentists graduate, they practice dentistry. When nurses graduate, they practice nursing. When pharmacists graduate, they don't practice pharmacy. And it hit her so hard that she had to make me repeat what I just shared with you. And this is the case with us. Our talent, our expertise, our knowledge is limited to a metric.

And this is concerning because as social contagions, as social creatures, we like to belong to a cause much bigger than us. And that is partly why we signed up for the help. program. Care system. We like to have a positive impact. But if you look at the healthcare system in the [00:06:00] United States we have the smartest people, smartest healthcare professionals in the world.

We have the most advanced technology in the world. And I can say this because I'm a global pharmacist who's gone all around the world, United States is the best place in the world, but every year we lose about quarter of a million lives due to preventable death. 

So it makes me wonder what is going on with this country. The problem is not you. The problem is not me. The problem is the system is run like a business. 95 percent of the healthcare system in this country is about Number crunches. And that leaves you and I, we make up the 5%, but we're only in the minority.

So when our talent, our expertise, our knowledge is limited to a metric, we lose fulfillment for the sacred profession that we signed up for. Because the more we focus on metrics, the more we're caught up in the details, ? And the more we're caught up in the detail, the more we retract not only from each other, [00:07:00] but also from this sacred profession that we signed up for.

And that's why there is an epidemic of loneliness in this country. Loneliness is up by 300 percent in the United States, and that's partly why the Surgeon General has made loneliness as the number one priority for his agenda, because loneliness is equivalent to having 15 cigarettes a day.

And also it's worse than obesity.

So it's really concerning.

And that is probably why he's making it a priority. And there is heavy emphasis in terms of how we can address loneliness in this country, especially among industry leaders and healthcare professionals.

[00:07:36] Mike Koelzer, Host: This is kind of cliche, of course, but wow. I've got all the, social media friends and I've got these

likes and I've got that kind of stuff and anybody who knows anything knows that doesn't really mean anything. But I wonder if people don't think they need real interaction.

They're like, well, if I need it, I have my phone, but they [00:08:00] might not even realize they're missing out. 

[00:08:03] Helen Sairany: Yes, and the concern here is that

Majority Of these smartphone companies, they've hired top notch neuroscientists and psycho, neuroscientists or whatever big term you want to use here to invent something that is dopamine driven, ? So now think about when you wake up first thing the morning, ?

You are in a what? You are in a. Beta state, which means you are in a meditated state. Your mind is clear, you're innovative, you're relaxed, and then the second you get on the phone, you indulge yourself with dopamine, after dopamine, and then 30 minutes to an hour later, your brain is hyperindulged with dopamine.

Which means you can't calm that brain down anymore. You're hyperactive, you're hyper intense, you're hyper vigilant, and that is the whole point because that dopamine is [00:09:00] supposed to excite you to get you hooked to the screen. Now we are adults with a mechanism that is already built in our brain to help us regulate, but even as adults we're struggling.

As adults, we're struggling to hyper regulate, and the next thing you realize, the day has gone by. the whole society is struggling with something called time famine , of our coping mechanism with these. Smart devices that is driven by dopamine, which is the the neurotransmitter that helps with our motivation.

Now this is with adult. Now, imagine if you're a child that does not have any mechanism that is supposed to help you with your brain regulation , because remember, the new cortex, the frontal part of the brain does not fully develop until we're 27. It's built in a way to replace the child's need for attunement and attachment from a caregiver. Because think about it, how does the dopamine pathway develops? Or the opioid, which is called the endorphins, ? Endorphins is an endogenous form [00:10:00] of opioids, ? How do these two pathways develop? They develop based on a strong attachment and attunement between the child and a caregiver.

The more the mother is attuned and attached to the child, the more the child develops a healthy pathway to both of these neurotransmitters. But because of the demand of the society, both parents are preoccupied, ? And because of the device that the child is being exposed to, ?

The dopamine that the child is supposed to get from the treatment and the attachments. They're not getting it from a healthy attachment. They're getting it From the device, ? And that's what's so scary. But if you understand that dopamine pathway, it helps with your appetite.

It gives you that pleasure, but at the same time, it numbs the pain. Because the pain and pleasure, they're in the same brain part, ? But when you deprive that child, Of the screen time that they got so hooked on. They're not only going through dopamine withdrawal, they're going through a lot of pain, so they're gonna do whatever it [00:11:00] takes, not because they wanna reach that initial level of dopamine, but because of the pain that they're going through, because that dopamine that they were initially exposed to and numb the.

Pathway and also gave him that extra pleasure, but that, dopamine should have come from their relationship with the provider that they're not getting. But instead, they're being exposed to a device. So whatever we're exposed to, it's pretty scary because research now is coming out.

Indicating that kids now are suffering from signs and symptoms

of Down syndrome,

and they don't have Down syndrome.

