EP138: The Manic Culture of Medicine: Insights from Dr. Tamara Greenberg

In this episode, the multifaceted emotional challenges faced by physicians and medical trainees are explored through the expert insights of Dr. Tamara Greenberg, a clinical psychologist specializing in adult mental health. Dr. Greenberg delves into the impact of early trauma, stress management, and the culture of emotional suppression in the medical field. Discussions encompass vicarious trauma, compassion fatigue, and the necessity of emotional integration. Practical advice on coping strategies, the importance of emotional intelligence, and the role of therapy highlight how medical professionals can balance personal well-being with professional demands. Additionally, the episode touches on the value of supportive social networks, understanding personality disorders, and the essential nature of objectivity in therapeutic relationships. Link to Dr. Abigail Zuger's article 

00:00 Introduction to Dr. Tamara Greenberg

01:10 Challenges Faced by Medical Trainees

01:49 Experiences with Trauma in Medical Training

04:34 Understanding Vicarious Trauma

10:21 Coping Strategies for Vicarious Trauma

12:25 The Importance of Emotional Awareness

14:17 Addressing Anger and PTSD

15:27 Challenges in Diagnosing Personality Disorders

15:47 Understanding the Whole Person Beyond Symptoms

16:35 The Complexity of Personality Disorders

17:18 The Role of Narcissism in Personality

17:44 The Impact of Trauma and Adverse Experiences

18:47 The Importance of Self-Understanding

22:28 Balancing Professional and Personal Life

24:30 The Value of Therapy and Social Support

30:05 Final Thoughts on Physician Well-being

Transcript

Christine Ko: [00:00:00] Welcome to today's episode. I'm excited to be with Dr. Tamara Greenberg, PsyD. Tamara McClintock Greenberg, PsyD, MS is a clinical psychologist based in San Francisco, California, specializing in the treatment of adults with depression, anxiety, trauma, relationship issues, and medical illness. She also treats couples and families. She served as a volunteer Full Clinical Professor at UCSF for 23 years where she taught and supervised psychiatry residents and worked in the UCSF hospitals providing consult liaison services. Licensed in California since 1999, she has published extensively on trauma, health psychology, and integrating psychotherapy methods. Her books include The Complex PTSD Coping Skills Workbook, Treating Complex Trauma, and When Someone You Love Has Chronic Illness. She has contributed to various publications and has been featured as an expert in Forbes, USA [00:01:00] Today, and Newsweek. Tamara is a member of the American Psychological Association and the California Psychological Association. Welcome to Tamara. 

Tamara Greenberg: Thank you for having me.

Christine Ko: I'm excited to talk to you because I recently rebranded this podcast and the focus is more on how to really survive and thrive in your career, especially for women physicians. Your work speaks to this. In your 23 years at University of California, San Francisco, you worked extensively with psychiatry residents. In your experience, are there common themes that doctors in training struggle with?

Tamara Greenberg: Yeah, absolutely. I taught foundations courses at the medical school and, some behavioral courses and worked for a couple of years at the medical student wellbeing program. So I think a lot about this stuff. The first thing I would say that I think doesn't get talked about enough is that most of the time when physicians are in training, they're young people and, [00:02:00] starting right away, but certainly by their third and fourth year clerkships, they're thrown into seeing all kinds of complicated medical patients. It involves a lot of trauma. I think that we just don't do enough to help these young people, integrate. Especially if they haven't seen a lot of trauma, or medical trauma, been exposed to it, you get hit with, when you're so young and you're so in training, and you're supposed to somehow, I don't know, be numb to it, and I do think that takes a toll on physicians. When I worked for the medical school, we had something called stress rounds during OB GYN, surgery, and internal medicine clerkships, and we would try to get them to talk about what they were experiencing. And, 90 percent of the time, the students were like, we don't have time for this. We're like overwhelmed trying to learn all the physical stuff. Don't make me think about my emotional life. It just was, it was overwhelming. It's really hard for medical students. And we don't talk about that enough.

Christine Ko: I love that answer. You're so [00:03:00] right. I was only 20 when I started medical school. The first patient I was a main caretaker of when I was a resident passed away suddenly. Unclear what happened, but he wasn't doing well, and he got transferred to the intensive care unit at nighttime when I wasn't in the hospital anymore. He passed away later that night. Uh, we never really knew what had happened, but there was no processing of that at all.

