EP149: Boundaries and Balance: Dr. Neda Frayha's Journey from Academic Medicine to Audio Storytelling

Pursuing Passion in Medicine: Dr. Neda Frayha's Journey from Academia to Audio Storytelling

In this episode, Christine hosts Dr. Neda Frayha, who shares her journey from the University of Maryland School of Medicine and her work in academic medicine to a career in audio storytelling. With a deep passion for humanizing medicine through education and storytelling, Neda discusses her transformative experience at an audio storytelling workshop and her fulfilling role as a Senior Medical Editor at HIPPO Education and host of the Primary Care Reviews and Perspectives Podcast. The conversation delves into the importance of following personal passion, the significance of caring and listening in medicine, and how setting healthy boundaries (also check out Only Human - the Boundaries episode! on Spotify, Apple Podcasts, or Hippo Education) and prioritizing self-awareness can significantly impact one's professional and personal life.

00:00 Introduction and Guest Welcome

00:04 Dr. Neda Frayha's Background and Achievements

01:50 Journey into Audio Journalism

03:50 Transition to Freelance Reporting and Career Change

04:40 Lessons Learned from Career Shift

06:19 Challenges and Reflections in Medicine

10:43 Importance of Caring in Medicine

15:48 Balancing Personal and Professional Life

24:02 Final Thoughts and Conclusion

Transcript

Christine Ko: [00:00:00] Welcome to this episode. I'm really excited to be with Dr. Neda Frayha. Dr. Neda Frayha attended the University of Maryland School of Medicine, and she stayed there to complete her residency and chief resident year in internal medicine. Following her internal medicine training, she joined the same institution as an Assistant Dean of Student Affairs, and she created many educational programs, winning numerous teaching awards, in addition to caring for patients, both in the hospital, as well as in the outpatient primary care setting. Neda is very passionate about humanizing medicine through education and storytelling. In 2018, she left her full time role in academic medicine and became a Senior Medical Editor at HIPPO education, where she serves as Editor and host of the Primary Care Reviews and Perspectives Podcast, a continuing education podcast that keeps primary care clinicians up to date. She has written for various media outlets, including The Washington Post and [00:01:00] Katie Couric Media, and she's produced public radio stories for NPR as well as been featured on other podcasts, such as The Curbsiders, The Nocturnists, The Broad Experience, and The Pulse. She continues to teach at her alma mater, and she sees patients as a physician volunteer at Shepherd's Clinic in Baltimore.

Welcome to Neda.

Neda Frayha: Thank you so much for having me. 

Christine Ko: Thank you for being here. I will confess to our listeners that sometimes I still have mental overload, and we were supposed to meet a couple of days ago and I wrote it down correctly in my calendar, but then when I translated it into my mind and the alarm on my phone, I added an hour for some reason. So she's very graceful in giving me understanding as well as being willing to reschedule this. So thank you to Neda. 

Neda Frayha: Oh, it's no problem at all.

Christine Ko: I would just love to hear a little bit more about your journey.

Neda Frayha: Sure. I'll say that my journey actually starts when I was a kid, and I would listen to NPR in the backseat of my parents car. I had a very [00:02:00] clear understanding and knowledge and feeling that I wanted to do that one day, that I wanted to report for NPR, and specifically I wanted to report on health and medicine stories as a physician. I had this idea that I wanted to go into medical school, and I wanted to pursue medicine as a career, but I specifically really wanted to be on NPR talking about health and medicine so that people could understand their bodies better, could understand their health a little bit better. Fast forward a whole bunch of years, and of course, by the time I got to medical school, I completely forgot about that dream, put it way by the wayside, just didn't even think about it anymore. And then, when I was a young attending, I happened to have a conversation with a colleague at a med school event when I was a relatively new faculty member, and his niece had just graduated from journalism school and was doing audio journalism. And I said, Oh, my gosh. I I was like, Oh, great, wanted to do that. That was always my dream. Now I'm too old [00:03:00] that ship has sailed. I can't do that. That led to a series of conversations where essentially some mentors and friends and people that know the industry were like, You can absolutely still pursue it. Why wouldn't you? So I ended up enrolling in this fantastic week long audio storytelling workshop through this fantastic organization called Transom.org. They host unbelievable workshops that are different lengths of time for people interested in audio and radio storytelling and production, and this one week on Catalina Island in California completely changed my life. I absolutely fell in love with the craft of putting together a radio story, and I found that a lot of the skills that I'd learned in medicine really translated very well to interviewing people to learn their stories. And after this transformative, life changing week, when I came back home to my academic medicine position [00:04:00] and my family where my son at the time was two years old, I thought, I have got to do something to keep that positive energy going. I can't just let that incredible week be only that one week. And so that led to me starting to do freelance audio reporting for the Philadelphia NPR station. They've got a great health desk. They've got a show called The Pulse, which is about the people in places at the heart of health and science. I began doing some reporting for them. And then that ultimately led to a career change in which I now do that kind of work essentially full time. I do that more than I do direct patient care.

