EP148: The Empath's Guide to Thriving in Medicine with Dr. Andrea Austin

Show notes

Revitalizing Healthcare: Coping Strategies and Empathy with Dr. Andrea Austin

In this episode, Dr. Andrea Austin, a distinguished emergency physician and author of the book 'Revitalized,' joins to discuss the challenges and coping mechanisms in healthcare. Dr. Austin shares her unique journey through military and emergency medicine, her experiences with stress and burnout, and how she revitalized her career by taking a sabbatical. She delves into the differences between empathy and compassion, effective coping strategies, the importance of setting boundaries, and utilizing objective data like heart rate variability to manage healthcare stress. Dr. Austin emphasizes the need for healthcare professionals to prioritize their well-being and offers valuable insights for thriving in high-stress medical environments.

00:00 Introduction and Guest Welcome

00:37 Dr. Austin's Journey in Emergency Medicine

01:16 The Impact of Stress and Maladaptive Coping

02:07 Revitalization and Sabbatical

04:38 Understanding Empathy and Compassion

06:18 Signs of Burnout and Taking a Break

15:57 Setting Boundaries and Coping Strategies

19:48 The Importance of Self-Care and Monitoring

23:35 Final Thoughts and Resources

Transcript

Christine Ko: [00:00:00] Welcome to today's episode. We're excited to have Dr. Andrea Austin with us, a renowned emergency physician and a leading voice in physician wellbeing. Dr. Austin has a rich background in both the military and emergency medicine, bringing a genuinely unique perspective to the challenges of healthcare today. She's here to share insights from her experiences and her new book, Revitalized, which offers a roadmap for healthcare professionals striving to thrive in their careers. I'll put a link to her book, Revitalized, in the show notes. Welcome to Andrea.

Andrea Austin: Thank you. It's wonderful to be here.

Christine Ko: I'll first start by asking you how your experiences in emergency medicine informed your approach to stress management for doctors. 

Andrea Austin: Initially, it was very seductive that, Oh, I love this adrenaline. I love not knowing what's coming through the door. You learn really through watching other people and how they [00:01:00] respond to that stress, and you develop the confidence, that one day I'll be able to do that. When we're watching other people and how they perform under stress, it's not always adaptively. There are often some maladaptive coping mechanisms. One short example is gallows humor and this idea of using really negative, often humor that's mean and directed at patients, as a maladaptive coping mechanism. When it happens, it's pretty insidious. You think, okay we're all making this joke in the doc room. What's the big deal? But what I noticed after years is it was hardening my heart. And I didn't like the type of doctor I was becoming. So when I went through my revitalization, it was really looking at, what are the maladaptive strategies that have gotten me here? And, what am I willing to leave behind? And, an [00:02:00] open question when I took a sabbatical was, will I want to come back? To emergency medicine. 

Christine Ko: You just mentioned that you started a revitalizing journey yourself. You took a sabbatical in order to start that?

Andrea Austin: In 2021, I hit a wall. I just was completely exhausted from the pandemic, and pre pandemic, I had also deployed to Iraq, and in between that I worked at a level one trauma center. Because I was the Navy doc, I did all the high intensity resuscitation shifts. I probably did the equivalent amount of medical resuscitations and trauma that somebody there would have done over 10 years. I did it in a two year period. It sounds cool at first, right? Like, we love those really challenging cases. But then when you take a step back, it's, wait a minute, that's a disproportionate amount of trauma, physical trauma, [00:03:00] emotional trauma; than probably what is appropriate or what is normative. And so you mix all that in and adding in some of my base tendencies of being a perfectionist, overworking. I essentially just hit a wall in 2021. I took a sabbatical. I didn't work in the emergency department for three months. I'm very thankful that I have another facet of my career in which I do medical simulation, and I took an online teaching job for that role. It coincided beautifully that I could get started in that, and it was part time and intermittent work. Ultimately, I answered the question that I could go back to emergency medicine in a part time way. I personally can't work a full time schedule. I think everyone's different. I also learned that I'm an empath, and I feel emotions really strongly. Working 12 to 16 shifts, which is an average full time [00:04:00] schedule, doesn't work for me. I'm glad it works for some people, but it doesn't work for me. Having the outlet of working in the simulation lab and having normal hours when I do that work really provides grounding for me and allows me to work part time. Like tonight, I'm working overnight in the emergency department, and I'm smiling. I'm actually happy about going in, and I'm looking forward to my shift. 

Christine Ko: A sign of burnout being a sense of dread, not that you're not able to do it in terms of competence, but just you're dreading going to work. So it that's nice to hear that you're excited about going. You're an empath. Can you talk about what it means to be an empath?