But the data is pretty scary because of the excessive exposure

to dopamine

coming out of these smart devices, if that makes sense.

[00:11:48] Mike Koelzer, Host: All right. Hello. Let me play devil's advocate here. So, I don't disagree with you. So this truly is the devil saying this I, know I get hooked right in the morning, not social media, but I get on the news and

[00:11:59] Helen Sairany: Oh [00:12:00] yeah, 

oh yeah.

[00:12:00] Helen Sairany: there 

[00:12:01] Mike Koelzer, Host: 50 years ago, my dad would get up and read the Detroit Free Press that came out in the morning.

And I would sit there and watch, you know, Mr. Rogers or Sesame Street or something. Can I argue Helen, this has been going on forever because I didn't have a phone, but I had Sesame Street and my dad had the free press. Is this a problem that's been going on forever or is there something special about the phone over those two, uh, mediums? 

[00:12:32] Helen Sairany: I'm glad you're bringing up the Sesame Street because I actually talk about Sesame Street in my second book and how when it came out, it was supposed to target kids from the minority community, ? Because growing up in an austere environment is an adverse childhood experience based on a study that came out.

From CDC as well as Kaiser Permanente. So there is evidence out there that kids coming out of austere uh, environment are more likely to end up with [00:13:00] attention deficiency because they're more dysregulated and I believe that was the whole point of Sesame Street. So Sesame Street was developed in a way to target these kids.

Kids specific from these neighborhoods who had issues with attention deficiency. But think about how the media has evolved over the years. How many times have you heard that if you make a link longer than XYZ, you're going to lose people.

 So we've developed an adaptation. To programming similar to, 

Homer Simpson because our attention actually has declined over the years. And tech world has established a system in a way where it feeds the brain in a snackable version.

So we've changed, the technology has changed,

and the society also has evolved over the years. 

[00:13:52] Mike Koelzer, Host: As you mentioned it now, if back in the day, I'm watching a TV show aBC wants me [00:14:00] to stay on that show so they can sell me the next ad. They don't want me flipping channels, but if I'm on Tik TOK, I call it Tic Tac, just so my kids say, dad, that's not, Tik Tack makes me look like I don't know what's going on, but I know a hell of a lot more than they think I do.

Tik TOK doesn't care. If you see something and flip to the next thing, after 0. 3 seconds, they don't care if you're on it for three seconds or 0. 3, because it's not like in the old days where they wanted to keep you, they don't care if they keep you, on a micro channel, They want you to stay on the app, but they don't care how.

Much you're focused on each one.

[00:14:41] Helen Sairany: It's about the clicks and it's about, metrics that we 

talked about earlier.

[00:14:45] Mike Koelzer, Host: . Now, I gotta play devil's advocate again. Here we go. Pharmacists are a bunch of babies because every profession has metrics. The doctors have to see so many people on their rounds. The nurses [00:15:00] have to take so many blood pressures. Everybody's got metrics. Why do pharmacists think their metrics are worse?

[00:15:08] Helen Sairany: So I wouldn't say they're worse. 

Burnout is not limited to pharmacists. I just want to make that 

clear. Pharmacists 

are not the only healthcare professionals that are reporting burnout I don't know if you saw the report come out of AMA indicating that 40 percent of physicians are thinking about leaving the profession in the next year or two.

Because of burnout due to documentation, EMR, administration Few minutes in, in their physician patient encounter. So they're also concerned. The same goes with nurses. So I just want to make that clear that burnout is not limited to pharmacists. Especially with COVID 19 physicians are coming out with burnout, nurses and pharmacists.

So every healthcare professional

have a burnout of some [00:16:00] sort. now you might argue pharmacists have it more because it goes back to my point. that I made earlier. Physicians practice what they signed up for.

Nurses practice what they signed up for, their code of ethics.

 But pharmacists don't practice what they signed up for. 

[00:16:16] Mike Koelzer, Host: You're saying that, when they train you as a nurse or a doctor, when you come out, you're saying, Oh, all right, we learned how to do this surgery, it's like, yeah, that's what we did in training pharmacy. I'm going to blame it on the universities. they. Show pharmacy to be one thing, but it's kind of a bait and switch. You get out and, you may have no idea what you're doing. It's not even close to some of the, carrot and stick of, patient care and time to do this and counseling and all that, that's what you're 

getting at?

It just looks different. 

[00:16:54] Helen Sairany: think the best way to explain this is that there is a gap. [00:17:00] When we graduate from pharmacy school, you are expected, and I'm using a metaphor here to direct a heavy traffic during rush hour with no prior experience. to directing a heavy traffic during rush hour.

Now, is that too much, too fast, too soon for the pharmacist? Yes, it is. And too much, too fast, too soon, it's the very core definition of trauma. With patients yelling, with phone ringing

we don't get educated on third claim, payments and issues, ? So we get screamed at on something that is not part of our training.