I'll share that the biggest lessons that I learned from that experience were number one, I found that at night when my son would go to sleep, I was so excited to work on public radio stories. I couldn't wait. I was energized. I was just elated to do it. But if you asked me to work on something [00:05:00] related to getting a paper published or doing something for academic promotion, I would just want to procrastinate and procrastinate. I didn't pay attention to that. I didn't ever stop to think maybe this is telling me something. I just thought, Oh, I'm just a bad academician, and I just like this hobby. But in retrospect, I realized that natural pull was actually very instructive, and I didn't listen to it. 

And then the other really important lesson that I learned was when I made the decision to leave full time academic medicine to host this primary care continuing education podcast and to do some more public radio work as well. I had such a hard time because I was so worried about disappointing all of my academic medicine colleagues and the students that I worked with. I spent months agonizing over the decision. I had acid reflux. I had insomnia. And I thought, what if people don't understand? What if people don't approve of the decision? It turns out that it was the best [00:06:00] decision I could have made for me and for what was right for me. In retrospect, it seems so easy and so obvious. If I could tell my younger self, don't lose that sleep, it's not worth it. I would do that in a heartbeat. But again, sometimes just in retrospect, some things become really clear when you're struggling with it in the moment. 

Christine Ko: Yeah, just a couple questions. So when you were in the backseat of your parents car, was it a NPR story related to health or are your parents physicians? 

Neda Frayha: That's a great question. They weren't necessarily healthcare related stories. It was just about anything. And my parents are not physicians. I knew that I liked science from a very early age. And I know that my mom had always wanted to go to medical school but couldn't for a variety of reasons in her own life. And so the seed was planted in my head that's what I would love to do one day. But the stories themselves that I enjoy didn't necessarily have to be about healthcare. 

Christine Ko: You left academic medicine in 2018. [00:07:00] When was it that you took the week long course in Catalina?

Neda Frayha: 2015. 

Christine Ko: Okay, so three years. When you said that when you went to a junior faculty meeting and the other colleague talked about an audio journalism thing and you'd forgotten, you'd pushed aside to some recess of your mind, something that you had always really been interested in. I think that happens to so many of us in medicine because there's so much to learn. It's like an impossible feat to learn it all. 

Neda Frayha: We're all always so busy. The medical students are so busy. They have so much to study, like you mentioned. There's so much to learn. And they have all these pressures to also do a ton of research when they're in medical school, and they have all of these different pressures of how they're going to get into their residency program of choice. And then when you're in residency, you are just so busy, slammed more than at any other time in your life, and maybe same with fellowship. And then when [00:08:00] you're a new physician, you're really busy trying to just establish your career. And if that happens to coincide with when you're starting a family, even busier, like it just never ends, right? We will just never ever magically have the time to pursue anything that's important to us. We have to very intentionally carve out that time. No matter when in our lifespan we're talking about. 

Christine Ko: We have to make the time. As you said, it takes awareness, too, of our own selves. It sounds silly when I say it out loud, but I think this happens to all of us, that we forget what we like, just like you didn't remember how important audio journalism was to you. 

Neda Frayha: Totally. 

Christine Ko: And even when you were so excited to work on the radio stories. You didn't realize that your excitement level for that versus something related to academic promotion, it's like vastly different, and you made a comment. You said you just thought you were a bad academician 

Neda Frayha: Yeah. 