Tamara Greenberg: I have a similar experience when I was really young, like 28, 29. I had started doing consult liaison work, and I had just gotten attached to this really lovely 75 year old woman. I was doing rounds at the end of the day, and she had missed an appointment. I ran into the attending who had referred her to me. She was seeing me in my outpatient practice. And I remember the attending, who I love actually, very sweet guy, but he just said very matter of factly, Oh, she died a couple of days ago. And then he just walked away from me. I was crying, at the nurses station, and I'm [00:04:00] like, Wait. What? What happened? She had a heart attack, but nobody let me know. For him, an older physician, he was just like ,this happens every day. What's the big deal? 

Christine Ko: Yes, I had a conversation with Cass Sunstein, who wrote a book on habituation. We get used to what's in front of us. If you have seen many of your patients pass, you're habituated to it. It doesn't mean that you don't care, actually. Definitely, I think your first time or your second time or even the fifth or maybe 10th time, I don't think you're habituated yet at all. 

I found this term on your website. You have a term called vicarious trauma for those caring for others with medical conditions. Does that apply to doctors, this concept of vicarious trauma?

Tamara Greenberg: Absolutely. Yeah. And there's different ways people describe it in the literature. In academic literature, people can be really picky about which term you use and how it's defined and everything. But basically, compassion fatigue, secondary [00:05:00] trauma, vicarious trauma. I lump these together. In fact, these concepts were developed with physicians in mind, quite frankly, physicians and first responders because of the amount of suffering that you endure. And, there's again, very little support in part because the culture of medicine, by necessity, I'm not saying this to knock it, but by necessity, the culture of medicine is more manic. You have to keep moving. You have to keep moving to solve real problems. There's often urgent situations, but also the benefit of moving quickly is you don't have to think much about what's going on. And so you can avoid painful, emotional situations. So absolutely, keeping moving is a way to not think about things. But it does catch up. I guess that's the point of vicarious trauma is you see so much suffering. Over and over again. And even if you don't process it, it does land somewhere.

I think it changes people. [00:06:00] I really do. I remember when I was doing consult liaison, I worked on a bone marrow transplant unit, 11 Long at Parnassus at UCSF, in the hospital seeing medical patients. I would offer therapy. I remember talking to somebody who had done something similar at Stanford. We were just like, we'll never be the same.

Christine Ko: You're right. Going back to what you just said about it changes you. Absolutely. Another person I spoke to on this podcast is someone named Laurie Paul. She's a philosopher. She's written about transformative experience. And I think that the whole aspect of training from medical school on is a transformative experience, taken as a whole. Another thing you said, which I've never thought about this way, but I like how you put it, that the culture of medicine is manic. I actually recently started therapy myself, and I was saying to my therapist, I was like, it almost is easier to not think about the stuff that bothers me. I'd like [00:07:00] to move on. And, like, is it really healthy to be thinking about this stuff if you can actually just move on and proceed? 

Tamara Greenberg: You and every single one of your colleagues, and I think really to some extent, anyone who's successful, doctor, lawyer, psychologists, you have to be very productive. At specific times you do have decreased sleep because out of necessity there is something that drives you to become a little bit hypomanic or manic. And it works until it doesn't, do you know what I mean? I think when it stops working, then people realize, Oh yeah I'm out trying to outrun thinking about stuff, but it's actually not working. I'm finding that I'm more anxious than normal, or I'm more depressed, or whatever it is, having intrusive thoughts sometimes, and then people decide to get help. 

But look, we live in a culture that calls for that. The whole culture's manic. Especially since the internet and social media. Think about people's attention spans, right? How long is a [00:08:00] TikTok video? This is the world we live in. And so there's nothing wrong with it. It's just people need to decide when it no longer serves them, or if they want to mix it up a bit, pause for a minute to try to get to know my own mind better and to try to think about what's bothering me, and what I'm really thinking and feeling. Because the thing about when we ignore our emotions, it just makes it harder for us to take care of ourselves, because relationships are hard. And if we ignore somebody who doesn't treat us very well, then we're going to keep going back for the same experience over and over again. I don't judge people. It's more like, there's practical benefits to knowing what's on your mind: just being able to take better care of yourself. 

Christine Ko: Yeah. I think what you said is key. It works until it doesn't. Especially women, if you're in a high intensity profession, like medicine, and you're also a mother or parent, there's just one thing after another. At least that's [00:09:00] how I felt life was, but still, overall, it was "working". But, I do think that I was really stressed at different times. And if I had developed tools when I was less stressed and overwhelmed, maybe the more stressful times wouldn't have been as stressful if I had tools in place that I was used to using to help myself.

