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The Current Transcript for October 18, 2018

Host: Piya Chattopadhyay

Prologue

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SPEAKER: So many people talk about Yemen as the forgotten war. It's an ignored war. And it's ignored because so many of the Security Council table are shielding Saudi Arabia from any criticism. And they all have blood on their hands.

PIYA CATTOPADHYAY: One of the Arab world's most desperately poor nations is being torn apart by a civil war. But the war in Yemen is also a proxy war. And many of the thousands of civilian deaths are caused by Saudi-led airstrikes. It is a conflict that has remained for the most part under the radar, neglected and arguably that's in part because Saudi actions are being protected by other countries. So could the disappearance of journalist Jamal Khashoggi and the intense global glare it has brought on Saudi Arabia be a turning point in the three-year-old Yemeni conflict? We're starting with the latest on the Kashoggi affair and the consequences it may have. Then, we'll return home, where as you well know, as of yesterday, pot is legal. So now what? Well, we're delving into the way that so-called “kind buds” can come between lovers.

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SPEAKER: Every time that I would high, I was not the same person. It was all about me, and that's when I made decisions. And that’s what ruined a perfect relationship.

PC: We’ll discuss the highs and the lows of marijuana in romantic relationships in half an hour. Also, last week here on The Current, we talked about burnout amongst medical professionals — including doctors-in-training like this Vancouver resident.

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SPEAKER: Doctors are supposed to be very self-sufficient. So you essentially blame yourself. And go I'm not working hard enough, or I’m not doing enough. And I didn't know that other residents we going through this as well.

PC: Well, after our conversation, we heard from doctors from across our country, who wanted to share their own stories. And we'll get to some of those in an hour. Hi, I'm Piya Chattopadhyay, sitting in for Anna Maria Tremonti, and this is “The Current”.

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Part one: Kashoggi and the Yemen response

Guests: David Kirkpatrick, Shireen Al-Adeimi

PC: The reverberations keep growing of what happened after Jamal Khashoggi walked into the Saudi consulate in Istanbul, Turkey? The potential ramifications reach as far away as Washington, and war-torn Yemen. Yesterday, the New York Times cited Turkish government sources, who offered a gruesome account of what they say happened to the Saudi journalist that fateful day more than two weeks ago, While Turkish crime scene investigators finally searched the Saudi Consul’s Istanbul home for evidence, the official Saudi line is still a complete denial of any involvement. And U.S. President Donald Trump is warning against a rush to judgment.

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DONALD TRUMP: If you look at Saudi Arabia, they're an ally, and they're a tremendous purchaser of not only military equipment, but other things. When I went there, they committed to purchase for 450-billion dollars’ worth of things, and 110-billion dollars’ worth of military. Those are the biggest orders in the history of this country — probably the history of the world. I don't think there's ever been any order for 450-billion dollars. So they're an important ally. But I want to find out what happened? Where is the fault? And we will probably know that by the end of the week.

PC: Our first guest has been all over the question of what happened. And just a warning: that some of the things we're going to be talking about will be disturbing to some listeners. International correspondent David Kirkpatrick has been covering the Kashoggi story for the New York Times. He is also the author of the book titled “Into the Hands of the Soldiers: Freedom and Chaos in Egypt and the Middle East”. And David Kirkpatrick is in Istanbul. Hello.

DAVID KIRKPATRICK: Hello.

PC: How convincing is the evidence so far that Jamal Khashoggi was murdered at the hands of the Saudis?

DK: Well, that's a very good question. None of us have seen the evidence, except for people in the inner reaches of the Turkish government. That said, the leaks coming out — including from Turkish officials talking to me — are growing in credibility. In part, because of their specificity. In part, because of the number of Turkish officials who are describing this same evidence recordings of the killing from inside the consulate. And in part because the United States and the Saudi Arabian governments are taking them very seriously. The report from my colleagues in Washington today is that the U.S. intelligence agencies assessed that these reports are accurate. And we've seen the rulers of Saudi Arabia shift from Mr. Kashoggi left the consulate freely. We have no idea where he is. To signaling that they’re going to start an investigation, and putting out word that they're moving to blame someone within their own intelligence services for his killing. So they're moving towards acknowledging he died in the consulate, as the Turks have said all along.

PC: So as you say, David, one of the kind of clues or hints are these recordings of the suspected killing that Turkish officials say that they have heard. Just tell us briefly about what some of the things that are said in this recording are?

DK: Well, it's not for the squeamish. This is an audio recording that is said to show that Jamal Khashoggi was taken into custody, was sort of seized shortly after he arrived in the consulate, was killed fairly rapidly and then dismembered. And as his body was chopped up, the Consul — the Saudi Consul — complained, and said to the agents carrying this out don't do this here, you're going to get me in trouble. And then his life was threatened. As the proceedings went on, an autopsy specialist — a forensic doctor — in fact one of the most prestigious forensic doctors in Saudi Arabia who had been brought for the purpose, as the body was being cut up, he instructed the others that it would be good idea to listen to music while you carry out this kind of work. And he put in earphones himself as he continued. OK. So it's a vivid and detailed picture of an ugly, ugly scene.

PC: Yeah, horrific. Turkish officials are leaking the details, but they haven't released these recordings. Why not? And why is it leaking all these details about what allegedly happened inside the consulate?

DK: Yeah, so the two questions there: why leak? And why not leak fully? So the first is clearly, they are trying to put some pressure on Saudi Arabia and the United States over Mr. Kashoggi’s disappearance. It's probably not incidental that Jamal kashoggi was a personal friend of the Turkish president, Recep Tayyip Erdogan. So the question is why not go all the way? Why not make public this information? You know the actual recordings? One reason is that these were probably gathered through espionage — through audio surveillance — that's not really something you want to announce publicly. Like, for example, if the Turks had bugged the Saudi consulate, that's not something that any intelligence agency really wants to go public with. A second reason why they haven't disclosed the audio itself yet may be that Turkey is still trying to reach some kind of an accommodation with Saudi Arabia, and doesn't necessarily want to go to direct conflict with Saudi Arabia or with the United States either. So if the Saudis can come up with some sort of a scenario that explains this — you know blame someone within their own intelligence services, and somehow mollify the Turks, there might be a way for those two parties to patch this up.

PC: OK. I'm going to put a couple of things you just talk to back to you in a minute. But I want to bring up one other thing before that. And that is that some critics of the Turkish government are surprised at how it is handling what happened to Jamal Khashoggi considering its own record on press freedom. We know that last year, the Committee to Protect Journalists declared Turkey to be the world's worst jailer of journalists — that happened for the second year in a row. And many Turkish journalists have also been forced into exile. I want to play a bit of tape. This is from Gulnoza Said, she's the program coordinator for Europe and Central Asia at the Committee to Protect Journalists.

