Dr. JESSI GOLD: EPISODE LINK
HOW DO YOU FEEL?: BOOK LINK
TRANSCRIPT:
Colleen: Welcome back to Hot Flashes and Cool Topics.
Today we are going to talk about finding humanity and medicine with Dr. Jesse Gold.
Welcome to the show.
Dr. Gold: Thank you for having me.
Colleen: Well, we read your book. How Do You
Feel? One Doctor’s Search for Humanity and Medicine.
And it really was so poignant in the book when you would talk about your own
personal journey because you were so busy taking care of patients that you weren’t
really taking care of yourself. And I think for us, we hear a lot from our
listeners that, obviously, that the medical field, that the medical world is just
completely upside down. They don’t feel seen, they don’t feel heard. And I think we
forget sometimes that doctors are also human and that they come with a whole history
of whether it’s mental health issues or personal issues. So I thought I would start
with saying, what has the response been since you wrote the book?
Dr. Gold: You just said so
many really important things. But I will think about the first question first because
I want to make sure I actually answer what you want me to. But, you know, I think
it’s interesting. I think people who are in health care, it can be mixed when we
talk about this stuff. So I think that there are people who are like, thank you
for talking about this. It’s brave, which to me I don’t love because I’m like, it
shouldn’t be brave. It should be boring. Like it should be that all of us are
talking about this. and I’m just another voice. I’m not like the voice or the
person who chose to like rip the bandaid off and be the person talking about it. So
I find that like personally a little hard to land even though it’s the nice
feedback. Then there’s some feedback that, you know, we shouldn’t be talking about
this stuff, that our job is just to take care of other people, that it’s sort of
like opening up stuff to the public that we barely talk about with ourselves.
I think sometimes the feedback can be kind of clearly linked to maybe what
somebody’s pandemic experience was and how they react to certain things in the book.
I think from patients, for the most part, the ones that have found it, and I hope
more people find it from listening to this and other things because it wasn’t
written solely for healthcare workers or anything. Like, I really wrote it for what
you’re talking about, which is like we kind of fight club through our jobs and
don’t talk about it and don’t talk about it with patients.
to sort of like connect this to people’s lives and what you see when you show up
in the office or why, you know, even as a health care worker, you might not have
like the easiest time explaining your symptoms to another doctor and still end up in
my office, you know, kind of throwing all that together. I think some the patient
folks who have read it have felt like they want to give their providers like a
thank you or a hug a little bit more than they might have or, you know, makes
them think a little bit differently about some of their own experiences. And I, and
I think it’s not to invalidate their experience because I think that all those
experiences and what you feel when you’re in the office is true and valid. I think
it just gives like a sort of different perspective to where it might be coming
from. And it might not just be that they’re bad people or they don’t care or they
are not listening or whatever it is, that there’s much more to it, you know?
Bridgett: Yeah,
that one thing that really stood out to me and I always suspected it, but I didn’t
know, was how much does, are people in the medical field were told, oh,
you know, you have to keep things to yourself. You can’t get too involved with your
patient. And when you said, hey, this is me, or this, I’m just kind of like this.
I’m a funny person. And how much people like you would be criticized for doing
that.
Dr. Gold: people who are competitive. And so we’re in an environment that they’re not a lot
of slots or we’re competing for a spot or we have to have high X, Y, or Z to
get there. So that already is excluding certain people. I remember, you know, being
somebody in college kind of paying attention to what people didn’t make it through
pre -med classes and being like, oh gosh, those were amazing humans who would have
been such good doctors. But what we’re doing as like the ways to get there are
also preventing some of those people. So there’s a weed out process that might weed
out unnecessarily some of the people who might be better. And then when you go to
med school, you don’t want to stand out for reasons that would make you look weak
or look like you have some sort of emotional problem that other people can prey on
or be something that people give you negative feedback for. So you like do something
and you get feedback and you alter or you watch and see how other people do things
and learn. So we call that like the hidden curriculum, like kind of not what’s
formally taught in a class, but what you see and what you experience. And so what
we see around us is not people sharing. And what we see around us, like even in
small groups with us, like let alone with patients, you know. And then what we
experience is like we’ll be in a clinic and we’ll ask a question about the patient
that’s not about their, you know, whatever we’re supposed to ask. And we’ll get not
in front of the patient, hopefully, but afterwards in writing or in feedback,
like you shouldn’t have done that, you have bad boundaries or why would you ask that
or that’s not what we’re here for or don’t make it about you or anything like
that. And so what you start to hear is like to do this, I can’t do that.