Tamara Greenberg: Especially for physicians, the culture doesn't support dealing with emotions. And so sometimes people can feel like, wait, am I crazy? Is there something wrong with me? Especially as women, right? We feel one ounce of anger, and of course we're crazy, so it's really hard. The culture doesn't support us dealing with our emotions, both in medicine and the wider culture.

Christine Ko: Everything you're saying feels so validating. This past weekend, my son had an appointment with another healthcare provider. The whole appointment, I was like, what is going on here? And I wasn't actually angry per se, but I was [00:10:00] questioning what was happening. And I felt like the pushback was, you're being a crazy mom, even though I really wasn't actually expressing much emotion. I was very much in control. If I'm not being relatively silent and going along with the flow and being pleasant, I was being crazy. 

Tamara Greenberg: Exactly. 

Christine Ko: Do you have tools for dealing with vicarious trauma rather than just sweeping things under the rug or just doing next, next, next thing till it doesn't work?

Tamara Greenberg: Finding people that you can talk to about what your experience is. People who get it, you know, people who understand. So that's often colleagues. If your partner's not in the same field, they may not understand. I definitely think medical trauma is a breed of its own. It is important to find people who really understand it. Find somebody who can validate you. You and I are privileged to be having this conversation. Of course, things could be so much [00:11:00] worse, but that doesn't mean that your suffering or anyone's suffering isn't valid and real. Find people who don't dismiss you, who understand that your suffering is genuine and who can help you think about it. I think the other thing is just to really practice that. Feeling entitled to have a relationship with your own mind. When people are very busy and they're distracted, the focus is on the outside and not the inside. 

Christine Ko: Okay. I love it. Your tips for avoiding vicarious trauma is really 1) to be able to talk to someone else who truly listens, but then also to be able to talk to yourself to understand what's going on internally.

Tamara Greenberg: Exactly. If you feel like your emotions are outsized, they probably aren't. Especially as women, I think really remembering that the message we've gotten from the wider culture is if we're angry, there's something wrong with us. Anger is just something really important for people to pay [00:12:00] attention and lean into. It's so neglected, even in my field. Even in my field, we don't want to talk about it. Nobody wants to talk about it. All of the emotions on the spectrum from irritation to being enraged are valid, and we need to be open to thinking about those. Obviously anger is not the only emotion. I'm harping on it a bit here though, because I think as women, gosh, we've just been taught not to have any kind of assertive voice.

Christine Ko: I've been learning about emotional intelligence as an adult. I started with the basic emotions, according to Ekman, although I understand that, like you were saying earlier, in true emotions research circles, there's a lot of controversy over that, et cetera. But I'll just keep it simple. Anger is one of those basic emotions. Emotions are data, and just use it as data, and anger has a positive. And the positive is that it's a signal that you need to do something. Your emotions are telling you that you want to do something to change X, Y, or Z. I thought that was a [00:13:00] very useful frame.

Tamara Greenberg: Yeah. Yeah, it really is. What I always tell people is just start to notice if, for example, if you get anxious or you find you go numb, try to notice what you're thinking about before. It's usually something like you're disappointed in something or someone, or you're irritated or you feel let down. Try to just notice. So many thoughts that we have about things in life, but especially our relationships, we just like shut down. And again, that is not unusual for highly successful, high functioning people. And again, there's nothing wrong with it because it works until it doesn't, but I think, midlife is such a great time to try to really work through this stuff and think about it because quite frankly, a lot of us have been busy.

Christine Ko: Yeah. Yeah, I was questioning myself about doing this podcast. Sort of jokingly, but in seriousness, I'm like, yeah, this is part of my midlife crisis. I have a great life. But I just feel like a lot [00:14:00] of it was just like, this next, what's next, this, and not really a lot of time to really reflect.

Tamara Greenberg: Exactly. And that's so many people, so it's nothing to feel bad about. It's a great opportunity in midlife to slow down a little bit and to try to think about this stuff.

Christine Ko: Yeah. Okay. And can I go back to anger? Can you talk about that?

Tamara Greenberg: Yeah,  difficulty controlling anger. It's one of the criteria for post traumatic stress disorder. It's hardly talked about in the literature. Less than 2 percent of papers even talk about it. But it's such a big problem, especially among veteran populations, combat vets have really high levels of, interpersonal aggression. We rarely talk about the impact of that, and I think it makes people feel so ashamed. So ashamed of their anger. 

