EP135: How Do You Feel? Exploring Mental Health in Medicine with Dr. Jessi Gold

In this episode of the Girl Doc Survival Guide podcast, Dr. Jessi Gold, a board-certified psychiatrist and Chief Wellness Officer at the University of Tennessee, discusses the critical issue of mental health among healthcare professionals. Dr. Gold delves into the stigmas that prevent doctors from seeking help for burnout, depression, and anxiety. She shares her personal journey with mental health, including overcoming internalized stigma around psychiatric medication. Dr. Gold offers practical advice on setting boundaries, recognizing early signs of burnout, and finding support systems. She also talks about her new role at the University of Tennessee, aiming to improve wellness through both systemic and preventive approaches. The conversation emphasizes the need for cultural change in medicine to support the mental health of doctors.

00:00 Introduction and Guest Welcome

00:46 Understanding Physician Mental Health

01:11 The Stigma Around Doctors Seeking Help

03:11 Personal Experiences with Mental Health

04:24 Overcoming Internalized Stigma

07:37 Self-Care Practices and Burnout Prevention

11:16 Setting Boundaries and Emotional Capacity

14:46 Advocating for Systemic Change

17:08 Role of Medical Education in Mental Health

20:38 New Role and Future Plans

25:27 Final Thoughts and Book Promotion

https://www.drjessigold.com/

 Dr. Jessi Gold is a board-certified psychiatrist and Associate Professor and Chief Wellness Officer in the Department of The University of Tennessee. She specializes in the mental health of healthcare professionals, focusing on the high rates of burnout, depression, and anxiety they face. Dr. Jessi Gold is dedicated to destigmatizing mental health issues in the medical community, with a focus on promoting open conversations about burnout, depression, and anxiety among healthcare professionals. She’s passionate about creating systemic change within hospitals and healthcare organizations to make mental health resources more accessible. Dr. Gold frequently advocates for early intervention, self-care strategies, and peer support systems, aiming to shift the culture of medicine to one that prioritizes physician well-being as a critical component of quality patient care.

Transcript

Christine Ko: [00:00:00] Welcome to the Girl Doc Survival Guide podcast. Today, I'm thrilled to have Dr. Jessi Gold with us. Dr. Gold is a board certified psychiatrist and Associate Professor and Chief Wellness Officer at the University of Tennessee, where she specializes in physician mental health. She's an expert on the high rates of burnout, depression, and anxiety among healthcare professionals and is a nationally recognized advocate for reducing the stigma surrounding mental health in the medical community.

Dr. Gold has written extensively on these topics and frequently speaks about the importance of addressing mental health challenges early and providing accessible support for doctors. She is the author of How Do You Feel, and I'm extremely pleased to have her here today. Dr. Gold, how are you? 

Jessi Gold: I'm all right. It's a busy day in my life as usual. As anybody who's probably listening feels. I appreciate you asking the question. 

Christine Ko: Yeah. People are really busy. Doctors are very busy. There's not enough time for [00:01:00] everything. We're trained to save lives, to cure certain diseases, or at least to help with certain diseases. But physicians also can end up struggling with their own mental health. Why do you think there's such a stigma around doctors seeking help for burnout? 

Jessi Gold: It starts with what you said, which is that we have this long bit of, this is what we're going to be doing, and I have no chance to question this or doubt this. And it starts before med school, because pre med is also a set time, right? So we just jump on a train and start moving. And it is almost like admitting a failure or defeat to, to question it, or to struggle with a class or to wonder if it's right for you. And so for the most part, we don't talk about that stuff because we want to be as good as possible as this like future doctor person. And we learn to compete, and we [00:02:00] learned that you fail or lose when you have a weakness, and we're afraid that someone else will beat us. And that's a problem.

There's also an ethos of doctors don't have their own feelings. Doctors shouldn't be affected by their work. Doctors should be stoic. And so the things that we're hearing and the messages we're receiving along the way, particularly once you start medical school, particularly once you start clinical work, This shouldn't bother you unless there's something wrong with you. You are fine, right? And we have stigma, too. There's data that suggests that even if you come into med school believing that emotional health is not a weakness, that it doesn't mean something's wrong with you, that you worry your supervisors will think that, your colleagues will think that, your residency applications will think that, and your patients will think that, right? So it doesn't actually matter what you think about you. It matters what everyone else might think about you, and the culture tells us, be perfect. [00:03:00] Don't make mistakes. Our environment tells us, compete and win and don't have a weakness. Our environment tells us, doctors don't have emotions; even if you do, probably don't talk about it. And so we don't talk about it. 