This is an administrative role. We were not educated to run an administrative role, ? So this is what I'm talking about here. think about an incident in your life, where you found yourself, you had to calm a group of super angry people.

 Totally exhausted. But that is an everyday, that's an everyday job for a [00:18:00] pharmacist. 

[00:18:02] Mike Koelzer, Host: I would go one step further in that actually hidden. From students, it's not that they just don't teach you. It's like, they don't even.

want to tell you that some of this stuff happens 

out of fear that people might leave the profession before they even step one foot into the classroom. I don't want to just blame universities, but I think there's this beautiful picture out there and anybody who benefits, whether it's chain pharmacies by switching the supply and demand to keep wages down or having enough employees or universities to, you know, Tuition or whatever. I think there's this kind of bait and switch. And that's part of that trauma earlier. It's like, look, you guys are my. In quotes, parents that were supposed to take me down the road. And now it's like, you flip this on me. And I think part of the reason they do it too, I don't want to say it's just money. 

they want, The world to pay us [00:19:00] more because we're trained more but it's not from lack of training 

but I think the answer for schools was train them more but our problems are not lack of pharmacy training. 

[00:19:10] Helen Sairany: exactly. And now there is PGY 3.

Adding more training PGY 3, that's equivalent to what medical doctors go through. But medical doctors have provider status. They get reimbursed for their services.

They practice something called medicine, but unless and you are in. Some sort of a, collaborative practice agreement, or I don't know what, you don't practice pharmacy, period.

Think about the chain, the most accessible providers in the healthcare, who are they? The community pharmacist,

but their job is 100 percent administrative.

What are the odds a patient will tell you, well, I would like counseling. I mean, they've gone through a long day with doctor's offices, and then you are the last stop.

They are pretty much done by the time they make it to the pharmacy.

They're ready to move on, get their medication, [00:20:00] and move on with their life, ?

[00:20:01] Mike Koelzer, Host: and how do you think I feel Helen being in the pharmacy. And a patient comes in a and they're asked you want counseling and they they look up with a question on their face and

they see 

me and they go

no My take on it is that they've got to be honest with people and pharmacy has a four year degree, period. Not, two plus four. It's got to be Two years of community college, two years of pharmacy.

That's what it takes to be a community pharmacist. And then if you want more training in the clinical, and you're going to be doing this and doing that, well, those people can be trained more. But there's got to be an honesty out there that says that the community pharmacist needs four years of college, period. 

[00:20:44] Helen Sairany: there needs to be, a shift in that gap. If we want to stick to the doctoral degree, which I think pharmacists are very capable and there is a huge missed opportunity out there. We just need to do a little more in terms of What we can do as providers.

But [00:21:00] between now until we get that providers and Provider is not about me being acknowledged as a provider. I think if you talk to anybody, a doctor, a nurse, a dentist, they will tell you pharmacists are providers. Okay.

I think there needs to be a shift in the gap. Okay adding more PGY 1s, it's not going to change the gap. Having a bill on provider status, I feel like it created a bit of insecurity or a Doubt in me as a provider, because I thought I signed up to be a provider.

Now, I am not a provider, and there needs to be a bill that needs to be voted on in Congress. I think the issue is not whether we're providers or we're not providers, because we are, the issue is a payment parity, it's like, there's a change in the regulatory language that needs to be adjusted

so we can get reimbursed for our services because that we are recognized for our services, which means Reimbursement for our services. That's when we are going to see a shift and a change in the [00:22:00] gap that I was talking about

[00:22:02] Mike Koelzer, Host: it's like there's a gap in training, but there's also a gap in being too much for the position, well, I'm just gonna say it. There's a gap in being honest 

[00:22:09] Helen Sairany: When we graduate. We don't practice what we were trained. We take what, how many modules of therapeutics do we take? we don't get recognized for our services and when I say the recognition it means we don't get reimbursed.

Find me a provider that spends 45 minutes with you for free, So now there are a lot of states and I applaud them who have gone to the extreme to expand the scope of practice. But without payment.

But pharmacists are already burnt out. 

Don't add anymore my plate if I'm not going to be recognized for it.

And I'm referring to contraceptives here. I'm referring to naloxone. I'm referring to tobacco cessation products. And I'm referring to PrEP and PEP. Okay, now those are amazing services. But it's, recognition for our services. Like really,

[00:22:58] Helen Sairany: Show me the [00:23:00] reimbursement.

 I'm already maxed out. You can't keep adding stuff to my plate

and not get recognized for it.

That's why pharmacists need to be

Not providers, because we are providers, but we need to be asking for that payment parity before we talk expanded scope of practice. 

[00:23:21] Mike Koelzer, Host: It's sad for me as I sit here and talk, because I knew exactly what I was in for and so when I was in class and they were talking. about, counseling this or that or whatever, it's like, I could always bounce it off the reality of the pharmacy and say, yeah, maybe I'll do that sometime and I'll have to do this and set this up and do that.