And so I better figure out like how to do that because I don’t want bad
evaluations and I want to get into a residency and I want to, you know, do all of
the things I came here to do. And so you sort of lose yourself in that more than
I think you realize. Like I don’t know that if you would have asked me in med
school that I would have known that I was sort of shifting a little bit to conform
because I was not liking the stuff people were saying about me or like what I was
getting is feedback and I was just like, I think the
and this is how you’re a nurse and this is how you’re a doctor and this is how
you show up. And so, you just think that you’re doing what’s right or what everyone
else was doing. And in that context, like, you really do, like, lose that part of you
that might have been different.
Bridgett: Right. And you had a great example in the book.
And I know you changed the names.
But it was Megan, the physician, the doctor, and that came back to get her.
If you could share just a little bit about how that came back
to get her.
Dr. Gold: Do you mean, like, which particular story?
Bridgett: Oh, I would say just how
she, you know, was so like, I don’t know, kind of blank and not feeling. And then
she said, I hadn’t cried. Oh, yeah, years or something like that. Yeah, you know,
we do this sort of like, it’s also self -protective, right?
Dr. Gold: So there’s an ER doctor and the stuff you see in the ER is pretty traumatic. And you get to the point where like, you know, you tell stories over dinner and other people are
crying and you’re like, wait a second. Like, was that traumatic? And the way I
think about this too is like there was that football player who coded on the field.
And everyone was like, oh my gosh, what is that? Like, that’s the most traumatic
thing I’ve ever seen. And all the healthcare workers on social media were like, is
that traumatic? Like was watching that, was it traumatic? We saw 10 of those yesterday,
right? Like, we have no idea. Like we basically are numb to a lot of the things
that like, of course, would make other people feel. And so in doing that,
you, you are really protecting yourself, but we shouldn’t do it all the time. But
we do it so much that, like, you don’t realize that you haven’t had emotions in 10
years. And then you come to my office and cry. Like, I would say the most common
thing for someone who finally shows up to see me would be like sort of what
happens to her, which is just like saying “hi” and crying and having no clue why and
also being very confused because you haven’t cried in a really long time and being
very embarrassed because we apologize for big emotions, especially women, but all
people really do for different reasons, like big emotions scare people. I don’t want
to put that on you, like, et cetera. And, you know, for me, I try to sort of say
everybody does that in here. But I think that it makes sense that, like, finally
having a space that is for you to share or is about you and no one else might
make you almost like overwhelms to the point that you have emotion just by simply
like existing in a space that asked you about you, right? And I think that’s what
happens in a lot of these situations.
Colleen: What I thought was interesting was that,
you know, you say in the book that expectations choke off room for anyone’s
humanity. And that’s kind of what you’re talking about going through med school that
you weren’t allowed to really share those emotions because they weren’t considered
beneficial to the program. You weren’t going to get ahead. And I remember I went to
law school and a lot of that was the same thing. You weren’t supposed to show
empathy. You were just supposed to read the law. And I always felt that that took
something away from clients because clients benefited from knowing that you have a
human interest in what you’re doing. It seems like from our
knowledge are they doing that? Do they find a disconnect? Or is it just something
that is part of our normal now?