Christine Ko: On your website, and I'll put a link to your website and the show notes, you have a couple of quotes. One of them is, "No matter how many times I've had conversations about why it isn't weak, a failure or shameful to need medication for your mental health, and wholeheartedly believe every word I have said, it turns out it didn't protect me from internalizing the same negative beliefs about taking psychiatric medication."

I thought that was so powerful.

Jessi Gold: Yeah, it's super weird. I had no idea that was true. I spend all day saying to patients who are primarily trainees, students, healthcare workers, that, oh, getting on meds is normal. It's the same as blood pressure meds. I really do believe that, but when it came to applying it to me and talking about my own meds or being comfortable being on them, I realized I actually [00:04:00] had internalized what the culture had told me, and about me, not about my patients, not about everyone else, but about me, I thought if people knew I was on meds that they would think, that's a problem. Oh, she's teetering on the edge, better adjust her brain chemistry. I was afraid patients wouldn't like me for that. That surprised me because I really don't, at my core, think that about other people. And I had to reflect on that.

Christine Ko: So what did you end up doing to get over that kind of internalized feeling? 

Jessi Gold: I brought it with me to therapy during this time in 2020 when a lot of healthcare workers were talking about their mental health on social media. I realized I had written about being a person who went to therapy, but I had filtered out that I had been on meds since college. It wasn't in line with like my core value of authenticity, especially about these topics. And I brought that to therapy. And in talking to my therapist, she said to me, I'm going to tell you something that I haven't told [00:05:00] anybody else, but I think is really helpful in this situation. What if I told you I take the same medicine as you? Does that change your opinion of me? I love my therapist. I think she's awesome. No, it didn't change my opinion about her ability to do her job. And if it doesn't change my opinion about her, it shouldn't change other people's opinions about me. After talking with her and having that conversation, I did share openly about being on meds, and the feedback has been nice, and I appreciate that.

I wish more people felt comfortable doing it, but we're not necessarily there yet, and I'm happy to be a pioneer of sorts in this conversation just because we haven't gotten to the point that we're comfortable. But, a lot of that for me is work, internal work and work in therapy. I did ultimately share and that was my choice, but I didn't do so immediately. I did take the time and make sure I really wanted to and tried to answer, like, why do I think I should be sharing this in the first place?

Christine Ko: Can you talk about what conclusions you came [00:06:00] to on that?

Jessi Gold: What I was really hoping to do was not share, hi, I'm Jessi and I'm on meds, but the, this challenge, this block, this stigma, this thing that's in my head that I didn't know was there, that is in the head of someone who's a fierce mental health advocate and a psychiatrist, which means it's in everybody's head. And I decided that conversation was one that needed to be had. It wasn't the conversation of just my self disclosure. It was the conversation around the block and the why. It's a kind of way of modeling it, like if I think about it, and I share or I talk about these things, maybe someone else will think about it and share and talk about these things. It's a way to really start changing the conversation and changing our culture, which does need to be changed. But I will say to anybody listening, I've never talked about every reason I've gone to therapy. And I've never talked about my whole story. There's lots of things that I don't really feel like everyone needs to know about me. And even with my book, [00:07:00] it is more memoir for me than I've ever written before and much more vulnerable. I did get asked by editors to say and do more because it is trendy to say and do more. And the bestselling books probably have a lot more sharing than I felt comfortable doing. And I had to boundary that and say, if people don't want to buy my book because I didn't share everything or because my problems aren't bad enough, I'm not sure I like that measure. 

Christine Ko: We can internalize stigma, even if we think that we're not, and it really takes one individual really experiencing something to really know how you might react to it. What practices or habits do you have that can help protect you while your multiple jobs, and you're an author, are so demanding?

Jessi Gold: I'm a work in progress, just like anyone's in work in progress. So I'm going to lead with that, which is to say, I am an example of human existence. Just because I do this for my job does not mean I'm great at taking care of [00:08:00] myself. Sometimes I still fall into the same patterns and still have to catch myself. One of the things that I have learned is that it's not a weakness to burn out; that it's almost like obvious that I'm going to burn out. I have a new job and a new book within a year, right? That's a lot. 

Christine Ko: Congratulations, but that's a lot.