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GULNOZA SAID: Those Turkish dissidents had to flee the country because they didn't feel safe due to Erdogan’s oppressive polices towards that critical voices. They don't feel safe even when they are in countries other than Turkey. They don't feel safe to go to Turkish consulates in New York or elsewhere themselves because they know that Erdogan may not act differently from how the Saudis acted allegedly.

PC: OK, David Kirkpatrick. So there are people pointing out the apparent hypocrisy here. What do you think are the real goals of the Turkish government in putting this pressure on Saudi Arabia?

DK: Well, you'll notice that when we had a cavity previously, I did not say President Erdogan is a great defender of free expression and the media. I'm sure that he is enjoying the novelty of being portrayed that way in some sense in that he is now speaking up on behalf of a journalist who has been disappeared and perhaps killed. But certainly there's no suggestion that his intentions here or the intentions of the Turkish government are about defending the universal right to free expression around the world. This is about Jamal Kashoggi. This is about the rivalry between Turkey and Saudi Arabia, which has ideological roots. And in a sense, it is probably for the Turkish government incidental that Mr. Kashoggi happened to be a member of the news media.

PC: Let me ask you about something else you brought up, and that is this idea that there may be some kind of fix in the works. What are the chances that the Turks would agree to some sort of narrative where all sides agree on this explanation that is being floated that look, this was an interrogation gone wrong or a rogue killing?

DK: You know the body language initially seemed to suggest that was very possible. Between the lines of the statements that I was hearing from Turks officials seem to be the implication that that kind of scenario would be totally acceptable to them. You know that it wasn’t impossible for them to know exactly who the Saudi government had ordered this? What was taking the Saudis so long to come up with a rogue actor explanation? I heard that question posed you know here in Istanbul several times. However, events have taken on a momentum of their own. I don't think anybody, certainly not the Saudis, expected the kind of international backlash to this particular killing that we've seen. It is really astounding even to me. I mean let's be frank, there have been worse massacres and rights violations often in the region. And I have never seen anything quite like this.

PC: Why do you think that is?

DK: There’s just something about the story, and the specificity of it. Well, there's just something about human nature. This is a person, first of all, he's somebody that all of us in the news media who've covered the region knew. That many diplomats in the American and British and Canadian governments knew. And he's a human. He's got a face and a story, and that makes it easier for people to empathize and the details. And the details are so gory, so for various reasons it seized people's imaginations and fired up people's passions in a way that I don't think anyone had expected. And that has led to a case where the news media — including ourselves the Washington Post — have pushed pretty hard to show as best we can you know who is responsible. You know to the extent that information is available what can we say about who may have ordered this operation. And our own paper, the New York Times, has come up with pretty compelling evidence that at least four members of the 15-person squad of suspects named by the Turks have pretty close ties to Crown Prince Mohammed bin Salman. To the extent that this gets stuck on Crown Prince Mohammed bin Salman, it's less and less easy for any of the governments, the Saudis, the Turks, or the Americans, to go along with a rogue actor explanation.

PC: OK. I'm glad you brought up the Americans. U.S. Secretary of State Mike Pompeo visited Turkey. We heard U.S. President Donald Trump off the top. And we've also heard criticism from other Americans from Silicon Valley, from the business community, who many of these companies say we're not going to this upcoming business conference known as “Davos in the Desert”. And the big question seems to be is how likely is it that at the end of this that the U.S.-Saudi relationship and perhaps Saudi Arabia's position in the world will end up substantially changed? What impact is this going to have?

DK: You know that's another very good question. You know there's change and there’s change. On the top level, you know does Saudi Arabia become a foe of the West? No, that's extremely unlikely. You know in more subtle ways, you know are they accorded privileged status among Arab allies that they now receive from the Trump administration? I'm not sure. Certainly, there have been real voices of outrage from people in the United States Senate. You know there are senators who have been supporters of Saudi Arabia and its general approach to the Middle East, which is hostile to Iran, suspicious of political Islam and in many ways consonant with conservative American goals in the region. There are many senators who are now saying you know I feel used and abused. The acts that have been described here are beyond the pale and I don't want to be associated with it. So on a more subtle level than a kind of fundamental realignment of the region that is going to change the way business is done.

PC: Thank you very much for your time. I appreciate it.

DK: Good to talk to you.

PC: David Kirkpatrick is an international correspondent for the New York Times, and also the author of the book called “Into the Hands of the Soldiers: Freedom and Chaos in Egypt and the Middle East”. He was in Istanbul Turkey. While the whole world is watching as the aftermath of Jamal Khashoggi’s disappearance plays out. Our next guest is watching especially closely, in the hopes that this tragedy may shed much-needed light on another tragic situation in the region. Shireen Al-Adeimi is Yemeni-Canadian — still has family in Yemen, where a vicious three-year-long war has brought her home country to the brink of collapse. Saudi Arabia is one of the key actors in that conflict. Shireen Al-Adeimi is an assistant professor of education at Michigan State University, and she joins us from East Lansing, Michigan. Hello to you.

SHIEEN AL-ADEIMI: Hi.

PC: So what have you been thinking about as the news of Jamal Khashoggi’s disappearance and suspected death has gained international attention?

SAA: Well, I think, first of all, like your previous guest mentioned, the story itself is pretty brutal, and really difficult to hear and to follow. But it sheds such an important light on this issue of you know Saudis involvement in this issue, and the extremes to which they would go to to not only torture but to assassinate a citizen of theirs in a foreign country. And then to go on this two-week cycle of you know denying involvement and now trying to come up with some kind of excuse that would absolve them from it. But I think it's not new for people who have been following Yemen closely because this is what we've been dealing with for the last three and a half years. Saudi Arabia committing countless atrocities in Yemen, and then you know either denying them altogether or trying to cover up their role in such alleged war crimes.

PC: As you say, it is not a surprise to those who have been following Yemen closely, but so few of us have been. So paint us a picture of the war that has been unfolding in Yemen described as a civil war, a proxy war?

SAA: Well, I don't think it can be accurately described as a proxy war. That's something that Saudi Arabia likes to push a narrative on that they're trying to fight off Iran in the region despite very little evidence to support that narrative. And it did begin as a civil war back in 2015, but it soon escalated to I suppose some kind of international attack because Saudi Arabia very quickly put together a coalition of several countries — including the UAE, and with support from the United States, and Britain, and of course, weapons sales from many countries in the world including Canada. And since 2015, They've been bombarding the country almost on a daily basis. There's been a blockade that has prevented food and medicine from entering the country in any consistency. And you know they've created the world's worst humanitarian crisis, and this is not something that you know I'm calling it, this is what the U.N. is calling it. And it's just supposed to get worse by the end of this year. About 13 million people are going to starve if this war isn't stopped.