Andrea Austin: I feel like I heard that word a very long time ago, maybe even 20 years ago. About being an empath. It's almost like a superpower of feeling emotions and being attuned to people. It's not really taught how to deal with being empathetic as a doctor. One of the most important things that helped me [00:05:00] recover was understanding the difference between empathy and compassion. Empathy is the ability to feel someone else's pain. You're literally imagining what it would be like to have whatever condition they're describing. You're literally activating the pain pathway of your brain while you're sitting with somebody in empathy. And if you think about doing that over and over throughout the course of your day and then add up the years, I felt like a dishrag that had been wrung out too many times. The good news is if you make a very slight mindset change and tell yourself that you're going to be compassionate, which is empathy plus an action, and you really don't have to do anything different than what you're doing as a doctor. Simply listening is an act of compassion. Simply walking out and ordering the medication that you plan to treat their condition is a compassionate act. Taking the moment to recognize [00:06:00] your agency in that moment, the compassionate act that you're doing, activates the reward center of your brain. It goes from, sadness, despair to, yeah, this is really sad, and I'm helping this person, and I'm capable of doing that.

Christine Ko: What were signs to you that made you realize you needed to take a step back and take a sabbatical and consider whether you would leave and not come back?

Andrea Austin: I was irritable. I wasn't a super fun person to be on shift with, and I own that. There were times I was not particularly kind to people around me. And that was really the point where I'm like, I can't do this. This isn't going to be sustainable for 20 years. So I just took the time off to rest and at that point I really needed to get my sleep in order. I was working a disproportionate amount of night shifts that last year of the full pandemic, and I [00:07:00] underestimated how severely the night shifts would add up. Even though I was getting the right amount of sleep, I don't think I was getting the restorative sleep that we need. I just needed that hard reset. 

Christine Ko: And how long had you been practicing when you took that sabbatical? 

Andrea Austin: It was six years. 

Christine Ko: And were you out of the military at that time? 

Andrea Austin: I left the military in 2020. Which in retrospect, leaving a job during the pandemic and starting a new job during the pandemic is very hard to do. I think back to that experience and sometimes I'm like, if I had started that job now, would I be there? And I might, and I think that's an important message. I think of careers a bit like relationships. A lot of us have people in our lives, or, Oh, I really clicked with that person, I even loved them, but I'm not with them because the timing of our lives.... I was going to college here. He was going to college there, whatever the story was. And that's how I feel about that period of [00:08:00] time with my career.

Christine Ko: Oh, that's interesting. I've never heard anyone talk about a job that way, but that makes sense that you could really click, but timing does matter. It does influence what might happen, certainly with a relationship, but a job. You said that maybe you shouldn't have gone into emergency medicine as an empath, but it worked out. What are some signs that someone's an empath? And do you think that there are better careers for them? 

Andrea Austin: My gut reaction is you shouldn't let being an empath keep you from anything, but just like any part of our personalities, whatever's a positive can be a negative. It's having that understanding of what are the strengths of this and what are potentially the things that are going to hurt me or drain me. As an empath, I can feel sadness really intensely. One of the most important things that I learned [00:09:00] is: emotions, as big as they feel, most emotions under most circumstances are going to only last 90 seconds. At first you're like, that's not true. A big emotion. It's going to last 15 minutes. It's going to last 20 minutes. And yet I look back on patients that I've pronounced dead, talking to family members about losing their family member. Sharing a cancer diagnosis with someone. These are hard things. And for the most part, it is that 90 second cycle of feeling the emotion, letting it come, not getting completely engulfed in it, letting it go. The second part, especially if you're an empath, maybe that 90 seconds isn't enough, or there's been too many of these interactions in one particular shift. You're going to need to do something else to release that buildup of [00:10:00] intense experiences. For me, I have on a good night, a 30 minute drive; on a bad night, a 60 minute drive home from work. Listening to music and thinking about my day and just allowing those emotions to happen. We can compartmentalize very effectively, and there is a role for some compartmentalization. I like the idea of safely containing much better in which you recognize that you need to set a situation aside in your mind, but you need to come back to it. The problem for a lot of us in these high stress specialties is if you keep compartmentalizing, never go back to what's forcing you to do that, you may wake up like me six years in, 10 years in, 15 years in and say, I don't have anything left in the tank.

Christine Ko: You don't have anything left in the tank. And you don't really have any feelings. Like feelings are overwhelming, but at the same time, you've conditioned yourself to shut [00:11:00] them off. So it's both things at the same time where you're overwhelmed by feelings, but you have none at the same time. And instead, it's expressed as irritation or irritability and dread of going to work to just have more come at you. Do you think that is true? 