I always bounce it off reality. most students, you would have no clue there was that gap. 

[00:23:50] Helen Sairany: they wouldn't.

Unless you've practiced prior, I would say they wouldn't.

[00:23:55] Mike Koelzer, Host: I'm not sure if the money will be there because those services are [00:24:00] being done. People are doing a lot of the services you mentioned. Devil's advocate again. As long as the market is still getting what they want. do they care about pharmacist mental health? 

[00:24:16] Helen Sairany: I would say yes for now. But have you at admission rates? There will be a major, a major 

shortage. You're 

almost guaranteed to get in. So What are we talking about? A jeopardy in quality. 

[00:24:30] Mike Koelzer, Host: what are the admissions? 

Are they quite down? 

[00:24:32] Helen Sairany: I know, like, two years ago, it was 1. 2 to 1. 3 for every slot.

Hmm. 

And now it's like, I'm sure it's even worse, especially with the reports of walkout and suicide and, incidents that are surfacing with pharmacists. But yes, the market is getting by fine. Yes, the loser might end up

feeling like it's a pharmacist and their wellbeing,

but give it another [00:25:00] year or two.

There will be a major decline

 in the number of pharmacists because the older is only going to get older. And then you need the younger, which are not interested anymore. So, Who's going to run the community pharmacists in every community 

[00:25:13] Mike Koelzer, Host: What happens is you get a pharmacist like me I own my pharmacy and I can kind of see the writing on the wall, or I can see the writing on the wall. but the issue is I give the same service pretty much to everybody, whether I'm making X on them or losing 0.

3 X or something like that, so I'm giving the same service, but what happens is that I'm not investing in that pharmacy anymore. As far as bringing up a junior pharmacist, I'm not building programs I could, but I'm just a lazy old guy. But what's going to happen is nobody's going to know when.

The cliff comes for me and someday I'll just say, ah, I'll lock the door. There's [00:26:00] a cliff. And now our pharmacy is not there anymore. And that's the cliff that's going to happen. That people won't know it though. Until as you're alluding to, they just dry up. There's no pharmacists. There's no pharmacies.

There's no one in the community. 

[00:26:15] Helen Sairany: no, it's, um, that's going to become a reality. Unfortunately , if , And the statistics are only gonna keep getting scarier and scarier. I mean the fact that every single year this country is sicker, this country is fatter, and this country is more depressed. This is no coincidence.

50 percent of Americans are reporting signs and symptoms of mental health. This is no coincidence, right? Depression is on the rise. Suicide is on the rise. It means something is not working. It means our work is making us sick. our work is making us sick. So, If is not going to be done about the whole workplace situation and the fulfillment, chances [00:27:00] are, you know, pharmacy shortage is going to become a major problem in a year or two because, you know, the admission rate is record low now.

Students are not applying to colleges of pharmacy. Now, you might hear, well, colleges of pharmacy have gone through explosion, and a lot of schools are closing down. This is bigger than pharmacy This is a problem that needs to be addressed. It is related to the overall well being of pharmacists not feeling that they practiced for something sacred that they signed up for. And I'm I'm talking every day with community pharmacists about their trauma struggles and the only way they can cope with the unbearable work condition by tuning out of their body. But how long are you going to tune out of your body? How long are you going to do that? And why would you want to put yourself in a situation that that?

So it needs to be addressed or else we're going to end up having to address the problem by having no pharmacist in a couple years [00:28:00] because there is a, there is going to be a major shortage because of the reports of mental health disorders as well as suicide that is, you know, going around in the news.

 It is a very disheartening situation. And, um, this is no different from what independents are going through with PBM. , They're also in a survival mode, they're also in a combat, fighting a goliath, called PBM. Then you have the chain pharmacist, they're fighting unbearable work conditions.

And then you have the hospitals also caught up in the whole dispensary situation. So it's, it's very, very tough. Each practice setting comes with its own challenges, And something needs to be done about this whole workplace situation or else we're going to keep losing independence. And every independent pharmacy we lose, 

you lose something from a community.

That's probably why we're so lonely. Because people no longer go to their mom and pop shop or pharmacy in their local community. [00:29:00] We're losing communities. We're losing a sense of family. We're losing spirituality. And what happens, a lot of people go to work hoping that work is going to become that community they've lost.

Work is going to be the house of God that they've lost, and work is going to be the family that they've lost. But that puts a lot of burden on the supervisor.

It puts a lot of burden because now work. has to give the spirituality, a sense of purpose. But if the corporate is going to limit you to a metric,

And you already don't have community and sense of spirituality and family.

I mean, we're talking about recipe for a disaster here. You're already lonely and you don't have at work. So what are we talking about here? It's very difficult. That's why we're not okay. We're not okay. And I go around the country and I share my message, but I'm only like shedding the light on the issue.