PC: You have family members in Yemen. How are they doing?

SAA: Like most people in Yemen, every family has been affected. So people are barely hanging on. Many people have lost their jobs. Many people lost their homes. Many people have been displaced mostly internally because there's no real way of getting out of the country because of the blockade. But it's a really dire situation. It's you know over 80 per cent of the population is in need of humanitarian aid.

PC: And so I'm not sure if you talked to your family in the last couple of weeks, but if you have, or what are you hearing from others in Yemen about you know their hope in terms of your hopes that one of the good things a very few good things that might come out of this Kashoggi disappearance is that the world will start focusing attention on Yemen, and the Saudi's role in all of that. Are they talking about that?

SAA: Well, no good thing can come out of murder, of course. But I think what I’ve been hearing is just as shock and surprise that really people are paying so much attention to this, which is great. This is welcome. But you know why have they not been paying as much attention or even a little bit of attention to what was going on in Yemen? When you know we have over 50,000 thousand people who've been killed by air strikes. In just two years, 113,000 children starved to death, or died from diseases like cholera, which is you know the worst outbreak in modern history in Yemen and this is largely because of Saudi Arabia. But I think we're hoping that. OK, well now that we've you know Saudi Arabia has really been exposed by the press. This is what happens when the press is actually paying attention to an issue that they should be paying attention to. This is what happens. There's a backlash in Congress. There's a backlash in the business community. And this backlash didn't exist when Mohammed bin salman, the Crown Prince of Saudi Arabia and the architect of the Yemen war, when he was in the United States earlier this year, he was welcomed with open arms from you know celebrities and businesspeople and politicians alike. And many of us have been trying to lobby Congress to end the war in Yemen. And these same people who were very much opposed to it are now starting to take action.

PC: Before this, when you have been lobbying Congress or talking to Canadian representatives, how have they responded as you've made pleas for help for Yemen?

SAA: So there's been a few responses. One response, and this came from representatives in the Canadian government as well as the U.S. and the British government, this line of well, if we don't sell them weapons they’ll buy it from someone else. So you know that doesn't really matter. Well, we know that Saudi Arabia doesn't manufacture its own weapons. They rely heavily on U.S. and U.K. weapons and also certain Canadian weapons.

PC: Armored vehicles most notably.

SAA: Armored vehicles, yeah. Made in my hometown of London, Ontario sadly. And I think that there was just a lot of pushback, well you know Saudi Arabia is our ally, and they're trying to defend Yemen from Iranians. So they kind of just wear parroting the Saudi Arabia narrative. And again, we see from this current incident just the extent to which Saudi Arabia's narrative changes according to what suits them best. I think they're surprised and taken aback by the attention they've received. Because frankly, they've been operating with impunity in Yemen for the last three and a half years. A bus full of children was bombed in August of this year. And there's no real backlash to any of the things that they do. Instead, they're you know tasked with investigating themselves. They're provided cover in the U.N. And you know Canada and U.S. and all these countries continue to sell weapons and support them.

PC: How hopeful are you that all the attention on Jamal Khashoggi’s disappearance and likely death leads to change for Yemen in terms of what the Canadian and the Americans do?

SAA: Well in the U.S., there's a vote coming up in the house that focuses on ending the U.S.’s role in Yemen. And this is this goes much beyond weapon sales for the Americans. And I hope that all of this backlash has highlighted the brutality of the Saudi regime, and would hopefully you know many senators or many representatives would want to distance themselves from Saudi Arabia in its actions in Yemen by you know supporting a bill like that. And I know that you know I'm hearing that Bernie Sanders is getting ready to introduce a similar bill in the Senate. And I hope that on the Canadian front that they would reconsider and just bring this issue into the public discourse. You know this issue of selling weapons to a country that we know is oppressing people.

PC: Shireen Al-Adeimi, we'll have to leave it there. Thank you very much.

SAA: Thank you so much for having me.

PC: Shireen Al-Adeimi is an assistant professor of education at Michigan State University. She is a Yemeni-Canadian now working in the U.S. And we reached her in East Lansing, Michigan. OK. The CBC News is next. Then everything you wanted to know about sex and marijuana, but were afraid to ask. We shall delve into the world of pot and intimate relationships. I'm Pia Chattopadhyay, sitting in for Anna Maria Tremonti. You're listening to “The Current”. We're back in just a bit.

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Part two: Sex and pot

Guests: Darren Roberts, Carlen Costa, Jonathan Bertram

00:00:01 - SPEAKER: F22

PC: Hi, i'm Pia Chattopadhyay, in for Anna Maria Tremonti. And you're listening to “The Current”.

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PC: Still to come: we're going to a follow-up visit of an important topic we recently took here on the show: doctors and burn out. And the seldom discussed issues of fatigue, depression and even suicide among medical professionals. After our conversation last week about doctors in training who hit the wall, we heard from doctors across our country who wanted to share stories and points of view. We'll hear from some of them in half an hour. But first, romancing the stoned.

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SPEAKER: The pros of being with someone who smokes is I rarely smoke alone. My girlfriend and I take turns rolling joints and buying weed. And sometimes, we’ll smoke when we have sex.

SPEAKER TWO: I've had relationships where weed was not as positive. I've dated people who smoked way too much weed. In past relationships, it's been sort of a situation where I'll go over to my partner's house, and he's stoned, and just wants to watch dumb videos on the Internet. It's just a bummer of a time.

SPEAKER THREE: My boyfriend and I are really lucky that we both have pretty similar weed habits and comfort levels. It feels like just another thing we do together — like eating food or drinking.

SPEAKER FOUR: I love having a partner I can smoke with. Pot is such a big part of my mental health and self-care practices that it feels a little alienating if my partner can't join in with me. When I was dating people who didn't smoke up, it was always a little sad for me because it's one of the ways we have quality time. You know get stoned, eat lots of food, get high, and [censored].

PC: Well, those were comments from some real cannabis consumers, who posted online about their experiences with marijuana and relationships. Of course, it can become an issue — positive or negative — for people in relationships. We're gonna explore those dynamics and more with guests, including a sexologist who says more and more couples are inviting cannabis into the bedroom. My first guest is someone who helps marijuana lovers find love. Darren Roberts is the CEO and co-founder of High There, a dating app known as the Tinder for tokers. We have reached him in Boca Raton, Florida. Hello.

DARREN ROBERTS: Hi. Good morning, Piya. Thanks for having me.

PC: Why in the world do people need a dating app for people who use cannabis? Why do we need that?

