EP146: Beyond The Lab Coat: Dr. Markus Boos on Authenticity in Medicine

Authenticity in Medicine: A Conversation with Dr. Markus Boos

In this episode, Christine interviews Dr. Markus Boos, a pediatric dermatologist at Seattle Children's Hospital and Associate Professor at the University of Washington School of Medicine. Dr. Boos shares his personal journey of coming out at 37 and discusses the importance of authenticity in both personal and professional life. The conversation delves into the challenges of maintaining one's true self within the structured and often conformity-driven environment of medical training and practice. Dr. Boos emphasizes the value of empathy, personal connection with patients, and the need for doctors to be genuine, not just as professionals but as human beings. The discussion also touches on the impact of social expectations, personal struggles with identity, and the significance of providing a supportive and inclusive educational environment for medical residents.

00:00 Introduction and Guest Welcome

01:11 Personal Journey and Coming Out

01:58 Reflections on Identity and Authenticity

03:02 Challenges of Conformity and Self-Acceptance

04:30 Balancing Professional and Personal Life

07:49 Parenting and Identity

10:55 The Importance of Empathy in Medicine

15:42 Final Thoughts on Authenticity

Transcript

Christine Ko: [00:00:00] Welcome to today's episode. I'm very pleased to be here with Dr. Markus Boos. Dr. Boos is a pediatric dermatologist at Seattle Children's Hospital and is an Associate Professor in the Department of Pediatrics at the University of Washington School of Medicine. He is also the Program Director of the Dermatology Residency Program at the University of Washington. He trained at the Hospital of the University of Pennsylvania in Dermatology and served there as a Chief Resident during his final year before completing a fellowship in Pediatric Dermatology at the Children's Hospital of Philadelphia.

Welcome to Markus. 

Markus Boos: Thank you for having me, Christine.

Christine Ko: One of the things that I want people to get out of listening to this podcast is how to be themselves in an authentic way. Especially in professions like medicine where training and the things that we have to do to get someplace are pretty proscribed, I think it's hard to figure out [00:01:00] sometimes what I might really want. You have said, you can figure out who you are way late. And I really liked that. Would you be willing to comment on that? 

Markus Boos: I can go into great detail, but what I'll start with is my own personal journey. I am 46 now and about 10 years ago, after being married to a woman and having children, I came out of the closet. This is shortly after starting my job here at Seattle Children's Hospital. And as you might imagine, that was a time of pretty significant personal upheaval. I had really supportive colleagues here, which is something that I'll always be grateful for. It was a huge turning point in my life. That quote came in the context of discovering who you are. For me, it was really coming to terms accepting my sexual orientation. But I think that people can apply it to lots of different ways. And I'll be honest with you. When I came out, I had this naive thought that, Oh, I can now accept this part of me. I'm a fully realized human being. And, [00:02:00] really, that's just the first step in the journey because there's lots of things to unpack in your own history as to why, why did I get to 37 before I could accept this about myself?

When I was really young, I was born in 1978 and in the eighties, there was a little bit of this sort of, reduce, reuse, recycle, save the planet type movement. If you remember Marvin, the Martian from the old Looney Tunes cartoons, he was like standing on Earth and he had a little flagpost and said, save the planet. I remember one day my mom was like, we have to go to church. And I was playing this video game, and I was really far in it. And I was like, I don't want to stop cause I'm like the farthest I've ever been in this game.

She's like, you can just pause it and come back. And I was like, I can't leave the TV on for an hour while we're at church. That was the mindset that I had. And then, you just go through life, and you get these messages that, oh, we don't actually have to think about conservation and taking care of the planet or whatnot. We don't have to worry about this. And, as you alluded to with medicine, it's very prescribed. You're just climbing a ladder and you do it, and if you don't take the time to reflect on it, it's very easy to just sort of show up one [00:03:00] day and be like, how did I get here?