Andrea Austin: A hundred percent. The first time I started to think maybe I have a problem, I told a mom that her son had died. It was a traumatic death. It was totally unexpected, and she wailed and she threw herself on the floor and was really inconsolable. I was so numb throughout that entire experience. I couldn't feel anything. And it was because I had, to use Brene Brown's term, armored up so hard. I knew I had to go back into my shift, and that may not be the only person that would die during that shift. That's how crazy it was working at that particular [00:12:00] trauma center. And that's when I was like, I've got to get some new tools because this is not healthy. I'm an empath, and I am walking out of the room, and I don't feel anything right now.  

Christine Ko: I think it is human, in a way, a strength, that we habituate, just meaning that we get used to whatever we see. But it can become a weakness to o. It sounds like you noticed that, okay, so I'm numb, and as someone who feels a lot normally, that's not good. You noticed that you were being irritable, and that's not good. You weren't looking forward to working. Do you think there are other signs of when people maybe need some kind of break? 

Andrea Austin: Maslach's classic burnout symptoms: exhaustion, depersonalization, and this reduced sense of pride. Maybe that's the one we haven't spent any time talking about. On one hand, I was proud to be an emergency physician. Intellectually, I knew that, but in my [00:13:00] heart, I didn't believe it. This is a really powerful thing that I talk about in my book. We're often running from negative emotions, like I don't want to feel, I don't want to go there and actually explore that I don't feel proud to be an emergency physician. The power is when you lean into that. Whoa. What's underneath that? That's a really big statement. And especially if you're feeling this cognitive dissonance of, I respect my colleagues. But I don't think I deserve respect. What is that about? That's where therapy and coaching came in. Therapy is helpful for looking backwards and coaching is helpful for looking forwards. I had to create a narrative of my own life that made sense. When I have a consultant yelling at me on the phone, how can I endure that moment and not sacrifice my own personal self worth? And that's essentially not being responsible for their [00:14:00] disregulated emotions. Knowing that I still have worth as Andrea, and I have worth as a practicing emergency physician, and not tying it externally to the fact that I have a consultant insinuating that I'm not as smart as them. I had to figure out a way that I could practice medicine with integrity because it really felt in some ways like I couldn't practice with this feeling of knowing who I was, what my ethics were, and how this all made sense.

Christine Ko: You mentioned therapy and coaching, and I like how you said therapy is looking backwards. Coaching looks forward. Can you share some effective coping strategies? 

Andrea Austin: Gosh, there's so many! I had to write a book. But a few quick hits for people. One of my mantras this year was, let people be wrong about you. That's the other problem with being an empath and a people pleaser: I actually [00:15:00] have a lot of distress when somebody doesn't like me or is disappointed, whether that's a patient or a colleague. It's important to make amends when amends are warranted and to try to be a good colleague a good doctor. But at the same time, a lot of the way people react to you is mainly about what's going on with them. I went through a phase like when you have increased boundaries. So allowing people to be wrong about you and to be willing to walk away in the moment. That's really helped me that when we have these conflicts, which in my specialty, it's pretty much every shift, there's going to be a conflict, a patient asking for opioids in which it's not appropriate. Me asking for someone to be admitted, and the other person doesn't think they need to be. There's going to be these conflicts. But how can we do it in a way that I feel that I have integrity for how I show up in those moments.

Christine Ko: How do you successfully set up [00:16:00] boundaries? 

Andrea Austin: I love Dr. Shideh Shafie's definition of boundaries, and Shideh says that boundaries really are rules for ourselves. What are we going to do when somebody crosses a boundary? So certainly you have to spend some time thinking about what really matters to you. I don't like it when a consultant yells at me on the phone. That is a boundary. So then what am I going to do when someone starts yelling? I've learned that I'm the type of person that thinks it's very rude to interrupt, but in those situations, I've interrupted and said, To continue this conversation, I'm going to need you to take a more collegial tone, or, It sounds like you're very busy or you're very stressed right now, if you would like to call me back in a few minutes, we could continue the conversation then. It's really rehearsing those strategies. When we develop boundaries, you go through this phase of, I really hope nobody crosses them. Now that I've developed them, I'm going with what we call in the military, the hope [00:17:00] course of action. I hope nobody crosses my boundaries, but the truth is they're going to. Having a strategy that you've worked out and even the phrasing. I love Nedra Tawwab's work on boundaries. Her interview on Glennon Doyle's podcast provides a whole lot of very actionable phrases. You can hear those phrases and then you need to rehearse how you're going to say that in a way that's authentic and works in the context that you're needing to speak to people. The way you speak to your five year old is usually different than the way you speak to an attending physician. Another strategy my therapist has told me is to think about that adult if they're emotionally acting like a toddler having a tantrum, you don't want to talk down to them, but maybe looking at them to generate some compassion of this person clearly in distress. Knowing that they're distressed, they actually don't have the right to transfer it onto me. 