Christine Ko: That makes sense. I was thinking well, you know, maybe I almost feel like I have post traumatic stress tendency. Like you could be like a true narcissist, but there's also sort of like you're a little bit like a narcissist, but it's not like you [00:15:00] really have the full on, medical criteria for borderline personality disorder. 

Tamara Greenberg: I think you're in good company. The true criteria of any disorder is that it interferes with your functioning in a significant way. Lots of people function in the world, being triggered and, having symptoms related to all kinds of different things, but it doesn't mean that they necessarily have to have a diagnosis or a label. In fact, our diagnostic system leaves so much to be desired, particularly when it comes to personality disorders. The interrater reliability coefficients of personality disorders is 0.30, which means 3 out of 10 clinicians would agree on the same diagnosis with somebody. Our diagnosis, it's a necessary evil in order for insurance reimbursements and stuff, but really understanding somebody as a whole person, not just in terms of their symptoms is key. Having a [00:16:00] therapist who understands that we all have conscious, but also unconscious motivations; people are really complicated. Having a really big picture of yourself in terms of, how you think about yourself is really important and it goes way beyond symptoms. 

Christine Ko: I appreciate the comments you've made, including before when you were saying your field oftentimes pathologized a lot of things that are probably just part of someone being normal because people are complex. And I appreciate what you said about the more difficult or traumatic experiences you have, the more you can be triggered, the more you will have a fight or flight response. Also, you said for a lot of personality disorders, there's only like point three concordance or something. That would mean then that the majority of therapists wouldn't agree on a given diagnosis. That relates to medical error. It's maybe not a true error if we're not agreeing, but it's not exactly the right diagnosis either if 5 other people are going to say something different. 

Tamara Greenberg: [00:17:00] Exactly. And actually, I compare it to medicine all the time. When I teach that point, I'm like, think about if that's how it was in medicine, it would be unacceptable. There's a push to change the system to think about it more from a developmental perspective. The criteria for all these personality disorders, they're so overlapping. You may know that there's like a group of people who've tried to diagnose a certain politician as narcissistic. To your point, we all have narcissistic aspects of our character. In fact, I worry if people don't have some narcissism; that's where the entitled part comes. Like, you need a little narcissism to feel entitled to take care of yourself. 

Christine Ko: Yes. Thank you for reminding me. A true disorder is when it interferes with your functioning. When I have jokingly, but actually also in all seriousness, say I'll have post traumatic stress about certain things, it doesn't interfere with my functioning completely. Like when I watch movies with someone with PTSD and they're like huddled in the corner all of a sudden because [00:18:00] they're triggered by something, it's not like that, but I will realize that, Oh, I could have handled that differently. But I responded with anger or irritation because I was triggered.

Tamara Greenberg: Flight, kind of fight flight. 

Christine Ko: Yeah, fight or flight. That's a good way to put it. 

Tamara Greenberg: That's normal. It exists on a range of normal because life is hard, right? When you're driving and somebody almost causes an accident and you have to slam on your brakes that causes fight or flight, that's terrifying. The more bad experiences you have in life, the more prone you are to go into like fight, flight, or even freeze. The more adverse experiences you have, the less resilient we become. Until we get therapy, until we get the right treatment. My tagline on my website, feel entitled to an absorbing life. Feeling entitled to an absorbing life means allowing yourself to know what you're thinking and feeling without judging yourself, without feeling ashamed, and just trying to use that information [00:19:00] to empower you to make different decisions for you to be able to get more of what you want.

Christine Ko: I loved that tagline when I first read it. I didn't think about that double meaning of absorbing.

Tamara Greenberg: What did it sound like? I'm always curious. 

Christine Ko: To me, my instinctive response to it was feel entitled to absorbing life. I thought, Oh, it's a life you are enchanted by. 

Tamara Greenberg: Oh, that's beautiful actually. 

Christine Ko: Yeah. But it has to me now after your explanation, it has a double meaning. A life you're enchanted by outwardly, but also inwardly like absorbing, enchanted, but also absorbing, like I'm looking and enchanted inwardly as well. 

Tamara Greenberg: Yeah. Feeling entitledto look inward. Because one of the things about adverse experiences in childhood or trauma, or even neglect, is thatyou don't have an opportunity to develop a relationship with your own mind. To be honest, my field, I just feel like we [00:20:00] pathologize people so much. We over pathologize people. When you're distracted as a kid, you just don't have a chance to develop a relationship with your own mind. So you don't know what you're thinking or feeling. But you can be really good at knowing what other people want from you. And again, part of that is, being women, prone to be people pleasers, people who are sensitive, empaths, however you want to call it. So many of us can spend so much time in other people's minds and not in our own. 