DR: You know just as one of the interviews just stated, you know there is stigma historically that's been so associated with cannabis consumption. And there's been a lot of experience too is where people start to date, and one of the partners consumes, the other doesn't — maybe a little bit too much or not. So right off the bat by creating a platform where you come in and everyone is some form of you know pro-cannabis or consumer, you know it's something that you have in common, and that's part of your lifestyle. And that was really lacking in the marketplace for the cannabis consumer.

PC: I want to play a bit of tape for you. This is Sean Berragin and Vanessa Lyn Mercier. They are Prince Edward Island couple who regularly use cannabis together, but it didn't start out that way. Take a listen.

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SEAN BERRAGIN: I first tried cannabis when I was 15, and have been a fairly regular almost daily user since then. And like Vanessa thought in the early stage of thought that it controlled, and she had a very stigmatized opinion cannabis use. And I don't think she really liked it that much.

VANESSA LYN MERCIER: So he kind of introduced me to it. I did not consume cannabis before meeting Sean. It was just this whole thing that I think it was more ignorance than anything. Like I thought that he had burned brain cells. I thought that it made you lazy. I think that I just didn't have a good education enough. And just I hadn’t been around people who consumed cannabis.

PC: Darren Roberts, that sort of stigma that anyone who uses cannabis is sort of this lazy pothead sits on the couch it's very real, as you know, in both pop culture and in some people's own minds. Have you heard about that stigma that Vanessa was describing there? To what extent do people say that's why I don’t want to be in a relationship with someone who smokes dope?

DR: Yeah, you know I think it has a different effect on a lot of different individuals without question. You know there is that sort of stereotype. And sometimes, depending on the environment, you know that's really where people tend to gravitate. But you know we have members of our community that you know are doctors, lawyers, entrepreneurs that actually enjoy cannabis as a stimulus as well. And not only socialize, but are able to in their daily lives you know continue to go and to excel. So I think it's also a combination of just sort of experience. You know she mentioned in that piece as well that you know there is a level of just sort of ignorance and not knowing. And just like anything else I think if you open yourself up a little bit it can have an effect on individuals in a different way, and sort of educate them you know to sort of get rid of that stigma that's been associated with quote/unquote “the typical stoner”, which is far from what a cannabis consumer is.

PC: OK. By the way, your thing is called. High There it's H.I.G.H. — High. So like how does it work? Swipe left if I like edibles? Swipe right if I like to smoke? Like what do I do?

DR: Yeah. So when people download the app, it will ask some questions about your location. So first and foremost, we want people to be able to connect on a local level. But, at the same time, you can communicate with people globally. It asks a little bit about your consumption preferences, what you do like. But it also, cannabis consumers are you know individuals that also have interests in culture and food and fitness. So we really want to try and get to know you as well so we can match you with common people. And then yes, it's swipe. We have significant updates and changes coming to the platform because we've also found from our community, not only are people interested in dating, but also establishing friendships, and seeing where that takes them. And you know we've been fortunate we've had multiple marriages, and thousands upon thousands of relationships, and some really good friendships that have been established as well.

PC: You’re an American app maker. Is your app popular here in Canada?

DR: You know, actually, we haven't really up until now really moved forward in targeting and getting involved in Canada. We're super excited right now with the legalization in what cannabis is doing for Canada. We actually have about 7 per cent of our user base, if you will, our community, is in Canada. So we're really excited to expand on that and bring more really cool features and a good platform to the country.

PC: I'm curious though now that it is legal here, and arguably the stigma will deteriorate with that. Will Canadian cannabis users still need an app for dating?

DR: Yeah, I think so. Just because legalization is taking place, you know it doesn't necessarily mean that people are comfortable and/or ready just to walk out their front door and say hey, I'm a cannabis consumer. I think being in an environment that you know you do have like-minded people that can sort of relate to. I think a stigma and judgment you know although will you know decrease significantly over time it's not something necessarily that happens immediately. And this type of platform keeps you in an environment where you know you might not be connected to your colleagues at work as much, or your bosses, or other people in your lives where you can have a little bit more of an anonymity that does not necessarily exist in some of the other social platforms.

PC: I guess the question now, especially now that it is legal here, is like I don't think that there's a dating app that exists for people who like beer or wine, and that is the baseline of which you're going to meet someone romantically. So why do we need one for cannabis beyond the stigma?

DR: It's just you know beer and wine you know have been around for decades upon decades, and it's socially acceptable. Here, you know cannabis still… and I envision even despite the legalization for a very you know in the near future as well will really be necessary for people to really relate and to talk about. It's really part of a lifestyle that you know just historically has been looked on because the legalization is something that's sort of taboo and profiled. And really right now also with education and people using cannabis for multiple reasons, whether it's medically, or recreationally, it's an area where they want to talk about. It’s very topical. And it can be very, very specific about people's individual interests. You know as well as you know learning more about the plant and all the effects that it has on people and how they enjoy it.

PC: Do you think mixing love and cannabis is a good thing romantically speaking?

DR: I do. You know I think cannabis creates an opportunity for people to sort of relax, enjoy themselves. Any time people enjoy it get a little bit more comfortable you know that always helps you know whatever that may be, whether it's cannabis, or whatever. It always gives people a level of more comfort to open up more and be more relaxed, which when it comes to you know you know sex and relaxation, I think you know everyone understands how important those to go together.

PC: Darren Roberts, thank you. Darren Roberts is the CEO and co-founder of High There, it is a dating app for cannabis users. We reached him in Boca Raton, Florida.

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SPEAKER ONE: Well, have you ever made love high?

SPEAKER TWO: Me? No, you know if I have grass or alcohol or anything I get unbearably wonderful. I don't know why you have to get high every time we make love?

SPEAKER ONE: It relaxes me.

SPEAKER TWO: You have to be artificially relaxed before we can go to bed?

SPEAKER ONE: I need grass.

SPEAKER TWO: Well, it ruins it for me if you have grass because you know I'm like a comedian, so if I get a laugh from a person who's high it doesn't count, you know? Because they're always laughing.

PC: Well, that is a classic scene from “Annie Hall”, the 1977 film starring Woody Allen and Diane Keaton. Diane Keaton's character says she needs a little grass before making love, even if it is a downer for her boyfriend. Annie Hall isn't alone in considering marijuana as an aphrodisiac. For more on that particular aspect of how the drug works, we're joined by Carlen Costa. She's a clinical sexologist and relationship psychotherapist. She is currently traveling across Canada with a cannabis company geared toward women. And she is in our London, Ontario studio today. Hello.

CARLEN COSTA: Hi, good morning.

PC: That scene from Annie Hall how common is this woman wanting to get high before having sex?