Christine Ko: Medical training has added things like learning how to do [00:18:00] difficult conversations. These skills like setting boundaries and practicing how to respond when that boundary is crossed and knowing what to do with your emotions, whether you're an empath or not, and how to deal with difficult things that all doctors encounter like death and severe illness and the patient's emotions. I don't think that I was ever taught really how to deal with any of that. And going back to what you said in the very beginning, that it's an apprenticeship, and the main maladaptive thing was just saying, Oh, well, this is the way it is and you just move on, and if you aren't able to just take in whatever happens and move on, you're not strong enough. There's something wrong with you. You're not cut out for this.

Andrea Austin: Exactly. Yeah, just get back on the horse. But there's no guidance on what getting back on the horse looks like. There was definitely [00:19:00] this idea that was taught to me of you're the doctor, and as a doctor, you're supposed to be professional, and being professional is like having this barrier in what the patient's doing doesn't get onto you. Counter transference is this very real thing. Everybody needs to understand that when you go in and have these interactions with people, there is counter transference. You're going to feel that person, that vibe is going to get on to you. Now, what do you do? Do you just stuff it, bottle it, and then come out and say a snide comment at the doctor's area? That's definitely a strategy. The question is, how's that working for you? For me as an empath, it actually wasn't working because I would feel really bad about the comment I had made.

Christine Ko: Do you have any recommendation then on daily practices that you would recommend to help us thrive in health care? 

Andrea Austin: Today, I worked a clinical [00:20:00] shift, and it was really important to me that I took care of myself going into my shift. So that preparation piece of getting enough rest before going to work. It can be very tempting to work before we work. So I try not to do that and to be really thoughtful about the recovery piece. I know I'm post night shift tomorrow, and I have nothing planned. I actually try not to drive aside from my drive home on days like that. I wear my Oura ring. And the Oura ring's been really helpful for me because I like to see my sleep score, my recovery score. And I also like the stress score. It's been fascinating to watch. It shows you hour by hour your stress spikes. It's given me a lot of insights. I was talking with this person from work when I've had recurrent stress spikes, and literally it drove me to have a meeting with this person because there had been something that had come up, and I didn't think it was [00:21:00] bothering me anymore, but my Oura ring gave me the information that I was actually quite stressed. I'm a big fan of having some objective information, like the Oura ring or another device that's giving you some information about your heart rate variability, getting enough sleep, meditating; all these restorative things. But I don't want anyone to take out of context. I'm not saying that you can meditate your way out of a crappy job or a dysfunctional system. If you truly are feeling like you hate your job, look into yourself and try to optimize your own coping mechanisms the best you can. After you've done that, if you still think you have a crappy job then you should make a move and do something else because I'm reminded every day that this life is not promised. Not all of us are going to make it into our nineties or hundreds. Having a negative emotion that you hate your job, you hate your life, it literally does hurt your heart. So I would encourage someone listening that if that's the way you're feeling, it's hard to go to therapy. It's hard to get a coach and work through this. [00:22:00] But I would say the alternative is you're taking a huge risk if you don't.

Christine Ko: Thank you for all of that. It's full of a lot of wisdom. I actually have an Oura ring as well. You mentioned heart rate variability. That is one thing that I am fascinated by because we can't control what our heart rate variability score is. So I do follow that because I feel like it gives me a global sense of how restored or rested I am. It is definitely connected with how much sleep I've had. I think it is useful. How long have you had your Oura ring? 

Andrea Austin: I'm coming up on two years ish. I actually have a lecture that I give on heart rate variability, and I call it the true fifth vital sign. The data is very clear that prolonged low HRVs is associated with worse than normal cardiovascular outcomes, depression, all of these things that are not great. Looking back over a year, I love their end of the year report. It was [00:23:00] fascinating looking at which day of the week did I have the highest stress reports, seasonal differences and sleep? I do think you have to be careful with data. You can get overwhelmed by it or fixate on it, especially as type A's. I did do a device holiday when I went home for my dad's funeral. I knew my scores were going to be bad. So I just left my Oura ring at home because I thought it might stress me to see "bad scores" when I'm going through something like that. 

Christine Ko: I agree. I mean, data is helpful, but sometimes I'm still working out what things that can really tell me. It's been so great to talk to you. Do you have any final thoughts?

Andrea Austin: Yeah. If you need to take a break, take a break. There's so many different people, entities, that might tell you otherwise. There's a British Medical Journal study that says ER doctors have the lowest life expectancy. If you need to take a break, reach out to get a therapist. Get a coach. If you're not sure where to start, stop by my [00:24:00] website. AndreaAustinMD.com. You can pick up a copy of my book. I have my coaching philosophy there, and I actually do incorporate the Oura ring into my coaching so we can combine the subjective with the objective. 

Christine Ko: Thank you so much for your time. I really enjoyed talking to you. 

Andrea Austin: Yes, this has been a joy, and thank you for what you're doing.