What needs to be done about this current situation now? Yeah, you can address the loneliness, but loneliness is only one factor of the problem. What about [00:30:00] fulfillment? \

And if I may add, there is already a shortage of primary care.

I think it's gonna become a universal problem. It's not gonna be you problem versus me problem. Is not my problem. I think it's, it's a universal problem because healthcare impacts everybody. I don't know about you, but there are times where I have to wait months until I get an appointment with primary care.

Now that is only gonna get worse when there is no access to community pharmacy and there is already shortage of. primary care. can pharmacists fill the gap when there is a shortage in pharmacists to begin with, It is something that is getting worse and that is because our healthcare has, like I said, I think the best way to explain this is that healthcare administrators I repeat, health care administrators, not health care professionals, health care administrators. They don't seem to know what their job is.

When you ask them, what is the number one [00:31:00] priority for you? They will tell you, my number one priority is patient's quality of care. And you ask them, great, when was the last time you've seen a patient? When was the last time you've seen a patient, Mr. Health Care Administrator? Your job is not to take care of the patient. Your job is to take care of those in your charge. So those in your charge can better care for the patient. But the problem

is we're not being 

cared for. We're not being cared for.

We're burnt out. 

Our expertise, Our talent, our 

knowledge is limited to a metric. How long are you going to wring that, 

towel until you 

run 

out of water? is where we're at. There is 

moment of reckoning in the healthcare profession, because 

healthcare administrators The number one priority 

is how can I 

get the, max out of these metrics? 

 But we are social creatures, we can never belong to a metric. We signed up for a cause where we felt like we 

can have a positive impact. [00:32:00] But we're not feeling we're having a positive impact. I told you earlier, when you talk to a patient, can I 

counsel you? They're 

like, no, I'm done. I've had a long day with doctor's appointments, you know, hopping from an office to the next.

I'm just here to pick up my pills and I'm ready to call it a day. What impact are we talking about here? There is no 

[00:32:18] Mike Koelzer, Host: And, if you do make an impact on somebody, when you realize that someone's paying you 12 cents to make that impact, you're like, that's not an impact. That's a handout. That's trick or treat. There's nothing there someone's putting that price on it.

 And that's the, cognitive dissonance you know, there's something there. Cause you know, that person would be in big trouble if you weren't there or if the store closed down, who's going to pick it up, but then it's worth 12 cents to somebody. 

[00:32:54] Helen Sairany: That is the whole concept of moral injury. It's a concept that started in combat [00:33:00] veterans when they get deployed overseas. They're like brothers and sisters tied in the platoon. Because that's how they refer to each other. One brother gets shattered into pieces, but you cannot provide care because you have to move on.

You're in a combat zone, And the toll of moral injury does not take a toll on you until you're back in the mainland, and you're like, gee, I could have done more to protect this individual, but I was 

powerless. I was powerless. 

I couldn't have done more. I couldn't have provided. I 

couldn't have prevented this from happening. Same exact concept with this whole 12 cents, I didn't have enough

to pay my employees provide dinner or to you know, provide for their loved ones. I had to let them go.

But imagine the impact it has on the, pharmacist who's in charge, who's running the show, and you can relate to this, right? And then imagine when you're telling a patient, I can't provide for you because your insurance has changed and I can't provide services to you. But [00:34:00] deep in your heart, you want to do it. But you have an obligation to make a living so you can keep your techs as well as those in your charge, right? So this is the moral injury we're talking about here.

It used to be a concept relevant for combat veterans, but now is equally being used in the medical community, especially with pharmacists. it is a tough spot to be in.

[00:34:23] Mike Koelzer, Host: one of the terms that comes to my mind and you tell me if this is correct, but I would always hear the term double bind. There's absolutely no way to do it, but you're required to do it, whatever that requirement is, whether it's a moral requirement or payments or things like that.

But it's like 

You're damned either way, 

[00:34:43] Helen Sairany: yes. Yes, you have to do it. But at the same time, at

what cost? you're an independent owner, at what cost? When I was a state exec, I used to visit my independents and I used to hear all these stories. They would bring in all the you know, all the audits,

[00:35:00] paperwork, and they will tell me what PBM has found after gazillion number of hours. They just found a discrepancy of a dollar or two and you're independent.

You can relate to what I'm talking about. Yes, you have to do, but at what cost? There is a whole concept that I talk about in 

my talks, which is very much in line with Dr. Gabor Mate's book, When the Body Says No. You can push and push and push until your body talks to you. As much as I hate to say this But disease is a blessing in this case Disease is a blessing in this case, because disease is the body's way of telling you, I have talked to you enough, but because you're in such a survival mode you have not attended to me. Because the body tries to talk to you, but because you're in such a survival mode, You just want to get through it, right?