Dr. Gold: I think both. So I think there will be people who
don’t love that, who wish that they didn’t have to document in their 15 -minute
visit. But if they don’t, they would be up until 4 a .m. doing it, and there’s no
other way. And that’s one of the reasons why something like paperwork has become
such a big burden for people in health care. and when you look at the data, like
the people doing electronic medical record notes and messaging into the evening are
like more likely to be burnt out. They’re also more likely to be women because
women also tend to have more complex cases that require more like longer notes.
We also write longer notes. Like some of this stuff is just like we’re set up to
fail in that situation. But, you know, I think that we like inherently wish that
wasn’t what was going on but there’s nothing else to do and then you do it so
much that you stop apologizing for it or you stop setting the stage around it so
you forget that like a new patient might not know what you’re doing and might not
understand why you’re doing it, right and so you are just so used to doing it that
it’s just what you do. I think the younger folks as they come up, like they
text they don’t even talk to people, so I think that that generation’s going to have
a very different view of that being not okay or that being something to explain
because they just think that you look at a screen and that’s all you do with
people. And so I think that that’ll be interesting. But for the current generation,
you know, I also think, and I joke a lot, that medicine’s a bit like fight club.
Like for some reason we don’t want to admit what’s wrong with it, even
though it’s not my fault that they gave me 15 minutes to see you. Right. Like if
I came to you and I said, it’s so lovely to meet you. I wish that I can look at
you and not take notes on a computer right now. However, I have 15 minutes to see
you. And if I don’t type some of this stuff down, it will never be typed down.
And then I will be doing this into the night and I won’t be a good mother. Like
if I said any of that, you would go, well, of course they’re typing. But instead,
like we just kind of go hi and go right to the thing because even explaining that
feels like a burden. And we don’t want to be apologizing. But really, we’re not
apologizing for ourselves. We are apologizing for a broken system. You
could understand because then if I’m cutting you off from a long emotional story,
I’ll be like, remember how I only have 15 minutes? And you go, oh, yeah, so
stupid. Of course. Like, hold on. Let me get to the point. Right. Like, it’s, it’s
like you’re on the same team instead of, like, we have a secret we’re not talking
about. You are mad at us for what we’re doing. And then we never actually, like,
ever blame the actual problem, which is not any of the people in the room. It’s
insurance companies. It’s like sort of the push in health care to have a certain
amount of money made every time you see someone, et cetera. And that’s nothing to
do with the person who’s doing the work in the room. In fact, if we had a choice,
we’d spend all of our time with people. Like we, if we did redesign the system and
they let us, we would not have 15 minute visits. That’s a joke, you know? So I
wish we talked more openly about some of that stuff and like I encourage like when
I talk to healthcare workers about a lot of this I try to encourage that degree of
vulnerability which isn’t necessarily like what you would get from me in the book
right but is a bit like this is hard for me but I have to do it anyway and I
hope you understand that it has nothing to do with how I care about you as a
human and it isn’t me ignoring you. It is what I was dealt and I have to do this,
you know? I think people would understand it a lot more.
Bridgett: Yeah. I mean, it’s funny, I was going to ask about the system, the whole system, because you go in, you only
have this amount of time and you have to see so many patients the day. And it’s
just, it’s crazy. And, you know, I was thinking about some of the people that you
included in the book as well and the amount of pressure they are under, Naya,
the medical student. I mean, oh my gosh, I felt so badly for her. And then there’s the pressure there. That was another thing, too,
where, and I don’t think this happens just in the medical world, but I think it
happens in any profession. When people want to seek mental health help, the stigma
that goes along with it, can you talk about how that is such an issue?
Dr. Gold: Yeah. I mean, and maybe it surprises people a little that people in health care stigmatize mental health, But maybe it doesn’t because you’ve been in a situation where you wanted to talk about mental health and you didn’t feel like the person who was
treating you was that comfortable with it. And some of that comes from that. And
some of that comes from the fact that if you asked me about how to suture, I
wouldn’t be comfortable either. It is an actual skill set that I went to four extra
years to learn about. So the fact that a surgeon is less comfortable with it should
make sense, not just what made a surgeon go into surgery, but so much else there,
right? And so, you know,
like, if you look at studies, like, med students that come in don’t actually think
that, like, mental health is something to hide. But if you ask them what everyone
else thinks, they worry. So they worry, like, will my colleagues judge me for it?
