EP125: Pathways to Balance: Dr. Alejandro Gru on Burnout and Continuous Learning

Managing Burnout and Continuous Learning with Dr. Alejandro Gru
In this episode of SEE HEAR FEEL, Dr. Alejandro Gru, an esteemed dermatopathologist and professor, discusses his strategies for managing burnout, including family support, travel, and exercise. He emphasizes the importance of continuous learning through interactions with trainees and colleagues, and openly shares his approach to handling and learning from errors in his field. Dr. Gru also talks about his experience with therapy and the value it adds to his personal and professional life.

00:00 Introduction to Dr. Alejandro Gru

00:51 Avoiding Burnout: Strategies and Insights

03:09 The Importance of Continuous Learning

04:43 Dealing with Errors in Dermatopathology

09:45 Final Thoughts and Personal Reflections

Dr. Alejandro Gru is the Leonard C Harber Professor of Dermatology and Director of Dermatopathology at Columbia University Irving Medical Center. He was previously at the University of Virginia, where he was Professor of Pathology and the Dermatopathology Section and Fellowship Program Director. He attended the Universidad de Buenos Aires, School of Medicine and did residency at Washington University in Saint Louis in Anatomic and Surgical Pathology. He has completed dermatopathology and hematopathology and surgical pathology fellowships. He is an expert in skin lymphomas and melanocytic pathology and currently serves as the President of the United States Cutaneous Lymphoma Consortium.

Transcript

Christine Ko: [00:00:00] Welcome back to SEE HEAR FEEL. Today, I have the honor of being with Dr. Alejandro Gru. Dr. Alejandro Gru, MD, is the Leonard C. Harber Professor of Dermatology and Director of Dermatopathology at Columbia University Irving Medical Center. He was previously at the University of Virginia, where he was Professor of Pathology and the Dermatopathology Section and Fellowship Program Director. He attended the Universidad de Buenos Aires School of Medicine and did residency at Washington University in St. Louis in Anatomic and Surgical Pathology. He has completed dermatopathology and hematopathology and surgical pathology fellowships. He is an expert in skin lymphomas as well as melanocytic pathology and currently serves as the President of the United States Cutaneous Lymphoma Consortium. 

Welcome to Ale. I'm just going to ask you several different questions. And one is, how do you avoid burnout?

Ale Gru: That's a great question. I have to say that I consider myself a bad example [00:01:00] of avoiding burnout. I do get burnout. I do work a lot, even, a lot of times after hours at home. It gets to a point every three months that I feel like I'm on the edge of getting into the burnout session. So one, I get a lot of support from the family, from my wife and two daughters at home. And then, my friends. Some of them I try to speak every day. Other things that I enjoy when I get to that limit of, I'm gonna be in the burnout zone, is some trip, even if it's a work trip. If I'm going away for three days, and I still have to give a talk or something, I like to have that time off, even being on a plane by myself and listening to music. And then I tried to, I've been better and trying to exercise more.

Christine Ko: That's cool. You've clearly thought about this a lot. I like the idea that you've put in here that we can cycle in and out of burnout. I don't think anyone's really touched on [00:02:00] that before, but I think that's true, at least for myself. And it sounds like it's true for you. And the relationships are important. I feel like I've been learning that for sure. So do you not work on the plane when you're traveling for work and about to give a lecture? 

Ale Gru: Sometimes I do, especially when I go unprepared, which is a lot of times. But at the same time I like to have that mind off period where I'm just flying and trying to relax and do something else. 

Christine Ko: I like that. I've also read recently that, kids, adults, when you're learning, you need some time off to let the brain process it all. You need a break from it. Ideally, you have some rest, like sleep even, pocketed within that learning, and it really helps solidify it. 

Ale Gru: Yeah. Sleep, as you mentioned, is a huge part of it. And that's something we really all need to be more conscientious and mindful. My Saturday is almost like sacred in the sense that I go to bed on Friday and then I try to sleep as much as I [00:03:00] can; sometimes I sleep like well over 12 hours. 

Christine Ko: Oh wow. 

Ale Gru: It's like a reset. The weekends are really a reset for me. 

Christine Ko: That's awesome. Another question I have for you is how do you continuously learn? What are your tricks and tips?

Ale Gru: That's a great question. How do I continue to learn? I learn in multiple different areas, I learn a lot from being involved in the societies and being involved in like reviews of clinical articles and et cetera. And I learn a lot with the trainees that I work with. The interaction with the trainees and people, just a great learning experience on both sides. It's a lot of fun. I wish I had more time to devote to reading. That is certainly something that I miss. I learn a lot by showing my cases or discussing cases with my colleagues. No matter what the level of experience the other person has, you can learn a [00:04:00] lot. A person who's looking at something for the first time, that diversity on the exposure, it's really important. It just makes your approach to things diverse and much different. It gives you different opportunities and different ways to tackle problems, learning different ways of how people deal with difficulties and things, and I really enjoy that. 