You just want to get through 80 hours a week until the body crashes When the body crashes, that's called disease. So what is the disease? Disease is never idiopathic. I [00:36:00] love when doctors say, Well, your disease is idiopathic. It just happened. There is no such thing as diseases being idiopathic. Disease is the outcome of a 

life lived.

Disease is the outcome of all the experiences that you 

put your body through. That's why the 

disease is on the rise. 

Mental health is on the rise. Right? 60 percent of Americans, 60 percent of 

Americans are 

reporting some sort of a chronic disease. 60 percent of Americans are at least on a medication or two.

That is not normal. That is not

just happened to you. It's a, it's disease is the outcome of a life lived of the food that you put in your system

 The 80 hours and the stress that you're putting yourself under. So yes, you can, you have to do it. 

I 

get it.

But at what cost? Until the body tells you enough is enough. 

And when the body tells You enough is enough, we're talking about cancer, we're talking about ischemia, we're talking about something really detrimental to your health. And that's why you really need to watch out for the stress [00:37:00] and the burden that you are putting yourself under. 

[00:37:02] Mike Koelzer, Host: Another stress, though, Is for people to make good decisions for themselves because it's hard, but then all right, so you you change careers or you sell the place or something.

Well, there's no guarantee that's going to be better. and I guess that's part of being, a victim maybe or something, but there's no guarantee it's going to be better and you might kick yourself later on. So what do they say? The problem, you know, is better than something you don't know. I enemy, you know, is better than the friend.

You don't know yet or something like that. But there's a lot of stress in, thinking of standing up for yourself and making your presence known and doing that, and it's like, that's hard too. So people getting these binds. 

[00:37:45] Helen Sairany: I

forget who said this. One of the, um, psychologists said people, um, have usually have a choice to make between the pain they know and the pain they don't know. And oftentimes they go with the pain they know, because at least they know what it feels like.

And they're terrified to [00:38:00] put themselves out there to experience the pain they don't know because they don't know, um, the outcome. We are the creatures of control. We feel, we want to control. We feel, we want to feel like we're in charge, right? It goes back to relationships. Like if you ask any male or female, like, why are you putting up with the toxicity of the relationship?

And they will tell you the enemy. I know it's better than the enemy. I don't, because of the fear of the uncertainty, you're not ready to put yourself out in the wilderness. And I believe that is probably why a lot of pharmacists kind of are stuck. it goes back to this very smart 

concept 

is called surplus. Powerlessness. Surplus. Powerlessness. The, the corporate wants 

to make you feel like you're powerless, over your situation. So when you feel you're powerless, You're stuck, you're stuck, but you're not powerless. you just have to be ready to face the pain that you don't know because Facing the pain you don't know is risky, but staying in the pain that you know is riskier. [00:39:00] Facing the pain you don't know is risky, but staying in the pain that you know is riskier. And I tell you, you're willing to put yourself out there. You're going to keep being the victim of that surplus powerlessness because they want you to feel powerless. Because when you're powerless, you feel like you're stuck.

You can't 

get out

of the toxic environment, 

[00:39:20] Mike Koelzer, Host: Maybe this is set up on purpose, the ease of pharmacy students going into debt, because talk about powerlessness when you have a couple hundred thousand dollars of, debt behind you too.

And there's not many jobs that can pay that except your chosen profession. 

[00:39:36] Helen Sairany: And we complain why mental health is on the rise among the millennials. I mean, do people understand how much trauma these millennials are putting up with? The number one trauma is what? The loans. The burden of loans that these kids are having to put up with.

I was one of them. I mean, you know how terrified I was? I was willing to settle for whatever job because I was in a [00:40:00] rush to pay my loan. So that's number one. Number two trauma is the inflation. The cost of living has skyrocketed on these kids. And number three, social media. The pressure that they need to present themselves in a way that is socially acceptable.

But they are not okay. But the society does not accept vulnerability . It needs to accept a fake facade, a fake persona of you,

so you can post it on social media and you can get that number of likes. So we are under stress, we are burnt out, we're under trauma, and then at the same time, we are faking it, so we, can get by into the society. So these millennials are going through a lot of pressure. And we're shocked that, you know, mental health is. 

On the rise.

We're, we're shocked because I don't think what millennials are going

through,

myself included, is acceptable. I mean, I was 

terrified when I graduated from pharmacy school.

How am I going to pay? What

job am I going to get? Because they give you

six months and then the loan kind of kicks in, right? So [00:41:00] that's the trauma that we're talking It's the jammed traffic

during rush hour that you have to direct with no prior experience. It's a very tough spot to be at. And, part of me

is, uh, I hate to, say it because I love being a pharmacist, but part of me is glad kids are developing an awareness that this is not what they want for them and their loved ones because it's not healthy, right? But at the

same

time, what are we going to do? What are we going to do about it? There needs to be something done about

it.