Will my supervisors judge me for it? Will my residency applications be judged for
it? Will patients judge me for it? And because of all of those layers of fear,
To take time off work, you have to be like actively hemorrhaging or hospitalized or
whatever, right? And if the bar for taking time off is like that,
mental health doesn’t even like hit the radar because you don’t see it for the most
part. We aren’t like really able to like articulate what it’s doing to our day to
day life that well usually. And by the time we are, We’re pretty well off, like,
pretty bad at that point, but still not actively hemorrhaging, right? And so also,
like, it doesn’t really fit in the what counts degree. And so if it doesn’t count
and there’s all this fear of what everyone else thinks about it, like hiding it
makes a lot of sense. And, you know, there’s added fears, which I’m sure, like, as a
lawyer, you know, too, about licensure and whether the licenses are going to ask
you questions that are really actually illegal and then you guys could make that
argument better than me but like you know like really legally they’re only allowed
to ask about current impairment due to the Americans with Disabilities Act but a lot
of these states are still asking things that are sort of like have you ever been
in therapy? Right? Like that’s an absurd question and if you know that
that’s in existence, you might hesitate to go talk to someone to go ask for help
because they’re going to take your license for it. And like, it’s very unclear what
they do with those answers. For the most part, if you went to therapy, they’re not
going to do anything about your license. But no one’s ever said that, right? Like
no one’s ever said, we ask those questions for this reason. We use them in this
way. Just because you ask for help does not mean that we’re going to take your
license. But the existence of those questions and an underlying lore of like,
oh my goodness, I know someone who checked the box and then they were followed
around for the rest of their career makes people really hesitant. And we’ve made a
lot of strides, particularly over the pandemic, particularly thanks to an organization
called the Dr. Lerner -Brinos Foundation to change like not just state by state
because we have to do it that way, but to also change credentialing in different
hospital systems because that’s just another layer of the same kind of questions.
Like there’s a big, big push with a significant amount of impact and change around
that. But even that has been sort of recent and no one knows if they don’t talk
about it. And so again, the lore is like, don’t do it, don’t do it, don’t do it.
They’re going to take your license. And you gave up like 10 years of your life to
go to school, all your money, your entire identity, you have no hobbies, all your
friends have money, it’s a lot to then just like lose. I mean
it’s the same with sort of like Luke’s decision to step back. It’s the
same thing. It’s like what like I have to do to take care of myself. Like I
can’t do that. I already gave up so much to be here. I don’t really know
who I am if that’s not what I’m doing, but also could I lose it? Like, that’s
really scary. And I think in the context of all that, we forget, like, you could
lose it because you’re ill, like, because you made a mistake, because you stayed
until it was too late. We’re so scared that we don’t ask when we should,
and we end up waiting so, so long that for the most part, most of my patients say
something like,” I haven’t hurt anyone yet” when they’re in my office. That’s a
terrible thing to say. Like as a patient, if you’re listening to this, you
probably are like “that is terrible, I want my doctor to get help 10 steps before
that not when they’re like I’m almost at the point of cutting off someone’s wrong
leg but I didn’t do it yet”! Like that’s a terrible barrier and that’s sort of
what they wait for because of stigma, because of fear of licensure, because of this
sort of like unhealthy bar of what counts. And it just makes it so we really
wait a long, long time until we finally do it. Or we get forced to do it because
we do make that mistake and we do have something happen. And that’s also not when I
want people to ask for help too.