If I'm being very honest about it, I understood that I was gay at a young age, but I didn't feel safe admitting that. I just didn't think about it or didn't address it until I had to. Here I am as an adult admitting this to myself and wondering, too, what else did I miss by pushing my feelings, and pushing who I am to the side, and just putting my head down and doing the things I was supposed to, to be successful, to get the good grades, to graduate first in my class, to match in dermatology... you know, all these things where you just do it, and without any sort of introspection, it's very easy to lose sight of yourself. Now here I am, I have a career that I never would have dreamed of. I was able to find this career that I love, but I had to incorporate me into that also. And so my niche areas of expertise are caring for queer kids. And the interface of climate change and pediatric dermatology, and I think back and I was like, oh, [00:04:00] somehow, just by bumbling through my adult years, I found my way back to that kid who knew who he was from the beginning, but somewhere, someone told him that he shouldn't be that way.

It's really important for us to stop and just really think about who we are, and how we want to show up at our job every day, and how we want to show up for our families and our friends every day, and be happy with that. Incorporate those things that we care about and the things that really make us who we are. Because if we don't, you're just going through the motions. I think that loss of authenticity probably contributes to burnout.

Christine Ko: I agree. Being able to really know who you are. As you said early on, it's not just sexual orientation. It's, when I see the residents, do I stay in academics or do I go in private practice? This identity of I'm going to be an academician, or I'm going to be a private practitioner. And, at this point in my career, I'm like, it doesn't matter what anyone else thinks. Figure out what you want, who you are. I've heard a lot of residents be like, but, no, I do care what other people think. That does mean a lot to me. [00:05:00] It's hard. 

Markus Boos: Yeah. It's especially hard because of the context in which we train, right? Our progression and our advancement and our success really is entirely dependent on what other people think of us, right? There's a few objective things like our USMLE scores. But otherwise, you're really just trying to impress the people that you're working with and hoping that they like you, and they say that you did a good job. It's really hard to pull yourself back from this sort of idea that your worth is entirely dependent on what other people think of you. It's just part of our culture just in general, right? People are chasing clicks and likes and stuff on Twitter and Instagram. 

Christine Ko: You feel like you knew who you were as a kid. Sometimes we're smartest about ourselves when we're kids, because kids get to be kids. It's like, my whole world is just myself. You achieved so much, and would you still have achieved it had you been focused on who you are? Maybe it served a purpose. 

Markus Boos: I have two boys from my marriage. I can't imagine a life without them. I love them so much. I have my husband, and I would not have met him if the [00:06:00] circumstances of my life didn't play out the way that they did. Everyone's story is their own. We just have to accept that and realize that there's not one way to go through life, especially when you're thinking about a certain aspect of your identity, right? Whether it's I'm a doctor or, I am gay, or whatever, right? Everyone has a different journey to get where they're going. To your point about, would I have been able to make it or gotten where I am?  If I hadn't put my nose to the grindstone... I don't know. The drama of the closeted gay man is perfectionist in every other way because we can't admit our sexual orientation to ourselves so we overcompensate. So, that's maybe something that was driving me. In addition, I'm a child of immigrants and definitely, we had that immigrant ethos in our house. You work hard, and school is important, and so like you're gonna get good grades. That was very much like drilled into me too. So there was that element, independent of any other aspect of my identity. And I guess my only thing that I can say about that is what I wish had happened was I had that encouragement to succeed and to do well while acknowledging it was safe for me to just be myself along the way. 

Christine Ko: Why [00:07:00] do you think it is hard for us to really be true to ourselves?

Markus Boos: It comes a lot from this idea of just being able to fit in. The way that you don't feel lost and alone is by conforming. When I was young, I was a chubby guy. I was teased about it, and I was very self conscious about it. I didn't know that I should be self conscious about it until middle school when people pointed out to me. I was like oh, there's something like wrong. I don't want to be like wrong, right? And that applies to like the sexual orientation thing too, right? If you can like flashback with me to like the eighties we threw the term gay around, like it was nothing. It was like, Oh, that's so gay. And that's what you say when something was bad. And so of course, if you are a gay person, that's going to be a very difficult thing to admit to. There's just a casual and callous use of terminology that I think really affected people still today.