Christine Ko: I love it. I love your answers. I love how thoughtful you are about them. One of the things you just said was the trainee part, the way they see it is different from someone who's seen it maybe a hundred or thousands of times, but we can learn something from them seeing it for the first time ever. I totally think that's true. Great answer. Related to what you just said also about showing other people our cases, how do you avoid error?

Ale Gru: I think error is unavoidable in what we do. No matter what we do, you have to [00:05:00] face and accept the fact that you're gonna make errors no matter how careful, conscientious, or good you are. It doesn't matter. Error is intrinsic to what we do. I think it's important to accept the fact first that you're going to make mistakes. And that you're going to get that dreadful call that the clinician so and so wants to talk to you about the case. And then you pull out the case and it's, dang... Try to be careful, be mindful, be respectful of the time you want to spend with each case that you're looking at. Try not to rush through things. But at the same time, when you make a mistake, and you see you've made a mistake, I think it's so important that you discuss with whoever the person is, when you have made a mistake and tell them, listen, I looked at this case and I thought so and so and but now I'm looking at this again and I can see your point and et cetera. And it's almost I think a lot of people [00:06:00] feel afraid about, that level of interaction and thinking, Oh, this person thinks I'm not very smart and how come that I made my mistake or et cetera, but really the fact is that when you have those conversations, the people usually face it very well. Of course, there's a lot of different personalities that have to be involved in that and et cetera. But I do think that whenever you have those conversations, you learn a lot from discussing with the person, and usually the outcome is very good. When you aren't sure about something, show your cases to other colleagues or just send the case out for a second opinion. But at the end of the road, you have to accept that no matter how best you think you're trying, there's still mistakes going to be made. 

Christine Ko: Yeah, I make errors. I try to be careful. I try to be conscientious. I do try not to rush. Still, I just scanned a slide for teaching the other day. I had put that there was no polarizable [00:07:00] material in it when I signed it out. It was from 2023, like December or something. And then I was looking at the slide. Clearly, even without the polarizer, there. It was very focal, but I was like, there, I bet this material is polarizable. Indeed. It was polarizable. I was like, ugh, an error. And so just as you said, I admitted it. I talked to the clinician who did the biopsy. And they were like, Oh yeah, the patient has lung sarcoidosis and prior known cutaneous sarcoid. It's not going to change anything. I changed my report, but I still felt really bad. 

Ale Gru: Yeah, 

Christine Ko: So do you have a way to deal with that feeling of, I guess failure, for me. 

Ale Gru: No, it is failure. It is failure. And I think it is hard to swallow it when you see that you've made a mistake.

And of course it matters the most when it's something that potentially can change the management for a patient. And this happens, for example, I've had a couple of cases where that happened from like I was dictating my cases. The paper got misplaced or [00:08:00] something, and I grabbed the wrong slide and thought basal cell cancer was an SK. And it's oh, dang. It changes management. And know. I think it's a day that you feel bad about it. And then the next day is just move on and say, okay, I'm going to try. How can I make this particular error better? How can I try to improve for the next time? Just thinking about alternative ways of how you can make it different or how you can make it better makes you feel a little bit better and try to improve it as much as you can and for whatever that time entails, and then move on.

You cannot get fixed into mistakes, no matter how bad they are. Of course, the mistake is bad. That makes you feel worse, and you take a little bit more time to recover. But to me, it's just, okay, I need to move on. There's a lot of things that needs to be finished. Otherwise, it almost paralyzes you and can't move on with my life and my career. I accept the fact that no matter what I know I'll be making [00:09:00] mistakes. 

Christine Ko: I like it. I love your answers because they comfort me. I'm learning from them because I think, I've never quite thought about it this way, but I think you're right. There's a necessary period of feeling bad, and then we do have to move on from that. But it is a necessary period. So I shouldn't beat myself up for feeling bad. And I think it just goes back to when I was younger, you're just supposed to be like upbeat, happy sort of person and not have negative emotions almost. And so I think I feel bad about having the bad feeling, but it's just, I should be feeling bad, and it's okay to feel bad. And then, move on from it when, depending on how large or small the mistake was, like, have the appropriate period and move on. This has been so good to talk to you. Do you have any final thoughts? 

Ale Gru: I want to thank someone else also in my life. Growing up in Argentina, my mother is a psychologist. I did psychoanalysis for a while. In Argentina, psychoanalysis is extremely [00:10:00] popular. And I do have a therapist that I see, who does cognitive dialectic therapy. She's a huge help in my life, and I always have a great hour with her every week. And I just get a lot of support from her too. So I wanted to mention that.

Christine Ko: Is she in New York or she's in? 

Ale Gru: Argentina. I see her via Zoom, and when I travel to Argentina, which I don't do that very often, but of course I see her. 

Christine Ko: Oh my gosh. Not to presume anything, but I think therapy works for you. I feel like because you've put in so much work, that's why your answers are so thoughtful. I'm really amazed. I'm so glad that I could do this with you. Thank you again.

Ale Gru: Thank you, Christine. It's such a pleasure to be here.