Colleen: Right. And I think your book clearly amplifies it
because it’s the pandemic. So that whatever emotions were on the surface then become
tenfold because you’re hearing this over and over. And I think in the book you
really describe that when you talk about the coding over and over and how the
nurses and the doctors are supposed to deal with going in every day and getting
used to hearing that coding sound. It’s not something you could ever get used
to. And I think also when you talk about it’s like because of what you do,
being a psychiatrist, you’re aware of symptoms, but I don’t even think doctors
necessarily, like physicians are aware of, “I’m not sleeping.” “Oh, must be a mental
health issue.” Instead, I was running around the kids. I had to tape my, you know, notes
doing all that. Oh, now I can’t, you know, my stomach’s upset. It must be the,
like you justify the symptoms until you can no longer justify them because you’re
either in and in the book you described, the panic attacks. You’re either in a
panic attack, think you’re having a heart attack. It seems like this
generation’s getting a little better. It seems like the younger students are starting
to be able to say, “I need a mental health day.” But when is it going to be okay
in the, in the healthcare system to say, “I can’t do this today?” Like, I need help.
Even you had trouble in the book saying that.
Dr. Gold: Totally. So much trouble. A lot of
that for me was like, I just wasn’t looking at myself at all. And I had a lot of
guilt about how much I wasn’t actually a frontline worker. Like I wasn’t in the
hospital. So my job was to work really hard and help the people who were. And I
was like, overwork makes up for guilt. Right. So, you know, I just did that as much
as I could. And I think so many of us really do that and not ever like really
look at ourselves in that equation, so it’s not just health care obviously, like
being a caregiver, being a mom, being like a teacher, being a you know like, I could
just keep going but being a human at this point a lot of things right and I think
it’s important for people to realize like the pandemic didn’t like come from the
clouds and make us sad, we weren’t great before and the pandemic
gave new stressors which made things worse. The same is true for college students
who’s my other sort of population I see. It’s not like they were great before. But,
you know, they have all these things and it made it worse. And I think, you know,
when I look around me as a student, as a healthcare worker, like what I see is
people don’t sleep, people don’t eat, people seem sort of sad and mostly burnt out.
And our numbers are over 50 % rate. So if you look around, most people you see are
burnt out. So then you think, I’m pretty sure that’s just what work is. I’m pretty
sure that work is overwork. Work is not feeling good. Work is pushing myself to a
limit. And that’s what being successful means. And that’s what working in this
profession means. And then, you know, if you start to go, hey, wait, like, that’s
terrible why is that okay then you blame yourself because you’re like everyone else
seems to be sad in cutting it. So if I can’t cut it and I need to ask for help
or I need to take a break, like maybe I shouldn’t be this, or maybe I’m in the
wrong field, or maybe I made a mistake, or maybe they didn’t know who they’re picking
and all this stuff which really just blames you for an entirely terrible baseline of
everyone else and a just terrible
work environment in this country in particular. And I think, you know, the newer folks come
up, like valuing work -life balance a bit more and talking about this more, but it
leads to a lot of conflict, you know, with the generation of folks who sort of
like made it through, but also the generation of folks who are kind of like me and
like in between where we had to adjust but we don’t love that we did and we kind
of think there’s an in between but it’s probably not working at all and I
think that there’s some balance that’s getting lost in that conversation. we deserve work life balance which is 100 % true but you’re in a profession
that is still really hard and has a lot of expectations that aren’t changing and
has a lot of system issues that can’t change tomorrow. So as much as you would
love to not work on a weekend, no one else is working. So you’re still working on
the weekend. So I think we are struggling with the transition in this conversation,
which is leading to some of the issues around like people just wanting to take the
time off, right? Because I think you see like one generation sort of fortifying like
we show up, this is what we do, we worked hard to get here. We work to the point
where now we’re allowed to have flexibility and vacation. We had to go through all
that before that, right? And then you have this one coming up saying like, why
would I do that? That’s terrible. Like I want a better workplace than that. And
something’s got to give. And I don’t know what that thing is. But sometimes I worry
that medicine’s going to have a really hard time recruiting people in that context
because we’re a big system behemoth that’s not changing tomorrow.