Christine Ko: Yeah. 

Tamara Greenberg: And so that's where the emphasis comes from. Again, it makes for being a really good doctor or a lawyer or psychologist to be able to be in other people's minds, but it often doesn't help us in our personal lives. 

Christine Ko: Yeah. And can I ask you to be extra granular? Why do you say have a relationship with your own mind? Like, why the term mind rather than self or spirit or whole person? 

Tamara Greenberg: Yeah, that's a great question. I think because I focus on thoughts and feelings a lot. I know people who [00:21:00] do everything in the world to take care of their bodies, they're like the poster children for self care, but, can they tell their husband, no? That's where I'm coming from. When we know what's in our minds, we know how to better take care of ourselves and set limits.

Christine Ko: Yeah. And so by mind, you are encompassing both thoughts and feelings. 

Tamara Greenberg: Exactly. 

Christine Ko: I do love this tagline even more now feel entitled to an absorbing life. Do you have any tools you can recommend to creating such an absorbing life? 

Tamara Greenberg: The main thing is to just really try to pay attention to what you're thinking or feeling. And for most of us, when we get anxious, that's a trigger. That there's something bubbling underneath that's bothering us. So really like listening to ourselves and just noting when we're feeling anxious, physicians actually are, and then it's not just physicians, but physicians, I think, are a really great group of people where their anxiety is more [00:22:00] somatic at first, like I think a lot of times people who move quickly might not be aware that they're anxious.

It's more in their bodies. They'll get anxious and they'll just go do something, go for a run, work more, work on that paper, finish your notes for the day, whatever it is. Just trying to pay attention to, is there something else driving this sense of nervousness that I'm feeling right now? That would be, I think, a really, really big key thing. 

Christine Ko: We in dermatology are one of the highest volume outpatient practices, which makes sense. Most of the patients are healthy and come into clinic. We don't really have an inpatient service. Because we can be high volume, that leads to problems like, okay, do more. And it touches on what you said. For physicians, you said that physicians are a group that tends to, if we feel anxious, we channel that in some ways productively, but we might channel it back into more work.

Tamara Greenberg: That's part of the culture of [00:23:00] medicine. That's how people are trained. 

Christine Ko: It is the culture of medicine. We do have to work hard to get things done in health care. Hard work is part of the job. But then in addition to that, as an example, if I go to a conference, sometimes you'll see someone who's giving 10 talks at that one conference, and most people are like, wow that's so impressive! You're giving 10 talks! Instead of, why are you giving 10 talks?

Tamara Greenberg: Exactly. Exactly. And 

Christine Ko: I have a mentor. It's great because she said early on, don't give any more than two talks at a conference. Even with two, it's hard to still enjoy the conference and still go to other sessions and be able to be present and listen to them. If you're giving more than two, you're running around like, where's my next talk? Thinking about the logistics. 

Tamara Greenberg: That's a really perfect example of that phenomena. And I remember I used to be on this board for one of the psychological associations  and I would give some talks, but I was always a person at a conference, like, I [00:24:00] will take a break, I will go outside and go for a walk. I always make sure I have water. I just try to like, make myself move slower because conferences are really intense. And I've definitely had colleagues be like, we didn't see you at such and such a session. And it was like, yeah, I was resting, and they're like looking at me like what's wrong with me. And it's, like, I was taking care of myself. People should have permission to do things at a pace that makes sense to them. Taking breaks is a big part of that. 

Also finding the right therapist if you want to get to know yourself better. And of course that can be expensive and it can be hard to find somebody good.

But I think I can't say enough about the value of a good therapist who wants you to know yourself. I mean, the tools, like all the tools in like, I call them the acronym therapies, CBT, ACT, DBT, ABC, whatever, they're, the acronym therapies are full of amazing tools. I'm not dissing them, but I [00:25:00] think for a lot of, really smart, educated people, you can read those books and pick up those tools quickly. A therapist is really more for trying to have a deeper understanding of yourself, trying to understand what your motivations are that are both conscious and maybe a little bit out of your awareness, trying to understand what drives your behaviors, what your underlying motivations are, and then thinking to the degree and extent that it's useful thinking about one's background, one's childhood and developmental challenges. 