My boys are now in eighth grade, in middle school. They're about to embark on this time that was very formative for me. They have their quirks, and I just want them to keep those quirks, and I want them to be the [00:08:00] weird kid because the weird kids become the most interesting adults. I also don't want them to come home, being teased, and crying. I feel now as a parent that I want my child to succeed, I want them to be authentic, and I don't want things to be hard for them. But sometimes, those goals are in opposition of each other.

For me, I do think that it was a lot of conforming so that I didn't feel alone. And, this is a total humblebrag now, but I was Homecoming King my senior year. Was it worth it? Again, I'm very happy with how my life is now, but the journey was complicated.

Christine Ko: I first started really thinking about identity because of my son who's deaf, and he has cochlear implants. He was around two when he was diagnosed. I read this book called Far From The Tree by Andrew Solomon. He talked about a vertical identity versus a horizontal identity. So a characteristic of mine that I pass on to my children, like being ethnically Korean, say, that's a vertical identity. Being deaf, he can't share that identity with his nuclear [00:09:00] family, but he could certainly find people in his generation, so horizontally, that are "the same" as him. 

Markus Boos: Society really wants to box us in. There's such a push, using gender identity as an example. The awareness that kids have of it has also led to lots of people feeling like they need to identify who they are very early before you might even know. There's just this push to say, I am this and I am that, and to put ourselves into these boxes and or communities. And sometimes that can be a wonderful thing. I love the queer community. It has been a lifesaver for me, literally, and gets back to your sort of like concept of the horizontal, right? That's my chosen family, the people who understand the struggles that I have gone through. There is just this idea of safety and being who you are. I wish that we weren't so quick to say, you are this or you are that, this is where you belong. And you're going to stay there. That's the damaging part, right? Where we say once you've chosen, you're never allowed to leave. And, I wish that society just had a little bit more [00:10:00] time and patience for everyone to be able to figure out who they are. I'm using sexual orientation, gender identity, as the example, but for anything, right? Even just, what is the question that we ask little kids? What are you going to be when you grow up? How is a five year old going to know, right? Like, why are we asking this question? There's so many loops in the road, and the best thing we can do is just tell people that we trust them to figure that out for themselves, and we are here to support them if it gets confusing or if it gets tough.

We could acknowledge that everyone has their own difficulties, and we want to support you through getting over those difficulties so that you can again lead the life that you want to lead. It's not the trauma Olympics. We all have challenges, and some people's challenges are more intense and more, maybe passed down from generation to generation, right? That require more support and more love and more understanding. And that's okay, too, right? We need to meet people where they're at and give them the resources that they need.

Especially professionally, we have all these talks, these course like humanism medicine. But what we [00:11:00] are implicitly told is that what is valued is if we take ourselves out of it. You don't want to get too close. You don't want to get too involved. You don't want to get too wrapped up in it, right? But, Christine, I'll tell you. I do. And I always have. Because that's why I went to medicine. That's what I enjoy about medicine, that someone knows that no matter how difficult a situation they're in, that I care about them. 

There are days where I'm just like, I am so tired. I don't want to give some illusion on this podcast like I'm always on all the time, and like I love always sharing. I'm an introvert in heart. But I love what I do.

I tell our residents this: being a good doctor is like 10 percent all the dermatology that my colleagues and I are trying to teach you in the next three years. It's 90 percent showing up for your patients and listening to them and hearing what they really need from you and then trying your best to help them get there.

And that's harder. It requires more work and in the insurance landscape that we're in right now, it makes it even more difficult. But, if you care about someone, you do it. And that's what I tried to guide me in my role as a program director, in my role as a physician, what I try to [00:12:00] impart to the residents, and what I try to remember for my family, too.

It's easy to be a generous person at work and then to forget that your family needs that generosity from you too. You don't get to just shut it off when you come home. They're the people actually need it the most. And they're the ones who you want to invest the most into. But I think sometimes it's easy to get so wrapped up in our jobs that we forget that the people at home need our time with them, too. 