And if you really, really do value work life balance, like there are things that
we’re doing that are better, but you could have the better work life balance in a
lot of other fields, you know? And so I think we have to figure that out some so
that we can compete and still get the same people, I think that there is probably
a happy medium between hard work and taking care of yourself that we haven’t figured
out yet. The pendulum tends to go, woo -hoo, because you can see that with
all things. Like the pendulum just goes like all in one direction. Like there’s no
nuance to anything anymore. But this is a very nuanced conversation because until
there are more people that do a field, if you’re the only one, your wellness is
complicated. And I think that we have to try to figure out how to help people do
their jobs and work hard in the way that they want to, but also feel
fulfilled and they’re taking vacation and they’re having meaningful lives and
they’re able to have real lives as humans and they don’t have to lose themselves in
it and all of that without necessarily being able to wipe clean and start over
as a system because I would love us to be able to do that. It’s just not
realistic. And I think sometimes when I talk to people in Gen Z, they’re just like,
why can’t this change tomorrow? Like, this is just the dumbest thing. Like, why do
we do that that way? It shouldn’t be done that way. And I’m
like, you don’t think anyone’s ever thought that before? Like, we’d love it to
change tomorrow. It’s stuck like that. You know, and it’s sad to have those
conversations in it. It takes away a bit of their like sort of hope
that I like kind of love. But it is true.
Bridgett: Yeah. It’s it to me when,
you know, I was reading your book and what I’ve heard from friends that are in the
medical field, it’s like a hazing. I’m like, why do you have hazing? Hazing was supposed
to be done away within colleges?
Why are you hazing these new people that are coming in? And we’ve talked
to other physicians where, especially in the field of gynecology and urology, that’s
a lot of our guests, where there’s going to be a shortage. And women can’t see
gynecologists in the area where they live and they’re having to travel. And thank goodness there is
telehealth. For some things, you can’t have a telehealth exam, pelvic exam.
But, You know, but it is like, that would be interesting. That’s okay. I think
that’s illegal.
But I don’t think I would want to see that. But anyway, it is like a hazing to me.
And when I was reading your book, too, how they rolled back some things. Like,
there was a thing you talked about, the 24 hour on call. And I can’t remember
exactly why did they take that back? Like, didn’t they roll it back?
Dr. Gold: Yeah, sometimes it’s like the data that they have to prove their points. And then like people
having strong opinions about one thing or another. So like sometimes the data says
something like “more people didn’t die when we had longer hours.”
And so what they take from that is, “oh, we can keep the long hours instead of
like, well, what else is there besides mortality or in a hospital that should be
measuring some of that.” Those studies are all like very skewed for lots of reasons
that are true too, which is if you report that you work extra hours, your hospital
system can get dinged for it and then you’re working at a hospital that gets
unaccredited because they’re violating duty hours. So with those studies,
people aren’t encouraged to be telling the truth of what their actual work
environments are. So, you know, I think that’s all really hard. But yeah, we re
-roll stuff back all the time, if it’s going to help get what you want or what you
need, you know. And that’s a really like, you know, working that long can lead to
like basically you’re working drunk because that’s what not sleeping can do to folks.