[00:41:29] Mike Koelzer, Host: The people that seem to rise above this out of all the fine people. I've talked to on the show are the ones that Maybe already had a plan, maybe not before pharmacy school, but quite early coming out, they had this plan to, , move up. but that's not the average.

The average is someone who signs up for it and kind of goes along with it and thinks

it's going to come out and they get slapped. 

[00:41:57] Helen Sairany: Because of the surplus powerlessness that [00:42:00] sucks you in. 

[00:42:01] Mike Koelzer, Host: Whenever I think of these stresses, like let's say we were talking and I would say, all right, Helen, we just talked for a while here and I'm thinking of things like anxiety. Depression, anger, fear, but you brought up a couple times loneliness and that's not something I would have thrown into this mix.

But how, how strong and how, uh, damaging for lack of a better word would loneliness be? Cause I wouldn't have even recognized it is loneliness, associated with 

this trauma.

[00:42:39] Helen Sairany: I think so, because when something bothers you, you, have a loved one, which is an outlet. To regulate you. So think about that one time where something upset you and then you called a good friend that you trust or a loved one that you trust. And you were like, Hey, this and this happened.

And that validation from this individual in your [00:43:00] circle, it's strong enough to regulate your dysregulated body from what upset you.

But think of that lonely that is burnt out because 96 percent of American CEOs have reported loneliness. So think of that CEO that is burnt out. Because the investors, the board, whatever, right? And then they come home and they have nobody, they don't have a venue to talk to, right?

So they have them and the wall, so they don't have a venue that helps get all the tension out of their system.

To regulate their body, 

from what happened. So now this is important 

because loneliness, like I said earlier, it's equivalent to having 15 cigarettes a day and it's worse than having obesity.

And then there was a study called the Harvard happy study. They 

found a 70 percent correlation, which is pretty significant, 70 

percent correlation between your happiness and

your [00:44:00] social connection. And I always tell people, you, tell me about your social relationships, I will tell you about the quality of your life. 

[00:44:07] Mike Koelzer, Host: hmm. Mm 

[00:44:08] Helen Sairany: The quality. But the society, the society has imposed this whole concept of I and only I can do it. No, you cannot do it by yourself. We need each other. We grew up in tribes. We grew up in tribes, If there were no tribes, there will be no human species left. But the society all of a sudden says, no, you do it. No, you cannot do it by yourself. We need each 

other. 

[00:44:36] Mike Koelzer, Host:  All right, just a second now. So, I want to agree with you, but I got to ask you something. that seems like a precursor to anxiety, depression, things like that.

I thought that loneliness was a by product of all this, I'm going to say that's a precursor. Where do I have that mixed up?

Because loneliness . Didn't come from this. In this the [00:45:00] CEO comes home. There's just nobody there. 

[00:45:02] Helen Sairany: So exactly. So here's the thing, because they're so preoccupied in delivering unrealistic metrics, They have not invested in maintaining those social relationships, They have not invested, again, whatever you don't use, you lose, their number one priority when you're in a combat, what is your number one priority? when you're about to be attacked? Survival. They're in survival mode. They don't have time for collaboration and teamwork and happy hour and I don't know what. So they're not investing. So when you don't invest in these, because they perceive these self care initiatives as secondhand . So they take a back seat because survival is a number one priority for these individuals.

So they will do whatever takes 80 hours, 90 hours on the computer because they need to get by, because if they don't get by, they associate their whole identity, their whole persona, based on this fact, on this outcome [00:46:00] that they promised the board with, if that makes sense. 

[00:46:02] Mike Koelzer, Host: we all know the definition of loneliness is not having people around. It's, communicating and so on, or getting deeper. I know times where I just have a little stress and my kids, I'll be sitting around and they'll want to play a, uh, you know, one of the games you pull out at Christmas, the board games or something like that.

And in my opinion, they're called board games for a reason. But, just yesterday I had to like force myself. To play with some of my kids and they're older, but I had to force myself to laugh and do this with them. I'd rather have just kind of been on my own. Cause I was thinking of something, but now multiply that stress it's hard to communicate with your family and to accept love and all that.

When your mind is somewhere else, when it's on the data sheets and on, that kind of stuff.

[00:46:51] Helen Sairany: But listening is about letting the individual feel that they're being seen by you. They're being validated by you. You're [00:47:00] acknowledging what they're trying to tell you. If that is not the case and being physically present does not mean the individual is having a social company.

 Some people are very lonely while they're married, right? Because they're not being seen. They're not being acknowledged in there. And that's the same case with staff. When they complain, I feel like I'm not being acknowledged.