Jessi Gold: My mindset used to be a person who is successful can have a new job and a new book and not be affected by that and be fine. My new perspective is a person with a new book and a new job should expect they will burn out, and they should prepare for that and be aware that they might have to drop some balls. That perspective shift has helped me tremendously because it's not my fault if all of the stuff I'm doing affects me, it's logical that all of the stuff I'm doing affects [00:09:00] me. I need to not blame myself for that when I'm approaching stuff. I've worked on just that perspective change and in doing so some self compassion, right? Kristen Neff is the expert there. To me, it just means be nicer to yourself, don't talk to yourself like you're a horrible person. I try to pause and hear my internal thoughts out loud and think about myself saying that to someone else; and realizing just how ridiculous that would have been if a friend said, I had a hard day, I made a mistake, and I said, that's because you're an idiot, right?

I go to weekly therapy. That's my one hour of preserved time a week on me no matter what. That's really important to me. I don't treat it like a crisis thing. I'm not in crisis. It helps me be better at my job.

I'm still on meds. 

I journal occasionally where it makes sense. I often joke that my journal is just for when I'm angry. And I think that's true sometimes. But that's okay. 

I'm also trying to be a bit better with emotions. I know [00:10:00] that sounds almost ridiculous again to say as a psychiatrist, but we spend a lot of time asking other people how they are and not a lot of time with ourselves. And as a result, we don't notice that we're not doing okay until we're really not okay. I'm trying to be better at noticing I'm not okay earlier. I get a lot of emails. I notice that when I'm more burnt out, the reaction I have to them is like, furor. I am so angry at them. I had to sit with that and try to understand what that was, and I realized that was because emails are asks, and people want me for something, and if I have nothing to give, or I'm afraid I have nothing to give, it just feels like asking for something I don't have, and that I have to disappoint people. I try to pay attention to when that starts to creep up so that I can be a little, do some stuff for myself, go get a massage, like whatever it is to like reset. [00:11:00] But I do try to be more mindful of that. 

Christine Ko: I like that. You're starting to give some tools that a doctor or someone else can use to sort of recognize early signs of burnout or a more significant mental health problem perhaps early on. You mentioned already setting boundaries when you talked about your book and what went into it and the editor or publisher, or, various people wanting you to reveal more. Do you have recommendations on how to set boundaries? Cause it sounds like you successfully set a boundary, no, this is the amount that I'm willing to reveal that I'm comfortable to reveal, and that's it. How do you do that? 

Jessi Gold: It's hard. So first understand that it's hard. You have to get out of that mindset that a successful person says yes to everything; that a successful person not only says yes, but is fully capable of doing everything, right? Important to just know that it is hard, and it's especially hard for women because I think we worry about coming off like [00:12:00] Insert curse word here.

When I'm looking at stuff and weighing it, I take into account my emotional capacity. So it's not just, is this a good idea? Or, is the person a friend? Or, does this help my CV? It's, Do I have the actual capacity to do this emotionally? And so I weigh that. I think that's important. I think we need to prioritize our no's as much as we value the yes's. I had a friend who told me that she had what's called a no list, which is basically like a CV of no's. Any time she said no to something, she would write in her no list, and she started to feel better about saying no, because she realized it gave her time for stuff, and it should be valued too. I did that as a kind of skill to be aware of all the stuff you get asked and the stuff you say no to. We don't need a thousand reasons to say no. We just can say no.

Christine Ko: I [00:13:00] like your tip on asking yourself if you have the emotional capacity to do it. It ties in with what you said before about asking your own self, how do you feel? Feeling your immediate gut reaction can maybe give you a sense of whether it's a good idea or not, no matter how awesome the opportunity might be.

Jessi Gold: Yeah, sometimes too, unfortunately we say no to things that actually would be good for us in terms of energy giving to us because it doesn't have as much prestige. So often when we're very overwhelmed, we start saying no to helping students and mentoring students. We start saying no to socializing or the activities that are actually the community building that we need. So also pay attention to what energy you get from certain events. Do you feel good after it? Do you feel drained after it? Some things that we feel drained from we're always going to have to do, but [00:14:00] be careful saying no to only the energy giving stuff, because you'll end up with only the mandatory draining stuff. Sometimes it's not just the number of activities you're doing, but the type. And I think we mess that up sometimes because we're just like, Oh my God, I can't do more. And that's true, but you can't do more of the things that are energy sucking. You can do more of the things that you enjoy. 