CC: Very common actually. It's a question I think I get asked at every one of the summits that we've been hosting across the country.

PC: Huh. And you know Annie Hall’s romantic partner is uncomfortable with the idea of her having to be artificially relaxed before they get romantic. What would you say to real life men who feel the same way?

CC: Well, sex and weed has always created contradictory claims regarding the effect, right? But when you find that one of the partners is feeling it into their ego about whether or not the other person needs to relax a little bit in order to be intimate with you that's really what they're talking about and they're feeding into is that ego — that personality that you know I need you to be present so that I can be aroused.

PC: What are the issues that arise if you're already in a relationship with a partner who hasn't used cannabis before? What is your advice, and how do you introduce that, especially now that it is legal?

CC: Well, I think you know kind of the rule about cannabis use and introduction is low and slow is the way to go. So whether you are a cannabis consumer currently, or you are trying to introduce that into your relationship, it's about first of all having that conversation, right? Communication is the key to a really positive relationship. So if you can introduce it slowly, and talk about how it helps you, how it supports you and how it will help increase your desire, pleasure and arouseability then you know that's a great place to start.

PC: So not necessarily a deal breaker if one partner smokes and the other doesn't?

CC: No, definitely not necessarily a deal breaker.

PC: So you're on tour with Van der Pop, A Canadian cannabis company specifically targeting women, speaking about cannabis and sexual health. So you know you talked about the pros. Do you talk about the cons of the two things going together?

CC: Definitely we talk about the pros and the cons. Now, I'm speaking to two women primarily across the country because as some of you may know, cannabis is a female plant. And I like to say that cannabis was created for women. And there are contradictory claims for both men and women that are dose-dependent onto the impact on our sexual performance, on our arousability, how we respond, how we enjoy sex and sexuality. And I actually see based on research more negative impact on men than on women. It actually has become more positive for women and the expression of their sensuality.

PC: OK, I'm glad you brought that up because I want to make a clip of Michael Eisenberg who is a urologist and director of male reproductive medicine and surgery at Stanford University. Last year, in 2017, he did a study. It was published in The Journal of Sexual Medicine. And it is one of the largest studies ever conducted on marijuana use and sex. Take a listen to what he had to say.

SOUNDCLIP

MICHAEL EISENBERG: What we found was that there was a positive association. In other words, the more marijuana use reported, the more sexual frequency that was also reported. There could be some biologic link. It's possible that the chemicals in marijuana may actually improve sexual function. You know another possibility is there could be sort of a confounded relationship. In other words, people that use marijuana or even report using marijuana may be more of a disinhibited. And they may just naturally engage in more sex. I think it's certainly possible that marijuana could have a used therapeutically. As we learn more about its potential risks as well as benefits, I think that certainly the study suggests that maybe sexual function can be one of those avenues.

PC: OK, Carlen Costa, he's saying you know good for the men as well. What have you seen in your practice — you're a sexologist — while working with couples who are using cannabis in the bedroom?

CC: Well, I'm actually glad that you brought up that study. I was just refreshing my thoughts on it this morning. And that study actually said that there is a positive link between cannabis and sex. And actually, a 15 to 20 per cent increase in sex frequency for cannabis users, which is a pretty good I'd say, right Piya? But when I'm speaking with my clients, you know I talk about what they're comfortable with. And I discuss you know what their usage was Up until this point, and what it is how they’d like to explore going into the future.

PC: So you know we started with a clip of Annie Hall, and talking about you know cannabis the aphrodisiac. Is cannabis an aphrodisiac?

CC: Well, I think the definition of aphrodisiac can be kind of contradictory, whether it actually has a physiological response or psychological response. Aphrodisiac tend to have one or the other, or both. But in terms of being able to fully express or accept our sensuality in terms of increasing our relaxation, decreasing our pain that we're feeling in our body. Because many women especially feel pain due to due to sexual penetration, right? It increases our connection and our presence. And it also slows down our time perception. So it allows us to get out of our heads and back into our bodies, whether you are a man or a woman.

PC: Carlen Costa, thank you for your time as well. I do appreciate it.

CC: Thank you.

PC: Carlen Costa is a clinical sexologist and relationship psychotherapist. She was at our studio in London, Ontario. Well, we have heard a lot about the benefits of mixing cannabis and romance, but it's not a positive combination for everyone who tries it.

SOUNDCLIP

SPEAKER: You know it started off on college as freshmen whatever on the weekends, had fun. And you know it slowly became something I used in situations I kind of didn't want to be in. Like if I had to go do something I didn’t want to do, or I mean I'd like to be high because if I was high I always felt happy. And you know then I met someone I really, really liked. And I know people are like it doesn't make you make bad decisions you know if you're on drugs. But you know what? It does — at least for me it does. Because every time that I would get high I was not the same person — not at all. It was all about me. And that's when I made bad decisions. And you know I had a you know that’s when I ruined a perfect relationship.

PC: That was Ryan Bonville, from New York. Sharing the story of how marijuana ended up costing him a relationship. It's a topic that Jonathan Bertram has spent time working on. Jonathan Bertram is an addiction physician at CAMH — the Centre for Addiction and Mental Health. And we reached him today in Bomanville, Ontario. Hello to you.

JONATHAN BERTAM: hi, Piya.

PC: What issues have you seen in your practice when it comes to people's cannabis consumption?

JB: Well, the people I see for cannabis use are usually coming forward because they want help with some with changing their cannabis use. And when they come for an appointment, we're trying to identify whether their use is problematic, whether it fits into an addiction category. And in many of those situations, whether it's problematic on its own without there necessarily being an addiction, or if there is in fact a diagnosable use disorder, which is the more official term for cannabis addiction that meets certain criteria. They do complain of problems with their relationships. But those two things aren't equivocal.

PC: You said if their use is problematic. I want to ask you about this about addiction in marijuana. There is a myth that you can't addicted to marijuana. Is that true or not?

JB: So it's true. It is a myth. A substance like marijuana has addictive potential. And you know speaking generally about addictive substances you know all substances carry with them the risk for addiction. That does not mean that, and if we're talking about cannabis, that a person who uses cannabis is going to get addicted. There are a lot of other factors that go into developing an addiction to cannabis, and for that matter any substance. And those are circumstantial, they're historical and obviously that plays a part when it comes to deciding if that's going to have an impact on your relationship, or already is having an impact.

PC: OK. You know we’re 0 plus 1 in terms of cannabis legalization in our country. There are lots of aspects to talk about this — the good things and the bad things. But as we're focusing on relationships today, I want you to take a listen to this. These are some couples chronicling their experience smoking up a little before going on a blind date together, which is you know most often a nervous experience. But they say we're smoking up or using marijuana to ease their nerves.

