EP171: Empowering Healers: Prioritizing Self Within Medicine

The Importance of Awareness, Boundaries, and Support in Medical Culture

In this episode of The Girl Doc Survival Guide, we continue our compilation from the last 40 episodes, focusing on critical topics like error and diagnostic discordance, dealing with mistakes, the toxic culture in medicine, the necessity of self-awareness, and prioritizing personal well-being. Featuring insights from various medical professionals, the episode emphasizes the importance of honesty, boundaries, emotional processing, and seeking help. The discussion also touches on the psychological toll medical training can take and the role of humanities in improving doctor-patient relationships. Ultimately, this episode aims to increase listeners' awareness of their passions, ways to ask for help, and the significance of setting boundaries.

00:00 Introduction and Recap

00:14 Confronting Errors in Medicine

00:56 Awareness and Emotional Intelligence

01:15 The Pressure of Medical Training

02:04 Balancing Personal and Professional Life

04:32 The Toxic Culture of Medicine

09:27 Prioritizing Self-Care

13:33 The Role of Humanities in Medicine

15:32 Maintaining Passion and Setting Boundaries

16:43 Conclusion and Call to Action

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. I am glad to be doing a second compilation of some of the last 40 or so episodes since everything didn't fit into one. In the last episode, we focused on error and diagnostic discordance and how rotten it can feel to have made an error, especially if there's an impact on the patient. Some of the skills and tools that we can use to work on error is just using our emotions to be able to really confront the error and think about why we made the error and be able to talk about it with our colleagues and use their advice and their experience to also help us. Part of that is awareness. Awareness in general is very [00:01:00] important. Awareness of my emotions, my thinking process, and how I deal with things. These are all really important, and Dr. Jessi Gold says in episode 135:

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

Christine Ko: Dr. Dawn Baker emphasizes in episode 166. 

Dawn Baker: We are used to letting go of what we need and what we want when we're a resident. Think of all the times you feel like you need to eat or go to the bathroom and you don't. We get used to that.

Christine Ko: Because we jump on this moving train of training, it is hard to fully assess whether we are still doing something that we love and want to be doing. Whitnee Hawthorne says in episode 153: 

Whitnee Hawthorne: We all deserve to have a life that we love. Don't should on yourself.

Christine Ko: Dr. Tamara, Greenberg similarly emphasizes in episode 138:

Tamara Greenberg: 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 to empower you to make different decisions for you to be able to get more of what you want.

Christine Ko: And [00:03:00] Dr. Amanda Swain discusses the honesty that we need in episode 162.

Amanda Swain: What's been really helpful and also hard to do is being brutally honest with myself about what I truly enjoy doing, and what I do because I have to do it, and what I don't have to do, because those are three categories. In order to figure out who you wanna be at any point in your career, you need to really think about those categories and not judge yourself while you're doing so, because there are people out there that might actually not love patient care. And that's okay. It might feel bad to admit that to yourself, but that's okay. That can be your truth. But in order to feel truly fulfilled, that's something you're probably going to [00:04:00] have to admit to yourself, if that's your truth, right?

Christine Ko: Being honest with ourselves will help us not only in our careers, but in all facets of our lives. Dr. Marcus Boos says in episode 1 46:

Markus Boos: 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 have come to believe that the toxicity of our existing medical culture limits awareness as Dr. Dympna Weil says in episode 161:

Dympna Weil: the culture is so toxic. And we are not even really aware of it because it's just the norm. We take this oath to do no harm, and yet we incur so much harm in the process [00:05:00] of becoming the physician that it's really important that I think we start to look at that and like, how do we undo that?

Christine Ko: Similarly, Dr. Deepa Bose says in episode 159:

Deepa Bose: it's a very toxic culture. And we do internalize it, and we do feel that we have to be bulletproof. But as you say, we are human. And in order to give the best of yourself, you need to recharge, and you need to take care of yourself because you can't be the best doctor if you haven't recharged or if you haven't looked after yourself. And I think that we're slowly starting to accept that. 

Christine Ko: How do we really deal with things in medicine? According to Dr. Tamara Greenberg in episode 138,

Tamara Greenberg: 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 [00:06:00] 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. But it does catch up. If you don't process it, it does land somewhere. 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.