Christine Ko: It's great to have a role model such as yourself. You have a book out. You're in this new job at the University of Tennessee, a prominent job. That kind of model can help more junior individuals, medicine is very hierarchical, or younger doctors or trainees. How do you recommend young doctors advocating themselves? Especially if the culture that they are in is still that culture that we, you know, grew up in, very, Do it all and don't complain. And, you're weak if you complain. 

Jessi Gold: Yeah, there's generational [00:15:00] gaps where different generations are moving towards work life balance being a priority and maybe talking about emotions as a priority. Older generations will say something's wrong with these students, they're too sensitive. But the real thing is they're just different, right? And I think that it's important that they're approached as different, not sensitive. Recognizing that system change and culture change takes a really long time is important. Be an advocate, give feedback where you can, but what you can control is how you live your life, how you feel your feelings, and how you treat other people, right? You can create a culture with your colleagues that is more of the culture you hope to see, and be aware that you might not see it yet in leadership. It's just a big change for a lot of folks. You aren't going to change it by just being mad and frustrated and coming in and saying that this is stupid. It is, but it's not going to change that quickly. Find those leaders that are like [00:16:00] me. Finding those people as allies will help you survive the harder situations. If you are listening and you're one of those people who wants to be an ally, sharing parts of your story, even if it's, work life balance and medicine's really hard. What's it been like for you? Or I remember med school, I questioned all the time if I wanted to be a doctor. You would be surprised how little comments like that actually show people it's a safe space to have feelings or reactions. People pay attention to that stuff. You can try to model that where you can. If you're a student, try to look for it. I found it when I was in school, and my mentor, who's still one of my closest friends, probably is the reason I'm in psych, and probably is the reason I stuck with med school. Those people do exist. Be aware that they're not the majority, and that might frustrate you for a while. And we're trying. We're really trying. It's just a big system with lots of things at play, and that change is. long and hard. 

Christine Ko: [00:17:00] Change is long and hard. Absolutely. And, most people are resistant to change, even though they think they're not, you know, we get comfortable. Do you think there's a way that medical education itself, or maybe just education itself, can adapt to better equip doctors or other people in sort of high stress jobs to manage stress and avoid burnout? Do you think there's something that can be done? 

Jessi Gold: Yeah. Half the skills I feel like I learn as a grownup, I wish I learned as a kid. If I learned as a kid that like saying no is okay, or that every time I had a feeling I didn't need to hide it, or that feelings were directly opposed to being good at your job or being perfect. Having these conversations as early as possible matters. I think there are lots of skills. I will give talks, and people get mad because when we teach skills, people feel like we're not admitting that the system is broken and needs to change, and we're not addressing system problems. It's important to think about [00:18:00] how systems need to be addressed and changed, and people like me need to address and change them. But what you need to do is figure out you and how to survive in the environment that's broken already. And if you don't want to quit, that might mean you have to learn some of these things to deal and not burn out. Understanding emotional regulation, understanding perfectionism, understanding what signs and symptoms to be looking out in others and yourself, understanding ways to address that in meaning and purpose and gratitude. Those things are really important, and I feel like I learned them only when I needed to as a result of being depressed or being burnt out. I should have learned them before I needed them, right? 

Christine Ko: Yeah, I totally agree. This is one of the reasons that I do this podcast, because I never learned about emotional intelligence. I never really learned how to ask myself, how do I [00:19:00] feel? That moving train of training to be a doctor, it's there isn't really time to think even, and so it seems like a luxury to think about how am I feeling? It's, I don't have time to think about how I'm feeling. I need to learn all these facts. Burnout is a system problem. And then there are also mental health or physical health issues. We don't even talk about burnout. And so then even mental health, as we've been talking about, can be really difficult to talk about. But the physician suicide level is still very high. Do you think there's an ethical responsibility for the system, whatever it is, the healthcare system or the educational system or the training, graduate medical education system, to provide some kind of mental health support against that?

Jessi Gold: Depression is the most cited reason for people to miss work days, right? These are real things that cost money to the [00:20:00] system, cost talent to the system, and you should care. I would love for them to care because of ethical reasons. But they do have a bottom line because a lot of them are businesses inherently. Ultimately, the arguments need to go there, because people who make decisions care about that. It sounds gross, I hate doing it, but burnout is expensive, like billions of dollars expensive. You need to be able to make those arguments and spell it out.

Christine Ko: You mentioned that someone like me should really start with thinking about how I feel, and that someone like you in your new position can maybe make inroads on actually changing the system. Are you willing to talk a little bit about some of the things you're trying to do? 