SOUNDCLIP

SPEAKER ONE: Are you as nervous as I am?

SPEAKER TWO: A little, yeah. I'm like waiting for the weed to get smoked and kicking.

SPEAKER ONE: My name Chi.

PC: All right, Jonathan Bertram. You know people going out on blind dates or dating, nervous before they go. But what comes to mind for you when you hear about people using marijuana to reduce anxiety before going on those kinds of dates, or in romantic relationships?

JB: I hear people report that to me quite often. It's not exclusive to marijuana. There are a lot of other substances that either people will use generally or in some cases they might have a unique response to it, and so it's quite common to hear people talk about using something that will help them be less anxious so that they can either you know handle a first date well, or manage that encounter well, or just put their best foot forward. So these all sound like benefits that a person is identifying. And this very much falls in line with the time line for a person using the substance. That's at the start they use it for their benefits. In some cases, those benefits remain. And there is a sustainable relationship. We're talking about the relationship between the person and the substance I mean. And in some cases, it becomes unsustainable because in many situations those benefits fade. And that applies to cannabis as well.

PC: Yeah, using marijuana's coping strategy in other words?

JB: For one.

PC: OK. How can people know if they veered into dangerous territory with cannabis, either in a relationship or alone? What are the signs you’re kind of asking yourself like is this a problem, or is this helping with my anxiousness or anxiety in the dating world?

JB: Great question. And I think a good one for discussion because it involves some objective pieces. Not always the easiest to put into practice when a person is trying to monitor themselves. But I think valuable nonetheless. Some of the things that we look at when a person's coming to us and kind of telling us their story with cannabis use, and for that matter any other substance, is it interfering with my personal relationships? Is interfering with my professional relationships? So much when I think back, is my use of my substance, in this case cannabis, getting in the way of my being able to keep up and fulfill obligations to people, and professional contacts, and for that matter school as well in my life? Am I trying to change my use either in response to those problems? Or you know just for my own motivation for different reasons. And in trying to change my use, am I not able to? And have I stopped or reduced my use in the past, but not been able to sustain that? Those are those are some of the sort of perceptual challenges that we talk about. And then more objective things are do I notice physically changes to myself if I stop using or I reduce significantly? So you know some basic things like am I sweating more, am I getting noxious? Or am I vomiting more? Am I more anxious in the mornings if I didn't smoke the night before and I didn’t smoke that morning?

PC: OK. We're going to have to leave it there. Jonathan Bertram, thank you for your time.

JB: Thank you very much. Appreciate it.

PC: Jonathan Bertram is an addiction physician at CAMH — the Centre for Addiction and Mental Health. We reached him in Bowmanville, Ontario. All right, coming up: a public health crisis faced by public health professionals. We're going to continue our conversation about doctor burnout with physicians who want to speak out. I'm Pia Chattopadhyay, sitting in for Anna Maria Tremonti. And you’re listening to “The Current”.

[Music: Theme]

Part Three: Doctor burnout follow-up

Guests: Shelly Dev, Catherine Pound, Caitlin Weston

PC: I'm Pia Chattopadhyay, in for Anna Maria Tremonti. And you are listening to “The Current”. We're picking up now on a conversation we began last week here on the show on physician burnout the Canadian Medical Association released a survey showing that a significant number of doctors in our country suffer from burnout, depression and even thoughts of suicide. The survey showed that residents — doctors-in-training — are particularly vulnerable. We spoke with a medical resident about her experience with mental health and we agreed to keep her name confidential because she has concerns about how coming forward might affect her career.

SOUNDCLIP

SPEAKER: Among my fellow residents, I see a lot of out burnout, and a lot of symptoms and signs of depression. When I entered internal medicine I just felt very unsupported, and I found myself going to my site director or various people seeking help. It was said that doctors I suppose he's very self-sufficient. So you essentially blame yourself, and go I'm not working hard enough, or I'm not doing enough. So I went through this, and then I experienced these symptoms of depression, and I blamed myself in the back of my head and it really affected me. Next thing I know, by the end of the year, three residents had taken stress leave on that exact same rotation.

PC: Well since that story aired, a number of health care professionals contacted us with their own stories. And I'm joined now by two doctors who wrote to us about their own experiences with mental health and burnout. Dr. Katherine Pound is a pediatrician and divisional research director at the Children's Hospital of Eastern Ontario, and an associate professor of pediatrics at the University of Ottawa. She is in Ottawa. And Dr. Shelly Dev is an intensive care physician at Sunnybrook Health Sciences Centre here in Toronto. She's with me in our Toronto studio. Hello to both of you.

KATHERINE POUND: Hi.

SHELLY DEV: Hi, Piya.

PC: Dr. Pound, let me begin with you. What was your own lived experience with burnout and mental illness?

KP: It was in 2012 — that's a year of my life. I'll never forget. I had been a fully-trained, graduated physician for about five years. And it crept up on me. It took months for me to recognize it. And it affected my life in many, many ways. As I said, I'd been a young staff for about five years. And I was at that point in my career where I really wanted to do well. I wanted to get my career started. And I felt like I had a lot to prove because I was working at the hospital where I'd trained as a resident, so I had to make that jump from being a trainee to all of a sudden now being in charge of my own patients. And it was really important for me that people saw me as no longer a resident. But as somebody who could do the work that I'd been trained to do. And I think like most people in medicine, I’m ambitious, I’m driven and I said yes to a lot of things. And worked really, really hard and what I noticed, or what I know now looking back is over to maybe a year, I very little by little I've lost that drive that I had — that desire to work. And I was working because I had to.

PC: I guess one of the things that people would think is like come on, you’re a doctor. Like you're trained in this stuff — you know to look for signs and symptoms of all kinds of things. And yet, as you say, you were kind of pushing it down, denying it. How difficult was it for you to accept that yeah, like I got challenges here, and then to do something about it?

KP: It was incredibly difficult. I didn't accept it until the point where I could no longer work. I couldn't function. I could barely get through the day. That's what it took for me to wake up one morning, walk into work, look at my division chief, and say I cannot do this. I don't know how I'm going to get through the day. And that's a day I'll never forget — the feeling I'll never forget. That feeling of hopelessness where you just you don't even know how you're going to make it through the next eight hours. I had developed so much anxiety, I couldn't sleep, I couldn't eat and yet, I kept working because that's all I knew how to do. And I it never even occurred to me that it was happening to me.

PC: Which isn't great you know for patients to hear that like their doctor is kind of faking it to make it because they feel so much pressure. Dr. Shelly Dev, what about you? What was your experience with burnout?