And that’s really, really hard. I luckily wasn’t in a program that had that, but I
had night float, which was a placement, you know, where people work for two weeks
at a time at night, and then, so you’re sort of tagging someone out. But,
yeah, I mean, it is hazing in a lot of ways. It’s also, you know, the word
resident, so the hospital was built on residents existing. It’s called resident
because they’d sleep in the hospital. Like, that’s what it is, they’re literally
residents,
you know, and it was built on their backs as a, you know, a hospital system really
can’t survive like a big academic hospital can’t survive without residents. Private
hospitals your little community hospital, if you don’t have residents they figured
it out but the big academic ones with the most caseloads function entirely on
a resident seeing most of the patients and someone supervising right, like that’s how
we’ve grown to be and if they’re not in the hospital who’s in the hospital and so
it’s really really hard in that way. I’ve never really understood like hard work
is one thing, hazing’s another and I’ve never really understood that we call it
mistreatment and somehow we think that’s different than hazing, it’s hazing but you
know we don’t some specialties are worse than others. Maybe in the same reason like
some frats are worse than others, some sororities are worse than others, but um you
know I’ve always respected hierarchy in like a knowledge sense, but I’ve never
respected it in a power sense. Like, I don’t think it’s very helpful to exist where
I’m up here and you’re down here and I know more so I’m better than you, but
instead, like, well, like, you’re supporting me, so how can I support you and
supporting me and the rest of the team? Because that’s true, right? Like, I do know
more. Like, that’s the point. Like, I went to more school. I’m done with the
school. I’ve been training longer. I’ve seen more patients. Like, sure, I respect you
for knowing more, but I don’t respect you for knowing more to the extent that now
you can treat me terribly or like embarrass me in front of people or trick me into
doing stuff or whatever it is. Like a lot of that stuff is just terrible or throw
things at me. I’ve seen that happen a lot. Like that stuff should just not be a
thing. Right. And so I think it’s gotten better as like some of our accrediting
bodies have paid more attention to it. But it’s subtle, some of it’s really subtle
in ways that like they will always get away with like a fraternity didn’t like make
somebody drink so much they like had to go to the hospital but maybe they almost
got there and it’s very simple like that. You know if you’re not raising the
red flags ,you’re kind of under the radar and some of that stuff is still
really under the radar. You know people will report the bad people and they
still stick around. It’s a bad culture in some places.
And I think a lot of work environments probably have bosses like that too, right?
Like, just how that boss is. I don’t know. But like that’s just horrible
justification for something that could be taught in a like leadership coaching and
like you could get rid of it as like a this is a never thing that we do. Right.
Colleen: I think there’s a mentality that if I survived it, I went through it, that you
have to go through it. And until that mentality is broken, until people say,
no, they don’t have to suffer just because we did. It’s going to take that to be
a part of it because that’s going to break it. And then the next generation, it’s
going to take them saying, you know what, I value more my family life. I value
more having a mental health because like you said this all goes into your mental
health as well your physical health. If your mental health is not strong, your
physical health is not going to be strong and especially in the field of medicine. I
don’t want a resident who hasn’t slept in 48 hours checking me out in the emergency
room. Like, who wants that? They can’t even remember their own name
let alone be cognitively aware to say oh i think you’re having a stroke or you
know what i mean?
Dr. Gold: Yeah. Like a lot of us are perfectionists and it’s not bad. And a lot of us would
want a doctor who’s perfectionist because maybe they won’t make mistakes, right? But
it’s like how do you view those mistakes and how are you incorporating like
perfectionism into you? I would like to be really good at things most of the time. If I’m not, I, world is not ending, and maybe that’s
something I could learn from and do better next time. Maladaptive is like, if I
make a mistake, I will never make one. There’s no way I can make one. How could I
possibly ever make a mistake? And if I make a mistake, I’m a terrible person and a
failure, and now I have depression, right? Like it goes very quickly into, like, how
that manifests in you as a mental health issue. I mean, if you look at errors in
health care, especially super correlated with burnout, with depression, with suicidal
thoughts, with anxiety. All of this should not surprise anybody. But it’s because
there’s like this built-up belief that somehow, you will never make a mistake.
That’s not possible. But maladaptive perfectionism is, you are striving
for something that is actually impossible. But you think it’s possible so when it
doesn’t happen the way that you think it’s going to happen, you really blame
yourself in a very bad way. I’m sure to people listening, I’ve seen that in
their peers and they’ve seen that in themselves too, where you’re like “all I did was
not reply to an email, why am i beating myself up about this so much” or
the simplest mistake shouldn’t be a 10 out a 10 thing either.