Jessi Gold: Sure, so I have a cool new role. I live in Memphis, but I am the Chief Wellness Officer of the University of Tennessee System. The University of Tennessee system is made up of five schools. The health science center where I'm physically based is one of them, but we also have UT [00:21:00] Knoxville, UT Chattanooga, UT Martin, and UT Southern. All of those schools are diverse and different and have different cultures. All of those schools have their own infrastructure around wellness. And my job is not to come in and tell them what to do, but to figure out where we have alignment or could need alignment. We're all struggling with some similar themes and needs. Where does getting in the same room and having conversations about this help? Where are we doing things right? Where are our gaps? Where are we struggling in comparison to other schools similar to us? In this early phase of my job, I started in February, I have the luxury in my job to not have to jump in and fix things right now. I wasn't hired in a crisis. I wasn't hired to be a fixer. I was hired to figure this out. And not a lot of people who get put in jobs like I do get that luxury, which is time.

In a public health approach, which is, what [00:22:00] data do we know? What are we missing, which is what programs are we doing? What are we missing? What are our peer institutions doing? And then once I know that I will be able to say, here's where we could use some help. Here's where we have some gaps. Here's programs we could consider.

I'm not at that spot yet. And I would hate to tell you that I know exactly what I'm doing. Cause I don't. What I know I'm doing is gathering data to be able to make an informed decision. And I don't know that everybody does that step. I think a lot of people do the, hey, this program looks cool. Let's get this app for everybody. Or, hey, this, let's just start a peer mentorship program. Okay how do you know we need a peer mentorship program? How do we even know that the current programs aren't working? Or how do we even know that people know about the current programs, which is a big problem.

I'm taking it slow, but I have the luxury of that because of my kind of support in my hiring and the support of my bosses. But I'm excited about that because I think there's a lot of [00:23:00] potential to leverage five schools to really move the needle on these conversations.

I'm working on wellness more broadly, so not just emotional wellness, but physical, spiritual, financial, right? All of those kind of overlap. And so also not just looking at the intervention side, the counseling services, the psychiatry services, the crisis services; but the prevention side where I think we don't spend enough time is like, how do we make sure that not everybody has to go to counseling? And, I'm excited about that, about the opportunity to really do something different in a different space with a big population, right? The student population is about 59, 000 students across the state. And, maybe some people would be scared of something like that, but I think it's cool and a really good opportunity and I'm really excited for it. 

Christine Ko: That's awesome. You also mentioned saying, what can we do to improve wellness so that not everyone has to go see a counselor? You said counselor. I'll insert the word therapist. Not that there's anything wrong with therapy, [00:24:00] as we've been discussing, but I think there aren't enough therapists like we saw in Covid. There just weren't enough therapists for the demand. Instead of therapy, could I just have better friends? 

Jessi Gold: Inherently, It serves a different purpose. Does everybody use it as that purpose? No, right? I think that loneliness is big. I think that the pandemic created more of it. I think that we have trouble with socializing as a result. And, having someone who will listen is not to be taken for granted. But I do think that we should see therapy as different than a friend. We should see it as a person who's helping us with us and is impartial, right? A friend is not impartial. That's very hard as a friend. And we should view them as different roles. But if you're feeling like your only person you're talking to is your therapist, that would be a sign that you might need to think about that. It's important that people realize it's not number of friends. It's [00:25:00] quality. And you could have one good friend, and that makes a big difference. If you look at burnout, besides meaning and purpose, social support is the answer to prevention. That is just a person. That's not a million people. And so know that having a friend helps you. It doesn't just make your life better. I love my friends, but it can help you with this stuff too, in a different role than a therapist can. 

Christine Ko:  Do you have any final thoughts that you would want to leave listeners with?

Jessi Gold: It's important to be okay with feelings and vulnerability, that it's not a weakness to be vulnerable, that it's not a weakness to ask for help, and that's a good place to start. I wrote a book called, How Do You Feel? One Doctor's Search for Humanity in Medicine. I didn't think about how much humanity you lose over a career taking care of people because you remove yourself from the situation so much because you think that's how you have to survive. I don't think that's how we should be [00:26:00] surviving. If people want to find me, I'm at drjessigold across platforms. The book is available starting October 8th. You can pre order and help me that way. 

Christine Ko: Thank you so much for your time. It's been really lovely to speak with you. 

Jessi Gold: You got it. Thanks for having me.