SD: I was far less self-aware about it. I had recently started working after I finished my training in 2006 at Sunnybrook, which is a very big, busy trauma centre. And the critical care department where I work in is a very busy place. And within a span of about three years, I had two beautiful little kids, and my father was diagnosed with terminal cancer. And the juxtaposition of the joy of my sons being born and the terror my dad's impending death instilled in me was horrifying and extremely untenable. And after he had died, I did not know if I could return to a workplace that had so much suffering and dying associated with the profession — with my specialty. And on the advice of a colleague, who's actually a mentor I should say, I went to see a psychiatrist to deal with my grief. And to me, this was a very specific need that I needed to address. And I intended to stay in therapy for about six months for grief counseling. And I ended up staying in therapy for three years. And I went weekly. And I never missed it because what started to happen to me in therapy was this revealing to me of what my life had been about in medicine. And what had changed in me — what had fundamentally changed about what I thought I would feel like in this profession vs. what I did feel like. And so I didn't know that I was struggling as much as I was.

PC: And so you're dealing with this privately with your therapist. You start talking about publicly then, right? So what happens when you go public? Like what are your fellow doctors saying to you, or are they just like I don't want to talk about this?

SD: When this became public — very, very fortuitously when I wrote about it or a speech that I had given was published as an essay — I agreed for it to be published online because I thought well, no one is going to read this, so I'll just do my due diligence and be a good citizen. And from that time my life has completely changed because I could not have imagined the hundreds and hundreds, and hundreds of messages and encounters that I have had because that went public. And it was revealed to me how my story is not a new story. It's such a common experience. And listening to my colleague on the line, the thing that is so typical of this experience is that these are people like the headline you'll never see is that most health care workers are just really good people who are trying to do their best. And it's hard. And they will push themselves, and their lives will fall apart. But they will come to work to do their good work.

PC: OK, so you know we hear like in certain work environments like and I'm just picking off the top of my head. But like say with police that there's sort of this macho culture, this stigma that we don't admit at least loudly that you know this job comes with challenges. What is it about doctors? Like what is it the culture that you both find yourselves working in that prevents people like yourselves from just saying yeah, like this is hard stuff, and it takes a toll on me. Dr. Katherine Pound, what's the culture like?

KP: I think a lot of the pressures that we feel are internal actually. Because what I have noticed over the years is a desire to talk about it. When we open up people are more receptive than anticipated. But I think what a lot of us feel is, especially as we're training or starting in our career, is that we need to prove ourselves to the world. We need to prove that we can do this. And when you think about it physicians are bred in a way to feel invincible in a way, right? Because they're at the top of the class in high school, and they're at the top of their class in college, and in university, and everybody around them is competitive. Not only competitive, but driven, and everybody is amazingly accomplished. And as an individual when you look around you all you see are these wonderful people that you're working with. And you lose a little bit of perspective, and forget that you also have done great things. And start feeling that you're not the same as everyone. And start feeling that you don't belong. And you don't want anybody to know that that you think you're not as good as anybody else, so you just keep working harder and harder, and harder. And keep pushing yourself to the lengths that otherwise people probably would not.

PC: You know it's so interesting hearing from the both of you is that you both are on the frontlines — your profession is on the frontlines saying hey, we need to get rid of the stigma of mental health and stigma that comes. And we need to talk about this more openly and what not. And yet, here you are, Dr. Dev, saying you know in my profession, it wasn't that easy to come out. What is it about the culture of your profession that prevents people from coming out?

SD: I think that this is a profession where a lot of people get into this profession very, very young. And I just believed most of them get into it because they believe that it's important to help other people. And no part of that initial instinct has anything to do with you personally. It has to do with your ability to provide. It's a service, right? And there is no part of that training, at least in the versions that most of us have been through, wherein your own health and abilities are connected to your ability to provide. And you are learning things in a curriculum about science, about discovery, about technology, but you're not learning about what you will feel when you see people go through these very difficult experiences. And because that's never really discussed, when you start to be impacted by it, it’s something that you were not prepared for.

PC: Vicarious trauma essentially?

SD: In a way. Like I think the people who feel the most in this profession do the best and suffer the most. Because they feel very connected to what they do. But they have never learned how to deal with their own internal suffering.

PC: You know, as I said, we heard from so many medical professionals from various places in our country. So we heard from a nurse from Newfoundland and Labrador, and she wrote to us, and she also didn't want us to use her name or any identifying details because she was worried about how that might affect her job. And I want to read you a bit of what she wrote. Here's what she said. I work in an isolated community with physician support via telephone that is a flight away. If we have a critical patient that is unstable, we have limited resources as well as no physician support. You sit there with a patient on the brink of death. And your only way to get them out is a flight that, on a good night, is three hours away. Due to burnout, I wanted to ask for help, but did it hesitantly because of the lack of support from management. Management is so stressed trying to fill vacant positions they forget that the permanent frontline staff need extra support to prevent burnout. I know that I'm not the only nurse that feels the same lack of support. We tend to forget the nurses in rural communities. They dedicate their lives to a community without the help of on-the-ground physician, equipment, staffing and little support from the management. Shelly Dev and Katherine Pound, Katherine, let me begin with you. I mean is this across the board a problem in the medical profession? And I mean I imagine it is. But what is specific to doctors?

KP: Well, I can speak anyways to doctors in the environment that I work in. But I know it applies to everyone across the board. I think it's very difficult as physicians and nurses to be going through crises with patients day in/day out. For instance, I think of the job we do where you know you'll see a patient — a child who's not doing well — or you break bad news, or just see somebody die. And you don't have time to process because five minutes later, you need to walk into somebody else's room and continue your work. And I think that's the trauma that adds up after a while is sharing in these very difficult moments with all these families and really not having any time to process it or any way to process it. And my colleague just touched upon that also a little bit before where we have never learned to do this. And you know although sometimes there will be group debriefs and discussions, the onus is on the physician to get that one-on-one help that the person might need to get through all this vicarious trauma and these difficult situations that we share with our patients.

PC: Dr. Shelly Dev, not to pick on your management, I'm not asking to speak personally, but like how common is that feeling from management that there just is enough support that they're providing for us in this realm.

SD: I think in general I mean it's a very common thing to discuss how pressed our health care system is, right? And there's so many wonderful things about our health care system. And clearly, there's things that are not working as well. And I think the part that we have not focused as much on is this part that we're talking about right now. And I I'm very excited about this being treated as a public health issue because this system, regardless of the resources that we have to fund it, will not be sustainable if the people who provide the care are not able to provide care. And I think we have not yet focused enough on that critical part of the system. Like forget the infrastructure of the system, it’s who populates the system.

PC: Right. We talk about doctor shortages all the time.