I feel like I'm not being seen by my supervisor. So just listening does not mean you're actually validating or, you know, seeing the individual for who they are, if that makes sense. Well, in the problem with 

[00:47:28] Mike Koelzer, Host: pharmacists is my friend calls me the world's greatest non listening listener, something like that. It's a terrible, term I've picked up, but I'm a good pretender to listen because the pharmacy trains 

you that way. It trains you to smile. And when someone says this, you agree with them.

And then, you know, enough to mirror that back. So they feel like you're listening to them and it basically gets them out of the store quicker. You acknowledge them, but it basically passes them on. It's a terrible 

trade I picked up, but I've got it, [00:48:00] but you can even look like you're present to your family, not even 

just physically being there, but you can even pretend you're there by picking up this skill I have of pretending like I'm listening when I not. So The pharmacy can really put you into some bad habits when you're in survival

mode, 

[00:48:18] Helen Sairany: And survival mode, you have to fake it until you make it. And let me tell you, there is two things that are very important here. And it happens, it starts in the, early childhood days, belonging versus fitting in. Belonging is basically what? You belong to somewhere, someplace, somewhere based on who you are. You show up at your natural best. The child is accepted. They're loved for who they are. Fitting in, the child says, well, I cannot cry. I cannot ask for a favor. I cannot ask for candy before dinner or else I'm not going to get the attachment and the attunement from mom and dad.

[00:49:00] So they know they're not going to be accepted for who they are. So what are they going to do? They're gonna split from some of their genuine childhood narcissistic needs because remember every child has a healthy narcissistic need but they are going to split from those Narcissistic need in order to get the attachment and the attunement from the mother and the father because they need it so badly That is called fitting in it's the same exact concept in companies Do you feel like you belong at your natural best or do you feel like you're faking it to make it?

That's called fitting in. And which culture is healthy? The culture of belonging and which culture fosters backstabbing lies and throwing you under the bus the culture of fitting in because you know you have to fake it until you make it. It's rooted back to how the child had to, cope but at the same time as an adult you're exposed to an environment where you know very well being vulnerable is not, it's not gonna go [00:50:00] by. Think about that leader that is supposed to be the hero of the organization. And then the second they show vulnerability, wait, you're supposed to be the hero. Yeah, but you're a human as a leader. You have human needs, it's a challenging situation to be in because the society expects the leader to be an aspirational figure.

Someone with no flaws and someone that just somehow has his act together and has an answer for everything. No, they don't. And that's why CEOs are burnt out because they've taken a lot of burden and a lot of time they fake it to make it, but that authenticity is important for the soul. But the second you fake it, you keep splitting and splitting and splitting until the body crashes on you.

Because belonging to your body, it's really, really healthy for you. 

[00:50:49] Mike Koelzer, Host: All right, so Helen, boy, the listeners got a whole hour of me pissing and moaning over here I know that you've, switched careers and now you don't have somebody [00:51:00] looking down on you.

And I'm in a situation where I don't have anybody looking down on me. And that gives us a power to open up a little bit more, 

[00:51:10] Mike Koelzer, Host: If we can leave one nugget for our listeners before we go here, what would that nugget of Information be to them? Hmm.

[00:51:21] Helen Sairany: I want to focus on wisdom as

a, as a war survivor, as a trauma survivor, as someone who's tried a lot of challenging positions and came out and realized that this was not for me. I want to focus on the wisdom. Now, why is that important? Because learning comes from experience.

Wisdom comes from bad experiences. There is no such thing as failure, right? We learned regardless. And usually the trauma survivors are the ones that I want to have with me on dinner table and the ones I want to have with me when I travel the world because they have so much wisdom to share because of this whole concept wisdom to share Post traumatic growth. so much growth that [00:52:00] comes out of it. So while it seems like it's scary moments, while it seems like, you know, yourself out in the uncertain pain, it's scary. But believe me, once you do it, Things will gradually settle down and there's so much growth, so much growth that comes out of it and I would hope that for everybody to try a dose of that, experience it, and share that wisdom with everybody else so everybody else can learn from their wisdom as well. 

[00:52:29] Mike Koelzer, Host: Well, Helen, boy, I feel like I'm lying in my back on the couch after my therapy session here, 

[00:52:38] Helen Sairany: I'm only a pharmacist in case you didn't 

[00:52:40] Mike Koelzer, Host: No, I know. but it comes from that wisdom, we can love whatever's happened, turn it into something wise, but it sure hurts like hell sometimes going through it. 

[00:52:50] Helen Sairany: no pain, no gain. 

[00:52:52] Mike Koelzer, Host: No pain, no 

gain. 

[00:52:53] Helen Sairany: The second you feel you're too comfortable, you're setting yourself for failure. Helen, thanks for your time. Thanks [00:53:00] for joining us and 

[00:53:00] Mike Koelzer, Host: great to see you again. 

[00:53:02] Helen Sairany: Thank you so much for having me. 

 You've been listening to the Business of Pharmacy podcast with me, your host, Mike Kelser. Please subscribe for all future episodes.