Christine Ko: Dr. Annie Im also emphasizes that we should be aware of the expectations of others versus what we truly, individually want to do In episode 164.

Annie Im: So much of what we do, we do because people expect us to do it. Or at least that's what I did for a long time. I was like people expect me to do X, Y, Z, so that's what I should do. I don't know how much soul searching people do to be like, [00:07:00] no, this is what I actually want to do, regardless of how people will look at that decision or how people will judge it, or what people expect me to do.

Christine Ko: In many ways, it is not wrong to focus on the expectations and needs of others. At certain times in our lives, it is necessary as Dr. Amy Oxentenko relates in episode 143:

Amy Oxentenko: I look back to the earlier point of my career, there were times that I clearly felt like I was in survival mode, when I was trying to make it in academic medicine, managing three young children in a physician marriage. Many times I felt like I was just surviving, burning the midnight oil to get all of those things done. it's hard because I suspect we all go through periods of our careers where we feel like we're in survival mode. And that's just an important thing to normalize. Not that we want to stay in that survival mode. I don't think that's healthy by any means, but there are times where the workload just increases and we need to figure out ways to balance.

Christine Ko: Dr. Celeste Royce says a similar thing in episode [00:08:00] 167,

Celeste Royce: We all have our inner compass that we follow, and sometimes in our lives we're just able to get dinner on the table for the kids or go to their basketball game. But other times in our lives, we can stand up and we can speak out. Other times in our lives, we can educate the next generation. Other times in our lives, we can be there for our communities. Recognizing that it's not everything everywhere, all at once. It's what we can do, when we can do it, when we have the strength and the power to do.

Christine Ko: It is important to be aware of the psychology of being a doctor as Dr. Caroline Elton says in episode 139.

Caroline Elton: Psychologically, when you're training as a student and then later as a practicing doctor, you are confronted by the most difficult things that can happen in life. Disease, [00:09:00] disability, destruction of lives, death. You're confronted by patients' hopes and fears. And very little thought is given to the potential psychological toll that this can have on students and doctors.

Christine Ko: So rather than blindly participating in the manic culture of medicine, what can we do? Firstly, prioritize yourself. It's not selfish. We need to overcome the habit of putting patients first, which is a positive thing that we learn in training, as Dr. Susan Hle says in episode 153, 

Susan Hingle: Prioritize yourself. It is not selfish. It's the exact opposite of selfish because if you're going to be a better doctor, a better educator, a better wife, a better mom, a better whatever, that's actually the opposite of selfish. So make sure you do whatever it is that you need to be [00:10:00] healthy.

Christine Ko: Dr. Anita Everett says in episode 150,

Anita Everett: We're really conditioned to put patients first, and of course we want to do that. But we also don't want to do that to the exclusion of other parts of our lives. It's hard sometimes to let go of that as you get past the training period.

Christine Ko: The basics are important, as Dr. Amy Oxentenko says in episode 143,

Amy Oxentenko: I know that if I don't get adequate sleep regularly, it just takes a significant toll. So honestly, I prioritize sleep probably above most other things in my day. I also prioritize exercise.

Christine Ko: Dr. Christine Won emphasizes the importance of sleep In episode 136.

Christine Won: Sometimes sleep is interpreted as something that sort of gets in the way of our productivity. The mentality is still, sleep is a waste of my time. I should stay awake as much as I can to do more, get more product out. When in fact, we sleep one third of our lives. There's a purpose to sleep. Sleep [00:11:00] deprivation can lead to things like poor judgment, high risk taking, overestimation of threat, lack of empathy. It definitely plays a role in how we process emotions. That's really important for us as doctors in particular, because, we are, as a field, highly sleep deprived. But we have to deal with a lot of emotions related to people being ill. Difficult conversations, things like that. So empathy, emotional regulations. I think this is very important for us as a field.

Christine Ko: Very important is asking for help. Dr. Chrissy Cammarata says in episode 144, 

Chrissy Cammarata: being willing to ask for support. We have to know that there's limits to what we can manage as human beings. Some of us who are perfectionists don't want to delegate our work. We don't feel like other people can do it as well.