SD: Right. And the most bendable or flexible part of this system has been the workers because the culture that we're talking about. Because I think this is essentially a discussion about culture. We have all joined in this mission agreeing that this is what our mission is to help other people. And we have agreed to bend and bend, and bend and just like Catherine is saying is you will still come to work and your life will be falling apart. And you will still come to work. And the colleagues of mine who've come up to me about when they realized that something was wrong was when they felt they couldn't do the work. It wasn't when their personal lives were falling apart. It's when my mission could not be completed.

PC: Okay, I want to bring in another guest Caitlin Weston is an Australian doctor, and she's been studying solutions in different countries to the issue of doctor burnout and mental illness. And she's in our Halifax studio today. Hello.

CAITLIN WESTON: Hi, Piya. Thanks for having me.

PC: Thank you for being with us. Dr. Weston, why did you want to study this issue?

CW: Well as a junior doctor in Australia, I mean you know it's been recognized that this is a worldwide problem. It's kind of a worldwide epidemic. Whilst I was still a medical student in 2013, there was a national study released of the health of Australian doctors and medical students. And the results of that were shocking, but not surprising.

PC: Meaning?

CW: Well, very similar things to what like the CMA study has shown. I mean, for example, it showed that one in four doctors in Australia across their lifetime would consider suicide — one in four. one in ten per year. And one in 50 had actually attempted suicide. So that was in 2013 that that was released. I was still a medical student; it was my final year. But you know in working you know I've now been a doctor for five years. And in the last two years, I've lost two friends to suicide. Both of whom were twenty-nine. It is it is shocking but you can see working in the system you know as Catherine and Shelly have both discussed, it's no mystery why to us when you're in that it's no mystery that those are the statistics.

PC: Okay so as you've been looking at this, Dr. Weston though like you're trying to come up with solutions like best practices. What are the best practices for treating or preventing physician burnout?

CW: So I was incredibly lucky to be able to do a Churchill Fellowship, so essentially I spent eight weeks last year travelling around the United States, Canada, and the UK looking at innovative solutions. I saw some incredible things. I mean the one that really inspired my trip in the first place was a time banking program at Stanford University Hospital.

PC: How does that work?

CW: So essentially for the emergency department, so for the activities that are often sort of under recognized and acknowledged, so things like mentoring, covering colleagues shifts at short notice and sitting on committees, these activities that contribute to the culture of the department — a positive culture — they can accrue credits by undertaking those, which they can then spend on a huge range of services and activities. For example, child care, elder care, domestic cleaning and like speech coaching, grant writing applications. So I found that this was a really elegant solution to a very complex problem in that it re-empowered the clinicians themselves to address the work-life and work-work conflicts in their own circumstances.

PC: And there is something that you discovered at the Mayo Clinic that you found interesting in its approach to leaders. Tell me about that.

CW: Yes, so Stanford and the Mayo Clinic are two pretty eminent leaders in the field of physician wellness. And the Mayo Clinic does regular as part of this sort of quality assurance, there normal quality metrics, they will do surveys of physician wellness, but also leadership. So leadership shapes culture. And culture is the hardest thing to change. But it is really I think at the core of what is driving this.

PC: Okay. I just want to interrupt because I want to talk about some of the innovations solutions that are being developed here in Canada as well. And I'm going to play a bit of tape. Dr. Thomas Saun, who is plastic and reconstructive surgery resident in Toronto, and he's working on a virtual reality project to help doctors avoid burnout. Listen to him.

SOUNDCLIP

THOMAS SAUN: It's called Project Breathe. And essentially it's a research study based out of St. Michael's Hospital in Toronto. And with tit, we're looking at the effectiveness of a brief virtual reality experience on reducing acute stress in resident physicians while on call overnight. You're essentially placed in a bioluminescent forest clearing with the Aurora Borealis overhead. And you interact with your environment through gaze and guided breathing. And essentially, you grow the forest around you with your attention, and you can choose hues from the sky’s Aurora to customize your own tranquil setting. If I could induce that same feeling of relaxation during a stress filled chaotic night on call, I think that would be huge. I don't see this as a panacea for burnout — just a small piece of a larger toolbox that desperately needs to be built.

PC: Dr. Shelly Dev, when you hear that, you work in intensive care. So would a solution like taking a virtual break help you do think?

SD: Well, I do have to you know put up my bias here: Thomas is one of my mentees. But what I will say about this is that this pays attention to the fact that stepping away and having a moment is meaningful. Having moments are meaningful. And the recognition that those things are meaningful is what change is, do you know what I mean? Like the previous culture would be this relentlessness of you just stick it out. You just suck it up. You just keep going and going, and going. And a real switch in the culture would be that to be your best, you need these moments to come to refuel yourself and come back. And what Thomas is talking about is making those moments accessible in the workplace, so you can refocus and come back.

PC: Dr. Weston, what would you like to see in terms of a change that could be applied you know no matter where you work what country in terms of helping doctors deal with burnout?

CW: I mean I think the fundamental thing that we need is a cultural shift. As Catherine and Shelly both discussed, it's often sort of the sense of shame and isolation in dealing with these problems, which are entirely natural responses to the situation that we place ourselves in. It's the shame and isolation that makes it so much worse. And feeling trapped like this will never get better.

PC: Are you seeing that shift happening though slowly?

CW: Very slowly. I mean I've only been a doctor for five years. But many of my mentors — people that I've spoken to — have been working in this area for 30 years. And you know it's not a new issue. In 1881, there's a publication from England showing that the physicians then had a higher suicide rate than the general population. And it's cyclical you know there'll be spikes of suicides, and you know there’s a brief response to it — you know inquiries and things. But I think now that that's happened, like nothing much has come out of those in the past. But I think now there's enough of a groundswell that it is actually like something profound does seem to be shifting. A lot of places are developing their own solutions to local problems. And I think just that acknowledgement from administration, from leadership that they value the wellbeing of this stuff in itself I think is a big thing.

PC: Dr. Catherine Pound, what kind of solutions would you like to see?

CW: I would like to see people more willing to talk about this. And I think there's already a shift towards this as my colleagues talked about. But I think by discussing these problems publicly, we make it okay for people who feel that way to ask for help. Although leaving the onus on people who were suffering to ask for help may be difficult. What I would like to see, and I don't even know if that's feasible, and maybe a little utopian. But I think having a system through which everyone can talk to someone about what they're going through. So in a hospital, having maybe therapists who can speak to someone, so that we don't have to actually make an appointment — take time out of our already busy day and recognize the fact that we have a problem, which I think is the biggest part where people don't necessarily recognize that they are struggling. And making it part of the daily routine where physicians would need to go speak to that person regardless of whether they feel they need it or not. And just make it part of the routine essentially. And if people really don't want to, they can opt out. But have it be part of the routine self-care.

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