Christine Ko: These days, therapy is more and more accepted, and I do accept it. I'm not trying to ding it in any way. I started going to therapy recently, and I think it is valuable. I am still in that. period where I'm like, this is painful. Can I just pass over it and somehow get to the less painful or more pleasant side? I don't know. I recognize now that it is different, but just to play devil's advocate, I've asked different people, if I had better friends, would I still need therapy?

Tamara Greenberg: You know what? I think that's a very fair [00:26:00] question. Now, first of all, I do want to just give a compliment to your therapist because if it feels painful, that means it's working. You know what I mean? That means the therapist is doing their job. I always tell my patients like, yeah, it's not supposed to feel like you're going to the spa. This is hard. So that's that, but I think it's a bidirectional situation. The healthier and more entitled we feel to good relationships, the better our social support systems are. It's a feedback loop because the better our social support systems are, the more resilient we are to stress. Think of it as maybe using therapy to develop the kind of network that will give you more of what you need. And it doesn't have to be either or. I think it's a fair question though. I think it's a very fair question. 

Christine Ko: You're the first person that said that it's a fair question.

Tamara Greenberg: Do other people get defensive? 

Christine Ko: No, like, the standard answer that I've gotten is that the big difference is your friend is not objective, whereas a therapist [00:27:00] should be objective. My issue with that is, as a therapist gets to know me, how can they still be objective, really? I would think they would be on my side. Also, unfortunately, I'm the type of friend, I don't want you to just automatically be on my side. With my sister, she'll tell me something, and I don't realize that I'm supposed to not be objective, and instead of just being supportive and on her side, like, that person's awful. And, like, how dare they? I'll be like, well, I can see that person's side. Maybe this or that. Whereas she's always on my side, always, always. So we've had discussions, cause we're so different. When I talk to you, I'll tell her, I don't want you to just automatically be on my side. I do want you to think it through with me. Whereas for her, she just wants me like 100 percent her side. So there's that difference which makes me confused about this idea of objectivity. 

Tamara Greenberg: Yeah. Yeah. It's hard for me to say in [00:28:00] some ways, cause I'm a bit more like you, I prefer honest feedback. I feel if somebody is just like our cheerleader, if your therapist becomes like always your cheerleader, then they're not necessarily doing their jobs actually. Whether you want to call it objective or not, part of the job of being a therapist is to artfully and compassionately address somebody's limitations and things they might want to work on. I think a therapist should do that. I think friends can do that. The way I would put it about a therapist isn't, I wouldn't necessarily even think about it as being objective or not. It's more like the therapist isn't in your life. It's a relationship that is very contained in this very specific frame. It's meaningful and important, but different, because they're not in your house. You're not hanging out with them in public. You're not working with them.  So it's more that I think the distance makes it so that the therapist hopefully can just think about [00:29:00] you in terms of your strengths and limitations, and you're protected in that you can talk about hard things, but then you don't have to see that person for another few days. So that's more how I think about it than objectivity, if that makes sense. 

Christine Ko: Yeah, I really like that. To address your strengths and limitations and to gently, artfully, as you said, I like your word, to push you to go beyond that initial limitation. That's great. So to summarize, the tools, I think you're saying: be aware of yourself, your mind, your thoughts, your feelings, your triggers .And therapy, which can help you develop a better social network that then you can also utilize to be more aware of your own mind, thoughts, feelings, et cetera. 

Tamara Greenberg: To just really try to pay attention to what you're thinking or feeling. And for most of us, when we get anxious, there's something going on underneath. An emotion that might be painful or [00:30:00] uncomfortable.

Christine Ko: Yeah. Yeah. Do you have any final thoughts? 

Tamara Greenberg: I just so appreciate this conversation, and I really appreciate a resource for physicians to think about the impact of becoming a doctor. It's really something we don't talk about enough. We have a real crisis in healthcare in this country. There's been so many factors that have eroded physician authority, physician autonomy. You could do a whole two hours talking about all the different factors. I remember 20 years ago, a physician named Abigail Zuger wrote an article in the New England Journal of Medicine, which predicted exactly where we are today.

It was so prescient. It's one of my favorite things I've read. She's brilliant, and it predicted where we are today. Physicians, more than ever, they need resources, and they really need support because it is rough being a doctor for all of the reasons we [00:31:00] discussed in terms of the training, but now all of the barriers that physicians experience in terms of their authority, it's just really hard.

Christine Ko: Yeah. Thank you so much, Tamara, for spending time with me.

Tamara Greenberg: Oh, thank you so much. This is great. Take care.