Christine Ko: Especially women, we're really hard on [00:09:00] ourselves. We'll just make a judgment like that I'm a bad academician because I don't want to write a paper; instead of thinking, actually I'm not a bad academician. Maybe I just don't want to do that. 

Neda Frayha: Yeah. Or even heaven forbid, give ourselves credit for something that we might be really good at. It took me such a long time to actually own up to the fact that I could be good at audio education, that I could be good at making a public radio story, that I could be good at hosting a podcast segment with a guest where we're learning about a fascinating medical topic. I always felt apologetic about it and still a little bit for a while, I felt a little bit sheepish that I had left my previous position. Whenever you do anything a little bit off the beaten path in medicine, I think there's a ton of people that don't understand it, and they look askance at you, and they're like, what are you doing? Especially as women, I think we [00:10:00] just have to be able to find our own confidence, to feel confident in our decisions and to say, okay, maybe I just don't want to do X, Y, Z. Maybe this path is just not the right path for me, but maybe another path is awesome for me, and I can be uniquely suited to excel in that other path. How fantastic. 

Christine Ko: Since you're an educator through HIPPO education, but also in teaching sessions at the University of Maryland, and you have this perspective of having been in academia, and as you just shared, feeling a little bit sheepish, even though we both agree it sounds like you shouldn't have, of leaving academia.... What do you actually think makes a good doctor?

Neda Frayha: The older I get, and the more time that I spend in the healthcare system, as both a physician and then of course, even as a patient: to me, it becomes so much [00:11:00] simpler as to what makes a good doctor. I think it's about caring and listening. I really do. I think that if you care even just a little bit about how that patient is doing, and you care even just a little bit about their story. You want to do right by them, and you take even a little bit of time to listen to what is really bothering them.... To me right there, you have won so many gold stars and bonus points. That is so enormous. We tend to judge ourselves based on medical knowledge. You mentioned earlier, we will just never know everything we need to know ever. So we always are looking things up constantly. I think that is to be accepted. That is to be completely embraced as part of our jobs. But if we can make that person across the table from us or in the hospital bed in the emergency department, coming out of the O. R., wherever we practice, [00:12:00] if we can make them feel cared for and heard, and less alone, they will be so much better off, in addition to the actual medical care that we deliver.

Christine Ko: Yeah, I think that patients often don't feel cared for. At least, when I've been in the medical system, I don't feel like I'm being cared for on a human level. I'm just seen as a problem or problems, whatever they are. And as an example, I had radiation therapy. I just really felt like they treated me like a slab of meat. Just lie this way. Don't lie this way. I 100 percent agree with you that a good doctor is someone who cares, and yet ,still the battle within my own head is I find it hard to believe that a good doctor doesn't have, I guess, more knowledge than a bad doctor.

Neda Frayha: That's very fair, yes. Yes, we have some obligation to actually [00:13:00] stay up to date and read and if we don't understand something, try to understand it. If we come across a disease again and again, it's incumbent upon us to actually know what that disease is, even if it's something we didn't learn in our training. Absolutely. In terms of what I've encountered, I think I've probably encountered more physicians who are great from a knowledge perspective but maybe really either lack a good bedside manner, or maybe they had a great bedside manner at one point, but the system has just beaten them down so much that they don't have the time or the energy to put on that good kind face any longer. And you know that has happened to me. I've experienced that, too, from that perspective. So I say that without judgment. I think most of us can probably think of one medical encounter we've had as a patient where the doctor just really wasn't that great to be around. And there are so many reasons for that. Just what you were sharing with your experience where you felt like you were a slab of [00:14:00] meat. Imagine if they had just turned their focus to you entirely and been like, how can we make you comfortable? How are you feeling? 

Christine Ko: I thought about that in my own head a long time and it's helpful to talk this over with you. That is the key, what you just said, that there's a certain amount of knowledge that we should have as a doctor, to be a good doctor, but there's always going to be a large amount of knowledge that we just don't know, yet, because it just came out in a journal or it's a new guideline or just because it's something rare that we haven't seen. And even though we've been in practice for even 50 plus years, it's the first time that anyone at the entire hospital has seen disease X. But when we're still striving and striving to learn all of the knowledge, which we can't do, and we neglect the caring part, I think that's where then it just seems like doctors know a lot, but they're not the best doctor they could be because they don't [00:15:00] really remember how to care for people.