Colleen: People write a lot about like what growth mindset things where
you say that the system is just as broken as the people working in it, which I
think really highlights your book in a lot of ways. Do you think a step in the
right direction would be for residents,
first -year doctors, or even once I’ve been practicing for 15 years, to be required
to see a therapist every couple month, would you think that would be a
step in the right direction to get them to maybe understand that humanity needs to
exist as a part of medicine?
Dr. Gold: I appreciate you asking that question. There are some
places that do something called Opt Out, which is, when there’s a new class of
students or when there’s a new class of residents, you are automatically given check
in appointments with a therapist or a coach, like however they want to define it,
like somebody in a wellness role.
So there’s definitely a place for that. And I think it makes a lot of sense. I think it’s hard sometimes just,
sheer volume because you have to think about where all those people are going if
they all chose to go all the time. That’s going to then make it like a
pretty significant strain on the system and you have to kind of think about what it
is. I think in that sense, also being mindful that our hours are terrible. And
so you need after hours, you need weekends. Like all of that is true. So you
do need a specific kind of person to do some of that. Like some people love
working weekends and they don’t work during the week. But you have to find those
people to be on the list who’s doing it. I think it’s harder when you get to
faculty and staff because there’s not like a clear orientation time. Right. Like it’s
not like clear that everyone comes in at once and they all get appointments, like, you
know, they’d have to do it when you started the job or something. And it’s just
less defined. Anybody who’s listening can probably argue that, like, faculty and staff
are often neglected in the conversation. And we spend a ton of time on students and
then residents because they are, you know, underpaid and you want to help their well
-being. But it’s also part of requirements to keep your accreditation and all
this stuff. But faculty and staff aren’t, and so they’re vocally not okay but they
tend to just be given HR benefits and I think that sometimes those are enough and
sometimes are not and I think that’s worth a conversation as we look to what we
change too because if people think that the only people that matter are the students
then it also creates more of that tension we are talking about if it’s a
universally applied thing that we need to be thinking about and working on. You then
feel less like you’re pit against the person who’s allowed to be well when you’re
not. And I think that matters. But yeah, I mean, I think I often say to people,
like, of course there are huge system changes that would be lovely to make, but
most of the things that would make our workplace better are really boring and
simple, like being more transparent, being a little bit more vulnerable and,
like, supporting each other a bit, you know, meaning and purpose are across the
board preventative against things like burnout. Like, what do you like about your
day? What don’t you like about your day? Do you have any ability to decide that?
If you don’t, do you have ability to make sure that you’re taking care of yourself
after all the things you don’t like? Like, what does that look like? And I think
none of us are really that mindful about like all the things we like and don’t
like. I think we’re just sort of like, Mondays are terrible, Tuesdays are okay, I
like talking to students, but we don’t really know what that looks like. And I
think, you know, another really just easy step for anybody in a workplace is
“ what do you like about your job?” What don’t you like about your job? Do you
have any ability to cancel some of those meetings that you don’t like or move them
or give yourself time for something else? When you’re saying yes and no to things,
do you ever think about yourself in that?
And you should also not just say no because you’re burnt out too, because I do
that all the time. I’m like, how dare someone want to be mentored by me right now?
I’m a terrible person. And then I’m like, when I’m talking to them, they have so
much more like hope and enthusiasm. And it’s like contagious because you’re like,
oh yeah, like there’s good stuff about my job. I just forgot until they
mentioned it to me. So being really mindful that some of this
stuff sounds so stupid. Like, you’re like, Jessi, the answer to a very broken health
care system is not being a little vulnerable and finding meaning. But, like, it
really oddly is. I would love to change some of the system stuff. I’m in a role where I’m working to do that in some capacity. But not all of us. Like, day to day, all of us need to
help each other and ourselves and be mindful. That doesn’t mean that we’re
saying you’re the problem but we’re kind of saying “please don’t quit” and
“please figure out what works and please like recognize that people like it
when you’re human” and “patients like it when you are human, if you react to something or you feel something or
whatever” talk about it, it matters!
Colleen: thank you so much Dr Gold make sure everybody
checks out the book.