Christine Ko: And Dr. Kathy Stepian says in episode 156,

Kathy Stepien: A big one is recognizing what is mine to carry and what is not mine. For those of us [00:12:00] who are socialized to be helpers and go into medicine, it's so easy for us to take on the responsibility of others. But to recognize, oh, wait a minute. This is mine. This is my responsibility. And that is not my responsibility, and letting go, and even being okay with what's not mine to carry, even if it disappoints others. So we carry stuff often for many reasons, but one of them is because other people will be disappointed. Letting go of people pleasing, letting other people own what they are feeling, and not carrying that for them has been a big piece for me as well.

Christine Ko: And Dr. Nina Shapiro says in episode 155,

Nina Shapiro: It's okay to ask for help. I don't just mean in the OR . I think help in a broader sense of, I'm feeling a little bit off with my career or my life or, whatever it is, family. We were taught as interns as a joke, they would say, [00:13:00] call me if you need me, but calling is a sign of weakness. That really stuck with me, and to this day, I'm not quite sure what they meant. The calling is so important, especially these days when, there's a lot of challenges with mental health at all levels, doctors especially are included that it, you don't realize how many other people are going through it until you actually say that you're going through something yourself. There's always somebody who's going to be able to help you. I think the hardest part is not necessarily finding them. It's just telling yourself that you need to get some help.

Christine Ko: Dr. Hingle in episode 153 and Dr. Danielle Ofri in episode 140 emphasize how humanities can aid awareness.

Susan Hingle: Really, when you think about what a physician does, who a physician is, it is medical humanities. We're interacting with human beings on a day to day basis. Learning how to develop those relationships, how to communicate with them, how to find [00:14:00] meaning in that work is really important.

Danielle Ofri: Medicine is an inherently human endeavor, and we're often told, well, let's take a page from the airline industry, which has these great checklists. Airplanes, complex as they are, they come in a finite number of models. You can make a spreadsheet big enough to list every airplane model and every piece that's in there. And you can cross check that. It'll be a big list, but it is finite. With humans, it's not quite that way. People, their illnesses, present in multiple different ways, depending on their genetics, their physiology, their habits, their environment, socioeconomic class, or culture, their language issues, economic issues, all kinds of things come into play. And you cannot make a checklist big enough. There's many dimensions to human illness that we can't easily checklist.

Humanities or music or anything else that we learn, it's not just good for ourselves. It's actually good for our thinking process because it allows you to think in these more subtle, sophisticated ways and also help you work with ambiguity. We don't talk much about uncertainty and ambiguity in medicine [00:15:00] because we don't like it very much. We want, oh, let's have a nice little algorithm, but so much of medicine and patients are ambiguous because they're human, and there's emotions involved. And so tolerating ambiguity and functioning within an ambiguous situation, which is often what we have to do, it's profoundly unsettling. But things that specialize in ambiguity, I'm thinking humanities, literature, music, all these complex art forms, that's what they revel in. And so it gets you more accustomed to that. And I think helps us be better in the ambiguous situations that medicine brings up.

Christine Ko: Dr. Vinny Arora in episode 152 touches on passion.

Vineet Arora: We're not robots, right? There are things that move us, right? And a big part of why we select people to go into medicine is because they are passionate about the work, right? Because we know it's not for everyone, right? You have to have an inner passion for it as well. How do you keep their passion alive?

Christine Ko: Key to keeping passion alive are boundaries. As Dr. [00:16:00] Andrea Austin says in episode 148,

Andrea Austin: 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.

Christine Ko: Dr. Nina Shapiro says a similar thing in episode 155.

Nina Shapiro: You have to make those boundaries, and it's really hard to do because you're 30, 32 years old, and you've never done that before. Nobody's going to do it for you. Not your spouse, not your bosses at work, not your patients. Once I was able to do that and really create some boundaries at work, it made my family life much better.

Christine Ko: I hope that listening to this compilation helps to increase your awareness of what you feel passion for, ways that you can ask for help, and the importance of boundaries. Thank you for listening in! Please rate, follow, and share if you want to support this podcast! [00:17:00] Thank you.