Neda Frayha: Yeah, and maybe the root of it is in curiosity for the sake of the patient. So if the goal is just medical knowledge acquisition and memorizing the textbook, that's one thing, but if the goal is being able to learn something to help someone, then maybe that kind of grounds the rest of it in caring for the patient.

Christine Ko: One of my goals with this podcast is to talk about soft skills, so called, like emotional intelligence and having a growth mindset that I think have helped me. I wonder what are some tools or methods that you think have helped you to be a good doctor, and to be a good educator, and to thrive in your career?

Neda Frayha: I haven't always been good about this at all, but I would say something I learned far too late in my career was having healthy boundaries. I'm a people pleaser by [00:16:00] nature, and I want to make other people happy, and I want to show other people that they are cared for, and so I think when it comes to primary care, and many other specialties, it can set up a really difficult dynamic from the beginning, because the more frequently you're in contact, and the quicker and quicker you respond to things, then that's the expectation that's set. I learned how to establish and then maintain better boundaries for me, and that takes work. 

It takes effort to realize, okay. What is it? That's really bugging me. What boundary violation is really pissing me off or is really depleting me? Then you can work backwards from there and say, Okay, how can I prevent that from happening in the future? To me, that can also mean knowing when to shut work off in the evening, if you can, if you have that luxury of coming home and not having to go back into the hospital at a moment's notice. Being able to really tune out work thoughts and then be present with whatever is in your life after work that is important to you, whether it's friends, whether it's family, whether it's [00:17:00] hobbies. If we constantly ruminate about all the things that we did that day at work, then we never really get a meaningful reprieve, and we never really can be refreshed and restored enough to go back the next day and be our best selves. So I think boundaries are really key. 

And then I think figuring out how you best blow off steam. Whether it's through exercise, whether it's through journaling, whether it's through going to music concerts, whatever the case may be, figuring out what lights you up and fills your proverbial cup. And then actually making the time to do that and building that into your day when you can. Again, I know we are all so busy, but that can go a long way in just restoring perspective and allowing us to put all the hard parts of what we experience as physicians in a broader perspective. That it's not just the hard parts. It's not just the one really unhappy person you interacted with that [00:18:00] day.

Christine Ko: In some ways it's like it's both things at the same time. Hard to keep things in perspective as a physician and at the same time we overly keep things in perspective. Like one time I was really mean to my mom without meaning to be because she had a small cut on her foot and I was like, oh you're gonna live, and she was so offended. I just meant, it's okay, but it, the way I said it was just so dismissive without really intending for it to come across that way. It was like a poor bedside manner in real life.

Neda Frayha: Our family gets that all the time from us. Don't they? I mean, partners, kids, parents... like that's who we're gonna be like, oh, you're fine. More than we would maybe with an actual patient of ours.

Christine Ko: Boundaries are good. You probably know more about this than I do. Boundaries are really setting up what your own response is. It's not like trying to control other people but just like you were saying, like, I'm not gonna work after this time when I get home if my schedule allows it, or you know, I'm not gonna say yes to this because then I know I'm gonna get irritated by whatever happens after that.

Neda Frayha: I'll put in a quick plug. My colleagues and [00:19:00] I did a really in depth look into different kinds of boundaries in medicine and healthy boundary setting in an audio mini series we did called Only Human: Real Clinician Stories Unfiltered. It's a four part mini series, but the second episode is called Boundary Issues, and it is all about this topic, and I learned so much from putting this podcast episode together that has really changed my life since then. You're exactly right, Christine. It is really about setting your own responses up for success and having it be far less about how other people behave or how other people react. 

Christine Ko: That's awesome. I haven't listened to it. I'll put a link to it in the show notes because I really have only recently started thinking about boundaries because as a woman physician, and mother, and wife, I feel like the patriarchy, society, the way I grew up, the culture I grew up in, really conditioned me to [00:20:00] be last. Mothers, in Korean culture, mothers are last, like a great mother sacrifices everything for her kids. A good wife in Korean culture is second to her husband. And then we know in medicine, patients are supposed to come first. I overall do agree with that, like when I am at work, yes, patients should be my priority, but patients can't be the priority 100 percent of my life, because otherwise, I definitely burn out.