Christine Ko: The actual experience of being in healthcare is not so humane at all. In talking to you, I'm coming to the thought that maybe it's important for us as physicians to be authentic so that we can really fully listen to what the patient needs.

Markus Boos: I would agree with that. I think that when you are human, it gives the patient, or their parents, in my case, an opportunity to connect with you in a truly authentic way. I'll give you an example here. I [00:13:00] have inflammatory bowel disease. I was diagnosed with Crohn's disease when I was 21. And in my clinic, I see many children with inflammatory bowel disease. I tell them, okay here's your plan. I was like, Here's the one last thing that I want to share with you. I don't share this with everyone, but I got to share with you. And I was like, I have Crohn's disease too. The reason I want to share this with you is because I want you to know that I understand what it's like to feel that uncertainty about what is going to happen next. I went on to medical school, and I became a doctor, and so there's nothing that you can't do, right? That lands a lot more powerfully than, we will get you through this. Don't worry, you're gonna be fine, right? Those are both expressions of empathy. But one is deeply rooted in who I am. And now, all of a sudden, my patients see me in a different way. When we can just be true to ourselves, no matter what someone's background is, they're going to be more open to being open themselves. And I think there's a lot of power in that, and I think that it's better for patient outcomes.

Christine Ko: Patients are vulnerable and afraid. Emotions are high. For me, it helped so much in my evaluation [00:14:00] of whether to trust a doctor or, whatever or not, if they would share something about themselves and seem like a human being.

Markus Boos: I agree with you. I've never thought about it that way. I'm a dermatology patient. I had melanoma. I see my dermatologist every few months. I've never thought about that aspect of it, but you're vulnerable. You want to make sure that who you are trusting your health care, and sometimes it's your life, literally, is someone that you get good vibes from.

Especially in dermatology like, we're asking people to strip naked so we can look at them, right? It's a very vulnerable state, even if you're just there for a skin check. And I think we have to remember that you do want the vibes to be good, and one way to do that is to show that you have some empathy and understand where people are coming from, and again, like you said, are relatable as a human being.

Christine Ko: Yeah. In dermatology, yeah, we could do things really fast. I can diagnose something quickly and, especially with support staff, be in and out very quickly, but it's just not the way I want to practice. I've likened it to when I go see the dentist and get my teeth cleaned and then a dentist does come in at [00:15:00] the end, interestingly, and they always introduce themselves and they're always like, Oh, and how are you? But I'm always thinking, okay. You're going to be out of here in like another two minutes. They're nice. But I never remember their name. I don't want to share anything.

Markus Boos: Yes. 

Christine Ko: I don't want to practice that way as a doctor. 

Markus Boos: I think our patients appreciate that. And sometimes they're surprised I actually do a fair amount of listening. I make sure I tell them you are not just a bunch of skin to me. You're a person, and I want to make sure that you feel good, and that you are getting all the care that you need from me. I care about you, and I want you to do well. Sometimes saying it out loud, it connects the dots for people. Sometimes we need to say what we're doing, and that helps people connect a little bit too, right? 

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

Markus Boos: We should really do our best to allow people to be themselves and be their authentic selves. The goal is not to make everyone super chatty and over sharers like me. The goal is to make people feel like they're allowed to be themselves, and they're [00:16:00] allowed to share as much of themselves as they feel comfortable sharing.

People want us to show up as ourselves. That's the bottom line. And I think we have to create a educational environment that allows residents to be themselves, that hopefully then they go out and they can be themselves. I want to push back on this idea that we should be sterile versions of ourselves and interchangeable, because we're not. That's not what doctors are supposed to be either. We're allowed to be ourselves and we give ourselves permission. And by giving ourselves permission, we start to give other people permission to do that, too, because they see us doing it. You don't even have to speak it.

Christine Ko: Yeah. Thank you, Markus. Thanks so much for doing this with me. 

Markus Boos: Yeah. Thanks for having me. I appreciate the invitation.