Neda Frayha: Yes. And it's figuring out, okay, I'm home now. What do I need to do to not have all of my attention and energy and heart and soul still be focused exclusively on patient care? 

Christine Ko: For me, it was  harder when my kids were younger because I wasn't aware of these things. As I said, I was conditioned a certain way. I'd never really thought about, what would really help me? What would fill my cup right now? It was just survival. It's, Go to work, come [00:21:00] back, feed the babies. Try to get a certain amount of sleep so that I'm not a total zombie.  I just didn't have the mental space to be thinking about myself, but I should have. I wish I had.

Neda Frayha: It's never too late to start. I really believe that, you could turn 75 years old and still realize you had never started to think about yourself as one of your priorities. So I would say give your younger self some grace, and you're thinking about it now, which is still wonderful.

Christine Ko: I agree with what you just said, too. I think the reason I'm doing this podcast is I wish that I had the awareness to reduce some of the stress that I felt a lot of the time. I don't regret the amount of time that I spent with and for my kids. I do actually love my job. Sometimes after they went to sleep, just like you were excited about the radio stories, I would be excited about a paper I was writing or whatever. I don't regret any of that, but I think my stress level of, this needs to get done, and this needs to get done, and this needs to get done, was astronomical at times. And it [00:22:00] didn't have to be that high. I just felt like, this and this and this and this, and I didn't even really know that I was doing that.

Neda Frayha: One of my M. A. 's in my clinic jokes that she tells her husband, if I sit down, I'm never getting back up again. I can see that, it's easier for us to go, okay. I'm running. I'm doing these 20 different tasks simultaneously. But once you do sit down for those five minutes, it's easy to be like, Oh, I'm tired, I'm not doing anything else tonight. 

Christine Ko: Yeah, I think that too. I think, you think, Oh if I get out of the rat race, maybe I'll never come back. Maybe that says something too, right? If you don't actually really want to come back, that means that, why are you still in it? 

Neda Frayha: Yeah, I've talked to so many students through the years who have questioned their own instincts about things, whether it's what the right residency program is for them or what field they want to go into. They'll say, Oh, I really loved my time in anesthesiology. But then they'll say, But I don't know if that's just because it was my first rotation, or, I don't know if that's just because I had a really great attending, and, what if it doesn't mean that I like it? Or, on and on.

I think we disavow [00:23:00] our instincts when it comes to our personal lives and even our professional decisions. When meanwhile, one of the biggest things we try to develop in medicine is to hone our clinical instincts, right? Like we develop our clinical is this patient sick or not sick kind of instinct over time. But then when it comes to a more personal kind of instinct, we're so conditioned to say, Oh I don't know if that's anything to pay attention to. 

Christine Ko: We get on this train of medical education, and we are taught, like, you're on call for 36 hours. You need to stay up, and sometimes you are hungry if you're in the middle of a surgery or something, you can't go eat, or you're thirsty, you can't go drink. I think there is this deliberate part of training that teaches you not to listen to even your bodily instincts as related to yourself. That just definitely exacerbates being unaware, maybe, of what you really love and people pleasing, because then you just listen to the people around you because you don't have the time to interrogate yourself. Everything you've said is very [00:24:00] important.

Do you have any final thoughts? 

Neda Frayha: I think it takes all of us in whatever lane we're occupying to make this world go around. It takes every specialty. It takes every kind of work. There are so many ways to be a wonderful doctor, whether you are doing 100 percent direct patient facing care or not, whether you're doing a lot of research, whether you love education, whether you're doing something a little bit different. It takes all of us to make this profession be something good and ultimately each of us is the only one looking at our own reflection in the mirror every morning. We are the only ones who have to live with our choices and what we do. And so all we can do is honor what feels like the right thing for us to do, what our own internal compass is telling us. A lot of times in [00:25:00] medicine we make decisions for other people, and I can tell you they're not thinking of us as much as we're thinking about their approval, right? The people that we're trying to please, they're not thinking about us. They're going to bed thinking about other things, maybe the people they're trying to please but they're not thinking about us. So, try to be your own cup of tea rather than just trying to be everyone else's cup of tea. Whatever you do and whatever path you choose is valid and important and we need it in this profession.

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

Neda Frayha: Thank you, Christine. This has been lovely.